臺灣博碩士論文加值系統

研究發現肥胖者血漿中脂肪細胞激素的濃度會改變，進而可能導致肥胖相關的代謝障礙。推測減重可使脂肪細胞分泌之激素(如：脂締素(adiponectin)和腫瘤壞死因子(TNF-α))濃度改變，因此本論文之目的為研究肥胖者（3位男性、11位女性，平均年齡：40.3 ± 10.8歲），經過8週的飲食控制和有氧運動訓練對其血清adiponectin、TNF-α及血脂肪濃度的影響，並探討這些指標間之相關性。
實驗結果顯示，經過8週的體重控制計畫，利用飲食控制和有氧運動訓練可使受試者體重下降3.28% （P＜0.001）、身體質量指數(Body mass index，BMI) 下降 2.33% (P=0.001)、腰圍下降3.64% (P=0.005)和臀圍下降2.27% (P＜0.001)及舒張壓下降6.25% (P=0.039）。另外，經過8週的體重控制計劃後，總膽固醇和低密度膽固醇(LDL-C)分別下降7.63% (P=0.001)和10.96% (P =0.004)，其他血脂肪則無顯著差異。空腹血糖值亦没有因飲食控制和有氧訓練而發生顯著改變。血清adiponectin和TNF-α濃度亦没有發生顯著改變。
在相關性分析方面，減重前，受測者血清中adiponectin濃度分別和體重及BMI呈負相關(r=-0.59，P=0.026及r =-0.562，P=0.036)；TNF-α與高密度膽固醇（HDL-C）亦呈負相關(r=-0.588，P=0.027)。減重後△adiponectin和△TNF-α呈負相關（r=-0.627，P=0.016）；△adiponectin和△三酸甘油酯（TG）亦呈負相關（r=-0.582，P=0.029），推論減重後adiponectin變化值上升，則TNF-α和TG變化值有下降的趨勢；△TG和△ TNF-α則呈正相關（r=0.547，P=0.043），△ TNF-α和△ 收縮壓（SBP）亦呈正相關（r=0.552，P=0.041），推論減重後TNF-α變化值下降，TG及SBP變化值也有下降的趨勢。進一步分組分析發現，減重前BMI＜30 kg/m2者(其減重達3%以上)，減重過程可觀察到其adiponectin顯著增加，血脂肪和體脂肪則顯著降低，推測要經由減重顯著改善血脂肪和體脂肪，且增加adiponectin濃度，以BMI＜30 kg/m2 (其減重達3%以上)者效果較為明顯。
綜合本研究結果，8週的體重控制計劃可有效降低肥胖者體重、BMI、腰圍、臀圍、總膽固醇及低密度膽固醇等測量值。減重後adiponectin變化值有上升而TNF-α變化值有下降的趨勢，TG及SBP亦有下降的趨勢。分組分析發現，BMI＜30 kg/m2 (且減重3%以上)者，減重過程可觀察到其adiponectin顯著增加，血脂肪和體脂肪則顯著降低，推測減重應可增加肥胖者體內之抗發炎作用及抗血管粥狀硬化作用。
關鍵詞：肥胖者；體重控制計劃；脂締素；腫瘤壞死因子-α

Many studies have shown that plasma levels of adipocytokine may be altered in obese subjects. These changes may further cause obese-related metabolic disorders. This study hypothesized that weight loss may affect the levels of adipocytokines (especially adiponectin and tumor necrosis factor, TNF-α). Thus, the aim of this study was to investigate the effects of an 8-weeks weight control program on serum levels of lipids, adiponectin and TNF-α in obese subjects and analyze the relationships among these indicators.
A total of 3 men and 11women subjects（mean age 40.3 ± 10.8 yr）completed this syudy. The results showed that body weight decreased by 3.28% (P < 0.001), BMI decreased by 2.33% (P=0.001), waist circumference decreased by 3.64% (P=0.005), hip circumference decreased by 2.27% (P<0.001) and diastolic blood pressure decreased by 6.25% (P=0.039) in all subjects through 8-week weight control program using dietetic control and aerobic exercise. Furthermore, plasma levels of total cholesterol (P = 0.001) and low density lipoprotein-cholesterol (LDL-C) (P = 0.004) also respectively decreased by 7.63% and 10.96%. However, there was no significant change among other lipid profiles, fasting glucose levels, serum adiponectin and TNF-α levels.
Further analysis on the association of different indicators showed that serum adiponectin levels were inversely correlated with body weight (r = -0.59, P = 0.026) and BMI (r = -0.562, P = 0.036) before the program begun. Serum TNF-α levels are inversely correlated with HDL-cholesterol (r = -0.588, P = 0.027). Net change of adiponectin (Δadiponectin) was inversely correlated with TNF-α net change (ΔTNF-α) (r =-0.627, P=0.016) through the weight control program. The Δ adiponectin were inversely correlated with the net change of plasma triglyceride (ΔTG) (r = -0.582, P = 0.029). The results suggested that obese subjects with weight loss increased the changes of adiponectin and decreased the changes of TNF-α as well as TG. The ΔTG were positively correlated with ΔTNF-α (r = 0.547, P = 0.043). The ΔTNF-α were positively correlated with net change of systolic blood pressure (Δ SBP) (r = 0.552, P = 0.041). and SBP. The results suggested that obese subjects with weight loss decreased the changes of TNF-α and decreased TG as well as SBP. Results from subgroup analysis showed that subjects with BMI below 30 kg/m2 with weight loss greater than 3 % significantly increased serum adiponectin levels, but decreased blood lipid profiles and body fat through the weight control program. The results suggest that weight loss of subjects with BMI below 30 kg/m2 might have better effects on adiponectin, blood lipids and body fat.
In conclusion, the results from this study demonstrated that obese subjects through the 8-week weight control program significantly decreased body weight, BMI, waist circumference, hip circumference, total cholesterol and LDL-C. The subgroup analysis further exhibited that weight loss of obese subjects with BMI below 30 kg/m2 and greater weight loss（≧ 3 % of initial weight）had better effects on adiponectin, blood lipids and body fat. This study suggests that obese subjects through the weight control program may have anti-inflammatory and anti-atherogenic effects which may be related to increased serum adiponectin and decreasing TG and SBP.

Key words: obese subjects; weight control program; adiponectin; tumor necrosis factor-α

表目錄 ……………………………………………………………… Ⅲ
圖目錄 ……………………………………………………………… Ⅳ
附錄目錄……………………………………………………………… Ⅴ
縮寫對照表 ………………………………………………………… Ⅵ
中文摘要 …………………………………………………………… Ⅶ
英文摘要 …………………………………………………………… Ⅸ

第一章 緒言 …………………………………………………… 1
第二章 文獻整理 ……………………………………………… 2
第一節 肥胖 ………………………………………………… 2
壹、 肥胖的定義 ………………………………………… 2
貳、 肥胖的趨勢 ………………………………………… 5
參、 肥胖與疾病的關係………………………………… 5
肆、 減重對身體的好處 ………………………………… 7
第二節 減重的方法 ………………………………………… 8
壹、 飲食控制 ………………………………………… 8
貳、 有氧運動 ………………………………………… 9
參、 其他方法 ………………………………………… 9
第三節 細胞激素 …………………………………………… 10
壹、 Adiponectin ……………………………………………11
貳、 TNF-α……………………………………………… 12
第三章 研究對象與方法 ……………………………………… 14
第一節 實驗目的 …………………………………………… 14
第二節 體重控制計劃及實驗流程 …………………………15
第三節 實驗對象 ……………………………………………16
第四節 介入方法 ……………………………………………18
第五節 體位測量 ……………………………………………18
第六節 血液檢測 ……………………………………………18
第七節 統計方法 ……………………………………………19
第四章 結果 ……………………………………………………20
第一節 受試者減重過程中體位的變化 …………………… 20
第二節 受試者血液生化值的變化……………………………23
第三節 受試者細胞激素的變化………………………………24
第四節 相關性分析……………………………………………25
第五節 受試者減重程度對其各項生理指標的影響 ……… 31
第六節 減重對不同肥胖程度的影響 ……………………… 34
第五章 討論 ……………………………………………………38
第一節 減重過程中受試者體位變化…………………………38
第二節 減重過程中受試者血液生化值變化…………………38
第三節 受試者血清細胞激素減重過程中的變化…………… 39
第四節 減重過程受試者各項生理指標變化的相關性分析… 40
第五節 受試者在減重過程中不同減重程度及不同肥胖程度對其各項生理指標變化的影響 ……………………… 42
第六節 研究限制………………………………………………43
第六章 結論 …………………………………………………… 44
第七章 參考文獻 ……………………………………………… 45

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