臺灣博碩士論文加值系統

米飯在減肥飲食中扮演的角色眾說紛紜，認為米飯含有較高澱粉，容易造成肥胖，但根據2005-2008年「國民營養健康狀況變遷調查」，無論男女其過胖之比率，皆有增加之趨勢，且和米飯攝取頻率呈反比，因此本研究擬探討米飯對減肥者在體位及相關指標之影響。以身體質量指數（BMI）≧ 30 kg/m2之60位受試者為對象，實驗組與對照組分別各30人。以12週減重課程介入，包括運動、心理及營養等，實驗組強調以米食為主之減重飲食原則。於第0及12週進行血液生化值、體位、24小時飲食回憶、SF-36及WHO生活品質問卷等資料收集。結果顯示：實驗組每週米飯攝取為9次高於對照組之每週8次，且無論實驗組或對照組在經十二週介入後體重、體脂肪重、身體質量指數、礦物質重、除脂重、全身肌肉重、基礎代謝率、總熱量需求、血壓、腹部肥胖率、腰圍、臀圍、內臟脂肪面積、內臟脂肪重、皮下脂肪重、左(右)手臂脂肪、左(右)腿脂肪、軀幹脂肪、左(右)腿肌肉、麩草醋酸轉胺酶、麩丙酮酸轉胺酶、熱量及蛋白質均顯著下降( p < 0.05)。體適能項目包括登階及柔軟度，兩組皆有顯著增加的情形( p< 0.05)。實驗組與對照組相比，在體重、BMI、蛋白質重、除脂重、全身肌肉重、基礎代謝率、總熱量需求、腹部肥胖率、白血球、血色素、麩草醋酸轉胺酶、麩丙酮酸轉胺酶、三酸甘油酯等皆達顯著改善( p < 0.05)。而實驗組之代謝症候群比例下降30%，對照組則下降13.4%。在WHO及SF-36生活品質問卷方面，實驗組及對照組在SF-36問卷，其一般健康（GH）、活力狀況（VT）皆顯著上升( p < 0.05)，而實驗組在WHO生活品質問卷之心理及生理構面亦具顯著上升( p < 0.05)。實驗組與對照組相比，在生活品質方面皆無顯著差異。因此，減重其間以低熱量飲食搭配米飯，並輔以運動，更有利於體重及相關指標改善。

There are many different views on the role of rice in the diets for body weight reduction. One such view is that rice has higher content of starch which easily leads to weight gain. According to the Nutrition and Health Survey in Taiwan from 2005 to 2008 (NAHSIT 2005-2008), there was an increase in prevalence of obesity in both men and women while there was a decrease in frequency of rice intake. The purpose of the study was to investigate the effect of rice intake on obese adults. There were 60 subjects (with BMI≧30) who had rice intake frequency≧8 times on weekly basis who were assigned to two groups, 30 subjects in each experimental and control group. All subjects took part in a 12-week weight reduction program. The program included exercise, psychological and nutritional education. The nutritional education of experimental (treatment) group component emphasized the principle related to rice consumption in weight reduction. Measurements were taken at week o and 12, including hematology laboratory evaluations, and anthropometry (e.g., height, weight), 24-hour dietary recall, short-form 36 health survey, and the brief version of the World Health Organization Quality of Life. After the 12 weeks treatment period, experimental (treatment) group’s subjects who had rice intake frequency ≧ 9 times higher than control group’s. And subjects. the subject’s intake of energy and protein and subject’s body weight, body fat mass, BMI, mineral, fat-free mass, muscle mass, BMR, total energy expenditure, blood pressure, abdominal [obesity], waistline, hips, visceral fat area, visceral fat weight, subcutaneous fat weight, left (right) arm fat, left (right) leg fat, trunk fat, left (right) leg [lean], GOT, and GPT all showed significant decrease in both groups. The physical fitness was enhanced which included step and fitness exercise in both groups. Besides, the loss of body weight, BMI, protein, fat free mass, muscle mass, BMR, total energy expenditure, [abdominal obesity], WBC, hemoglobin, GOT, GPT and TG in treatment group were significantly different from those of control group in 12 weeks. The total rate of metabolic syndromes for the treatment group improved 30% compared with the control group’s 13.4%. Moreover, general health and vitality quality of life showed significant difference after intervention in both groups. Mental and physical domain of the WHOQOL-BREF significantly increased in treatment groups. There was no significant difference in quality of life between experimental group and control group. Therefore, it would increase the effectiveness on weight loss and related indicators that giving moderate rice diet combined with exercise to those overweight and obese individuals. This study showed that low-energy diet with rice intake, in combination with exercise, was helpful for body weight improvement in overweight and obese individuals.

目 錄
謝誌………………………………………………………………………………………I
目錄………………………………………………………………………………………II
圖目錄…………………………………………………………………………………VI
表目錄…………………………………………………………………………………VII
縮寫表…………………………………………………………………………………IX
中文摘要………………………………………………………………………………XI
英文摘要………………………………………………………………………………..XII

第一章 緒論………………………………………………………………………………1
第二章 文獻回顧
第一節 肥胖的定義
一、 世界衛生組織（World Health Organization）的定義…………..2
二、 亞洲地區的定義………………………………………………..3
三、 衛生署的定義…………………………………………………3
第二節 肥胖問題的探討
一、 肥胖的盛行率…………………………………………………5
二、 肥胖對健康的影響……………………………………………..7
第三節 稻米之介紹
一、 米食攝取之迷思………………………………………………11
二、 稻米的構造組成………………………………………………11
三、 稻米的品種……………………………………………………12
四、 稻米的營養以及其對人體健康之影響………………………13
五、 台灣稻米種植現況、米食及醣類攝取量與肥胖率變化情形..15
六、 各種主食1份所含的營養成份……………………………….16
第四節 生活品質之測量
一、 生活品質之概念………………………………………………17
二、 WHOQOL-BREF台灣簡明版的發展………………………..18
三、 SF-36健康量表起源與介紹………………………………….20
四、 評估SF-36健康量表（methods of administration）方法的
研究……………………………………………………………21
第三章 研究目的………………………………………………………………………..22
第四章 研究方法
第一節 研究架構………………………………………………………………23
第二節 研究設計………………………………………………………………24
第三節 研究對象………………………………………………………………28
第四節 研究工具………………………………………………………………28
第五節 資料處理與統計分析…………………………………………………37
第五章 研究結果
第一節 研究對象之基本資料
1-1. 體位狀況………………………………………………………39
1-2. 血液生化值狀況………………………………………………40
1-3. 體適能狀況……………………………………………………41
1-4. 飲食狀況………………………………………………………41
1-5. 結論……………………………………………………………...41
第二節 營養教育課程之不同對受試者飲食部分之影響
2-1. 熱量及三大營養素之變化……………………………………41
2-2. 結論……………………………………………………………...42
第三節 營養教育課程之不同對受試者體位改善之結果
3-1. 血壓及體位變化………………………………………………42
3-2. 腹部肥胖分析…………………………………………………43
3-3. 四肢及軀幹之肌肉及脂肪分析………………………………43
3-4. 身體類型………………………………………………………44
3-5. 結論……………………………………………………………...44
第四節營養教育課程之不同對受試者血液生化值改善之結果
4-1. 血液生化值之分析……………………………………………45
4-2. 結論……………………………………………………………...46
第五節 營養教育課程之不同對改善代謝症候群危險因子之結果
5-1. 改善代謝症候群盛行率的效果………………………………46
5-2. 改善代謝症候群危險因子異常個數之效果…………………46
5-3. 結論……………………………………………………………...47
第六節 營養教育課程之不同對受試者體適能改善之結果
6-1. 體適能改善情況………………………………………………47
6-2. 結論……………………………………………………………...47
第七節 營養教育課程之不同對受試者生活品質之改善
7-1. SF-36健康生活品質量表 & WHOQOL-BREF……………………48
7-2. 結論……………………………………………………………...50
第六章 討論
第一節 營養教育課程之不同對受試者飲食攝取之影響………72
第二節 營養教育課程之不同對受試者體位測量值影響之探討………73
第三節 營養教育課程之不同對相關血液值改善之影響
3-1. 對血液檢查（白血球、血色素及促甲狀腺素）之
改善效果…………………………………………………………74
3-2. 對肝功能（麩草醋酸轉胺酶、麩丙酮酸轉胺酶）之改善效果…74
3-3. 對血清尿酸之改善效果………………………………………75
3-4. 對血清膽固醇之改善效果……………………………………75
3-5. 對血清低密度脂蛋白膽固醇之改善效果……………………76
第四節 營養教育課程之不同對代謝症候群危險因子改善之影響
4-1. 對腰圍之改善效果……………………………………………76
4-2. 對血脂質之改善效果…………………………………………77
4-3. 對空腹血糖之改善效果………………………………………77
4-4. 對血壓之改善效果……………………………………………78
第五節 營養教育課程之不同對改善受試者體適能之影響……..…78
第六節 營養教育課程之不同對改善受試者生活品質之影響…….79
第七章 結論……………………………………………………………………………..80
參考文獻…………………………………………………………………………………81
附錄………………………………………………………………………………………93













圖 目 錄
圖一、19-64歲成年男女性攝入主食類之趨勢………………………………………16
圖1、研究目的…………………………………………………………………………...22
圖2、研究架構…………………………………………………………………………...23
圖3、成人腰圍的測量…………………………………………………………………...33
圖1-1-1. 實驗組及對照組米飯攝取狀況………………………………………………66
圖1-1-2. 實驗組及對照組主食類攝取比較……………………………………………66
圖1-1-3. 實驗組及對照組熱量攝取變化………………………………………………67
圖1-1-4. 實驗組及對照組蛋白質攝取變化……………………………………………67
圖1-1-5. 實驗組及對照組脂肪攝取變化………………………………………………68
圖1-1-6. 實驗組及對照組碳水化合物攝取變化………………………………………68
圖3-4-1. 經十二週介入後，實驗組及對照組學員體型之變化……………………...69
圖5-1-1. 經由減重課程介入後代謝症候群之盛行率變化……………………………69
圖5-2-1. 實驗組代謝症候群危險因子異常率之變化………...……………………….70
圖5-2-2. 對照組代謝症候群危險因子異常率之變化…………………………………70
圖7-1-1. 評估自身的生活品質…………………………………………………………71
圖7-1-2. 評估自身的健康狀況…………………………………………………………71










表 目 錄
表一、世界衛生組織於1988年對肥胖之定義…………………………………………2
表二、建議亞洲成人對肥胖之定義………………………………………………………3
表三、成人肥胖定義………………………………………………………………………4
表四、因肥胖造成之健康問題，其相對危險性…………………………………………10
表五、民國70-100年國人米食食用量變遷……………………………………………15
表六、1993-1996年與2005-2008熱量、三大營養素與肥胖比率之關係……………16
表七、各種主食1份所含的營養成份…………………………………………………17
表八、實驗組及對照組課程相異之處…………………………………………………25
表九、實驗組之營養課程………………………………………………………………26
表十、對照組之營養課程………………………………………………………………27
表十一、WHOQOL-BREF的範疇及層面架構………………………………………30
表1-1-1、受試者體位基本資料…………………………………………………………51
表1-1-2、受試者腹部肥胖分析基本資料………………………………………………51
表1-1-3、四肢及軀幹之肌肉及脂肪分析………………………………………………52
表1-2-1、受試者血液生化值之基本資料………………………………………………52
表1-3-1、受試者體適能基本資料………………………………………………………53
表1-4-1、受試者飲食基本資料…………………………………………………………53
表2-1-1、實驗組及對照組介入前、後測飲食之變化…………………………………54
表3-1-1、實驗組及對照組介入前、後測血壓及體位之變化…………………………55
表3-1-2、經性別校正後，實驗組及對照組介入前、後測血壓及體位之變化……..56
表3-2-1、實驗組及對照組介入前、後測腹部肥胖之變化…………………………….57
表3-3-1、實驗組及對照組介入前、後測四肢及軀幹之肌肉及脂肪分析…………….58
表3-2-2、經性別校正後，實驗組及對照組介入前、後測腹部肥胖之變化……….59
表3-3-2、經性別校正後，實驗組及對照組介入前、後測四肢及軀幹之肌肉及脂肪
分析…………………………………………………………………………………59
表4-1-1、實驗組及對照組介入前、後測血液生化值之變化…………………………60
表4-1-2、經性別校正後，實驗組及對照組介入前、後測血液生化值之變化…………61
表5-2-1、代謝症候群危險因子異常個數之改變情形…………………………………62
表6-1-1、實驗組及對照組，每週運動分鐘數…………………………………………...63
表6-1-2、實驗組及對照組介入前、後測體適能之變化……………………………….63
表6-1-3、經性別校正後，實驗組及對照組介入前、後測體適能之變化……………….64
表7-1-1、實驗組及對照組前、後測生活品質各構面之得分情形……………………..65

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