老年少肌性肥胖患者肌肉质量评价及与膳食摄入的相关分析

Evaluation of muscle quality and its correlation with dietary intake in elderly with sarcopenic obesity

目的探讨老年少肌性肥胖患者肌肉质量情况及少肌性肥胖发生的影响因素。方法回顾性分析,696例老年人中少肌性肥胖(55例)、单纯肌少症(8例)、单纯肥胖(481例)及非少肌非肥胖对照组(152例)间身体成分、膳食摄入能量及三大营养素量和比例组间差异,采用多元线性回归分析与老年少肌性肥胖发生相关的影响因素。结果与对照组比较,老年少肌性肥胖组患者年龄、体质指数、腰臀比、脂肪、体脂百分比、内脏脂肪面积、空腹血糖、估算肾小球滤过率较高(均P<0.01或P<0.05),而握力、骨骼肌、骨骼肌指数、肌肉质量(握力/四肢骨骼肌)、摄入的能量、碳水化合物、脂肪、蛋白质、矫正体重能量、矫正体重蛋白质、矫正理想体重能量、矫正理想体重蛋白质均较低(P<0.01)。老年人少肌性肥胖检出率为7.90%(55例),其中男性为7.60%(48例),女性为11.48%(7例)。少肌性肥胖检出率60~69岁为0.07%(2/287),70~79岁为4.94%(12/243),≥80岁为24.70%(41/166),少肌性肥胖检出率随增龄而增加(χ^(2)=87.76,P<0.01)。以握力/四肢骨骼肌量中位数为切点,老年人肌肉质量(肌质)降低率为12.36%(86/696)。对照组(2.63%,4/152)、单纯肥胖组(11.64%,86/635)、单纯肌少症组(37.50%,3/8)、少肌性肥胖组(41.82%,23/55),肌质降低者逐步增加,差异有统计学意义(χ^(2)=62.25,P<0.01)。多因素Logistic回归分析结果显示,少肌性肥胖发生的影响因素为增龄、内脏脂肪面积偏多、摄入蛋白质不足、基础代谢降低(P<0.01或P<0.05)。结论老年少肌性肥胖患者肌质降低者高于其他人群。老年少肌性肥胖的发生与增龄、摄入蛋白质不足、基础代谢降低、内脏脂肪面积增加有关,对老年少肌性肥胖患者应及早进行个性化评估和干预。

Objective To investigate the muscular quality and its related influencing factors in elderly with sarcopenic obesity.Methods The internalized 696 elderly subjects meeting inclusion and exclusion criteria were divided into four groups including the sarcopenic obesity(n=55),sarcopenia(n=8),simple obesity(n=481)and normal control(n=152)groups.The intergroup difference was retrospectively analyzed in the parameters of body composition,dietary intake of total energy and three major nutrients and their proportions.Multiple linear regression analysis was used to analyze the influencing factors related to the occurrence of sarcopenic obesity in the elderly.Results The sarcopenic obesity group versus normal control group showed a higher level or value in age,body mass index,waist-hip ratio,fat mass,percentage of body fat,visceral fat area,fasting blood glucose,estimated glomerular filtration rate(P<0.01 or 0.05),and showed a lower level or value in grip strength,skeletal muscle,skeletal muscle index,muscle quality(grip strength/limb skeletal muscle),intake of energy,carbohydrate,fat and protein,body weight-adjusted intake of energy and protein,as well as ideal body weight-adjusted intake of energy and protein(P<0.01).The detection rate of sarcopenic obesity was 7.90%(n=55),including 7.60%in males(n=48)and 11.48%in females(n=7 cases).The detection rate of sarcopenic obesity was increased along with increasing age with 0.07%(2/287)in 60-69 years old group,4.94%(12/243)in 70-79 years old group,and 24.70%(41/166)in≥80 years old group(χ^(2)=87.76,P<0.01).Taking the median point of grip strength/limb skeletal muscle volume as the cutoff point,the decrease rate of muscle quality was 12.36%(86/696)in total elderly subjects,2.63%(4/152)in the control group,11.64%(86/635)in the obesity group,37.5%(3/8)in the sarcopenia group and 41.82%(23/55)in the sarcopenic obesity group,with an increasing trend of the decrease of muscle quality,which had significant differences(χ^(2)=62.25,P<0.01).Multiple logistic regression analysis showed that aging,excessive visceral fat area,insufficient protein intake and decreased basal metabolism were the independent risk factors for sarcopenic obesity in elderly people(P<0.01 or P<0.05).Conclusions The incidence of decrease of muscle quality is higher in the elderly with sarcopenic obesity than other elderly groups.Sarcopenic obesity is correlated with aging,insufficient intake of protein,decreased basal metabolism and excessive visceral fat accumulation.Individual evaluation and support is necessary in elderly people with sarcopenic obesity.