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研究生:張惠萍
研究生(外文):Hui-Ping Chang
論文名稱:醫院自製天然養生灌食配方的營養成份探討
論文名稱(外文):Evaluation to Nutrient Composition of Hospital-Made Healthy Tube Feeding Formula
指導教授:趙挀瑞
指導教授(外文):Jane C-J Chao
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:保健營養學研究所
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:97
中文關鍵詞:管灌飲食植化素自製天然養生灌食配方
外文關鍵詞:Tube feeding dietphytochemicalshospital-made healthy tube feeding formula
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管灌飲食是醫院及長期照護體系中常見的一種飲食方式,自從1970年以來,商業配方因方便使用及人力節省已然成為主流,但其雖可提供符合基本營養素建議量,但卻由於不含天然食材,因而未能涵蓋近年來被一一發現存在植物界,對人體健康極為重要的化合物,簡稱植化素(phytochemicals)。臺北市立聯合醫院營養部,於2005年起陸續推出以營養豐富且多樣化之天然食材為主的自製天然養生灌食配方(養生配方)及蔬果精力湯,供應予住院及護理之家個案使用。為暸解配方在經過烹調、攪打、過濾等製備過程後實際供應之營養量,與依據食品營養成份資料庫計算值的差異,收集6套不同食材製作之養生配方和1套蔬果精力湯樣本,實際檢測其具代表性的營養素及植化素含量。研究結果顯示,營養素及植化素實測值顯著高於計算值者有:熱量、蛋白質、膳食纖維、維生素A、葉酸、β-胡蘿蔔素、茄紅素、葉黃素/玉米黃素等,因食品營養成份資料庫不完整,少許食材沒有數據可供參考。低於計算值者則有鈉和植物固醇。實測值顯示,以一日提供1,800 kcal 之蛋白質、脂肪、醣類分別佔總熱量之18.8%、30.5%、50.7%;礦物質中鋅含量僅達我國成年男性每日營養素參考攝取量(Dietary Reference Intakes; DRIs)的61%,配方食材設計上尚有調整空間;至於維生素A、維生素B1、葉酸、鈣等,均可達到每日參考建議量(DRIs)以上;此外,此灌食配方尚含有多數商業配方所缺乏的 β-胡蘿蔔素(14.2 mg)、茄紅素(36.7 mg)、葉黃素(10.3 mg)、玉米黃質(22.4 mg)、多酚類(716 mg)及植物固醇(140 mg)等植化素。因此本研究顯示,使用多元化食材製備之天然養生灌食配方,可提供適當的營養素及豐富的植化素,對於需長期以管灌飲食維生的個案,應優先選擇其做為管灌飲食中的主要供應配方。後續研究值得更進一步探討此類天然食材灌食配方的臨床應用及效益。
Tube feeding diet is widely used in many hospitals and nursing homes in Taiwan. Since 1970, commercial formulas have almost become the standard for the reasons of convenience and man-power saving. Recently, the studies have revealed that a variety of phytochemicals in plant foods only are very important to human health, however, the commercial tube feeding formula does not provide these components. Therefore, we have added natural foods into the formula since 2005 to re-made healthy blended tube feeding formula (NFB formula) and fruit-vegetable juice (FV juice) to the in-patients in Taipei City Hospital and the residents in the nursing home. To understand whether the nutrient contents in the formula change after cooked, blended, and filtered, we collected six different formulas and one fruit-vegetable juice made from a variety of foods, and measured the actual nutrient contents including phytochemicals as compared with the calculated values based on the food composition table. The results showed that the measured nutrient contents, including energy, proteins, dietary fiber, vitamin A, folic acid, lycopene, lutein and zeaxanthin, were higher than the caculated values. Some of foods were not analyzed due to insufficient nutrient databases. However, sodium and plant sterol contents were lower compared with the calculated values. The measured values revealed that proteins, lipids, and carbohydrates were 18.8%, 30.5%, and 50.7% of total energy, respectively, in 1,800-kcal daily supply of the formula (NFB-FV formulas). Zinc content was only 61% Dietary Reference Intakes (DRIs) for the adult males, which can be further adjusted by modification of recpes. Vitamin A, B1, folic acid, and calcium contents were above the DRIs. In addition, our formula contains β-carotene (14.2 mg), lycopene (36.7 mg), lutein (10.3 mg), zeaxanthin (22.4 mg), total phenol (716 mg), and phytosterol (140 mg), which not provided by most commercial formulas. Therefore, adequate nutrients, various choices of foods, and rich in phytochemicals blended tube feeding formulas are considered preferentially for long-term care patients receiving tube feeding. Further studies are required to investigate these natural feeding formulas in clinical efficacy.
中文摘要 I
英文摘要 III
致謝 V
目錄 VII
圖目次 X
表目次 XI
第一章、緖論 1
第一節、研究的動機 2
第二節、研究目的 4
第二章、文獻回顧 5
第一節、腸道灌食配方的發展史 5
第二節、醫院自製灌食配方營養素含量之相關研究 8
第三節、臺灣地區長期照護機構管灌飲食供應狀況及營養含量調查 9
第四節、植化素攝取與管灌病患健康之相關性 11
第五節、魚油攝取與管灌病患健康之相關性 20
第六節、膳食纖維攝取與管灌病患健康之相關性 21
第三章、計畫實施方法及步驟 26
第一節、天然養生灌食配方及蔬果精力湯食材內容及份量設計 26
一、配方的名稱定義 26
二、食材內容及分類 27
三、配方使用食材之份量及重量 28
四、食材購買地點、產地來源及製備型態 28
五、各配方營養素及植化素含量計算 28
第二節、配方樣本之製備及送檢流程 34
一、設備及器具 34
二、配方樣本之製備 34
三、配方取樣及送檢 36
三、配方取樣及送檢 37
第三節、配方樣本營養素及植化素之檢測方法 38
一、熱量 38
二、粗蛋白 38
三、粗脂肪 38
四、碳水化合物 39
五、 膳食纖維 39
六、EPA、DHA 39
七、維生素A 40
八、維生素B1 40
九、葉酸 41
十、鈉、鈣、鎂、鋅 41
十一、ß-胡蘿蔔素、葉黃素、玉米黃質、茄紅素 41
十二、多酚類 42
十三、異黃酮素 42
十四、植物固醇 42
第四章、統計分析方法 43
第五章、結果與討論 44
第一節、配方液體比重及實際灌食所需時間 44
一、配方樣本之液體比重 44
二、觀察配方實際灌食所需時間 46
第二節、配方營養素及植化素的含量分析 49
一、養生配方之營養素及植化素平均含量 49
二、蔬果精力湯之營養素及植化素平均含量 49
三、養生精力組合配方之營養素及植化素平均含量 50
第三節、養生配方間營養素及植化素含量之差異及與計算值之比較 53
一、熱量、三大營養素、EPA、DHA及膳食纖維 53
二、維生素及礦物質 57
三、植化素 60
第四節、養生精力組合配方營養素及植化素平均含量與計算值之比較 68
第五節、養生精力組合配方之營養素平均含量與DRIs之比較 75
第六節、研究限制及貢獻 80
一、研究限制 80
二、研究貢獻 81
第六章、結論及建議 82
第一節、結論 82
第二節、建議 83
參考文獻 85
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