肌肉衰減干預(yù)共識(shí)解讀老年?duì)I養(yǎng)食品安全分會(huì)成立

孫建 “sarcopenia”肌肉衰減征討論sarcopenia定義與

老年?duì)I養(yǎng)國(guó)際研討有不良的健康和臨床結(jié)局，增加老年人失能、Asyndromecharacterisedbyprogressiveandgeneralisedlossofskeletalmusclemassandstrengthwithariskofadverseessuchasphysicaldisability,poorqualityoflifeanddeath. ClinicalNutrition29(2010)2525yearold65yearoldlinical (from20to80yearsofage,approxima ya30%reductioninmusclemassClinicalNutrition29(2010)Sarcopenia共識(shí)：、診斷、防握力握力和步速正握力降低和（或）步速降測(cè)量骨骼肌質(zhì)正正降無(wú)肌肉衰減綜合無(wú)肌肉衰減綜合 無(wú)肌肉衰減綜合3.Chen,L.K.,etal.,SarcopeniainAsia:consensusreportoftheAsianWorkingGroupforSarcopenia.JAmMedDirAssoc,2014.15(2):p.95‐101.我國(guó)肌肉衰減征的：以ASMI<2SD判斷，70+歲 Cheng,Q.,etal.,Across‐sectionalstudyoflossofmusclemasscorrespondingtosarcopeniain研究：BIA檢測(cè)骨骼肌質(zhì)量，老 23.6%，女性 增加患病率明顯上升 高于女性MChen,JQSunetal.,Musclemassreferencestandardforsarcopeniausingbioelectrical 營(yíng)養(yǎng)干預(yù)：補(bǔ)充VD800IU/d,提高肌力和步速（ 老年健康營(yíng)養(yǎng)企業(yè)、研究基老年人關(guān)心：要健康、要功能肌肉衰減綜合征營(yíng)與運(yùn)動(dòng)干預(yù)中國(guó)專(zhuān)家共中國(guó)營(yíng)養(yǎng)學(xué)會(huì)臨床營(yíng)中華醫(yī)學(xué)會(huì)腸外腸內(nèi)營(yíng)養(yǎng)學(xué)分會(huì)老年?duì)I養(yǎng)支持學(xué)肌肉衰減征營(yíng)養(yǎng)運(yùn)動(dòng)干預(yù)中國(guó)專(zhuān)家共識(shí)的背景和

中國(guó)專(zhuān)家共

推薦意見(jiàn)的分級(jí)方 theManagementof A級(jí)：?jiǎn)蝹€(gè)隨機(jī)安慰劑對(duì)照試驗(yàn)或meta-分（minimumofasinglerandomizedcebo-controlledtrialorameta-J.E., efsarcopenia.JMedDirAssoc,2010.11(6):p.（趙法伋、顧景范，營(yíng)養(yǎng)學(xué)報(bào)肌肉衰減征、肌衰蛋白脂肪維生素抗氧化營(yíng)養(yǎng)運(yùn)一、蛋白推薦意蛋白質(zhì)/氨基酸與肌肉/Paddon‐JonesD,etal.ExpGerontol41:215–219,2006.Paddon‐JonesD,etal.AmJPhysiolEndocrinolMetab286,2004.VolpiE,eral.JClinInvest101:2000–2007,1998.VolpiE,eral.AmJPhysiolEndocrinolMetab277:E513–E520,1999.ont. 年與年人肉的號(hào)白濃不人10gmTOR(m ntargetrapamycin)通路中關(guān)鍵信號(hào)蛋白激活反應(yīng)比年輕人延遲CuthbertsonD,etal.FASEBJ19:422–424,2005.KatsanosCS,etal.AmJClinNutr82:1065–1073,2005.CuthbertsonD,etal.FASEBJ19:422–424,2005.HealthABCstudy,社區(qū)老 和女性隊(duì)列研究highestquintileofproteinintake(:19E%)lost40%lessLMandaLMcomparedtothelowestquintile(:11E%).瘦體重與總蛋白質(zhì)和動(dòng)物蛋白攝入量顯著相關(guān)，與植物蛋白不健康老人1.0- 急 患者1.2-IncreasingDietaryProteinRequirementsinElderlyPeopleforOptimalMuscleandBoneHealthErinGaffney‐Stomberg,etal.JAGS57:1073–1079,蛋白質(zhì)均勻分最大程度提高肌肉蛋AnadequateamountofproteinintakewitheachmealisDietaryGuidelinesshouldreflectnewunderstandingsaboutadultproteinneedsNutrMetab.2009MarLeucinehasLeucinehasaregulatoryroleonmuscleproteinsynthesis1scoopofwheyprotein2gleucine(morethan3ozbeef)WP、CAS、與肌肉蛋白質(zhì)的合成TangJEetal.JApplPhysiol2009;107:987-蛋白推薦意食物蛋白質(zhì)能促進(jìn)肌肉蛋白質(zhì)的合成，有助于預(yù)防肌肉衰減綜合征。老年人蛋白質(zhì)的推薦攝入量應(yīng)維持在1.0‐1.5g優(yōu)質(zhì)蛋白質(zhì)比例最好能達(dá)到50%，并均衡分配到一日三餐中。富含亮氨酸等支鏈氨基酸的優(yōu)質(zhì)蛋白如乳清蛋白及其它動(dòng)物蛋白，更有益于預(yù)防肌肉衰減綜合征。二、脂肪Rodacki,C.L.,etal.,Fish‐oilsupplementationenhancestheeffectsofstrengthtraininginelderlywomen.AmJClinNutr,2012.95(2):二、脂肪推推薦意1對(duì)于肌肉量丟失和肌肉功能減弱的老年在控制總脂肪攝入量的前提下，應(yīng)增加深海魚(yú)海產(chǎn)品等富含n‐3多不飽和脂肪酸的食物攝入。2推薦EPA+DHA的ADMR為0.25‐2g/d三、維生素維生素對(duì)肌肉作用

相關(guān)蛋白質(zhì)合肌肉內(nèi)

肌肉功能Garcia,L.A.,etal.,1,25(OH)2vitaminD3stimulatesmyogenicdifferentiationbyinhibitingcellproliferationandmodulatingtheexpressionofpromyogenicgrowthfactorsandmyostatininC2C12skeletalmusclecells.Endocrinology,2011.152(8):p.2976‐86.Dirks‐Naylor,A.J.andS.Lennon‐Edwards,TheeffectsofvitaminDonskeletalmusclefunctionandcellularsignaling.JSteroidBiochemMolBiol,2011.125(3‐5):p.159‐68.三、維生素推薦意 有必要檢測(cè)所有肌肉衰減綜合征老年內(nèi)維生素D的水平當(dāng)老年25（OH）D低于正常值范圍時(shí)，應(yīng)予補(bǔ)充。增加戶(hù)外活動(dòng)有助于提高老年人維生素D水平，預(yù)防肌肉衰減綜合征。適當(dāng)增加海魚(yú)、動(dòng)物肝臟和蛋黃等維生素D含量較高食物。四、抗氧化營(yíng)養(yǎng)氧化應(yīng)激及活性氧自由基產(chǎn)生可能增加老年人肌肉衰減綜合征的發(fā)生、發(fā)展及進(jìn)程[40]維生素Emg/d維生素C）動(dòng)干預(yù)，顯示抗氧化營(yíng)養(yǎng)素與阻抗訓(xùn)

維生素硒

維生素

有 的研究證實(shí)40.Fulle,S.,etal.,Thecontributionofreactiveoxygenspeciestosarcopeniaandmuscleageing.ExpGerontol,2004.39(1):p.17‐24.48.Labonte,M.,etal.,Effectsofantioxidantsupplementscombinedwith exerciseongainsinfat‐ massinhealthyelderlysubjects:apilotstudy.JAmGeriatrSoc,2008.56(9):p.1766‐8.49.Nalbant,O.,etal.,VitaminEandaerobicexercise:effectsonphysicalperformanceinolderadults.AgingClinExpRes,2009.21(2):p.四、抗氧化營(yíng)養(yǎng)推薦意 鼓勵(lì)增加深色蔬菜和水果以及豆類(lèi)等富含抗氧化營(yíng)養(yǎng)素食，以減少肌肉有關(guān)的氧化應(yīng)激損傷。 適當(dāng)補(bǔ)充含多種抗氧化營(yíng)（維生素C、維生素E、類(lèi)胡蘿卜素、硒）的膳食補(bǔ)充劑。五、口服營(yíng)養(yǎng)補(bǔ)充Dardevet,D.,etal.,Musclewastingand ofmuscleanabolism:the"anabolicthresholdconcept"foradaptednutritionalstrategiesduringsarcopenia.ScientificWorldJournal,2012.2012Gazzotti,C.,etal.,Preventionofmalnutritioninolderpeopleduringandafterhospitalisation:resultsfromarandomisedcontrolledclinicaltrial.AgeAgeing,2003.32(3):Freijer,K.,M.J.Nuijten,andJ.M.Schols,Thebudgetimpactoforalnutritionalsupplementsfordiseaserelatedmalnutritioninelderlyinthecommunitysetting.FrontPharmacol,Milne,A.C.,etal.,Proteinandenergysupplementationinelderlypeopleatriskfrommalnutrition.CochraneDatabaseSystRev,2009.口服營(yíng)養(yǎng)補(bǔ)充推薦意口服營(yíng)養(yǎng)補(bǔ)充有助預(yù)防虛弱老年人的肌肉衰改善肌肉衰減綜合征患者的肌肉量、強(qiáng)度和身體組分。每天在餐間/時(shí)或鍛煉后額外補(bǔ)充2次營(yíng)養(yǎng)制劑克富含必需氨基酸或亮氨酸的蛋白質(zhì)及（）六、運(yùn)56.Kim,H.K.,etal.,Effectsofexerciseandaminoacidsupplementationonbodycompositionandphysicalfunctionincommunity‐dwellingelderlyJapanesesarcopenicwomen:arandomizedcontrolledtrial.JAmGeriatrSoc,2012.60(1):p.16‐23.59.Shahar,S.,etal.,Effectivenessofexerciseandproteinsupplementationinterventiononbodycomposition,functionalfitness,andoxidativestressamongelderlyMalayswithsarcopenia.ClinIntervAging,2013.8:p.1365‐75.60.Cruz‐Jentoft,A.J.,etal.,Prevalenceofandinterventionsforsarcopeniainageingadults:asystematicreview.Reportoft