糖尿病患者的营养评价及其少肌症发生的影响因素  

Analysis of the nutritional state and the influence factors of sarcopenia in diabetes

作　　者：汪明芳[1] 王丽娟[1] 任姗姗[1] 程博[1] 丁丽丽[1] 陈燕波[1] 王璐[1] 杨子艳[1] 李长平[1] 孙明晓[1] 

机构地区：[1]北京医院营养科,100730

出　　处：《中华临床营养杂志》2015年第5期271-277,共7页Chinese Journal of Clinical Nutrition

基　　金：国家“十二五”科技支撑计划课题（2012BAK21802-04）;国家“863”生物和医药技术领域课题（2014AA022306）

摘　　要：目的 了解糖尿病患者的营养状况及其少肌症的影响因素。方法 对2013年1月至2014年12月北京医院营养科门诊297例糖尿病患者进行回顾性分析，比较非超重组［体质量指数（BMI）≤23.9 kg/m^2］与超重组（BMI≥24.0 kg/m^2）人体测量指标、身体成分、实验室检查指标、膳食摄入的差别，并分析糖尿病患者少肌症发生的影响因素。结果 超重组183例、非超重组114例，非超重组左手握力、右手握力、腰臀比及臂肌围均低于超重组［（24.14±7.76）kg比（27.78±9.31）kg，P=0.00;（25.55±7.86）kg比（28.62±9.55）kg, P=0.01;0.85±0.06比0.92±0.07,P=0.00;（21.45±3.73）cm比（25.18±4.36）cm,P=0.00］；非超重组的肌肉量、体脂百分比、内脏脂肪面积及骨骼肌指数均低于超重组［（37.64±6.58）kg比（45.66±8.92）kg;（27.25±8.15）%比（35.52±6.56）%;（71.56±25.28）cm^2比（118.84±28.18）cm^2;（6.22±1.17）kg/m^2比（7.41±1.25）kg/m^2］（P均=0.00）；非超重组血红蛋白水平低于超重组［（136.29±14.81）g/L比（141.01±13.47）g/L， P=0.03］；两组总蛋白及白蛋白水平差异无统计学意义（P=0.15，P=0.52）；非超重组血糖水平低于超重组［（7.08±2.28）mmol/L比（7.76±2.57）mmol/L，P=0.03］；非超重组与超重组的能量及蛋白质摄入差异无统计学意义（P=0.17,P=0.35）。糖尿病患者少肌症的检出率为10.4%（31/297），非超重患者的少肌症检出率高于超重患者（22.8%比2.7%，P=0.00）。回归分析结果显示，女性（B=-1.371，95% CI=-1.595～-1.146）、增龄（B=-0.018，95% CI=-0.027～-0.009）、低BMI（B=-0.115，95% CI=0.092～0.138）、能量摄入的减少（B=0.014，95% CI=0.000～-0.029）是骨骼肌指数降低的主要危险因素。结论 糖尿病患者BMI在适度超重的范围内有更好的营养状态,有利于预防少肌症的发生。Objective To evaluate the nutritional status and risk factors for sarcopenia in diabetes. Methods 297 diabetic patients who visited nutrition clinic of Beijing Hospital during the period from January 2013 to December 2014 were retrospectively analyzed. The patients were divided into overweight group （BMI≥24.0 kg/m^2） and non-overweight group （BMI≤23.9 kg/m^2）, and the differences in anthropometry, body composition, laboratory indexes, dietary intake were analyzed between these two groups. The risk factors for sarcopenia in diabetes were analyzed by multiple linear regression. Results There were 183 patients in the overweight group and 114 in the non-overweight group. Compared with the overweight group, the left and right hand grip strength [（24.14±7.76）kg vs. （27.78±9.31）kg, P=0.00; （25.55±7.86）kg vs. （28.62±9.55）kg, P=0.01], waist-to-hip rate（0.85±0.06 vs. 0.92±0.07, P=0.00）, arm muscle circumference[（21.45±3.73）cm vs. （25.18±4.36）cm, P=0.00], the muscle mass [（37.64±6.58）kg vs. （45.66±8.92）kg, P=0.00], percentage of body fat [（27.25 ±8.15）% vs. （35.52±6.56）%, P=0.00], visceral fat area [（71.56±25.28）cm^2 vs. （118.84±28.18）cm^2, P=0.00], and skeletal muscle index [（6.22±1.17）kg/m^2 vs. （7.41±1.25）kg/m^2, P=0.00] in the non-overweight group were significantly lower. Hemoglobin and serum glucose level were also significantly lower in the non-overweight group [（136.29±14.81）g/L vs. （141.01±13.47）g/L, P=0.03; （7.08±2.28）mmol/L vs. （7.76±2.57）mmol/L, P=0.03]. The total protein and albumin levels showed no significant inter-group differences （P=0.15, P=0.52）, nor did the energy and protein intakes （P=0.17, P=0.35）. The detection rate of sarcopenia was 10.4% （31/297）, which was higher in the non-overweight group than in the overweight group （22.8% vs. 2.7%, P=0.00）. Female（B=-1.371, 95% CI=-1.595--1.146）, aging（B=-0.018, 95% CI=-0.027--0.009）, lower BMI（B=-0.115, 95% CI=0.092-0.138）, a

关 键 词：糖尿病 超重 营养状态 少肌症 

分 类 号：R587.1[医药卫生—内分泌] R151.41[医药卫生—内科学]