營養教育介入對運動減重學童身體組成及營養代謝指標之影響

Abstract

兒童期體重過重，是導致成年後肥胖重要因素。本研究之目的，乃探討運動減重學童，經營養教育介入後，對身體組成、飲食攝取、健康體適能及血、尿液營養代謝指標之改變是否有加乘之效果。經徵得學童家長與學校同意後，受試者為自願參與運動減重之四、五年級體重過重之男、女學童（男童37位，身體質量指數≧20.3公斤/公尺2，年齡10.1±0.7歲；女童27位，身體質量指數≧20.1公斤/公尺2，年齡10.1±0.6歲）。依體脂肪百分比與性別對稱平衡分為四組：無營養教育介入之運動減重男童17位、無營養教育介入之運動減重女童13位；有營養教育介入之運動減重男童20位、有營養教育介入之運動減重女童14位。另招募控制組男童18位（身體質量指數≧20.3公斤/公尺2，年齡10.1±0.8歲）、控制組女童14位（身體質量指數≧20.1公斤/公尺2，年齡9.9±0.7歲），不進行運動減重、營養教育、採血、取尿等之涉入，僅於研究前、後均測量身體組成、「飲食行為與運動習慣問卷」調查、健康體適能（坐姿體前彎、1分鐘仰臥起坐、立定跳遠、800公尺跑走）測量。參與12週「運動減重課程」之國小學童（共64人），每人每週均施行三次，每次各40分鐘之運動訓練課程。運動減重組中僅34人（四年級14人，五年級20人）進行「營養教育介入課程」，每人每週均施行二次，每次各40分鐘，為期12週。營養教育及運動訓練介入前、後均進行身體組成測量、「飲食行為與運動習慣問卷」調查、健康體適能測量，空腹血脂肪、空腹血糖與血漿胺基酸濃度，以及尿液羥基脯胺酸、三甲基組胺酸、肌酸酐濃度、尿液酸鹼值測量。 研究結果發現，有營養教育介入之運動減重男童其身體質量指數、三頭肌皮脂厚度、體脂重、體脂重百分比顯著下降 (p< 0.05)，身高、除脂體重百分比、肌肉重百分比顯著增加 (p < 0.05)；就介入前、後之改變量而言，有營養教育介入之運動減重男童較控制男童其三頭肌皮脂厚度、體脂重、體脂重百分比之減少量顯著為多，體重之增加量顯著為少 (p < 0.05)，而除脂體重百分比、肌肉重百分比之增加量則較控制男童顯著為多 (p < 0.05)。研究介入前、後，有營養教育介入之運動減重女童其身高、體重、除脂體重、骨重、身體總水重、肌肉重顯著增加 (p < 0.001)。就介入前、後之改變量而言，無營養教育介入之運動減重女童其身高增加量較控制女童顯著為少 (p < 0.05)，而腰臀比之增加量則較控制女童顯著為多 (p < 0.05)，其餘身體組成各項改變量，同性別之各組間則無顯著差異。 運動減重12週後，無營養教育介入之運動減重男童其蛋豆魚肉類、蔬菜類每日攝取代換數與蛋白質密度攝取量顯著下降 (p < 0.05)，但同性別之各組間其飲食攝取各項改變量則均無顯著差異。無營養教育介入之運動減重男童其每週零食之攝取頻率顯著下降 (p < 0.05)，控制女童其每週含糖飲料之攝取頻率顯著增加 (p < 0.05)，但同性別之各組間其每週零食、宵夜、含糖飲料、低油食品、高油食品之攝取頻率，以及每週零食、宵夜與含糖飲料攝取之總頻率其前、後測之改變量均未達顯著差異。 研究介入前、後，有營養教育介入之運動減重男童其每次運動時間顯著下降 (p< 0.05)，而控制女童其每週運動時間顯著下降 (p < 0.05)。同性別之各組間其每週運動頻率、每次運動時間、每週運動時間改變量均未達顯著差異。除有營養教育介入之運動減重女童外，其餘各組其立定跳遠距離均顯著增加 (p < 0.05)。然而，每組之坐姿體前彎長度、1分鐘仰臥起坐次數、800公尺跑走秒數則無顯著改變。同性別之各組間其健康體適能各項改變量均未達顯著差異。 研究前、後，有營養教育介入之運動減重男童其空腹三酸甘油酯濃度顯著下降 (p < 0.05)，空腹血糖濃度顯著上升 (p < 0.05)；有營養教育介入之運動減重女童其空腹總膽固醇濃度顯著上升 (p < 0.05)；有營養教育介入之運動減重男童較無營養教育介入之運動減重男童其空腹三酸甘油酯濃度之降低量顯著為多 (p < 0.05)，而二組運動減重女童其空腹血脂肪及空腹血糖濃度各項改變量則未達顯著差異。運動減重各組其空腹血漿胺基酸總濃度無顯著差異；同性別之運動減重各組間其空腹血漿胺基酸濃度各項改變量皆未達顯著差異。研究前、後，有營養教育介入之運動減重男童其尿液三甲基組胺酸濃度顯著上升 (p < 0.0001)，其餘運動減重各組各項尿液分析均未達顯著改變；同性別之運動減重各組間其尿液羥基脯胺酸與三甲基組胺酸濃度、尿液酸鹼值改變量均未達顯著差異。 本研究之減重設計並未影響發育中學童身體之恆定狀態。根據前述，本研究認為營養教育配合運動訓練對男童身體組成與血中三酸甘油酯濃度確有顯著改善效果，但對飲食攝取與健康體適能之改善則不明顯。而營養教育配合運動訓練對女童其身體組成與血脂濃度則未有改善效果，原因可能是與女童正值青春期發育有關，或許是受到女性荷爾蒙之影響，而干擾其效應。The purpose of this study was to investigate the effect of nutrition education intervention on the body composition, dietary behavior and health-related physical fitness, as well as the fasting plasma and urinary biomarkers of exercising school children. Ninety-six school children (boys, N=55, BMI≧20.3kg/m2 [grade 4, n=24; grade 5, n=31]; girls, N=41, BMI ≧20.1kg/m2 [grade 4, n=15; grade 5, n=26]) voluntarily participated in exercise and nutrition education intervention study for 12 weeks. Based on body fat percentage and gender difference, school children were divided into six groups: school boys without nutrition education and exercise intervention (NNNM, n=18, 10.1±0.8 years; control boys), school girls without nutrition education and exercise intervention (NNNF, n=14, 9.9±0.7 years; control girls), exercising school boys without nutrition education intervention (NNEM, n=17, 10.2±0.7 years), exercising school girls without nutrition education intervention (NNEF, n=13, 10.2±0.6 years), exercising school boys with nutrition education intervention (YNEM, n=20, 10.0±0.8 years), and exercising school girls with nutrition education intervention (YNEF, n=14, 10.1±0.6 years). The prescribed 12-week exercise program was: 3 exercise sessions/week, and 40 min/session. The prescribed 12-week nutrition education program was: 2 courses/week, and 40 min/course. Before and after intervention, data of body composition, dietary and exercise habits questionnaire, health-related physical fitness (sit-and-reach, 1min curl-ups, standing long jump, and 800m run/walk), and fasting plasma and urinary biomarkers were assessed for all subjects except the NNNM and NNNF groups whose plasma and urinary samples were not collected. Plasma samples were analyzed for the concentrations of glutamine, alanine, valine, leucine, isoleucine, f-tryptophan, total cholesterol, triacylglycerols, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, and glucose. Urinary samples were analyzed for the concentrations of hydroxyproline, 3-methylhistidine, and creatinine, as well as the pH value. After intervention, the body mass index, triceps skinfold thickness, body fat, and body fat percentage decreased significantly (p< 0.05) in YNEM group, but height, fat free mass, and muscle mass percentage increased significantly (p < 0.05). As compared with NNNM group, the decreases in triceps skinfold thickness, body fat, and body fat percentage of YNEM group reached the significant levels. The increases in the weight of YNEM group were significantly smaller (p < 0.05) than those of NNNM group, but the increases in the fat free mass percentage and muscle mass percentage were significantly larger (p < 0.05) than those ofNNNM group. The height, body weight, fat free mass, bone mass, total body water, and muscle mass increased significantly (p< 0.001) in YNEF group. The increase in height of NNEF group was significantly smaller (p < 0.05) than that of NNNF group, but the increase in the waist to hip ratio was significantly larger (p < 0.05) than that of NNNF group. After intervention, egg, bean, fish, and meat consumption, vegetable consumption, and protein density consumed of NNEM group decreased significantly (p < 0.05); the frequency of snack consumption of NNEM group decreased significantly (p < 0.05); the frequency of soft drink consumption of NNNF group increased significantly (p< 0.05). After study, the exercise time (min/session) of YNEM group decreased significantly (p < 0.05), the exercise duration (hr/week) of NNNF group decreased significantly (p < 0.05). The standing long jump distance of all groups increased significantly (p < 0.05) except YNEF group. After intervention, the fasting plasma triacylglycerols of YNEM group decreased significantly (p < 0.05), and the fasting plasma cholesterol of YNEF group increased significantly (p < 0.05). The decrease in thefasting plasma triacylglycerols of YNEM group was significantly larger (p< 0.05) than that of NNEM group. In general, there was no significant difference in the fasting plasma amino acid concentrations of all the exercise groups before and after intervention. However, the urinary 3-methylhistidine concentration of YNEM group increased significantly (p < 0.0001) after intervention. The homeostasis of the school children was not affected by the design of the study. Based on the aforementioned results, the combined effects of nutrition education and exercise training enhanced the body composition of school boys, along with the fasting plasma triacylglycerols; but, there was no influence on the dietary intake and health-related physical fitness of the group. The combined effects of nutrition education and exercise training, however, did not improve the body composition and fasting plasma lipid concentrations of the school girls. The possible mechanism could be due to the influence of estrogen in those school girls who are beginning their puberty.