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研究生:陳怡彣
研究生(外文):CHEN, YI-WEN
論文名稱:利用不同質地黑豆麴食品來探討安養院住民牙口狀態與營養攝取的相關性
論文名稱(外文):Using Different Texture of Black Soybean Koji Food to Study the Correlation of Oral Status and Nutrition Status in Taiwan Nursing House Elderly.
指導教授:黃惠宇黃惠宇引用關係
指導教授(外文):Huang, Hui - Yu
口試委員:張美鈴徐建業羅文良蔡佳良
口試委員(外文):Chang, Mei-LingHsu, Chien-YehLo, Wen-LiangTsai, Chia-Liang
口試日期:2019-07-25
學位類別:碩士
校院名稱:實踐大學
系所名稱:食品營養與保健生技學系碩士班
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:2019
畢業學年度:108
語文別:中文
論文頁數:70
中文關鍵詞:老人長期照服機構質地分級口腔狀況熱量攝取
外文關鍵詞:elderlynursing housetexture classificationoral statusenergy intake
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隨著年齡的增長,高齡者的胃口、咀嚼能力、吞嚥能力、消化能力逐漸下降,導致體力、體重均下降,使疾病更容易發生。先前有研究顯示,口腔健康狀況不佳與巨量和微量營養素攝取不足、營養不良有關,因此改善老年人的飲食,促進營養吸收,增強體力與活動力,可以減少患病與臥床的機率,進一步提升老年人的生活質量。本實驗室開發黑豆麴,其富含大豆異黃酮、總酚類化合物、花青素等,其含有更豐富分子量更小的去醣基異黃酮(Aglycone form),更容易讓人體吸收。本研究目的(一)依據日本介護食品協議會(Universal Design Foods, UDF)、國際吞嚥困難飲食標準(International Dysphagia Diet Standardisation Initiative, IDDSI)及台灣食品發展工業研究所(台灣食品所)之標準開發不同質地高齡者高優質黑豆麴蛋白質產品;目的(二)建立台灣高齡者牙口量表;目的(三)探討高齡者牙口狀況與營養攝取之相關性。本研究除利用黑豆麴原料製備不同質地黑豆麴食品外,亦與新北市三峽清福養老院老人長期照護中心合作進行老人牙口狀態與營養狀態調查,研究共招募187位65歲以上住民為受試對象,由牙醫師使用牙口量表進行牙口檢測,評估長者牙口狀況,其中84位住民經過試吃不同質地產品分出三個組別(G1、G2、G3)。評估量表則參考日本牙口量表(牙齒數目、咀嚼因子、吞嚥因子),並由台北榮民總醫院口腔醫學部口腔顎面外科主任羅文良醫師設計牙齒的咬合隅數指數(Bite couple index, BID),分數越高代表咀嚼能力越好,其量表經由專家審定及利用集群分析(Cluster analysis)及線性迴歸(Linear regression)分析其相關性來建立屬於台灣高齡者之牙口量表,並以秤重紀錄法記錄受試者三日飲食攝取。結果顯示,結果(一)本研究所開發之不同質地高優質蛋白質黑豆麴產品其硬度為黑豆麴硬餅乾1.4x105 (N/m2)、黑豆麴小酥餅4.4x104 (N/m2)、黑豆麴小饅頭1.4x104 (N/m2),皆符合IDDSI、UDF及台灣食品所之硬度標準;結果(二)在187位受試者之牙口量表數據,經集群分析可以準確分出四組;其中84位有試吃不同質地產品組別中其統計結果為羅文良醫師所設計之咬合隅數指數(BID)與三個組別(G1、G2、G3)有高達七成的相關性;結果(三)熱量攝取在這三個組別中並沒有顯著差異,這可能是因為照服機構已有醫師及營養師初步規劃適合住民個別飲食質地,讓住民在咀嚼及吞嚥食物方面較沒有障礙。結論,期許未來可以朝與多家照服機構或是社區合作,招募更多高齡者來提升量表建立的準確性。
With the increase of age, the appetite, chewing ability, swallowing ability and digestive ability of the elderly are gradually decreasing, resulting in a decrease in physical strength and body weight, making the disease more likely to occur. Previous studies have shown that poor oral health is associated with an inadequate intake of macro and micronutrients and malnutrition. Therefore, improving the diet of the elderly, promoting nutrient absorption, and enhancing physical strength and activity can reduce the risk of illness and bed rest, and further improve the quality of life of the elderly. Our laboratory has developed black bean koji, which is rich in isoflavone, total phenolic compounds, anthocyanin, and converted into a richer molecular Aglycone form that is more easily absorbed by the body. The purpose of this study (1) is based on the standards of the Universal Design Foods (UDF), the International Dysphagia Diet Standardisation Initiative (IDDSI) and the Taiwan Food Industry Research and Development Institute(FIRDI)to develop the High- protein black soybean koji products for the elderly; Objective (2) establishing the oral assessment scale of elderly in Taiwan; Objective (3) to explore the correlation between the dental status and nutritional intake of the elderly. In addition to the use of black soybean koji to prepare different textures of black soybean koji products, the study also cooperated with the elderly long-term care institution of the Sanxia Qingfu Nursing Home in Xinbei City to investigate of dental status and nutritional status of the elderly. A total of 187 residents aged 65 and over were recruited as participants. The oral assessment scale was used by the dentist to evaluate the oral status of the elderly. Among them, 84 residents were divided into three groups (G1, G2, G3) after trying different texture products. The evaluation scale referred to the Japanese oral assessment scale (number of teeth, chewing factor, swallowing factor), and the Bite Couple Index(BID) is designed by Dr. Luo Wenliang, director of the Department of Oral and Facial Surgery in Taipei Veterans General Hospital. The higher the score, the better chewing ability. This scale was evaluated by experts and analyzed by cluster analysis and linear regression to establish the oral assessment scale of the elderly in Taiwan, and we used the weighing method to record three-day dietary intake. The results(I) showed that Normal cookie hardness was 1.4x105 (N/m2), NDD3 cookie hardness was 4.4x104 (N/m2), NDD2 cookie hardness was 1.4x104 (N/m2), and all products were in line with the standards of IDDSI, UDF and FIRDI;results (2) showed that the data of the 187 participants could be accurately divided into four groups by cluster analysis; and the statistical results showed the BID designed by Dr. Luo has a correlation of up to 70% with the three groups (G1, G2, G3);results (3) showed that there was no significant difference in nutrient intake between the three groups. This may be because the physicians and dietitians in the care center have initially planned suitable dietary characteristics for the residents so that the residents had no obstacles in chewing and swallowing food. In conclusion, it is expected that we can work with several care institution or communities to recruit more elderly to improve the accuracy of the scale establishment in the future.
第一章 緒論 1
老化衍生的生理改變 1
黑豆、黑豆麴與豆類蛋白質的功能性研究 2
大豆異黃酮-去醣基異黃酮(Aglycone) 4
老人口腔健康評估 5
咀嚼與吞嚥 6
老年人食物質地 8
質地標準 10
國際吞嚥障礙食物標準(Dysphagia Diet Standardisation Initiative, IDDSI) 10
日本的介護食品協議會(Universal Design Food, UDF)標準 10
台灣財團法人食品工業發展研究所(簡稱台灣食品所)公告之標準 10
研究目的與研究架構 12
(一)開發不同質地黑豆麴高優質蛋白質產品 12
(二)老年人牙口量表建立 12
(三)營養狀態與牙口狀態相關性 12
實驗設計 13
第二章 實驗材料與方法 14
實驗材料 14
實驗儀器 14
實驗方法與步驟 15
(一)不同質地高優質蛋白質黑豆麴點心之製做開發 15
硬度測試 15
黏度測試 15
(二)老人牙口量表建立 16
研究對象 16
牙口量表檢測因子 16
牙口量表建立之流程圖 17
(三)老年人營養狀態 18
三日飲食紀錄 18
統計方法 18
第三章 結果 19
產品開發 19
黑豆麴原料營養價值 19
開發適合老年人不同牙口之黑豆麴高優質蛋白質食品 19
不同質地之黑豆麴優質蛋白質食品之設計與製作 19
產品營養成分分析 20
質地建立 20
產品硬度結果 20
與國際吞嚥障礙食物標準(Dysphagia Diet Standardisation Initiative, IDDSI)比較結果 20
與日本介護食品協議會(Universal Design Food, UDF)標準比較結果 21
與台灣的財團法人食品工業發展研究所(台灣食品所)公告之標準比較 21
老年人牙口量表之建立 23
牙口檢測 23
牙口量表信效度評估 24
牙口量表信度 24
專家信度會議 24
牙口量表模組之建立 25
集群分析(Cluster analysis) 25
線性回歸分析(Linear Regression Analysis) 25
老年人牙口與營養狀態相關性 29
受試者基本資料 29
營養狀態 29
第四章 討論 30
結論 33
參考文獻 34
附件一 58
附件二 64
附件三 65
附件四 66

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