高齡長者之營養因子與代謝症候群及肌少症之探討

老化過程之生理功能改變造成高齡長者減少營養素攝取並影響身體營養因子狀態，且相關之代謝異常問題及肌肉功能下降更不利於高齡長者健康老化。本研究目的為評估高齡長者營養因子狀態，並了解其與老化代謝及肌少指標之相關性。本橫斷面研究依照年齡層分為65-74歲之老化初期（初老組）及75歲以上之老化晚期（老老組）長者。收集研究對象之基本資料、飲食紀錄及體位測量，並透過老人營養風險指標（geriatric nutritional risk index, GNRI）評估營養狀態；使用雙能量X光吸收儀測量體組成，並評估肌力表現。採集空腹血液檢測血糖、血脂、白蛋白、氧化壓力指標、總抗氧化力及營養因子（輔酶Q10、β胡蘿蔔素及維生素A）濃度。結果顯示老老組之身體質量指數、上臂環圍、小腿圍、GNRI及熱量攝取量皆顯著低於中年組（p < 0.05）；且老老組之肌肉功能亦顯著低於中年組（p < 0.01），而體脂率則顯著較高（p < 0.01），具顯著最高之肌少症及肌少型肥胖人數比例（p < 0.01）。此外，老老組之輔酶Q10、維生素A濃度及總抗氧化力顯著低於中年組（p < 0.01），而紅血球丙二醛及蛋白質羰基濃度則顯著較高（p < 0.01）。另代謝症候群者相較於無代謝症候群具顯著較低之β胡蘿蔔素濃度（p < 0.01），而肌少症者相較於無肌少症具顯著較低之輔酶Q10濃度及老人營養風險指標（p < 0.01）。相關性結果發現，輔酶Q10、β胡蘿蔔素及維生素A濃度與總抗氧化力呈顯著正相關（p < 0.05）；進一步以邏輯式迴歸分析發現，經年齡、性別、疾病及生活習慣調整後，低輔酶Q10及低GNRI分數與肌少症及其組成因子異常之發生風險呈顯著正相關（p < 0.05），而低輔酶Q10及低β胡蘿蔔素濃度與代謝症候群及高血糖之發生風險呈顯著正相關（p < 0.05），同時營養因子與GNRI分數皆與代謝症候群及肌少症罹患風險呈顯著之正相關性（p < 0.01）。由以上結果得知，營養因子狀態與其代謝及肌少有關，建議高齡長者應定期監測與評估營養因子狀態，維持較佳營養因子狀態有助於代謝及肌肉功能。

關鍵字

營養因子；老人營養評估；代謝症候群；肌少症；高齡

並列摘要

Aging may change physiology and affect the nutrient intake and nutritional status of the elderly. Metabolic disorders and muscle dysfunction also commonly occur in the elderly. The purpose of the present study was to evaluate the nutrients status of the elderly and further investigate the correlation between nutrition and metabolic and sarcopenic parameters. This cross-sectional study was stratified the elderly participants into the 65-74 years (young-old group) and over 75 years (old-old group). The characteristics, dietary records, and anthropometric data were collected, and the nutritional status was assessed by the geriatric nutritional risk index (GNRI). The body composition was measured by dual-energy X-ray absorptiometry, and the muscle strength was evaluated. Fasting blood was collected to analyze the level of glucose, lipid profile, albumin, oxidative stress, total antioxidant capacity (TAC), and nutrients (coenzyme Q10, β-carotene, and vitamin A). The results showed that the old-old group had significantly lower levels of body mass index, mid-arm circumference, calf circumference, GNRI, and energy intake than the middle-aged group (p < 0.05). The old-old group had significantly poorer muscle function, but a higher level of body fat percentage than the middle-aged group (p < 0.01), thus the old-old group had the highest proportion of sarcopenia and sarcopenic obesity (p < 0.01). Moreover, the old-old group had significantly lower levels of coenzyme Q10, vitamin A, and TAC (p < 0.01), as well as higher levels of erythrocyte malondialdehyde and protein carbonyl than the middle-aged group (p < 0.01). Subjects with metabolic syndrome had a significantly lower level of β-carotene than those with the non-metabolic syndrome (p < 0.01), while subjects with sarcopenia had significantly lower levels of coenzyme Q10 and GNRI than those with non-sarcopenia (p < 0.01). The levels of coenzyme Q10, β-carotene, and vitamin A were significantly positively correlated with the level of TAC (p < 0.05). Furthermore, after adjusting the age, gender, disease, and lifestyle, low levels of coenzyme Q10 and GNRI were significantly positively associated with the risk of sarcopenia and its components (p < 0.05), while low levels of coenzyme Q10 and β-carotene were significantly positively associated with the risk of metabolic syndrome and hyperglycemia (p < 0.05). Subjects with poor nutrient status (coenzyme Q10, β-carotene and GNRI) were associated with the risk of metabolic syndrome and sarcopenia (p < 0.01). Since nutritional factors were related to the metabolic and sarcopenic parameters, regular monitoring of nutritional status is necessary, which may be helpful for metabolic and muscle function.

並列關鍵字

nutritional factors ； geriatric nutrition assessment ； metabolic syndrome ； sarcopenia ； aging

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