極低熱量飲食在肥胖治療上的角色

The Roles of Very Low Calorie Diets in Treatment of Obesity

張秦松(Chin-Song Chang) ； 吳至行(Chih-Hsing Wu) ； 張尹凡(Yin-Fan Chang) ； 吳坤陵(Kun-Ling Wu) ； 張智仁(Chih-Jen Chang)

《台灣家庭醫學雜誌》 13卷1期 (2003/03) Pp. 1-16

https://doi.org/10.7023/TJFM.200303.0001

摘要

肥胖已知會增加罹患多種慢性疾病的機會，更可能導致較高的死亡率，如果有一種快速且安的減重方法，對於肥胖並且合併有嚴重的健康問題的患者，將會有極大的助益。當病人因為醫療上、行為上或生活型態的理由需要快速的體重減輕時，極低熱量飲食(very low calorie diet, VLCD)是一個有用的選擇；它有以下四個特點：(1)它提供每日400到800卡的熱量(2)加強蛋白含量的比重(每天公斤理想體重0.8-1.5克) (3)能供應足量的營養，包含維生素、礦物質、電解質及脂肪酸的每日建議量(4)能完整的取代日常的飲食。
使用VLCD的時機包括：(1)中度至重度肥胖(BMI≧30)，並且具有強烈動機者(2)曾經嘗試多種保守的減重方法後仍失敗者(3)經由快速減重能立刻改善病人的病況者，包括控制不良的第二型糖尿病、高三酸甘油酯血症、阻塞性睡眠中止症以及有症狀的週邊水腫等。近年的研究雖已證實VLCD的使用是相當安全的，但仍有其危險性存在，所以其執行應在醫師、營養師以及行為治療師等專家團隊的監抭下進行12到16週。執行前應審慎評估參與減重者的健康情形以及是否存有使用上的禁忌症，完整的評估包括身體檢查、抽血檢驗以及心電圖、超音波等，並詳細告知參與者可能發生的危險性。
研究証明VLCD在快速減重降低體脂肪、減輕疾病用藥上頗有助益，但長期而言仍有復重的情形發生；證據顯示初期使用VLCD獲得較大的體重減輕，再加上主動追蹤的體重維持計畫，包括行為治療、營養教育以及運動處方，便可以改長期的體重維持，達到提升健康的目的。

並列摘要

It had been well documented that obesity will increase the risk of many kinds of chronic diseases and also induce higher mortality rate for all age groups. Therefore, to develop a fast and safe weight reduction program is critical for the health of those who was obese with co-morbidity. When a fast weight reduction is recommended because of medical, behavioral, or life pattern reasons, VLCD (Very Low Calorie Diet) will be an effective choice. VLCD has four characteristics: (1) Provide 400to 800 kcal calories per day (2) Enrich the content of protein with 0.8 to 1.5 gram/kg ideal body weight/day (3) Contain sufficient daily recommended nutrients including vitamins, minerals, electrolytes and fatty acid (4) Totally replace daily food intake.
The indication for the use of VLCD include (1) moderate to severe obesity (BMI＞30) with strong motivation (2) those who had failed after several conservative weight reduction program (3) who may immediately improve his health conditions through fast weight reduction, such as poor controlled type II diabetes, hypertriglyceridemia, obstructive sleep apnea syndrome and symptomatic peripheral edema.
Although the safety of VLDO had been approved by many studies, however, there are some risks existing after all. The prescription of VLCD should be performed 12 to 16 weeks under the carefully monitor by special teamwork which included well trained physicians, dieticians and behavior therapists. Detailed evaluation with complete physical examination, laboratory test, cardiac echo and abdominal echo should be arranged to exclude any possible contraindications. The participants should be discussed the benefit and risk of VLCD treatment with physicians and dieticians.
VLCDs are beneficial in fast weight reduction, lowering body fat and reducing pill amount for disease control. Long-term and followed-up studies revealed that weight regain is still the major problem. There are many evidences suggest improving long-term weight control, VLCDs should be arranged in early stage to gain fast weight reduction followed by active followed-up maintenance program which contains behavior therapy, nutrition education and exercise projects.

並列關鍵字

very low calorie diet ； obesity ； body weight control

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