臺灣博碩士論文加值系統

隨醫療發展的進步與癌症篩檢的普及，癌症存活率逐年上升，癌存活者的人口數日益增多，為無法忽視的一族群，除營養補充品外，癌存活者的食物攝取狀況仍未有足夠之資料。本研究目的係以台灣飲食習慣為基礎，蒐集居家癌存活者之飲食資料，建立一份適合評估癌存活者食物攝取狀況之飲食頻率問卷，並檢測其信效度。研究以17 位之居家癌存活者為對象，由合格營養師進行6次團體衛教及9次個人營養諮詢，為期近7個月。照護期間癌存活者以小組支持與互助形式參與精力湯製作及活動討論，並以飲食記錄本紀錄個人每日飲食內容與接受兩次飲食頻率問卷施測，由研究人員將飲食資料蒐集後於「營養九九資訊網—專業營養網」建檔，所得數據使用統計軟體分析。結果顯示，與飲食記錄相比，飲食頻率問卷所獲之資料有高估情況，尤是熱量、維生素A效力、維生素B1、維生素C、磷、鉀、鎂和鋅這些項目達到顯著性差異 (p < 0.05)；而豆魚肉蛋類、水果類、蔬菜類與乳類與飲食記錄均有良好的相關性 (r = 0.57 - 0.81, p < 0.05)，將食物類別轉換為營養素後，以熱量、蛋白質、膽固醇、維生素B1、磷、鉀、鐵、鎂達到顯著相關性 (r = 0.49 - 0.78, p < 0.05)。
另外，欲瞭解癌存活者生活品質狀況及提供營養照護對其生活品質之影響，經授權同意後採用歐洲癌症治療與研究組織發展之癌症病人生活品質核心問卷 (EORTC QLQ-C30 version 3.0) 台灣中文版及自編式自我效能問卷，於營養照護前後進行問卷調查。實驗組為接受營養照護者，計 39 人；對照組為一般癌存活者，計 48 人。結果發現，實驗組在營養照護後整體生活品質平均分數為 82 ± 17 分，顯著比對照組之 66 ± 22 分高 ( p < 0.001)，且生理功能（平均分數為 90 ± 9 分）、角色功能（平均分數為 96 ± 10 分）、情緒功能（平均分數為 87 ± 12 分）及社會功能（平均分數為 90 ± 13 分）得分皆顯著比對照組高，在症狀評估方面，實驗組之噁心嘔吐（平均分數為 1 ± 6 分）、疼痛（平均分數為 16 ± 17 分）與財務困難（平均分數為 5 ± 12 分）得分顯著比對照組低，顯示實驗組於此三方面的狀況比對照組佳。在自我效能評估方面，實驗組在營養照護後自評估計食物份量大小的能力增加，且相較於對照組更能夠應用食物類別及份量概念，規劃與搭配自己每日的飲食。本研究結果可應用於目前的癌存照護上，營養師提供癌存活者營養照護服務有助於改善其生活品質及增進飲食營養技能，且可以此飲食頻率問卷作為營養諮商的輔助工具。本研究獲得「財團法人癌症關壞基金會」及「中華民國癌友新生命協會」之協助。

Due to advances in medical development and an universal cancer screening, cancer survival rates increase year by year, and the number of cancer survivors has increased as a population sector which cannot be ignored. There is not enough data in food consumption of cancer survivors except dietary supplements. The objective of this study is to proceed from a consideration of the Taiwanese diet and collect cancer survivor’s dietary data, to create a suitable assessment of the dietary consumption of cancer survivors through a food frequency questionnaire, and confirm its reproducibility and validity. The study subjects are 17 live at-home cancer survivors, who received group education and individual nutrition which was conducted in a group supporting form counseling by a qualified dietitian lasting about seven months, followed by the cancer survivors completing a food record during the treatment period, and completing two food frequency questionnaires, and the dietary data would.be inputed in a diet management website to conduct a statistical analysis. The results indicated that compare to the food records, the food frequency questionnaire detected intake overestimations reached significance (p < 0.05) especially for calories, vitamin A efficacy, vitamin B1, vitamin C, phosphorus, potassium, magnesium and zinc; while for fish, eggs and beans, fruits, vegetables and dairy, the food record had a good correlation (r = 0.57 - 0.81, p < 0.05). If we converted the food categories into nutrients, then used the calories, protein, cholesterol, vitamin B1, phosphorus, potassium, iron, and magnesium contents, we noted they achieved a significant correlation (r = 0.49 - 0.78, p < 0.05).

In addition, we considered the quality of life among the live at-home cancer survivors, and the impact of provision of nutritional care for cancer survivors quality of life. The European Organisation for Research and Treatment of Cancer quality of life Core Questionnaire instrument (EORTC QLQ-C30 version 3.0) Chinese language version was used with permission, along with a self-efficacy questionnaire before and after the nutritional care. A qualified dietitian provided the treatment group with nutritional care, for a total of 39 subjects; along with the control group of general cancer survivors, for which there were a total of 48 subjects. The results found that in terms of nutritional care, the treatment group''s overall quality of life mean score of 82 ± 17 points, was significantly higher than the control group score of only 66 ± 22 points high (p < 0.001), and the treatment group’s scores for physical functioning (average score of 90 ± 9 points), role functioning (average score of 96 ± 10 points), emotional functioning (average score of 87 ± 12 points) and social functioning (average score of 90 ± 13 points) scores were significantly higher than the control group, while in terms of symptomatic assessment, the treatment group suffered from nausea and vomiting (the average score was 1 ± 6 points), pain (average score of 16 ± 17 points) and financial difficulties (average score of 5 ± 12 points) which were significantly lower than for the control group, indicating that the experimental group had a better situation than the control group for these three symptomatic aspects. In addition, in terms of self-efficacy assessment, after undergoing the nutrition care the experimental group found they were better able to engage in self-assessment taking into account increases in the size of food portions, and compared to the control group, were better able to use food categories and concepts with their daily dietary planning and arrangements. The results of this study can be applied to current cancer survivor care, while nutritional care for cancer survivors from dietitians can help improve cancer survivors'' quality of life and improve their nutrition skills, and the food frequency questionnaire is an efficacious instrument for supporting nutritional counseling. This study is supported by “Cancer Care Foundation” and “Taiwan Cancer Friends New Life Association”.

總目錄
中文摘要 i
英文摘要 iii
表目錄 ix
圖目錄 x
前言 1
第一章 文獻回顧 2
第一節 癌症現況 2
一、全球癌症發生率、死亡率及存活率 2
二、台灣地區癌症發生率、死亡率及存活率 2
第二節 癌存活者及癌存照護 3
一、癌存活者定義 4
二、國內外癌存照護現況 5
第三節 營養照護對癌存活者營養狀況及生活品質之影響 6
一、癌症對癌存活者營養狀況之影響 6
二、國內外研究飲食與營養對癌存活者之重要性 8
三、國內外研究營養狀況對癌存活者生活品質之影響 8
第四節 飲食評估工具 9
一、24 小時飲食回憶法 9
二、飲食記錄 10
三、飲食頻率問卷 11
(一) 飲食頻率問卷之實施 11
(二) 飲食頻率問卷之限制 13
(三) 飲食頻率問卷信效度分析 14
第二章 癌存活者飲食頻率問卷之建立及信效度檢測 16
第一節 研究動機與目的 16
第二節 飲食頻率問卷之設計 17
一、營養素資料庫來源 17
二、食物分類 17
三、飲食頻率與份量設計 19
第三節 信效度研究 23
一、研究架構 23
二、研究場域及對象 24
三、研究流程 24
四、研究工具 26
1. 飲食頻率問卷 26
2. 飲食記錄 26
3. 個人化飲食營養管理評估系統 26
第四節 資料處理與分析 28
一、飲食頻率問卷資料建檔前置作業 28
二、專業營養網建檔 28
1. 飲食頻率問卷 28
2. 飲食記錄 29
三、資料運算與統計分析 29
第五節 研究結果 31
一、基本資料 31
二、飲食記錄所測五大類食物份數與營養素平均攝取量 33
1. 五大類食物份數攝取情形 33
2. 每日平均熱量與營養素攝取情形 33
三、飲食頻率問卷所測五大類食物份數與營養素平均攝取量 39
1. 五大類食物份數攝取情形 39
2. 每日平均熱量與營養素攝取情形 39
3. 飲食與烹調習慣攝取情形 39
四、飲食頻率問卷與飲食記錄之飲食資料比較 45
1.五大類食物份數攝取比較 45
2.每日平均熱量與營養素攝取比較 45
五、飲食頻率問卷之信度 48
六、飲食頻率問卷之相對效度評估 49
1. 飲食頻率問卷與飲食記錄所測五大類食物攝取之相關性 49
2. 飲食頻率問卷與飲食記錄所測熱量與營養素攝取之相關性 50
第六節 討論 54
一、癌存活者五大類食物與營養素攝取情形 54
1. 由飲食記錄所測五大類食物與營養素攝取情形 54
2. 由飲食頻率問卷所測五大類食物與營養素攝取情形 55
3. 營養照護對癌存活者食物與營養素攝取之影響 55
二、癌存活者飲食頻率問卷之信度 56
三、癌存活者飲食頻率問卷之效度 56
四、研究限制 57
第三章 營養照護對癌存活者生活品質之影響 58
第一節 研究動機與目的 58
第二節 研究方法 59
一、研究架構 59
二、研究對象 60
三、研究流程 60
四、癌存活者生活品質與飲食營養問卷 63
1. 歐洲癌症治療與研究組織生活品質核心問卷 63
2. 個人基本資料、生活習慣與疾病相關因子及自我效能評估 63
第四節 統計分析方法 64
第五節 研究結果 65
一、癌存活者之基本資料 65
二、癌存活者之生活習慣與疾病相關因子情形 70
三、實驗組及對照組癌存活者生活品質前後測得分情形及比較 73
四、實驗組與對照組癌存活者自我效能前後測得分情形及比較 75
第六節 討論 77
一、營養照護對癌存活者生活品質之影響 77
二、研究限制 77
第四章 綜合討論與結論 79
第一節 營養照護對癌存活者飲食攝取與生活品質之影響 79
第二節 結論 79
第三節 建議 79
謝誌 81
參考文獻 82
附錄一 人體試驗委員會研究計畫通過函 88
附錄二 個案營養狀況評估表 89
附錄三 飲食頻率問卷 91
附錄四 飲食記錄表 107
附錄五 癌存活者生活品質與飲食營養問卷 108

表目錄
表 2-1、飲食頻率問卷之頻率選項對應每日平均攝取頻率表 22
表 2-2、飲食份量定量工具 22
表 2-3、癌存活者之基本資料 32
表 2-4、癌存活者飲食記錄所測五大類食物攝取情形 35
表 2-5、癌存活者飲食記錄所測熱量與營養素攝取情形 36
表2-6、癌存活者飲食頻率問卷所測五大類食物攝取情形 41
表2-7、癌存活者飲食頻率問卷所測熱量與營養素攝取情形 42
表2-8、癌存活者飲食頻率問卷所測飲食與烹調習慣填答情形 43
表 2-9、癌存活者飲食頻率問卷與飲食記錄五大類食物份數攝取比較 46
表2-10、癌存活者飲食頻率問卷與飲食記錄熱量與營養素攝取比較 47
表 2-11、癌存活者兩份飲食頻率問卷所測五大類食物攝取之信度檢定 48
表 2-12、癌存活者兩份飲食頻率問卷所測熱量與營養素之信度檢定 49
表 2-13、癌存活者飲食頻率問卷與飲食記錄所測五大類食物攝取之相關性 52
表 2-14、癌存活者飲食頻率問卷與飲食記錄所測熱量與營養素攝取之相關性 53
表 3-1、團體衛教課程主題 61
表 3-2、自我效能評估之評估項目與問題 64
表 3-3、癌存活者之基本資料 66
表3-4、對照組之前後測基本資料比較 68
表 3-5、癌存活者三餐之用餐習慣百分比分佈情形 71
表 3-6、癌存活者之生活習慣與疾病相關因子百分比分佈情形 72
表3-7、實驗組及對照組癌存活者生活品質前後測得分情形及比較 74
表3-8、實驗組及對照組癌存活者自我效能前後測得分情形及比較 76
 
圖目錄
圖 2-1、飲食頻率問卷食物選項訂定流程 21
圖 2-2、飲食頻率問卷信效度研究架構圖 23
圖 2-3 研究執行時間圖 25
圖 2-4、營養九九資訊網－專業營養網之首頁畫面 27
圖 2-5、飲食資料處理與分析流程 30
圖2-6、癌存活者飲食記錄所測五大類食物攝取變化趨勢圖 37
圖2-7、癌存活者飲食記錄所測熱量與群體體重變化趨勢圖 38
圖 3-1、癌存活者生活品質研究架構圖 59
圖 3-2、癌存活者生活品質問卷各場次執行時間 61
圖 3-3、癌存活者生活品質研究流程圖 62

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