不同減重程度對非糖尿病肥胖者代謝症候群的影響

Effects of Different Degrees of Weight Loss on Metabolic Syndrome in Obese Non-Diabetics

10.7023/TJFM.200512.0220

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

weight loss ； non-diabetic ； obese ； metabolic syndrome

台灣家庭醫學雜誌

15卷4期（2005 / 12 / 01）

220 - 231

繁體中文

肥胖是代謝症候群的主要原因，而減重及運動被建議為第一線之治療。為了探討肥胖者於減重前後代謝症候群的變化及減重比例程度不同對代謝症候群相關因子的影響，本研究收集南部某醫學中心體重管理特別門診自2001年12月至2004年5月間以orlistat輔助治療並完整追蹤至28週之非糖尿病肥胖個案共63位為研究對象。全部個案減重前平均身體質量指數為32.7±5.0(kg/平方公尺)，於28週時平均減重9.8±5.7公斤(11.l±5.3%)，各項代謝症候群因子如腰圍、收縮壓與舒張壓、空腹血糖、三酸甘油酯值及高密度脂蛋白膽固醇均達統計學上有意義的改善。減重後有代謝症候群者由全部個案的54%顯著降至37%。依據減重程度不同分為兩組比較發現體重減輕達初始體重10%以上組（34人）比未達10%組（29人）在身體質量指數、腰圍、總贍固醇值及三酸甘油酯值的改善差異程度顯著較高。進一步分析發現減重前有代謝症候群者比無代謝症候群者，在減重前有較高的身體質量指數、代謝症候群因子數及較低的高密度脂蛋白膽固醇值；另外也發現不論有或無代謝症候群兩組減重後身體質量指數及各項代謝症候群因子的平均改善百分比並無明顯差別，但有代謝症候群者的高密度脂蛋白膽固醇值平均改善較佳。對於非糖尿病肥胖者而言，以orlistat輔助六個月以上之完整減重計畫可以達到預期的減重成效。肥胖者不論有無合併代謝症候群，減輕體重後均可以改善代謝症候群之比例，當減輕的體重達到10%以上時，代謝症候群的改善程度將更為顯著。

Obesity appears to be the central component of the metabolic syndrome (MetS). The weight loss, along with increasing physical activity, is recommended as the first-line treatment for metabolic syndrome. To assess the influences of different degrees of weight loss on MetS in obese non-diabetics, subjects who had completed the 28-week of comprehensive dieting program with orlistat 120mg thrice daily in the weight management clinic of a tertiary medical center in southern Taiwan were collated from Dec. 2001 to May 2004. A total of 63 obese non-diabetics (36 female, 27 male) with initial mean body mass index 32.7±5.0 kg/m^2 were included. On 28-week follow-up examination, a moderate weight loss (9.8 kg, 11.1%) and significant improvement of main factors of MetS, such as waist circumference, systolic/diastolic blood pressure, fasting plasma glucose, triglyceride and high density lipoprotein (HDL) cholesterol, were noted. The prevalence of MetS was also reduced from 54% to 37%. According to the degree of weight loss, subjects were dichotomized into less than 10% (29 cases) and≧10% (34 cases) groups. Concerned about the effects of different degree of weight loss, the≧10% group showed a better improvement than ＜ 10% group in terms of the body mass index, waist circumference, total cholesterol and triglyceride level. Furthermore, the subjects with MetS (n=34) had higher initial BMI and metabolic parameters, but lower HDL cholesterol than those without MetS (n=29). However, after 28-week of diet and orlistat intervention, the changes of body weight and metabolic parameters were similar in both groups with or without MetS, except that the better improvement of HDL cholesterol was noted in the group with MetS than that without MetS. In conclusion, for the obese non-diabetics, the 28-week of comprehensive dieting program with orlistat 120mg thrice daily could bring about an acceptable weight reduction effect and improvement of MetS. A modest weight reduction of more than 10% body weight was associated with greater improvement of MetS. The effects of weight loss on the improvement of metabolic parameters were not significantly different between the subjects with or without MetS.

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