苏州市老年人肌少症的相关因素
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摘要
目的研究苏州市老年人群肌少症相关指标的特征,探讨肌少症的保护因素及危险因素。方法选取苏州市3个地区符合条件的志愿者,采用横断面调查的方法,调查患者的一般资料、饮食及运动情况。应用DBA-210人体成分分析仪测定不同部位肌肉质量,用JAMAR握力计测定握力,采用4 m步行测试评估受试者的躯体功能,按照亚洲肌少症工作组诊断标准综合诊断肌少症。对肌少症的相关因素做Logistic回归分析,明确肌少症的危险因素及保护因素。结果肌少症检出率为28. 8%,其中男性为30. 4%,女性为27. 9%,性别间比较,差异无统计学意义(P> 0. 05)。同一年龄段肌少症组体质量指数(body mass index,BMI)、上肢肌肉量、下肢肌肉量、四肢骨骼肌量、骨骼肌质量指数(appendicular skeletal muscle index,ASMI)、握力、步速均低于非肌少症组,差异有统计学意义(P <0. 05)。肉类(χ2=17. 99,P <0. 01)、鱼类(χ2=8. 13,P<0. 05)、蛋类(χ2=13. 56,P<0. 01)、奶类(χ2=11. 95,P<0. 01)的摄取频率不同,肌少症发生率不等。每周进行有氧运动(χ2=16. 28,P<0. 01)、抗阻运动(χ2=15. 86,P<0. 01)的不同时长段的肌少症发生率比较,差异有统计学意义(P<0. 05)。Spearman相关分析显示年龄与肌少症呈正相关(r=0. 307),而BMI (r=-0. 253)、上臂围(r=-0. 192)、小腿围(r=-0. 280)与肌少症呈负相关,肉类(r=-0. 229)、鱼类(r=-0. 159)、蛋类(r=-0. 201)、奶类(r=-0. 193)摄入频率增加与肌少症呈负相关,有氧运动(r=-0. 226)、抗阻训练(r=-0. 221)时长与肌少症呈负相关(P均<0. 05)。Logistic回归分析结果显示,年龄是肌少症的危险因素,而BMI、膳食中进食肉类、蛋类、奶类是肌少症的保护因素。结论老年人是肌少症的高发人群,对其进行运动干预、营养指导有利于延缓进展、改善不良预后。老年人要保证能量和蛋白质的充足供应,保持适宜的体质量指数,同时在保证能量摄入充足情况下,可加大富含优质蛋白的动物性膳食的摄入。
Objective To study the characteristics of sarcopenia among the elderly population in Suzhou city,and to explore the protective factors and risk factors of sarcopenia. Methods We selected qualified volunteers from three communities in Suzhou,and investigated their general condition,diet,and exercise habit with cross-sectional survey.Body muscle mass was measured by bioelectrical impedance analyzer(BIA) with model DBA-210. Muscle strength was determined by JAMAR handgrip strength(HS) and physical function was evaluated by the subjects' 4 m gait speed(GS). The sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia(AWGS) Criteria. We analysed the related factors of sarcopenia with Logistic regression analysis. Results The prevalence of sarcopenia was28. 8%,30. 4% in men and 27. 9% in women,and there was no statistically significant difference between men and women(P>0. 05). The average body mass index(BMI),arm muscle mass,lower limb muscle mass,appendicular skeletal muscle(ASM),appendicular skeletal muscle index(ASMI),handgrip strength,and gait speed in sarcopenia group were lower than those in non-sarcopenia group with the same age(P < 0. 05). Different intake frequency of meat(χ2= 17. 99,P<0. 01),fish(χ2= 8. 13,P< 0. 05),eggs(χ2= 13. 56,P< 0. 01),and dairy products(χ2= 11. 95,P<0. 01) led to different prevalence of sarcopenia. Different duration of weekly aerobic exercise(χ2= 16. 28,P< 0. 01)and resistance exercise(χ2= 15. 86,P<0. 01) also led to different prevalence of sarcopenia(P<0. 05). According to the spearman correlation analysis of the sarcopenia and related factors,age(r = 0. 307) was positively correlated with sarcopenia,while BMI(r =-0. 253), upper arm circumference(r =-0. 192), crus surrounds(r =-0. 280) and sarcopenia were negatively correlated. Meat(r =-0. 229),fish(r =-0. 159),eggs(r =-0. 201),and dairy(r =-0. 193) intake frequency were negatively correlated with sarcopenia. Aerobic exercise(r =-0. 226) and resistance exercise(r =-0. 221) time were negatively correlated with sarcopenia(all P<0. 05). Logistic regression analysis showed that age was a risk factor for sarcopenia,while higher BMI,meat,eggs,and dairy products were protective factors. Conclusion The elderly are at high risk of sarcopenia. It will be helpful to delay the progress and improve the poor prognosis if we give exercise intervention and nutritional guidance in advance. The elderly should ensure the adequate supply of energy and protein and maintain appropriate BMI. Furthermore,under the condition of adequate energy intake,they can increase the amount of animal food rich in high quality of protein.
Objective To study the characteristics of sarcopenia among the elderly population in Suzhou city,and to explore the protective factors and risk factors of sarcopenia. Methods We selected qualified volunteers from three communities in Suzhou,and investigated their general condition,diet,and exercise habit with cross-sectional survey.Body muscle mass was measured by bioelectrical impedance analyzer(BIA) with model DBA-210. Muscle strength was determined by JAMAR handgrip strength(HS) and physical function was evaluated by the subjects' 4 m gait speed(GS). The sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia(AWGS) Criteria. We analysed the related factors of sarcopenia with Logistic regression analysis. Results The prevalence of sarcopenia was28. 8%,30. 4% in men and 27. 9% in women,and there was no statistically significant difference between men and women(P>0. 05). The average body mass index(BMI),arm muscle mass,lower limb muscle mass,appendicular skeletal muscle(ASM),appendicular skeletal muscle index(ASMI),handgrip strength,and gait speed in sarcopenia group were lower than those in non-sarcopenia group with the same age(P < 0. 05). Different intake frequency of meat(χ2= 17. 99,P<0. 01),fish(χ2= 8. 13,P< 0. 05),eggs(χ2= 13. 56,P< 0. 01),and dairy products(χ2= 11. 95,P<0. 01) led to different prevalence of sarcopenia. Different duration of weekly aerobic exercise(χ2= 16. 28,P< 0. 01)and resistance exercise(χ2= 15. 86,P<0. 01) also led to different prevalence of sarcopenia(P<0. 05). According to the spearman correlation analysis of the sarcopenia and related factors,age(r = 0. 307) was positively correlated with sarcopenia,while BMI(r =-0. 253), upper arm circumference(r =-0. 192), crus surrounds(r =-0. 280) and sarcopenia were negatively correlated. Meat(r =-0. 229),fish(r =-0. 159),eggs(r =-0. 201),and dairy(r =-0. 193) intake frequency were negatively correlated with sarcopenia. Aerobic exercise(r =-0. 226) and resistance exercise(r =-0. 221) time were negatively correlated with sarcopenia(all P<0. 05). Logistic regression analysis showed that age was a risk factor for sarcopenia,while higher BMI,meat,eggs,and dairy products were protective factors. Conclusion The elderly are at high risk of sarcopenia. It will be helpful to delay the progress and improve the poor prognosis if we give exercise intervention and nutritional guidance in advance. The elderly should ensure the adequate supply of energy and protein and maintain appropriate BMI. Furthermore,under the condition of adequate energy intake,they can increase the amount of animal food rich in high quality of protein.
引文
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[7] Beasley JM,Shikany JM,Thomson CA. The role of dietary protein intake in the prevention of sarcopenia of aging[J]. Nutr Clin Pract,2013,28:684-690.
[8] Tieland M, Brouwer-Brolsma EM, Nienaber-Rousseau C,et al. Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people[J]. Eur J Clin Nutr,2013,67:1050-1055.
[9] Rizzoli R,Stevenson JC,Bauer JM,et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women:a consen-sus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoar-thritis(ESCEO)[J]. Maturitas,2014,79:122-132.
[10] Harber MP, Konopka AR, Douglass MD, et al.Aerobic exercise training improves whole muscle and single myofiber size and function in older women E[J].Am J Physiol Regul Integr Comp Physiol,2009,297:1452-1459.
[11] Liu CJ,Latham NK. Progressive resistance strength training for improving physical function in older adults[J]. Cochrane Database Syst Rev,2009,8:CD002759.
[12] Visvanathan R,Chapman I. Preventing sarcopenia in older people[J]. Maturitas,2010,66:383-388.
[13] Brotto M,Abreu EL. Sarcopenia:pharmacology of today and tomorrow[J]. J Pharmacol Exp Ther,2012,343:540-546.
[14]李喜凤,赵柯湘,徐凌杰,等.住院老年患者骨骼肌减少与骨密度的关系[J].中华骨质疏松和骨矿盐疾病杂志,2015,8:21-26.
[15] Ishikawa S,Naito S,Iimori S,et al. Loop diuretics are associated with greater risk of sarcopenia in patients with non-dialysis-dependent chronic kidney disease[J]. PLoS One,2018,13:e0192990.
[16] Cruz-Jentoft AJ,Bahat G,Bauer J,et al. Sarcopenia:revised European consensus on definition and diagnosis[J]. Age Ageing,2019,48:16-31.
[17] Edmunds K,Gislason M,Sigurethsson S,et al. Advanced quantitative methods in correlating sarcopenic muscle degeneration with lower extremity function biometrics and comorbidities[J]. PLoS One, 2018,13:e0193241.
[18] Kim JS,Kim WY,Park HK,et al. Simple age specific cutoff value for sarcopenia evaluated by computed tomography[J]. Ann Nutr Metab,2017,71:157-163.
[2] Bortz WM. A conceptual framework of frailty:a review[J]. J Gerontol Med Sci,2002,57A:m283-m288.
[3] Avers D,Brown M. White paper:strength training for the older adult[J]. J Geriatr Physic Ther,2009,32:148-158.
[4] Chen LK,Liu LK,Woo J,et al. Sarcopenia in Asia:consensus report of the Asian working group for sarcopenia[J]. J Am Med Dir Assoc, 2014, 15:95-101.
[5] Coin A,Perissinotto E,Enzi G,et al. Predictors of low bone mineral density in the elderly:the role of dietary intake, nutritional status and sarcopenia[J].Eur J Clin Nutr,2008,62:802-809.
[6] Morley JE,Argiles JM,Evans WJ,et al. Nutritional recommendations for the management of sarcopenia[J]. J Am Med Dir Assoc,2010,11:391-396.
[7] Beasley JM,Shikany JM,Thomson CA. The role of dietary protein intake in the prevention of sarcopenia of aging[J]. Nutr Clin Pract,2013,28:684-690.
[8] Tieland M, Brouwer-Brolsma EM, Nienaber-Rousseau C,et al. Low vitamin D status is associated with reduced muscle mass and impaired physical performance in frail elderly people[J]. Eur J Clin Nutr,2013,67:1050-1055.
[9] Rizzoli R,Stevenson JC,Bauer JM,et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women:a consen-sus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoar-thritis(ESCEO)[J]. Maturitas,2014,79:122-132.
[10] Harber MP, Konopka AR, Douglass MD, et al.Aerobic exercise training improves whole muscle and single myofiber size and function in older women E[J].Am J Physiol Regul Integr Comp Physiol,2009,297:1452-1459.
[11] Liu CJ,Latham NK. Progressive resistance strength training for improving physical function in older adults[J]. Cochrane Database Syst Rev,2009,8:CD002759.
[12] Visvanathan R,Chapman I. Preventing sarcopenia in older people[J]. Maturitas,2010,66:383-388.
[13] Brotto M,Abreu EL. Sarcopenia:pharmacology of today and tomorrow[J]. J Pharmacol Exp Ther,2012,343:540-546.
[14]李喜凤,赵柯湘,徐凌杰,等.住院老年患者骨骼肌减少与骨密度的关系[J].中华骨质疏松和骨矿盐疾病杂志,2015,8:21-26.
[15] Ishikawa S,Naito S,Iimori S,et al. Loop diuretics are associated with greater risk of sarcopenia in patients with non-dialysis-dependent chronic kidney disease[J]. PLoS One,2018,13:e0192990.
[16] Cruz-Jentoft AJ,Bahat G,Bauer J,et al. Sarcopenia:revised European consensus on definition and diagnosis[J]. Age Ageing,2019,48:16-31.
[17] Edmunds K,Gislason M,Sigurethsson S,et al. Advanced quantitative methods in correlating sarcopenic muscle degeneration with lower extremity function biometrics and comorbidities[J]. PLoS One, 2018,13:e0193241.
[18] Kim JS,Kim WY,Park HK,et al. Simple age specific cutoff value for sarcopenia evaluated by computed tomography[J]. Ann Nutr Metab,2017,71:157-163.