- 學位論文
代謝症候群病人之肌少風險因子與營養相關性之探討
Relationship between risk factors of sarcopenia and nutritional status in patients with metabolic syndrome
摘要
臺灣代謝症候群盛行率逐年增加，肌少症之盛行率亦隨著臺灣高齡化社會的發展有增加之趨勢。本研究目的為探討代謝症候群之肌少風險因子與營養狀態之相關性。本橫斷面研究招募20歲以上之代謝症候群病人，並收集基本資料；透過雙能量X光吸收儀測量體組成；以握力、背筋力計、啞鈴彎舉次數、坐姿起立、步行速率以及簡易身體功能量表評估肌肉功能；營養狀態以迷你營養評估量表（mini nutritional assessment, MNA）評估，以24小時飲食回憶法瞭解其飲食營養素攝取情形。本研究共招募90名代謝症候群之研究對象，其中50名有肌少症風險。結果發現有肌少症風險者之熱量及維生素B1攝取顯著低於無肌少症風險組（p < 0.05），七成以上有肌少症風險之研究對象鉀、鈣、鎂、鋅、菸鹼酸、維生素B6及葉酸之攝取未達國人膳食營養素參考攝取量，且其MNA總分顯著低於無肌少症風險者（p < 0.05）。進一步以MNA總分（小於26.5分為營養不良風險）進行次分組分析，發現於MNA量表與飲食攝取相關題目，有肌少症風險且有營養不良風險者在蛋白質攝取不足（p = 0.07）、每天攝取不足兩份蔬果（p < 0.01）、每天飲用少於5杯流質（p = 0.03）及自覺營養不良（p < 0.01）之比例有顯著較高於無營養不良者。相關性結果顯示，MNA量表總分與5次坐姿起立秒數、6公尺步行速率、6分鐘步行速率及簡易身體功能量表呈顯著之相關性（p ≤ 0.01）。以邏輯式迴歸分析發現，營養不良風險與低四肢肌肉質量、5次坐姿起立秒數、6分鐘步行速率及肌少症風險呈顯著之正相關，且經調整干擾因子後此顯著性依然存在（p < 0.05）。由前述結果得知，代謝症候群者之飲食營養素攝取有未達建議攝取量之情形，且營養不良與肌肉功能表現不佳有關，故我們建議代謝症候群應監測其營養狀態，以避免暴露於肌少症風險。
並列摘要
The prevalence of metabolic syndrome (MS) in Taiwan is increasing annually. Due to the aging society, the prevalence of sarcopenia also tends to increase in Taiwan. The purpose of the present study was to investigate the relationship between risk factors of sarcopenia and nutritional status in subjects with MS. This cross-sectional study recruited people aged over 20 with MS and collected the characteristics data. The body composition was measured by dual-energy X-ray absorptiometry, and the muscle function was assessed by grip strength, back-leg strength dynamometer, dumbbell curl, chair stand test, gait speed test, and short physical performance battery (SPPB). The nutritional status was assessed by Mini Nutritional Assessment (MNA) questionnaire. The 24-hour diet recall was used to investigate the dietary food and nutrients intake of the subjects. A total number of 90 subjects with MS were included, and 50 subjects were at risk of sarcopenia. The results showed that subjects at risk of sarcopenia had significantly lower calories and vitamin B1 intake (p < 0.01), and over 70% of the subjects at risk of sarcopenia had a lower intake of potassium, calcium, magnesium, zinc, niacin, vitamin B6 and folate, which did not reach the dietary reference intakes. Furthermore, we used the MNA score (< 26.5 points as at risk of malnutrition) for subgroup analysis. We found that subjects at risk of sarcopenia and malnutrition had a higher proportion for consumed less than two servings of protein food daily or weekly (p = 0.07), consumed less than two servings of fruits and vegetables per day (p < 0.01), consumed less than 5 cups of fluid per day (p = 0.03), and self-views as being malnourished (p < 0.01) than those without malnutrition subjects. In addition, the MNA score was significantly correlated with the chair stand test, 6-meter or 6-mins gait speed, and SPPB (p ≤ 0.01). Subjects at risk of malnutrition may have an increased risk of low appendicular skeletal muscle mass index, lower muscle function (chair stand test, 6-meter or 6-mins gait speed), and the risk of sarcopenia (p < 0.05); the statistical significance still existed after adjusting for confounding factors. Subjects with MS may suffer from malnutrition, which is related to poor muscle performance. Thus, we suggest that subjects with MS should monitor their nutritional status to prevent the risk of developing sarcopenia.