對非糖尿病且非高血脂症用藥之代謝症候群個案比較低熱量營養教育與合併部分代餐減重計畫之成效

Effect of a Reduced Calorie Diet Plan Versus a Partial Meal Replacement Plan on Weight Loss in Individuals with Metabolic Syndrome without Diabetes or Current Therapy with Lipid-lowering Agents

目的：代謝症候群的防治以積極型生活型態改變為主軸，增加活動量、健康飲食與控制體重。文獻顯示合併代餐輔助減重計畫有其益處。本研究的目的在探討針對代謝症候群個案施予積極型生活型態改變，比較傳統低熱量營養教育與合併部分代餐輔助減重兩者之成效。方法：依立意取樣收集某綜合醫院家庭醫學科門診非糖尿病且非高血脂症用藥之代謝症候群者參與研究。經由營養師做營養諮詢，復健師實施體適能測驗與指導增加活動量之後，個案依流水號單雙數分配至兩組，低熱量營養教育組(conventional reduced calorie diet plan, RCD)與合併部分代養輔助減重組(partial meal replacement plan, PMR)。代餐產品經由營養師講解使用方式，每天代用一餐。經四週後，再調查其飲食與運動狀況，測量體重、腰圍與體脂肪百分比，量血壓並抽血檢查血糖、膽固醇、三酸甘油酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇。結果：完成研究者有64位，對象平均年齡43.4±9.9歲，女性佔45.3%，平均體重為81.5±13.9公斤，所有個案皆屬於體重過重或是肥胖（BMI≧24kg/平方公尺）。經過四週介入後，兩組皆顯著降低體重、腰圍與身體質量指數；RCD組平均減輕體重為1.3±1.7公斤，PMR組平均減輕體重為3.6±3.2公斤，能夠在四週減輕體重超過1.5公斤的個案，PMR組遠多於RCD組(75.0% vs. 31.3%)，觀察腰圍減少的公分數也是PMR組較多（3.7±4.8 vs. 1.9±2.8公分）。營養師與復健師衛教介入可以回轉代謝症候群，在RCD組代謝症候群回轉率為21.9%，而PMR組代謝症候群回轉率為40.6%。結論：短期生活型態改變計劃可以改善非糖尿病且非高血脂症用藥之代謝症候群，合併代養輔助減重計畫增加代謝症候群回轉率。

Purposes: Prevention of metabolic syndrome lies mainly with intensive lifestyle modification. The purpose of this study was to explore the differences between the effects that a conventional reduced calorie diet plan and a partial meal replacement plan can make in individuals with metabolic syndrome without diabetes or current therapy with lipid-lowering agents. Methods: A total of 64 individuals were enrolled. Following consultation about nutrition and physical fitness, the subjects were randomly distributed into two groups: one with a conventional reduced calorie diet plan (RCD) and the other with a partial meal replacement plan (PMR). In the PMR group, the meal replacement product was prescribed by a dietician to replace one meal per day. After four weeks, anthropometric indexes and blood tests including plasma glucose, serum cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol levels were measured. Results: The mean age of subjects was 43.4±9.9 years and their mean weight was 81.5±13.9 kg. All individuals were either overweight or obese (BMI≧24 kg/m2). After a four week intervention, there was a significant reduction in weight, waist circumference and BMI in both groups. The average amount of weight loss in the RCD group was 1.3±1.7 kg while that in the PMR group was 3.6±3.2 kg. The percentage of individuals who lost more than 1.5 kg within four weeks was higher in the PMR group than in the RCD group (75.0% vs. 31.3%) and the result was the same for waist circumference, with the PMR group demonstrating a more significant reduction (3.7±4.8 vs. 1.9±2.8 cm) An intervention involving a dietician and a rehabilitation therapist could reverse metabolic syndrome as the resolution rate was 21.9% in the RCD group and 40.6% in the PMR group. Conclusions: A short-term program of lifestyle modification improved metabolic risk factors. The meal replacement plan increased the resolution rate of metabolic syndrome in individuals who were non-diabetic and taking no current lipid-lowering agents.