比較不同飲食種類的減重效果：網絡整合分析

Compare the Effects of Different Dietary Pattern on Weight Loss: A Network Meta-analysis

朱育瑩(Yu-Ying Chu)

指導教授 ： 陳崇鈺

高雄醫學大學/藥學院/藥學系碩士在職專班/碩士(2019年)

摘要

研究背景：肥胖的發生率及盛行率逐漸增加，不論在台灣，甚至是全球都有體重肥胖的健康衛生問題。而且隨著身體質量指數的增加，死亡率也隨之增加。肥胖會增加罹患許多疾病的風險，像是冠心病、第2型糖尿病或癌症。
研究目的：減重計畫需要由行為修正、飲食控制及增加活動量的方面介入。飲食控制在減重過程中是重要的，也因此發展出許多不同種類的減重飲食。多數的飲食介入試驗，通常介入2至3種飲食，較少同時比較多種飲食的試驗。所以，藉由網絡整合分析的研究方式，能一次分析多種的飲食介入。本篇研究主要探討不同三大營養素比例的飲食，對於體重體位的改變及代謝相關數值的影響進行分析。其結果可作為臨床工作使用，在減重計畫中飲食建議的參考。
研究方法：搜尋的資料庫有Pubmed、Cochrane Central Register of Controlled Trials、EMBASE及華藝線上圖書館，納入至2017年12月發表的文獻。探討不同三大營養素比例的飲食：(1)均衡低熱量飲食、(2)低碳水化合物飲食、(3)低脂飲食及(4)高蛋白飲食對於減重的效果。納入的對象為體重過重或肥胖的健康成人。排除有任何疾病（如：第二型糖尿病、腎臟疾病等）、使用任何藥物及有抽菸喝酒習慣者。觀察飲食在短期（3個月）及長期（6個月及12個月）的影響。利用RevMan 5.3及WinBUGS 14軟體進行統計分析。
研究結果：本研究共納入6篇文獻，依納入的文獻分析低脂飲食、低碳水化合物飲食及高蛋白飲食的影響。在短期減重效果方面，整合分析結果為低脂飲食的減重效果優於低碳水化合物飲食(-0.15 kg; 95% CI: -5.20, 4.91)。但在網絡整合分析結果，則是低碳水化合物飲食減重效果優於低脂飲食-0.95±0.99 kg (95% CI: -1.01, 2.90)。在長期減重效果部分，網絡整合分析結果，無論在6個月及12個月都是高蛋白質飲食減重效果較好，接續是低碳水化合物飲食及低脂飲食。但高蛋白質飲食及低碳水化合物飲食兩組之間，對於體重的改變量差異不大-0.27±1.16 kg (95% CI: -2.00, 2.54)。
討論與建議：網絡整合分析的研究，在營養的領域運用較少。目前那種飲食對於減重效果較佳，並無一致的看法。本研究利用網絡整合分析方式，比較不同三大營養素比例飲食，對於短期及長期減重及相關代謝的影響。因為聚焦於營養素比例的影響，將其他的干擾因素降低，但也因此排除許多文獻。總結本篇研究，在長期減重效果部分，高蛋白飲食有較好的減重效果。低碳水化合物飲食相較低脂飲食在降低三酸甘油脂、血糖及增加高密度膽固醇效果較好，而低脂飲食在降低低密度膽固醇效果比低碳水化合物飲食較好。另外，高蛋白飲食在於減重及血脂方面的也有正面改善的效果。

關鍵字

飲食種類 ； 減重 ； 網絡整合分析

並列摘要

Background: The incidence and prevalence of obesity are increased gradually, whether the world or Taiwan, there have had health problems of obesity. With the body mass index increases, the mortality is also grown. Obesity will increase the risk of many diseases, such as coronary heart disease, type 2 diabetes mellitus or cancer. The weight loss program requires interventions of behavioral modification, diet control and increased exercise. Diet control is important part in the weight loss process, therefore there have developed various weight loss diets. Most dietary trials usually intervene 2 to 3 diets, but multiple interventions in the trial is less.
Aims: Therefore, we used the method of network meta-analysis to analyze variety of dietary interventions in the same time. We focused on different macronutrients distribution of dietary, which effects of body weight, anthropometry and metabolic laboratory data. The results can be used as a reference for clinical work and dietary recommendations in weight loss programs.
Methods: We searched the databases include Pubmed, Cochrane Central Register of Controlled Trials, EMBASE and Airiti Library, included the studies were published before December 2017. We investigated the diets of different macronutrients distribution, such as (1) balanced low calorie diet, (2) low carbohydrate diet, (3) low fat diet, and (4) high protein diet. The included criteria of subjects were healthy adults who were overweight or obese. The excluded criteria were who had any diseases (such as: type 2 diabetes mellitus, kidney disease, etc.), use any medicine, and have the habit of smoking and drinking. The effects of diet on short-term (3 months) and long-term (6 months and 12 months) were observed. Statistical analysis was performed using RevMan 5.3 and WinBUGS 14.
Results: There were included 6 trials in this study. There were 3 trials which intervention 3 months, mainly with low fat diet and low carbohydrate diet intervention. There were 1 trial intervention for 6 months, another 1 intervention for 12 months, and the other 1 intervention for 6 months and 12 months. The effect of short-term, the weight loss results of meta-analysis is low fat diet better than the low carbohydrate die (-0.15 kg; 95% CI: -5.20, 4.91). However, in the network meta-analysis, the weight loss effect of the low carbohydrate diet is better than the low fat diet (-0.9475 kg). In the long-term section, whether at 6 months and 12 months, the results of network meta-analysis is high protein diet with a great weight loss effect, followed by a low carbohydrate diet and a low fat diet. However, there was no significant difference between the high protein diet and the low carbohydrate diet on body weight changes.
Conclusion: The method of network meta-analysis is less used in the study of nutrition. At present, there are no consensus of which diet has been better effects on weight loss. This study used the method of network meta-analysis method to compare the effects of different macronutrients distribution on weight loss and related metabolism. Because of the focus on the proportion of macronutrients, it was excluded many studies to reduced interference factors. Summary of this study, low carbohydrate diet and high protein diet had better effects of weight loss. The low carbohydrate diet was better on reduced triglycerides and blood sugar, while the low fat diet was better on reduced low-density lipoprotein. In addition, the high protein diet also had a positive effect on weight loss and improved blood lipids. The above results can be used as a reference for clinical weight loss programs.

並列關鍵字

Dietary pattern ； Weight loss ； Network meta-analysis

參考文獻

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