老年性肌少症（Sarcopenia）与营养干预

肌少症（Sarcopenia）是老龄化进程中以骨骼肌质量及其力量下降为特征的一类临床综合征,可降低老年人生活质量,增加老年人残疾发生率和疾病死亡率。营养素缺乏及其导致的肌蛋白合成减少、肌肉组织的特殊变化等都是肌少症发生和进展的重要原因。因此,深入探讨营养干预对老年性肌少症的防治具有重要的理论和临床意义。     

如何预防肌少症

<正>随着年龄增长,人体逐渐出现骨骼肌的萎缩、力量减弱和身体活动能力的下降,这种在老年人中极其常见而又容易被忽视的现象被称为骨骼肌减少症,简称肌少症。肌少症可导致难以站立、平衡障碍、极易跌倒骨折、失能、住院率以及病死率增加等,严重影响老年人的生活质量。运动锻炼、充足营养和慢性病管理可延缓和减少肌少症的发生和发展。     

运动预防肌少症

肌肉减少症简称肌少症,是指随着年龄增长出现的骨骼肌量减少、肌肉力量或肌肉功能减退,是一种渐进性、全身性的骨骼肌疾病.对于老年人来说,肌少症与虚弱、跌倒、功能衰退、死亡等风险增加有关.随着全球老龄化的急速加剧,肌少症逐渐成为科学运动的关注热点.研究显示,科学的营养和运动干预对防治肌肉减少症有显著的积极作用,可不同程度地改...     

弹力带抗阻运动对老年2型糖尿病合并肌少症干预效果

目的肌少症作为老年人常见综合征之一,在老年2型糖尿病患者中患病率达15.9%～39.9%。抗阻运动是预防和治疗肌少症的最佳方式。本研究将探讨弹力带抗阻运动在老年2型糖尿病合并肌少症患者中的应用效果。方法采用类试验设计,选择两家医院中符合纳入标准的60例老年2型糖尿病合并肌少症患者作为研究对象,对患者实施12周的渐进式弹力带抗阻运动,对干预前后肌少症诊断指标、空腹血糖、糖化血红蛋白和生活质量的改善效果进行评价。结果 49例患者按计划完成整个干预内容,干预12周后,四肢骨骼肌质量(appendicular skeletal muscle mass,ASM)(F=86.050,P0.001)、四肢骨骼肌指数(appendicular skeletal muscle mass index,ASMI)(F=1 138.995,P0.001)、握力(F=232.990,P0.001)、6m步行速度(F=55.584,P0.001)均增加,肌少症患病率减小(χ~2=69.284,P0.001);空腹血糖(F=9.247,P=0.001)和糖化血红蛋白(F=36.951,P0.001)降低,与干预前相比,差异有统计学意义;生活质量得分较干预前有所提高,但差异无统计学意义(F=1.566,P0.05)。结论弹力带抗阻运动能够有效改善肌少症诊断指标,控制血糖水平。     

终末期肝病合并肌肉衰减症的早期识别和营养干预

肌肉衰减症(简称肌少症), 是终末期肝病(end-stage liver disease, ESLD)最常见的并发症之一, 是ESLD患者死亡的独立危险因素。营养支持是改善ESLD合并肌少症预后的重要途径之一, 及时识别和早期营养支持对于患者的预后和生活质量改善十分必要。近年来, 随着对ESLD患者肌少症发病机制、代谢特点等方面的深入研究, 对ESLD合并肌少症患者的营养支持提供了更多的证据。该文就ESLD合并肌少症早期识别和营养风险筛查、评估及干预的研究进展进行综述。     

炎症性肠病中的营养不良与少肌症

炎症性肠病目前尚无完全治愈的方法,但药物、营养、和手术治疗可以使疾病缓解。营养不良是炎症性肠病最主要的并发症,导致预后、生活质量恶化。同时,炎症导致机体骨骼肌、脂肪、骨代谢紊乱,引起少肌症,因此对于炎症性肠病的营养不良判定同时不能忽视少肌症。     

"养肌防老"从现在开始

正机体老化的过程,事实上在青年时期即开始启动,最早发生的是动脉粥样硬化;此后随年龄增长,相继发生骨量减少、骨质疏松、食欲下降;再往后进展,机体骨骼肌质量和肌肉力量进行性下降,当下降到一定程度时,则出现肌少症。肌少症的出现是老年人机体"由盛转衰"的一个关键节点。肌肉是维持躯体功能最重要的物质储备之一。肌肉的流失,会让老人更容易进入衰弱阶段。增强个体肌肉质量及肌肉力量,应该越早干预越好,我们提供"存钱不如存肌肉",每个人都应从现在开始"养肌防老"!     

老年肌少症与衰弱综合征之间的关系

正老年肌少症和衰弱综合征是老年失能领域的研究热点,患病率随着年龄的增长而增加,表现相似,又各有其特点。因此,明确老年肌少症和衰弱综合征的定义,关注二者的临床表现、发病机制之间的联系,了解二者的诊断标准、评估及治疗策略尤为重要。1定义及流行病学肌少症为一类进行性的、广泛性的骨骼肌量和肌力减少以及骨骼肌功能减退,是导致机体功能和生活质量下降甚至死亡的综合征。国外流行病学研究显示,肌少症在患病率方面存在明显差异,但整     

骨骼肌减少症与代谢综合征关系的研究进展

中国社会人口老龄化趋势日益加剧,骨骼肌减少症和代谢综合征等老年人群常见疾病逐渐成为影响其生活质量的关键因素。骨骼肌减少症是伴随年龄增长而发生的骨骼肌质量下降和功能衰退。代谢相关疾病如肥胖、高血压和糖尿病等在肌少症的发生发展中起到了重要作用。近年来,肌少症和代谢综合征之间的关系也成为研究热点,但是否互为危险因素仍缺乏有力证据。汇总了近5年来国内外有关肌少症与代谢综合征相关关系研究的流行病学资料,就肌少症和代谢综合征的流行病学背景、研究现状及其在生物学机制方面的潜在联系加以综述。肌少症和代谢综合征存在显著的相关关系,且可能具有相似的生物学机制。但该研究目前尚存在一定的局限性,肌少症早期筛查诊断的方法应进行持续探索以达到简便、快速和高效的目的。综述旨在提高人群对肌少症和代谢综合征等慢性综合征的认识,并为两者关联性的进一步研究提供理论支持。     

慢性心力衰竭合并肌少症的治疗进展

慢性心力衰竭(CHF)是冠心病、心肌梗死、心肌炎等多种心脏疾病发展的终末阶段,主要表现为心脏结构和功能异常。肌少症是与增龄相关的,以进行性的骨骼肌数量减少、肌肉力量下降和(或)躯体功能减退为特征的综合征。近年有关CHF合并肌少症的研究越来越多,本文仅对CHF合并肌少症的治疗及其研究进展进行综述。     

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia—The Incidence of Osteosarcopenia: A Narrative Review

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.     

Effects of Internet-Based Nutrition and Exercise Interventions on the Prevention and Treatment of Sarcopenia in the Elderly

Effective nutrition and exercise interventions may improve sarcopenia in the elderly. The purpose of our study was to investigate the effectiveness of Internet-based nutrition and exercise interventions in the elderly with sarcopenia. Participants were divided into 4 groups: control, nutrition, exercise, and comprehensive (nutrition plus exercise) groups; there was at least 50 participants in each group. Our trial lasted 12 weeks. We conducted dietary and exercise interventions through an app and collected feedback from the participants every three weeks. Information on the diet, skeletal muscle mass, and muscle function was collected before and after the interventions. The comprehensive group had higher high-quality protein intake than the control (p = 0.017) and exercise (p = 0.012) groups. After the interventions, we obtained differences in skeletal muscle mass, skeletal muscle mass/height², skeletal muscle mass/weight, muscle mass/BMI, and skeletal muscle mass/body fat percentage (p < 0.05). Changes in average daily energy and total daily protein intakes were not significantly different; however, there was an overall improvement in the intervention groups relative to baseline data. There were no changes in the average daily time of moderate physical activity. The Internet was an effective tool of nutrition intervention in the elderly with sarcopenia. The Internet-based nutrition intervention improved high-quality protein intake and skeletal muscle mass in the elderly with sarcopenia.     

A Vicious Cycle of Osteosarcopenia in Inflammatory Bowel Diseases—Aetiology,Clinical Implications and Therapeutic Perspectives

Sarcopenia is a disorder characterized by a loss of muscle mass which leads to the reduction of muscle strength and a decrease in the quality and quantity of muscle. It was previously thought that sarcopenia was specific to ageing. However, sarcopenia may affect patients suffering from chronic diseases throughout their entire lives. A decreased mass of muscle and bone is common among patients with inflammatory bowel disease (IBD). Since sarcopenia and osteoporosis are closely linked, they should be diagnosed as mutual consequences of IBD. Additionally, multidirectional treatment of sarcopenia and osteoporosis including nutrition, physical activity, and pharmacotherapy should include both disorders, referred to as osteosarcopenia.     

社区慢性阻塞性肺疾病合并糖尿病患者的康复干预效果评价

[目的]探讨干预措施对社区慢性阻塞性肺疾病合并糖尿病患者康复及生存质量的影响。[方法]对52例慢性阻塞性肺疾病合并糖尿病患者的康复进行干预指导8~12个月,比较干预前后患者肺功能,并利用生存质量量表(SF-36)测评患者的生活质量。[结果]干预后患者的肺功能各项指标均有明显的改善(P<0.05);生存质量各维度评分与干预前比较差异有统计学意义(P<0.05)。[结论]对社区慢性阻塞性肺疾病合并糖尿病患者康复治疗的干预有助于患者肺功能改善和生存质量的提高。     

Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients

With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.     

Malnutrition,Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD

Purpose: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world population. In addition to airflow obstruction, COPD is associated with multiple systemic manifestations, including impaired nutritional status or malnutrition and changes in body composition (low muscle mass, LMM). Poor nutritional status and sarcopenia in subjects with COPD leads to a worse prognosis and increases health-related costs. Data from previous studies indicate that 30–60% of subjects with COPD are malnourished, 20–40% have low muscle mass, and 15–21.6% have sarcopenia. This study aimed to assess the prevalence of malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in elderly subjects with COPD and investigate the relationship between COPD severity and these conditions.Patients and methods: A cross-sectional study involving 124 patients with stable COPD, aged ≥60, participating in a stationary pulmonary rehabilitation program. Nutritional status was assessed following the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia with the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. The results of pulmonary function tests and exercise capacity were obtained from the hospital database. Results: 22.6% of participants had malnutrition according to the GLIM criteria. Subjects with malnutrition had lower gait speed (p = 0.0112) and worse results of the Six Minute Walk Test. Sixteen participants (12.9%) had sarcopenia; 12 subjects with sarcopenia had concomitant malnutrition. The prevalence of severe and very severe obstruction (GOLD3/GOLD4) was 91.7%. It was significantly higher in patients with malnutrition-sarcopenia syndrome. Conclusions: Malnutrition was found in nearly one out of four subjects with COPD, while sarcopenia was one out of seven patients. About 10% of our study sample had malnutrition-sarcopenia syndrome. The prevalence of severe and very severe obstruction was significantly higher in patients with malnutrition-sarcopenia syndrome.     

Management of Sarcopenia: A Network Meta-Analysis of Randomized Controlled Trials

ObjectiveThis study aimed to determine the comparative effectiveness of interventions in treatment of sarcopenia. The primary outcome was the measure of treatment effect on muscle mass, and secondary outcomes were the treatment effect on muscle strength and physical performance.DesignSystematic review and network meta-analysis (NMA).Setting and ParticipantsParticipants with sarcopenia receiving interventions targeting sarcopenia in any setting.MethodsData sources: Relevant RCTs were identified by a systematic search of several electronic databases, including CINAHL, Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) from January 1995 to July 2019. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed.Data extraction: All RCTs examining sarcopenia interventions [mixed exercise (combined aerobic and resistance exercise), aerobic exercise, resistance exercise, balance exercise, physical activity and protein or nutrition supplementation, acupuncture, whole-body vibration, protein supplement or interventions to increase protein intake, any nutritional intervention other than protein, and pharmacotherapy] were included. Comparators were standard care, placebo, or another intervention.Data synthesis: We performed Bayesian NMA; continuous outcome data were pooled using the standardized mean difference effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome.ResultsA total of 59 RCTs were included after screening of 4315 citations and 313 full-text articles. Network meta-analysis of muscle mass outcome (including 46 RCTs, 3649 participants, 11 interventions) suggested that mixed exercise were the most effective intervention (SUCRA = 93.94%) to increase muscle mass. Physical activity and protein or nutrition supplementation, and aerobic exercise were the most effective interventions to improve muscle strength and physical performance, respectively. Overall, mixed exercise is the most effective intervention in increasing muscle mass and was one of the 3 most effective interventions in increasing muscle strength and physical performance.Conclusions and ImplicationsMixed exercise and physical activity with nutritional supplementation are the most effective sarcopenia interventions. Most of the included studies have a high risk of bias. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.     

Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Background

Much interest has been focused on interventions for treating sarcopenia; however, the effects have gained little evidence.

Effectiveness of cardiac rehabilitation for prevention and treatment of sarcopenia in patients with cardiovascular disease - a retrospective cross-sectional analysis

Objective

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, with the risk of frailty and poor quality of life. This study aimed to clarify the clinical characteristics of sarcopenia and to investigate the effects of comprehensive cardiac rehabilitation (CCR), including nutrition, physical exercise and medication, in patients with cardiovascular disease (CVD).

Methods

We retrospectively studied 322 inpatients with CVD (age 72±12 years). Muscle mass, muscle strength and physical performance were assessed before and after exercise training in patients with and without sarcopenia, which was defined as either a gait speed of <0.8 m/s or reduced handgrip strength (<26 kg in males and <18 kg in females), together with lower skeletal muscle index (SMI) (<7.0 kg/m2 in males and <5.7 kg/m2 in females). The actual daily total calorie and nutrient intake was also calculated.

Results

Sarcopenia was identified in 28% of patients with CVD, these patients having a higher prevalence of symptomatic chronic heart failure and chronic kidney disease. SMI was significantly associated with protein intake and statin treatment. The ratio of peak VO₂ and SMI was significantly higher in the statin treatment group. Handgrip strength, gait speed, leg weight bearing index, and nutritional intake improved after exercise training in patients both with and without sarcopenia.

Conclusions

The present findings suggest that CCR is a promising strategy for prevention and treatment of sarcopenia in patients with CVD.

     

癌性恶病质肌肉减少的病理生理机制和治疗方法

肌肉减少是处于恶病质期癌症患者的主要临床特征之一。癌性恶病质下肌肉减少的主要病理生理机制是在慢性炎症介导下出现的肌肉合成代谢和分解代谢通路异常。目前针对癌性恶病质肌肉减少的治疗主要包括激素治疗、营养支持、运动疗法和其他药物,但目前仍无法实际有效地阻止肌肉丢失和增强肌肉功能。增进了解癌性恶病质下肌肉减少的发病机制有助于寻找多靶点治疗方法。