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  • 學位論文

營養衛教及營養補充劑樟芝菌絲體膠囊對改善非酒精性脂肪變性肝炎病患之功效

Improvement effects of Antrodia cinnamomea oral supplement plus nutrition consultation on Nonalcoholic Steatohepatitis patients

指導教授 : 劉凱莉

摘要


脂肪肝是臨床上常見的肝病之一,又可分為酒精性脂肪肝疾病(AFLD)與非酒精性脂肪肝疾病(NAFLD)。非酒精性脂肪肝疾病在病程的發展中,可能會衍生出肝臟纖維化的機轉,即為非酒精性脂肪變性肝炎(NASH),本研究想了解NASH患者的營養診斷與飲食和生化的相關性和營養師介入衛教之功效。本研究招募中部某地區醫院之非酒性脂肪變性肝炎受試者之營養記錄評估單,以國際膳食與營養術語(IDNT)給予營養診斷,以瞭解台中海線地區非酒性脂肪變性肝炎患者常見的營養問題,並了解營養診斷與飲食問題和生化的相 關性。 方法:本研究招募年齡20~80歲之中部某地區醫院肝炎門診之非酒性脂肪變性肝炎患者共37位,研究時間為104年5月至105年6月,營養師評估受試者之基本資料、生化數值、脂肪肝程度判斷等資料,依際膳食與營養術語(IDNT)給予至多4個的營養診斷,並進行相關性分析。非酒精性脂肪變性肝炎(NASH)受試者經營養師衛教後,隨機雙盲分為營養衛教+樟芝菌絲體組介入組和營養衛教+安慰劑組,並於3個月後第一次複診及6個月後進行第二次複診。第一次複診受試者回診人數共31人,分別為營養衛教+樟芝菌絲體組17人與營養衛教+安慰劑組14人。營養師會再評估受試者之基本資料、生化數值、脂肪肝程度判斷等資料,依際膳食與營養術語(IDNT)給予至多4個的營養診斷,並進行相關性分析。非酒性脂肪變性肝炎受試者於第一次營養評估時,最常出現之營養診斷依百分比排序分別為:體重過重/肥胖共24.3%、脂肪攝取過多23%、熱量攝取過多13.5%、醣類攝取型態不理想13.5%、體能活動不足10.1%、脂肪攝取型態不理想5.4%、纖維質攝取不足4.1%、營養相關的檢驗值改變3.4%、醣類攝取過多1.4%、礦物質攝取過多0.7%以及熱量攝取不足0.7%。受試者最常出現之營養診斷的分類,以NI(攝食量)佔最多數佔62.2%,其次為NC(臨床面)佔27.7%,再來為NB(行為-環境)佔10.1%,可見非酒性脂肪變性肝炎患者營養問題中以飲食攝取量問題佔最大宗。統計分析發現,醣類攝取型態不理想營養問題與受試者LDL異常統計上有顯著相關;體重過重/肥胖營養問題與受試者BMI異常統計上有顯著相關,體重過重/肥胖營養診斷與受試者BMI相關性之邏吉斯迴歸分析發現,BMI每增加一個單位(kg/m2),會有體重過重/肥胖營養診斷的機會就增加36倍;脂肪攝取過多營養診斷與受試者脂肪攝取比例異常統計上有顯著相關,脂肪攝取過多營養診斷與受試者脂肪攝取比例相關性之邏吉斯迴歸分析發現,脂肪攝取量每增加總攝食熱量的1%,會有脂肪攝取過多營養診斷的機會就增加11.33倍;熱量攝取過多營養診斷與受試者精緻糖類攝取過多於統計上有顯著相關,但兩者邏吉斯迴歸分析則無顯著相關;醣類攝取型態不理想與受試者精緻糖類攝取過多於統計上有顯著相關,但兩者邏吉斯迴歸分析則無顯著相關;體能活動不足與受試者精緻糖類攝取過多於統計上有顯著差異,但兩者邏吉斯迴歸分析則無顯著相關。第一次複診之31位非酒精性脂肪變性肝炎受試者中,最常出現之營養診斷依百分比排序分別為:體重過重/肥胖共30人次(24.2%)、脂肪攝取過多30共人次(24.2%)、體能活動不足共22人次(17.7%)、營養相關的檢驗值改變共19人次(15.3%)、醣類攝取種類不理想共8人次(6.5%)。受試者最常出現之營養診斷的分類以NC佔最多數佔39.52%,其次為NI佔37.90%,再來為NB佔17.74%,另外NO目前沒有營養診斷佔4.84%。另外,3個月介入後回診共31位受試者中,營養衛教+樟芝菌絲體組17位受試者,於介入3個月後,其平均熱量、蛋白質、脂肪、碳水化合物、與精製糖類攝取克數以及平均GOT、GPT、TG、Ferritin濃度顯著小於介入前,而蛋白質攝取比例顯著大於實驗介入前。而營養衛教+安慰劑組實驗14位受試者,於介入3個月後,平均熱量、平均蛋白質攝取克數、平均脂肪攝取克數以及生化數值平均GOT、平均GPT、顯著小於實驗介入前。第二次複診回診人數共23位非酒精性脂肪變性肝炎受試者中,分別為營養衛教+樟芝菌絲體組12人與營養衛教+安慰劑組實驗11人,營養衛教+樟芝菌絲體組實驗12位受試者,於介入6個月後,平均ActiTest肝臟發炎指數和平均SteatoTest脂肪肝指數顯著小於實驗介入前;另外平均FibroTest纖維化指數、平均NashTest脂肪肝炎指數、平均AshTest酒精肝炎指數介入前後無顯著差異。營養衛教+安慰劑組實驗11位受試者,於介入6個月後,平均ActiTeste肝臟發炎指數顯著小於實驗介入前(P值為0.013);另外平均、平均FibroTest纖維化指數、SteatoTest脂肪肝指數、平均NashTest脂肪肝炎指數、平均AshTest酒精肝炎指數介入前後無顯著差。 總結,非酒性脂肪變性肝炎營養診斷分析發現,患者大多有體重超過理想範圍,加上熱量攝取超過所需、脂肪和精緻醣類攝取過量,以及活動量不足等狀況,此可能與增加非酒精性脂肪變性肝炎(NASH)發生率相關。複診的營養診斷中發現醣類攝取過多、脂肪攝取型態不理想以及礦物質攝取過多的營養問題已不存在,可見在NASH患者再經過營養師的衛教與飲食調整介入後醣類攝取過多、脂肪攝取型態不理想以及礦物質攝取過多的問題已不存在也較容易改善。而體重過重/肥胖與脂肪攝取過多問題依然是複診營養診斷中百分比排序的前兩名,建議營養師可加強低油飲食衛教與飲食份量控制,並強調規律回診與持續追蹤體重變化的重要性。另外,當營養衛教介入3個月後追蹤NASH兩組受試者(即營養衛教+樟芝菌絲體組及營養衛教+安慰劑組)共31位,兩組受試者飲食中熱量、蛋白質、及脂肪攝取克數於統計上皆有顯著下降,可見在營養師給予營養衛教及飲食調整後,兩組受試者了解飲食控制的重要性,故攝取熱量、油脂及精緻糖類攝量有減少。除此之外,介入後兩組精緻醣類攝取量皆有減少,但營養衛教+樟芝菌絲體組介入前後,受試者精緻醣類攝取量於統計上有顯著差異。此結果可能與營養衛教+樟芝菌絲體組受試者覺得服用樟芝菌絲體介入後身體狀況有改善,飲食控制方面也更積極有關。介入後兩組肝指數GOT、GPT、ActiTeste肝臟發炎指數於統計上皆有顯著下降,而營養衛教+樟芝菌絲體組TG、Ferritin與SteatoTest脂肪肝指數 於統計上也有顯著下降。由此可知,非酒精性脂肪變性肝炎(NASH)患者經過營養師營養諮詢衛教與飲食修正後,受試者減少熱量、脂肪和精緻糖類的攝取後,可改善肝指數GOT、GPT以及ActiTeste肝臟發炎指數異常,而服用樟芝菌絲體更有助於減少TG 、Ferritin和SteatoTest脂肪肝指數。

並列摘要


More and more people in Taiwan suffering from liver disease in recent years. Liver disease include two part of it, alcoholic fatty liver disease (AFLD) and nonalcoholic fatty liver disease (NAFLD) could further developing into liver fibrosis , or Nonalcoholic Steatohepatitis (NASH). This study was conducted to investigate the effect of nutrition education association with NASH patients’ nutrition diagnosis, diet, and biochemical examination. We aimed to clarify nutrition diagnosis among Taichung individuals with Nonalcoholic Steatohepatitis , and identify differences in dietary problem through NCP of IDNT. Methods:Nutritional diagnosis were conducted and analyzed in 37 patients with Nonalcoholic Steatohepatitis (NASH), aged 20–80 years from outpatient clinics in Taichung hospitals by using the NCP of IDNT. Collect NASH patients’ nutrition diagnosis(one patients at least four nutrition diagnosis), blood biochemical, stage of fatty liver degree. After giving 37 patients of NASH nutrition education ,randomized controlled trial into two group, nutrition education + intake Antrodia cinnamomun mycelia group and nutrition education+ Placebo group , follow up data After 3 months and 6 months . 3 months later,31 patients back to the outpatient clinics, nutrition education + intake Antrodia cinnamomun mycelia group 17 patients and nutrition education+ Placebo group 14 patients,analyzed their diet, and biochemical examination and using the NCP of IDNT collect NASH patients’ nutrition diagnosis(one patient at least four nutrition diagnosis). Overweight/obesity(24.3%)、Excessivefat intake(23%)、Excessive energy intake(13.5%)、Less than optimal intake of types of carbohydrate(13.5%)、Physical inactivity(10.1%) are the most common nutrition diagnosis and dietary problem in newly diagnosed 37 NASH patients in Taichung hospital.Nutrition diagnosis has three general domains, include of Intake 62.2%、Clinical 27.7%. Behavioral 10.1%, intake problem is most part of all. Dietitians give newly diagnosed 37 NASH patients diet education, and after three months later, 31 NASH patients back to outpatient clinics , collect their nutrition diagnosis: Overweight /obesity(24.2%)、Excessive fat intake(24.2%)、Physical inactivity(17.7%)、Altered nutrition-related laboratory values(15.3)、Less than optimal intake of types of carbohydrate(6.5%). Then, three general domains in 31 NASH patients in three months later are Intake 62.2%,Clinical 27.7% ,Behavioral 10.1% and No Nutrition Diagnosis At This Time 4.84%. And after 3 months 31 NASH patients in two groups(nutrition education + intake Antrodia cinnamomun mycelia group 17 patients and nutrition education+ Placebo group 14 patients), the average calories intake, the average grams of protein intake, the average grams of fat intake, the average grams of carbohydrate intake, the average grams of refined carbohydrate intake and average GOT, average GPT , the average TG and the average Ferritin are significantly decrease after interventions,protein percentage of total calorie intake significantly increase after interventions on nutrition education + intake Antrodia cinnamomun mycelia group ; Beyond that ,average calories, the average grams of protein intake, the average grams of fat intake and average GOT, average GPT, significantly decrease after interventions on nutrition education+ Placebo group. In 6 months later , 23 NASH patients back to out patient clinic , 23 NASH patients in two groups (nutrition education + intake Antrodia cinnamomun mycelia group 12 patients and nutrition education+ Placebo group 11 patients) , average ActiTest and SteatoTest , significantly decrease after interventions on nutrition education + intake Antrodia cinnamomun mycelia group ; Beyond that ,average ActiTest significantly decrease after interventions on nutrition education+ Placebo group. In conclusion , obesity/overweight, excessive calorie intake , excessive carbohydrate intake、excessive fat intake、Physical inactivity may associate with NASH. Moreover,after giving nutrition education 3 months later :Excessive carbohydrate intake、Less than optimal intake of types of fats、Excessive mineral intake problem are Improved in NASH patients. But Overweight/obesity and Excessive fat intake problem are still most of proportion ,so dietitians can give NASH patients low-fat diet education ,how to control food exchange and follow body weight in outpatient clinics regularly . And follow up 2 groups of NASH patients(nutrition education + intake Antrodia cinnamomun mycelia group 17 patients and nutrition education+ Placebo group 14 patients) after nutrition education in 3 months ,both of two groups know how to control diet and have less calories intake ,fat intake and refined sugar intake , so average calories, average grams of protein and average grams of fat intake are significant decrease in two group .and then the average grams of refined carbohydrate also intake decrease in two group , but significant decrease in nutrition education +intake Antrodia cinnamomun mycelia group . Liver blood biochemical data GOT, GPT and ActiTest significant decrease after intervention in two group , and TG , ferritin and SteatoTest significant decrease after intervention in nutrition education+ intake Antrodia cinnamomun mycelia group.The results show NASH patients’ GOT , GPT and ActiTest data improved after nutrition education and food Adjustment ,and continuous taking Antrodia cinnamomun mycelia significant decrease TG , ferritin and SteatoTest.

參考文獻


(7) 黃鈞源、黃麗卿、楊俊等。台北市65 歲以上老人非酒精性脂肪肝相關因素探討∼某一地區醫院老人健檢資料分析。台灣老年醫學暨老年學雜誌 2010;5(1):62-75。
(4) 譚健民。台灣醫界雜誌第51卷,2008第7期。
(5) 楊逸菊、謝蕙宜、陳振寬、林敏雄等。台灣成年人非酒精性脂肪肝相關因子之分析。中華家醫誌 2000; 10: 59-66。
(10) 陳進初、林文鑫、陳清農、許勝傑、黃仕政、陳炎鍊等。台灣特有真菌-樟芝菌絲體之開發,2001。
(3) 李咏馨。非酒精性脂肪甘疾病診斷與處置,台北市醫生工會會刊2013,第57卷第1期。

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