林瑞雄臺灣大學：預防醫學研究所張皓翔Chang, Hao-HsiangHao-HsiangChang2007-11-282018-06-292007-11-282018-06-292004http://ntur.lib.ntu.edu.tw//handle/246246/59200研究背景 代謝症候群各組成之間關係複雜，相互影響程度未明，尚待釐清。 研究目的 本研究目的在探討代謝症候群各組成間，如何相互影響，進而發展成為代謝症候群的路徑分析。 研究方法： 以456位30歲以上民眾自主參加龍崎鄉，台灣南部鄉村地區，社區整合型疾病篩檢者為對象，進行橫斷面研究，以整合型疾病篩檢為平台，蒐集代謝症候群、身體組成資料與肥胖指標。以結構方程模式來分析並檢定各種可能路徑，找出最符合的致病機制。 研究結果 (1)參與篩檢者中，整體的代謝症候群盛行率為31.8%，男性、女性分別為19.6%、41.4%。 (2)以生物電阻法分析所得之身體組成指標如身體脂肪比，無法比身體質量指數更準確預測代謝症候群。 (3)以因素分析將代謝症候群相關的9個變項，簡化成4個組成，包括肥胖、血脂肪、血壓與胰島素阻抗等組成。 (4)代謝症候群有兩個主要路徑，其一，以肥胖為開始，進而造成胰島素阻抗與不良血脂肪成份這兩個代謝症候群的主成分，其二，透過血壓昇高的路徑。此外，相關有趣的是肥胖本身對代謝症候群的直接影響薄弱，肥胖對血壓的直接影響也不顯著。 結論 肥胖與身體組成是代謝症候群的先驅變化，胰島素阻抗與不良血脂肪成份是介於其中間的機轉，而血壓昇高對代謝症候群則是另一獨立的路徑。Background: The interrelationships of individual components of metabolic syndrome are intricate and hard to disentangle. Objectives: The aim of this study was therefore to develop the pathway of MS underlying its components. Methods: There were total of 456 volunteer participants aged 30 years or older attending a community-based integrated screening in Long-Chi, a remote township of southern Taiwan. A cross-sectional study nested within the screening program was conducted to ascertain metabolic syndrome and to measure indicators of body composition, anthropometric indicators. A structural equation model was adopted to test a series of the proposed pathways to identify the most appropriate ones. Results (1) The overall prevalence rate of MS was 31.8% with 41.4% and 19.6% in females and males, respectively. (2) Indictors for body composition in predicting MS was not superior to those using anthropometric measures such as BMI. (3) Nine variables were reduced to four components, including “obesity”, “blood lipids”, “blood pressure”, and “insulin resistance”. (4) There are two major pathways leading to MS. One starts from obesity, which, in turn, increases the risk of developing insulin resistance and also dyslipidemia, two major factors responsible for the risk of MS. The other pathway is through the elevation of blood pressure. It is very interesting to find there was a weak direct effect of obesity on MS. The impact of obesity on blood pressure is also not substantial. Conclusions: Obesity and body composition are the precursor of MS and insulin resistance or dysplipidemia are two transient states in association with MS. Elevation of blood pressure is another independent pathway to MS.Contents ……………………………………2 Table list ……………………………………3 Abstract ……………………………………5 中文摘要 ……………………………………7 CHAPTER 1 INTRODUCTION ………………………………9 CHAPTER 2 LITERATURE REVIEW 2.1 Body composition analysis and body fat easurement …13 2.2 Bioelectrical impedance analysis, principles and validation …17 2.3 Metabolic Syndrome …………18 2.4 Body fat, BMI and metabolic syndrome …………20 2.5 Structure of metabolic syndrome …………22 CHAPTER 3 MATERIALS AND METHODS 3.1 Target population and study sample …………24 3.2 Study design and data collection 3.2.1 Anthropometric measures …………24 3.2.2 Body composition …………25 3.2.3 Biochemical markers …………26 3.2.4 Life style factors ………26 3.3 Definition of metabolic syndrome (MS) …………27 3.4 Statistic analysis …………30 CHAPTER 4 RESULT 4.1 Descriptive results …………33 4.2 Comparison of anthropometric measures and body composition …………34 4.3 Variables reduction with factor analysis …………35 4.4 Pathway of metabolic syndrome …………36 CHAPTER 5 DISCUSSION …………38 REFERENCE …………44 APPENDIX …………46570931 bytesapplication/pdfen-US結構方程模式代謝症候群metabolic syndromestructure eqaution model[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/59200/1/ntu-93-R91846014-1.pdf