- 學位論文
肌少症病人之營養狀態與肌少相關因子之探討
Investigation of nutritional status and sarcopenia-related factors in patients with sarcopenia
摘要
隨著老化社會進展，肌少症之盛行率漸增，肌少症者之營養狀態逐漸備受重視。本研究目的為探討肌少症者營養狀態與肌肉功能指標之相關性。藉由橫斷面之研究設計，於中山醫學大學附設醫院家庭醫學科門診招募年齡介於40－85歲肌少症及無肌少症者，且收集研究對象之基本資料及體位測量；並以雙能量X光吸收儀測定體組成；以握力、啞鈴彎舉次數、背筋力、坐姿起立表現、步行速率及簡短身體功能量表評估其肌力功能；以24小時飲食回憶法及迷你營養評估（mini nutritional assessment, MNA）量表了解其飲食營養狀態；採集血液樣本量測血液生化值及抗氧化營養素（維生素A、-胡蘿蔔素及維生素E）濃度。結果發現，本研究共招募99位研究對象，分別為46名肌少症者及53名無肌少症者，有營養不良風險之肌少症者相較於正常營養狀態之肌少症者具有顯著較多MNA題目異常之人數比例（p < 0.05），包含過去三個月內有減少食量（41.4%）、體重下降1公斤以上（51.7%）、身體質量指數< 19公斤/公尺2（41.4%）、每天進食少於兩份水果或蔬菜（55.2%）及飲用少於5杯流質（86.2%）；在飲食評估則有顯著較低之水果類攝取份數、熱量及支鏈胺基酸之攝取（p < 0.05）；在微量營養素方面則有八成以上研究對象於鐵、鈣、鎂、鋅及葉酸有攝取量不足之情形。然而各組間血漿維生素A、β-胡蘿蔔素及維生素E之抗氧化營養素濃度無顯著差異。於相關性分析結果發現，研究對象之MNA量表總分與肌肉質量、小腿圍、啞鈴彎舉次數、坐姿起立次數、步行速率及簡易身體功能量表呈顯著正相關（p < 0.01）；利用邏輯式回歸分析則發現，經年齡及性別變項調整後，有營養不良風險者會顯著增加肌少症及其組成因子異常之風險（p < 0.05），而隨著肌少症嚴重程度越高，MNA量表總分則有顯著下降之情形（ = -2.41，p < 0.01）。由以上數據得知，長者容易處於營養不良狀態，且營養不良與肌少症相關指標異常有關，故我們建議高齡長者需密切監控其營養狀態，以降低其暴露肌少症之風險。
並列摘要
Taiwan is an aging society with an increased prevalence of sarcopenia. The aim of the present study was to investigate the relationship of nutritional status and muscle function in patients with sarcopenia. This study was designed as a cross-sectional study and recruited people aged 40-85 with sarcopenia or non-sarcopenia in department of Family and Community Medicine of Chung Shan Medical University Hospital. Patients with sarcopenia were assigned to the case group, without sarcopenia were in the control group. We collected the characteristics and anthropometric data and performed dual-energy X-ray absorptiometry to measure the body composition of the participants. The muscle function was assessed by grip strength, dumbbell curl, back-leg strength, chair stand test, gait speed test, and short physical performance battery (SPPB). Nutritional status was determined by a 24-hour diet recall and mini nutritional assessment (MNA) scale. The blood sample was collected to measure the levels of hematological data and antioxidant nutrients (vitamin A, β-carotene and vitamin E). A total number of 99 older adults, 46 sarcopenic patients and 53 nonsarcopenic patients, were recruited in the study. The results show that sarcopenic patients with the risk of malnutrition who had a significantly higher proportion of the MNA measurements (p < 0.05), such as food intake declined over the past three months (41.4%), weight loss greater than 1kg during the last three months (51.7%), body mass index <19 kg/m2 (41.4%), consumed less than two servings of fruit or vegetables per day (55.2%), consumed less than five cups of fluid per day (86.2%), had a significantly lower intakes of fruit servings, total calories, branched-chain amino acids (p < 0.05) in the dietary record; and over 80% of participants had lower intake of iron, calcium, magnesium, zinc, and folate than those with normal nutritional status. However, there was no significant difference in the concentration of plasma vitamin A, β-carotene and vitamin E among the groups. In addition, the MNA score was significantly positively correlated with muscle mass, calf circumference, dumbbell curl times, 30s chair stand times, gait speed, and SPPB scores (p < 0.01). After adjusting for age and gender, participants with malnutrition may increase the risk of sarcopenia and its components (p < 0.05); and the MNA score was associated with the progress of sarcopenia ( = -2.41, p < 0.01). As a result, aging people may suffer from malnutrition and it was associated with the risk of sarcopenia. Thus, we suggested that the elderly should monitor their nutritional status frequently to prevent the development of sarcopenia.