臺灣博碩士論文加值系統

營養過剩與運動不足是造成現代人肥胖及代謝症候群的兩大主因，分析本校教職員工和學生健康檢查數據，體重過重佔40%、尿酸過高者佔21.07%，膽固醇過高佔22.25%、三酸甘油脂過高佔10.95%、飯前血糖過高10.95%，顯示有必要強化校園成員的健康意識，讓教職員工生們養成良好的健康飲食和運動習慣，達到預防相關疾病的效果。
本研究的目的在於探討透過8週的飲食教育與運動訓練對於學員們的身體組成、血液生化值及體適能之影響。將18.5 ≤ BMI ＜24共39名學員歸類為體位正常組，不介入任何措施。24.1 ≤ BMI ≦35共100名學員歸類為實驗組，接受為期8週飲食教育與運動訓練介入措施，包括營養課程6堂、運動課程4堂搭配每週至少3次中度運動每次30分鐘以上。
參與學員於試驗前、後都接受身體組成測量、健康體適能檢測及抽血取樣分析，所有檢測數據資料經以SPSS第21版進行統計分析。兩組學員在年齡上無顯著差異，但體位正常組因男性學員數較少，而在性別統計分析上，對於身體組成的體重方面呈現顯著差異影響。以成對樣本t檢定統計分析比較經實施8週飲食教育及運動訓練介入之成效，結果發現實驗組學員在身體組成方面，包括體重、身體質量指數、體脂肪等數值，皆達到顯著降低之效果；在體適能包括一分鐘屈膝仰臥起坐、坐姿體前彎、三分鐘登階等項目之表現方面，皆能達到顯著改善成效；在血液生化值統計分析方面，分析結果發現兩組成員的總膽固醇、低密度膽固醇、血管硬化指數、飯前血糖皆有顯著的下降的現象。而三酸甘油脂、高密度膽固醇、胰島素及尿酸等數值之統計分析結果則呈現皆無顯著差異表現之變化。若依據學員BMI數值分佈區間分組進行成對樣本t檢定統計分析，則發現僅在中度肥胖組(30≦BMI<35)學員的胰島素值有顯著上升的現象。本研究發現隨著BMI愈高，發生胰島素抗性的機率愈高，且實驗組經過8週介入營養教育和運動訓練後，胰島素抗性改善效果優於體位正常組。
接續使用Pearson相關性雙變異數統計分析結果發現，BMI的下降變化對其總膽固醇、三酸甘油脂、低密度膽固醇、血管硬化指數及尿酸等生化數值之改善都有顯著的影響。但如個別分析體位正常組和實驗組，僅在分析實驗組學員數據時呈現顯著效應，在體位正常組學員的資料分析時並沒發現有顯著差異影響。
綜上所述，由本研究結果得知經過為期8週飲食教育和運動訓練介入，對於實驗組學員的身體組成、體適能表現以及血中總膽固醇、低密度膽固醇、血管硬化指數、飯前血糖及尿酸等數值，都具有較為顯著的改善效益。

Excessive nutrient and insufficient exercise are the two main causes of obesity and metabolic syndrome in modern people. The physical examination data showed that 40% of our faculties and students are overweight, 21.07% have high blood uric acid levels, and 22.25% have hypercholesterolemia. In addition, 10.95% of them have high triglycerides, and 10.95% have high blood glucose before meals. This data strengthens the fact that our campus members need to develope good health habits of diet and exercise to achieve effect of preventing related diseases.
The purpose of this study is to explore the effects of 8-week dietary education and exercise training on body composition, blood biochemical values and physical fitness of the participants. 39 participants with 18.5 ≦body mass index (BMI) < 24 were classified as normal weight group, without any intervention measures. 100 of participants with 24.1≦BMI < 35 were classified as experimental group, receiving 8 weeks of dietary education and exercise training intervention measures, including 6 nutrition courses, 4 exercise courses, and 3 times per week of moderate exercise for at least 30 minutes duration each time.
The body composition of each participant measured, blood sample collected for biochemical analysis before and after health fitness training. All data were analyzed using SPSS version 21. There was no significant difference in age between two groups. But the normal weight group had fewer male participants resulting in a significant difference in body weight in the gender statistical analysis. The paired sample t-test statistical analysis used to compare the effectiveness of implementing 8 weeks of intervention. The results showed that the experimental group participants had significant reduction in body composition values, including body weight, BMI and body fat. Their performance of physical fitness, including one-minute knee bends and sit-ups, seated forward and bends, and three-minute step test, all showed significant improved. In blood biochemical value statistical analysis, both group showed significantly reduction in total cholesterol, low-density lipoprotein cholesterol, arteriosclerosis index and fasting blood glucose. The results indicated there were no significant change in the value of triglyceride, high-density lipoprotein, insulin and uric acid. However, when the participants were divide into groups according to their BMI range and analyzed using paired t-test, average of insulin level was found significantly elevated only in the moderate obesity group (30≦BMI<35). This study found that the higher the BMI, the higher the probability of insulin resistance, and the experimental group had the better insulin resistence improvement effect than the normal weight group after 8 weeks of dietary education and exercise training intervention.
The Pearson correlation bivariate analysis results showed that the decrease in BMI had a significant effect on the improvement of biochemical values such as total cholesterol, triglycerides, low-density cholesterol, arteriosclerosis index and uric acid. But if the same statistical analysis was performed on the data of indivisual group, we found a significant impact of BMI reduction on the changes of blood biochemical values only in the experimental group, but not in the normal weight group.
In summary, our study confirmed that 8-week duration of diet education and exercise training have significant impacts on the improvement of body composition, and blood biochemical values, including total cholesterol, low-density lipoprotein, arteriosclerosis index, uric acid, fasting blood glucose, and also the performances of physical fitness in the abnormal bady mass experimental group.

論文審定書……………………………………………………………………… i
中文摘要…………………………………………………….…..……………… ii
英文摘要… ……………………………..……………………. ……………… iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 5
第二章 文獻探討 6
第一節　肥胖體質者之血液生化值 6
第二節 肥胖體質與個體健康之相關性 9
第三節 飲食介入的探討 14
第四節 身體活動介入的探討 17
第五節 健康體適能介入的探討 19
第三章 研究方法與步驟 23
第一節 研究內容 23
第二節 研究工具 24
第三節 研究流程 25
第四節　資料處理與統計分析 26
第四章　分析與結果 27
第一節　研究樣本的描述性統計 27
第二節　體位正常組和實驗組組內身體組成之結果 29
第三節　體位正常組和實驗組組內血液生化值之結果 32
第四節　體位正常組和實驗組組內體適能之結果 44
第五章　討論 47
第一節 飲食教育和運動訓練介入後對受試者身體組成的影響 47
第二節 飲食教育和運動訓練介入後對受試者血液生化值的影響 48
第三節 飲食教育和運動訓練介入後對受試者體適能的影響 51
第六章　結論與建議 52
第一節 結論 52
第二節 建議 53
參考文獻 54
中文部份 54
英文部份 56
附錄 60
附錄A 根據三波臺灣國民營養健康狀況變遷調查，臺灣體位(過輕、正常、過重、輕度肥胖、中度肥胖與重度肥胖)盛行情形之變化 60
附錄B 2006~2015臺灣地區13歲以上國人規律運動人口比率 61
附錄C 18歲以上成人的體位BMI判定標準 62
附錄D 糖尿病飯前/飯後血糖值標準 63
附錄E 血脂肪範圍參考值 64
附錄F 國民飲食指標12項原則 65
附錄G 成人有氧適能活動量建議 66
附錄H 20-64歲臺閩地區男性坐姿體前彎百分等級常模 67
附錄I 20-64歲臺閩地區女性坐姿體前彎百分等級常模 68
附錄J 20-64歲臺閩地區男性仰臥起坐60秒百分等級常模 69
附錄K 20-64歲臺閩地區女性仰臥起坐60秒百分等級常模 70
附錄L 20-64歲臺閩地區男性三分鐘登階心肺耐力指數百分等級常模 71
附錄M 20-64歲臺閩地區女性三分鐘登階心肺耐力指數百分等級常模 72
附錄N IRB訓練證明書 73
附錄O IRB核准同意書 74
附錄P 張貼公開海報證明 75
附錄Q 窈窕減重班公告海報 76
附錄R 每日飲食和運動紀錄表 78
附錄S 窈窕健康減重班課程表 79

中文部份
衛生福利部國民健康署網站(2018年7月4日)。肥胖是慢性疾病！ 調整飲食及運動生活是最佳處方。資料引自https://www.mohw.gov.tw/cp-16-42429-1.html
衛生福利部國民健康署網站(2018年11月15日)。關於過重與肥胖。資料引自
https://www.hpa.gov.tw/Pages/List.aspx?nodeid=1757
衛生福利部國民健康署網站(2018年1月2日)。痛風與高尿酸。資料引自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=637&pid=1210
衛生福利部國民健康署網站(2020年06月02日)。響應世界肥胖日，控制體位，預防肥胖併發症上身。資料引自https://www.mohw.gov.tw/fp-3567-37751-1.html#:~:text=
行政院衛生署(2002)。國人肥胖定義及處理原則。資料引自http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&now_fod_list_no=3942&level_no=2&doc_no =32
教育部體育署體適能網站(2015)。體適能指導。資料引自https://www.fitness.org.tw/direct01.php
吳昭新(2007)。脂質檢查-膽固醇和三酸甘油脂(中性脂肪)。資料引自http://olddoc.tmu.edu.tw/chiaungo/comsense/lipid.htm
行政院衛生署國民健康局(2010)。臺灣健康體能指引，2010。
國民健康署(2013)。肥胖防治白皮書，2013，10。
衛生福利部國民健康署(2018)。台灣肥胖防治策略，2018，3。
衛生福利部國民健康署(2016)。國民健康署年報，2016，38-42。
衛生福利部國民健康署(2018)。成人肥胖防治實證指引，2018，32-33。
中華民國血脂及動脈硬化學會(2009)。台灣血脂異常防治共識，2009，22。
何忠鋒(2002)。十二週健走運動與飲食控制計畫對停經婦女身體組成及血脂肪的影響，體育學報,(32),11-24。
林美惠 (2003)。有氧舞蹈教學對國小學童健康體適能影響之研究。國立臺灣體育學院體育研究所，台中市。
林瑞興(2003)。運動訓練及飲食教育計畫介入對體重過重大學生的效果探討。國立臺灣師範大學體育學系博士班，臺北市。
邱淑娟、彭雪英(2010)。社區生活型態介入計對中年女之代謝危險因子的成效。臺灣醫學,14(5),496-508。
洪小理(2014)。12週超慢跑運動對國小學童健康體適能之影響。經國管理暨健康學院健康產業管理研究所碩士班，基隆市。
徐雯渟(2008)。營養教育介入學童減重計畫對代謝症候群相關因子之影響。中國醫藥大學碩士論文，未出版，臺中市。
莊哲偉、王鈞逸、簡偉倫、謝沛蓁(2017)。靜宜大學學生體適能現況分析。臺中科大體育學刊，(13)，123-139。
葉清華(2009)。減重課程入實施成效分析與追蹤評估。大專體育學刊，11(1)，93-104。
陳全壽、劉宗翰、張振崗(2004)。我國體適能政策指標之建議。運動 生理暨體能學報，(1)，1-11。
陳國華、林國欽、李俞麟(2014)。清華大學新生體適能檢測與追蹤分析。臺大體育學報，(27)，51-63。
陳律盛、林學宜、陳世昌、張育瑞、曾明郎(2012)。不同訓練頻率有氧運動對大專男生代謝症候群與健康體適能之影響。嘉大體育健康休閒期刊，11 (2)，1–12。
鄭佩泠(2005)。運動訓練及營養教育介入對過重學童健康體適能及血脂肪之影響。國立台北師範學院體育學系碩士班，臺北市。
劉倩伶(2006)。有氧運動結合營養教育對過重女性減重和體適能之影響。國立體育學院論叢, 17(4)，59-67。
戴世然、王人生、方雩、黃文成、陳福財、吳明杰(2009)。不同身體質量指數女性運動選手胰島素阻抗性之差異。大專體育學刊，11(2)，107-114。
顏郁晉、黃惠屏、薛夙君、李昭憲、許秀月、鍾蝶起、黃淑珠、楊燦（2007）。 屏東地區中老年人肥胖指標與代謝症候群之相關探討。中華職業醫學雜誌，14(3)，149-160。
American Heart Association.Metabolic Syndrome Increases Risk of Coronary Death.
(n.d.). Internet: (Accessed 13 March 2003).
http://www.americanheart.org/presenter.jhtml?identifier=3024259
Andersen, R, Wadden, T, & Bartlett, S. (1999). Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. JAMA , 281, 335–340.
Ballor, D, & Poehlman, E. (1994). Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding. Int J Obes Relat Metab Disord, 18, 35–40.
Bezerra, I, Curioni, C, & Sichieri, R. (2012). Association between eating out of home and body weight. Nutrition Reviews, 70, 65–79.
Bogers ,R, Bemelmans, W, & Hoogenveen, R. (2007). Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300000 persons. Archives of Internal Medicine 2, 167, 1720–38.
Bray, G, Fruhbeck, G, Ryan, D, & Wilding, J. (2016). Management of obesity.
Lancet , 387, 1947–56.
Clark, J. (2015). Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18-65 years old)who are overfat, or obese; systematic review and meta-analysis. J Diabetes Metab Disord, 14, 31.
Chang, CH., Yang, CH., & Chang , YH. (2017). Morbid obesity in Taiwan: prevalence ,trends, associated social demographics, and lifestyle factors. PLOS ONE, 12, 0169577.
Chen, H., & Pan, W. (2007). Probable blind spot in the international diabetes federation definition of metabolic syndrome. Obesity (Silver Spring), 15: (10) , 96-100.
Daniels, M., & Popkin, B.(2010). Impact of water intake on energy intake and weight status: a systematic review. Nutrition Reviews , 68(5) , 05-21.
Denke, M. (1996). Lipids,estrogen status, and coronary heart disease risk in women. Medicine and Science in Sport and Exercise, 28(1),13-14.
ElloMartin, J., Roe, L., Ledikwe, J., Beach, A., & Rolls, B.(2007). Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss
diets. The American Journal of Clinical Nutrition, 85(14) , 65-77.
Fu, T., Wen, T., Yeh, P., & Chang, H.(2008). Costs of metabolic syndrome-related diseases induced by obesity in Taiwan. Obesity Reviews ; 9(Suppl 1) , 68-73.
Garbagnati.(1996).Urate hange in leanand obese during pubertal development. Metabolism, 45(2), 203-205
Guh, D., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C., & Anis, A. (2000). The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health , 9 , 88.
Gutin, B., Cucuzzo, N., Islam, S.,Smith,C. & Stachura, S. (1998). Physical training,
lifestyle education,and coronary risk factor in obese girls. Medicine and Science in
Sports and Exercise, 28,19-23.
Haffner, S., Valdez, R., Hazuda, H., Mitchell, B., Morales, P., & Stern, M. (1992).
Prospective analysis of the insulin-resistance syndrome (syndrome X). Diabetes ,
41(7) , 15-22.
Kirk, S., Penney, T., McHugh, T., & Sharma, A. (2012). Effective weight management practice: a review of the lifestyle intervention evidence. International Journal Obesity (Lond) , 36 , 178-185.
Kraemer, W. J., Volek, J. S., & Clark, K. L. (1999). Influence of exercise training on physiological and performance changes with weight loss in men. Medicine and Science in Sports Exercise, 31, 1320-1329.
Knowler, W., Barrett, C., Fowler, S., et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346, 393-403.
Kuller,L.H. , Simkin ,S. ,Laurey ,R. ,Wing,R.R,& Meilahn , E.N.(2001).
Women healthy lifestyle project: a randomized clinical trial: results at 54 months.
Circulation, 103, 32-7.
Lean, M., & James, W. (1986). Prescription of diabetic diets in the 1980s. Lancet, 1, 723-725.
Liou, T., Huang, Y., & Chou P. (2009). Prevalence and secular trends in overweight and obese Taiwanese children and adolescents in 1991-2003. Annals of Human Biology, 36, 176-85.
Morino, Katsutaro, Kitt, & Gerald (2006). Molecular mechanisms of insulin resistance in humans and their potential links with mitochondrial dysfunction. Diabetes, 55 Supplement 2, S9-S15.
Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation, 133, 187-225.
National Institute of Health.(2001). Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel, or ATP III). National Institutes of Health Publication, No.02-5215.
Poirier, P., Giles, T., & Bray, G. (2006). Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arteriosclerosis Thrombosis and Vascular Biology, 26, 968-76.
Papadopoulou, A., et al. (2004). Clinical and biochemical manifestations of syndrome X in obese children. European Journal of Pediatrics, 63, 573-9
Raynor, H., & Champagne, C.(2016). Position of the academy of nutrition and dietetics: interventions for the treatment of overweight and obesity in adults. Journal of the Academy of Nutrition Dietetics, 116, 129-147.
Sartorelli, D., Franco, L., & Cardoso, M. (2008). High intake of fruits and vegetables predicts weight loss in Brazilian overweight adults. Nutrition Research, 28, 233-238.
Schwingshackl, L., Dias, S., & Hoffmann, G. (2014). Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis. Systematic Reviews, 3, 130.
Shaw, K., Gennat, H., O’Rourke, P ., & Del, M .(2006). Exercise for overweight or obesity. The Cochrane Database of Systematic Reviews, CD003817.
Tsai, CH. (2009). Metabolic syndrome in non-obese Taiwanese: new definition of metabolically obese, normal-weight individual. Chinese Medical Journal (Engl) , 122 , 2534-9.
Thorogood, A., Mottillo, S., & Shimony, A. (2011). Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Medicine, 124, 747-755.
Yeh, C., Chang, H., & Pan, W. (2011). Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT 1993-1996 to NAHSIT 2005-2008. Asia Pacific Jrnal of Clinical Nutrition, 20, 292-300.