老年糖尿病肌少症患者的代谢特点及膳食分析  

Analysis of dietary and metabolic characteristics in elderly sarcopenia patients with diabetes mellitus

作　　者：何清华 孙明晓[3] 岳燕芬 景洪江 杨彩哲 胡景 庄晓明[8] 张如月[9] 张春梅 郭立新[1,2] He Qinghua;Sun Mingxiao;Yue Yanfen;Jing Hongjiang;Yang Caizhe;Hu Jing;Zhuang Xiaoming;Zhang Ruyue;Zhang Chunmei;Guo Lixin(Graduate School of Peking Union Medical College,Beijing 100005,China;Department of Nutriology,Luhe Hospital Affiliated to Capital Medical University,Beijing 101199,China;Department of Endocrinology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Endocrinology,Beijing Eden Hospital,Beijing 100195,China;Department of Nutriology,Pinggu Hospital,Beijing Traditional Chinese Medicine Hospital,Beijing 10120,China;Department of Nutriology,Air Force Characteristic Medical Center,Beijing 100142,China;Department of Endocrinology,Air Force Characteristic Medical Center,Beijing 100142,China;Department of Nutriology,Fuxing Hospital Affiliated to Capital Medical University,Beijing 100038,China;Department of Endocrinology,Fuxing Hospital Affiliated to Capital Medical University Beijing 100038,China;Department of Nutriology,Haidian Hospital,Third Hospital of Peking University Beijing 100080,China)

机构地区：[1]北京协和医学院研究生院,100005 [10]首都医科大学附属北京潞河医院营养科,101199 [2]北京医院内分泌科,国家老年医学中心,100730 [3]北京怡德医院内分泌科,100195 [4]北京中医医院平谷医院营养科,101200 [5]空军特色医学中心营养科,北京100142 [6]空军特色医学中心内分泌科,北京100142 [7]首都医科大学附属复兴医院营养科,北京100038 [8]首都医科大学附属复兴医院内分泌科,北京100038 [9]北京大学第三医院海淀院区营养科,100080

出　　处：《中华老年医学杂志》2019年第5期552-557,共6页Chinese Journal of Geriatrics

摘　　要：目的了解老年2型糖尿病(T2DM)肌少症患者的代谢指标、身体成分和营养膳食摄入特点。方法选取北京地区9家医院内分泌科就诊的60岁以上2型糖尿病652例(男性327例,女性325例),采用生物阻抗法(BIA)进行身体成分检测并计算四肢骨骼肌指数(ASMI),肌少症诊断标准为ASMI低于同种族同性别健康年轻人最低五分位值,诊断截值为男性<7.18kg/m^2、女性<5.73kg/m^2。将全部受试者分为肌少症组和对照组,比较两组人群在人体测量指标、身体成分、实验室检查和膳食摄入方面的差异。以空腹血糖(FPG)<7mmol/L和糖化血红蛋白(HbA1c)<7%分别计算血糖达标率;以体脂百分比男性>25%、女性>30%计算肥胖率。结果肌症少组116例(17.8%),对照组536例(82.2%)。无论男女,肌少症组年龄高于对照组[(67.4±6.1)岁比(70.6±7.3)岁,t=-4.385,P=0.000],体质指数[(26.2±3.0)kg/m^2比(23.0±2.6)kg/m^2,t=11.724,P=0.000]和腰臀比[0.93±0.06比0.90±0.06,t=4.173,P=0.000]低于对照组。男性肌少症组的FPG[(7.5±2.4)mmol/L比(8.5±2.5)mmol/L,t=-3.450,P=0.001]和HbA1c[(7.0±1.6)%比(8.2±1.7)%,t=-5.745,P=0.000]高于对照组,FPG达标率[127(51.8%)比27(32.9%),χ^2=8.817,P=0.003]和HbA1c达标率[131(53.5%)比23(28.0%),χ^2=15.934,P=0.000]均低于对照组。男性肌少症组红细胞、血红蛋白、白蛋白、估算肾小球滤过率(eGFR)均低于对照组(均P<0.05),女性肌少症组eGFR低于对照组(t=4.090,P=0.000)。无论男女,肌少症组ASMI、握力、上臂无脂肪周长、骨矿物质含量和基础代谢率低于对照组(均P<0.05)。男性肌少症组每日摄入总热量、碳水化合物、蛋白质、脂肪量均低于对照组(均P<0.05)。结论与非肌少症的糖尿病相比,合并肌少症的老年糖尿病患者年龄更大,BMI和腰臀比更低,糖代谢水平和肾功能更差,肌肉含量和力量明显下降,营养状态更差,更容易罹患骨质疏松,同时存在膳食营养摄入不均衡,应该适当增加蛋白质尤其Objective To investigate the metabolic characteristics, body composition and dietary intake in elderly sarcopenia patients with type 2 diabetes(T2DM). Methods A total of 652 T2DM patients(327 males and 325 females)aged over 60 years were selected from endocrinology department of nine different hospitals in Beijing.Body composition was measured by bioimpedance analysis, and the appendicular skeletal mass index(ASMI)was calculated.Sarcopenia was defined as body height-adjusted skeletal muscle mass(ASMI)below the lower quintile of the young reference group.The diagnostic cutoff points for sarcopenia were 7.18 kg/m^2 for men and 5.73 kg/m^2 for women.All patients were divided into the sarcopenia group versus the control group(below vs.not below 7.18 kg/m^2 for men and 5.73 kg/m^2 for women). The anthropometric parameters, body composition, biochemical laboratory results and dietary intake were compared between the two groups.The blood glucose target levels were less than 7 mmol/L of fasting plasma glucose(FPG)or less than 7% of haemoglobin A1c(HbA1c). The obesity ratio was calculated according to body fat percentage more than 25% in men and more than 30% in women as obesity. Results There were 116(17.8%)patients in the sarcopenia group(men/women, 82/34), and 536(82.2%)patients in the control group(men/women, 245/291). Age was higher in the sarcopenia group than in the control group(t=4.385, P=0.000), and body mass index and waist hip ratio(WHR)were lower in the sarcopenia group than in the control group(t=11.724 and 4.173, P=0.000 and 0.000). FPG[(7.5±2.4)mmol/L vs.(8.5±2.5)mmol/L, t=-3.450, P=0.001]and HbA1c[(7.0±1.6)% vs.(8.2±1.7)%, t=-5.745, P=0.000]were higher in male sarcopenia group than in male control group.The control rate of FPG(127.0% or 51.8% vs.27.0% or 32.9%,χ^2=8.817, P=0.003)and HbA1c(131.0% or 53.5% vs.23.0% or 28.0%,χ^2=15.934, P=0.000)were lower in the sarcopenia group than in the control group.The red blood cell counts, hemoglobin and serum albumin levels, estimated glomerular filtration rat

关 键 词：糖尿病 肌少症 营养评价 代谢 

分 类 号：R587.2[医药卫生—内分泌] R685[医药卫生—内科学]