高龄男性肌少症患者的活动能力与下肢肌肉质量和肌力的相关性研究

目的 探讨高龄（＞85岁）男性肌少症患者的活动能力与其下肢肌肉质量和下肢肌力的相关性。方法 根据亚洲肌少症工作组（AWGS）纳入和排除标准,入选2014年6月至2015年2月于解放军总医院门诊部查体的87名高龄肌少症男性患者,年龄（89.5±4.4）岁,平均相对骨骼肌肉质量指数（RASMMI）为（6.04±0.62）kg/m2。分别对研究对象进行身体成分测试、握力测试、下肢肌力测试（分别测试髂腰肌、股四头肌、胫前肌及腘绳肌的最大等长肌力）,并研究上述指标与活动能力测试如步速（6min最大步行速度测试）、计时“起立?行走”时间测试（TUGT）、5次起坐时间测试（FTSST）和闭目单腿站立测试的相关性。结果 步速、TUGT、FTSST、闭目单腿站立时间主要与年龄（r＝?0.567,P＝0.018;r＝0.742,P＝0.001;r＝0.632,P＝0.007;r＝?0.489,P＝0.047）、下肢肌肉质量（r＝0.489,P＝0.045;r＝?0.579,P＝0.012;r＝?0.641,P＝0.003;r＝0.476,P＝0.048）和下肢脂肪含量（r＝?0.517,P＝0.032;r＝0.513,P＝0.031;r＝0.528,P＝0.015;r＝?0.533,P＝0.012）相关。步速、TUGT、FTSST、闭目单腿站立时间与髂腰肌肌力（r＝0.313,P＝0.000;r＝?0.887,P＝0.000;r＝?0.666,P＝0.003;r＝0.515,P＝0.035）和与股四头肌肌力（r＝0.251,P＝0.017;r＝?0.775,P＝0.000;r＝?0.612,P＝0.013;r＝0.671,P＝0.002）相关。结论 高龄肌少症老人的活动能力与身体成分及下肢肌力相关程度较高。脂肪含量高而下肢肌肉质量低的老年人活动能力相对差;下肢肌力高的老年人活动能力较好,尤其以股四头肌、髂腰肌肌力为代表。     

Sarcopenia and dysphagia: Position paper by four professional organizations

This report was written by the Japanese Society of Dysphagia Rehabilitation, the Japanese Association of Rehabilitation Nutrition, the Japanese Association on Sarcopenia and Frailty, and the Society of Swallowing and Dysphagia of Japan to consolidate the currently available evidence on the topics of sarcopenia and dysphagia. Histologically, the swallowing muscles are of different embryological origin from somatic muscles, and receive constant input stimulation from the respiratory center. Although the swallowing muscles are striated, their characteristics are different from those of skeletal muscles. The swallowing muscles are inevitably affected by malnutrition and disuse; accumulating evidence is available regarding the influence of malnutrition on the swallowing muscles. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles. When sarcopenia does not exist in the entire body, the term “sarcopenic dysphagia” should not be used. Additionally, sarcopenia due to neuromuscular diseases should be excluded; however, aging and secondary sarcopenia after inactivity, malnutrition and disease (wasting disorder and cachexia) are included in sarcopenic dysphagia. The treatment of dysphagia due to sarcopenia requires both dysphagia rehabilitation, such as resistance training of the swallowing muscles and nutritional intervention. However, the fundamental issue of how dysphagia caused by sarcopenia of the swallowing muscles should be diagnosed remains unresolved. Furthermore, whether dysphagia can be caused by primary sarcopenia should be clarified. Additionally, more discussion is required on issues such as the relationship between dysphagia and secondary sarcopenia, as well as the diagnostic criteria and means for diagnosing dysphagia caused by sarcopenia. Geriatr Gerontol Int 2019; 19: 91–97 .     

增龄相关的肌肉数量减少及功能下降相关研究进展

老年人多存在不同程度的肌肉数量减少和功能下降。增龄相关的肌肉数量减少和功能下降与患者的再住院率及总死亡率增加密切相关。本文将对增龄相关的肌肉数量减少和功能下降相关研究进行综述,重点阐述增龄过程中肌肉蛋白质合成和分解的测量、影响因素及分子调控机制。以期增进我们对老年人肌少症相关研究的了解,促进进一步研究的开展。     

日本吞咽障碍老人家庭营养管理的新进展介绍

根据我国老年人主要以居家养老为主的现实,针对因衰老引起的吞咽进食功能下降或因疾病(如脑卒中)引起的吞咽障碍问题,本文介绍了日本吞咽障碍老人家庭营养管理模式。建立以地区为单位,医院、社区、养老机构共同联动,多层次的居家养老服务网络。有效保证吞咽障碍老人居家照护的质量,形成和推广"预防为主"的居家养老新医疗保健观念。以期有效减少居家吞咽障碍老人疾病的发生,减少医疗费用开支并延长预期寿命。     

Association of dietary protein intake with skeletal muscle mass in older adults: A systematic review

Protein supplementation has been shown to be effective in attenuating the loss of lean body mass and muscle mass in older adults; however, its benefits as dietary protein remain unclear. This systematic review of observational studies aimed to investigate the association of dietary protein intake with skeletal muscle mass (SM). Observational studies that investigated the association of dietary protein intake with SM in older adults were retrieved from MEDLINE, Web of Science and Cochrane-CENTRAL databases. Of the 26 analyses in the 17 studies, 18 showed a significant positive association. In cohort studies, 55.6% (five of nine analyses) showed a significant positive association. Of these, four analyses were adjusted for well-known confounding factors, used energy-adjusted protein intake, and used the amount of change of SM between baseline and follow-up as the outcome, with two of them showing a significant positive association. Although 69.2% (18 of 26 analyses) of the 17 studies showed a significant positive association between dietary protein intake and SM in older adults, most studies were cross-sectional and had at least one important methodological limitation. Therefore, we could not draw any conclusions. Thus, well-designed cohort studies are needed in future to identify the association between dietary protein intake and SM in older adults. Geriatr Gerontol Int 2021; 21: 1077–1083 .     

Estimation of appendicular muscle mass and fat mass by near infrared spectroscopy in older persons

Aim: Near infrared spectroscopy has been reported to have a high reliability and accuracy in assessing the percentage of body fat. However, whether muscle mass can be accurately estimated using this method has not been established. This study examined whether a near infrared spectroscopy method could estimate appendicular muscle mass and fat mass, with dual‐energy X‐ray absorptiometry as the standard method for comparison. Methods: A total of 20 orthopedic inpatients (mean age 73.2 ± 6.8 years) were recruited for this study. Their body composition was assessed using near infrared spectroscopy and dual‐energy X‐ray absorptiometry. Appendicular muscle mass and fat mass were estimated from height, weight and optical densities. Results: The optical densities for the upper arm (biceps, triceps) and forearm (flexor carpi radialis) were significantly correlated with appendicular muscle mass (r = 0.534 to 0.623) or fat mass (r = ?0.483 to ?0.827). Estimated appendicular muscle mass and fat mass explained 89% and 80% of the variance in the dual‐energy X‐ray absorptiometry‐derived muscle mass and fat mass estimates using height, weight and optical density values of the proximal flexor carpi radialis. Conclusions: Near infrared spectroscopy is a useful method to assess not only fat mass, but also muscle mass in older adults. Geriatr Gerontol Int 2012; ??: ??–?? .     

The effects of bolus supplementation of branched-chain amino acids on skeletal muscle mass,strength, and function in patients with rheumatic disorders during glucocorticoid treatment

Objectives: To test the effects of bolus supplementation of branched-chain amino acids (BCAA) on skeletal muscle mass, strength, and function in patients with rheumatic disorders taking glucocorticoid (GC).

Methods: Patients with rheumatic disorders treated with prednisolone (≥10?mg/day) were randomized to ingest additional daily 12?g of BCAA (n?=?9) or not (n?=?9) for 12 weeks. At baseline, and 4, 8, and 12 weeks, they underwent bioelectrical impedance analysis, muscle strength and functional tests, and computed tomography analysis for cross-sectional area of mid-thigh muscle.

Results: Disease activities of the patients were well controlled and daily GC dose was similarly reduced in both groups. Limb muscle mass was recovered in both groups. Whole-body muscle mass and muscle strength and functional mobility were increased only in BCAA (+) group. The effects of BCAA supplementation on recovering skeletal muscle mass were prominent in particular muscles including biceps femoris muscle.

Conclusions: This trial is the first-in-man clinical trial to demonstrate that BCAA supplementation might be safe and, at least in part, improve skeletal muscle mass, strength, and function in patients with rheumatic disorders treated with GC.