老年糖尿病肌少症患者的代谢特点及膳食分析

摘要

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/m2 for men and 5.73 kg/m2 for women.All patients were divided into the sarcopenia group versus the control group(below vs.not below 7.18 kg/m2 for men and 5.73 kg/m2 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％,x2=8.817,P=0.003)and HbA1c(131.0％ or 53.5％ vs.23.0％ or 28.0％,x2 =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 filtr ationrate(eGFR)were lower in male sarcopenia group than in the male control group(P＜0.05).eGFR was lower in female sarcopenia group than in female control group(t =4.090,P =0.000).Both in men and women,ASMI,grip power,fatless circumference on upper arm,bone mineral content and basal metabolic rate were lower in the sarcopenia group than in the control group(P＜0.05).The total daily intake of energy,carbohydrate,protein and fat were lower in male sarcopenia group than in male control group(P＜ 0.05).Conclusions Compared with the control group,sarcopenia patients are older with worse glycemic control and lower levels of BMI,WHR,renal function,muscle mass and muscle strength.Sarcopenia patients are more prone to osteoporosis.Furthermore,they have poorer nutritional status with an imbalance of dietary intake.Appropriate increase of protein especially high quality protein intake should be recommended to sarcopenia patients with T2DM.%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＜7.18 kg/m2、女性＜5.73 kg/m2.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人方面的差异.以空腹血糖(FPG)＜7 mmol/L和糖化血红蛋白(HbA1.)＜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,f=-4.385,P=0.000],体质指数[(26.2±3.0) kg/m2比(23.0±2.6) kg/m2,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％),x 2=8.817,P=0.003]和HbA1c达标率[131 (53.5％)比23(28.0％),x2=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人不均衡,应该适当增加蛋白质尤其是优质蛋白质的摄人.