臺灣高中生飲食、運動、靜態生活與肥胖關係之橫斷面研究，2011臺灣營養健康狀況調查

Cross-Sectional Study on Diet, Physical Activity, Sedentary Lifestyle and Obesity in Taiwan Senior High Students, Nutrition and Health Survey in Taiwan, 2011

郭怡妗(Yi-Jin Guo)

指導教授 ： 潘文涵

國立臺灣大學/生命科學院/生化科技學系/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10680

摘要

研究背景與目的
根據WHO數據，全球青少年及兒童的肥胖盛行率逐年提升。青少年之過重肥胖，會增加罹患疾病的風險，而此風險會延續至成年。在眾多致胖因子之中，飲食、運動、靜態生活為關鍵因素。因此本研究首先探討2011臺灣高中生飲食、體能活動、靜態活動與肥胖之關係，並利用集群分析，探討不同行為型態與肥胖之間的關係。
材料與方法
使用「2011臺灣營養狀況變遷調查」高中職學生之問卷、24小時飲食回憶、體檢資料。以事後加權計算高中職學生性別、年級別、地區別過重肥胖之盛行率。使用卡方檢定比較類別變項分佈之差異。利用廣義線性模式比較經多變量調整後組間連續變項平均數之差異以及趨勢檢定。以Wilcoxon檢定肥胖指標組間中位數分佈之差異。使用因素分析萃取飲食因子，再以集群分析求得由飲食因子、靜態生活和體能活動構成之行為型態，並比較行為型態間各種肥胖及代謝指標之差異、於年級、地區層的分佈以及與減重行為之關係。
結果
整體而言，臺灣高中職學生過重肥胖總盛行率為31%，男生之盛行率為32.8%顯著較女生28.8%要高；依年級分層，高中三年級之男、女生過重肥胖盛行率最高；依地區分層，男生中部層、女生北一層之盛行率最高。超過60%的高中生已進入青春期晚期或已完成青春期發育；女生最近半年有嘗試減重之比例以及有中、重度心理沮喪之比例顯著較男生高；男生堅果類、鮮奶類、家禽/家畜肉類、蛋類、蔬菜類、飲料類、油炸食品類攝取頻率顯著較女生要高，優酪乳及優格類、新鮮水果及蔬果汁類、零食甜點類攝取頻率顯著較女生要低。父母親的肥胖程度與青少年肥胖有關。
本研究發現靜態活動時間長、體能活動量少為高中職學生致胖之關鍵因素。飲食頻率分析結果，發現男生飲食頻率與肥胖指標之關係皆與預期相反，但去除過去半年曾經嘗試減肥之個案後，全穀類食物攝取頻率與肥胖指標呈顯著負相關，魚及小魚類、家禽肉類及家畜肥肉類攝取頻率與肥胖指標呈顯著正相關；女生全穀類、非魚之海產類、其他內臟類以及高熱量密度之食物攝取頻率與肥胖指標呈顯著負相關，去除過去半年曾經嘗試減肥之個案後，部分高熱量密度之食物攝取頻率與肥胖指標呈顯著但微弱之負相關。而在24小時飲食回憶分析結果，若未考量個案減肥行為，發現肥胖的高中職學生飲食品質較好，但去除過去半年曾經嘗試減重之個案後，高中職學生飲食品質與肥胖程度並無相關性。
集群分析結果，高中職男生可得「高熱量密度食物少，靜態活動多」及「體能活動多，靜態活動少」共2種行為型態。「高熱量密度食物少，靜態活動多」內個案為北一層及東部層之比例顯著較「體能活動多，靜態活動少」型態要低，男生屬於「高熱量密度食物少，靜態活動多」之型態，肥胖指標、血壓以及最近半年曾嘗試減重之比例顯著較個「體能活動多，靜態活動少」型態內之個案要高，女生個案屬於「高熱量密度食物少，靜態活動少」型態，舒張壓顯著較「高熱量密度食物多，靜態活動多」型態內之個案要低，男、女生行為型態間血液代謝指標之比較皆未達顯著差異。
結論
長時間從事靜態活動以及低體能活動量為高中職學生肥胖的最關鍵因素。

關鍵字

臺灣營養狀況變遷調查 ； 肥胖 ； 飲食 ； 靜態生活 ； 體能活動 ； 集群分析

並列摘要

Research background & Purpose
According to WHO, worldwide adolescent obesity is increasing. Adolescent obesity is associated with increasing the risk of chronic diseases, and obese adolescent tends to become obese adult. Among many obesity-related risk factor, diet, physical activity and sedentary lifestyle were the most frequent research topics. Therefore, the purpose of this study was to investigate the relation between diet, physical activity, sedentary lifestyle and overweight and obesity in Taiwan senior high school students, then we will identify obesity-related behavior pattern, and compare the obesity and metabolic indicators between the behavior patterns.
Material &Method
The study was used data obtained from Nutrition and Health Survey of Taiwan Senior High School Students. We used post-stratification method to estimate the prevalence of overweight and obesity in sex, grade levels and different geographic locations. The chi-square test was used to examine the proportion difference between categorical variables. In continuous variables, we used generalized linear model to compare the difference between groups, with control multiple factors. Wilcoxon test was used to compare the medians of obesity indicators’ tertiles. After extracted two healthy and unhealthy dietary factors, we put them, physical activity and time of engaging sedentary activity into cluster analysis to obtain obesity-related behavior patterns. Besides, we compare the difference of obesity and metabolic indicators between clusters. Chi-square test was used to identify the association between the clusters on grade levels, geographic locations and weight-reducing behavior.
Result
Overall, the prevalence of overweight and obesity of senior high school students in Taiwan was around 31%, and boys’ were higher than girls’, which was 32.8% versus 28%; in grade levels, the prevalence of overweight and obesity was highest in 3rd grade of boys and girls; in geographic locations, boys in the middle stratum and girls in the 1st stratum had the highest prevalence of overweight and obesity. In the baseline characteristics, most students belonged to the late pubertal or post pubertal stage. More girls tried to reduce weight in the past 6 months, and had moderate to severe mental depression than boys. Boys had higher intake frequency of nut, milk, poultry, livestock meat, egg, vegetable, beverage and fry food but lower intake frequency of yogurt, fresh fruit or juice and dessert than girls. Parent obesity was associated with adolescent obesity.
In this study, too much sedentary activity and less physical activity were key risk factors of obesity. Before excluding subjects had weight-reducing behavior, in boys, the results were contrary to expectation, in girls, whole grain, non-fish seafood, other organs and high energy density foods were negative associated with obesity indicators. After excluding subjects had weight-reducing behavior in the past half years, in boys, whole grain were negative associated with obesity indicators and fish/small fish, poultry and fat livestock meat were positive associated with obesity indicators. From the results of 24-hours dietary data analysis, we found the diet quality was positive associated with obesity indicators, but after excluded subjects had weight-reducing behavior, the associations were no longer existence.
We could obtain four behavior patterns from senior high school students. After multivariate adjustment, in boys, those who belonged to “less high-energy density foods and high sedentary activity” pattern had higher waist, waist-hip ratio, percent body fat, triceps and subscapular skinfold thickness and systolic pressure than those who belonged to the “less sedentary activity and high physical activity” pattern, but in girls, we only found the diastolic pressure was higher in the subjects in “high-energy density foods and high sedentary activity” pattern than subjects in the “low high-energy density foods and low sedentary activity” pattern. The differences of metabolic indicators between behavior patterns were non-significant.
Conclusion
Too much sedentary activity and low physical activity were key risks of adolescent obesity.

並列關鍵字

NAHSIT ； obesity ； diet ； sedentary activity ； physical activity ； cluster analysis

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