老年人身體活動量與肌少症的相關性

Abstract

前言：肌少症描述伴隨老化的肌肉量下降加上肌力減退或身體表現變差。肌少症的後果包含跌倒、骨折、失能、住院或需入住長照機構、生活品質下降，甚至死亡。肌少症的定義和診斷尚未一致，亞洲肌少症小組（AWGS）在2014年提出肌力減退或身體表現變差此二項至少一項加上肌肉量下降以診斷肌少症。肌少症的原因包括老化、疾病、營養失調、缺乏活動等，身體活動是預防肌少症的一個重要關鍵。國際身體活動量調查問卷-短版（IPAQ-S）是測量身體活動量的問卷之一，臺灣版本的IPAQ-S信度及效度都已經過檢定。本研究的主要目的為以臺灣版本的IPAQ-S和亞洲定義的肌少症去探討老年人身體活動量和肌少症的相關性，次要目的為探討其他和肌少症相關之因子。 材料及方法：本研究為橫斷式研究，搜集一次性問卷、老人健檢和身體量測的數據。研究族群為65歲以上於2019年參與某區域醫院老人健檢的志願者，本研究通過院方的研究倫理審查，所有受試者皆簽署知情同意。 結果：最終納入分析的有500位參與者，平均年紀為73.87 歲，265位（53%）為女性。106位（21.2％）被歸類為低度身體活動量，394位（78.8%）為中至高度身體活動量。大多數女性參與者（142/265, 53.5%）及男性參與者（131/235, 55.7%）為中度身體活動量。依照2014年AWGS診斷標準，共有104位（20.8%）參與者符合肌少症診斷，其中女性67位，男性37位。女性參與者在調整年齡、身體質量指數、白蛋白、三酸甘油酯、血紅素後，相對於低度身體活動量組，中至高度身體活動量對肌少症的勝算比為0.47（95%信賴區間 0.24-0.90, p值=0.024）。男性參與者在調整年齡、身體質量指數、血紅素、飲酒、心血管疾病史、糖尿病史、高血壓病史、機構居住、總膽固醇、空腹血糖、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇、三酸甘油酯後，相對於低度身體活動量組，中至高度身體活動量對肌少症的勝算比為0.18（95%信賴區間 0.05-0.59, p值=0.005）。依照2019年AWGS診斷標準，共有138位（27.6%）參與者符合肌少症診斷，其中女性87位，男性51位。女性參與者在調整年齡、身體質量指數、白蛋白、血紅素後，相對於低度身體活動量組，中至高度身體活動量對肌少症的勝算比為0.52（95%信賴區間 0.27-0.98, p值=0.043）。男性參與者在調整年齡、身體質量指數、心血管疾病史、心臟病史、機構居住後，相對於低度身體活動量組，中至高度身體活動量對肌少症的勝算比為0.34（95%信賴區間 0.12-0.95, p值=0.039）。 結論: 不論依照2014或2019年AWGS的肌少症診斷標準，在調整干擾因子後，身體活動量對肌少症有統計上顯著的保護作用，且在男性參與者較為明顯，較高的身體質量指數對肌少症有保護作用，老化則為肌少症之危險因子。依照2014年AWGS的肌少症診斷標準，其餘呈現統計上顯著相關者還有：較高濃度的白蛋白在女性參與者對肌少症有保護作用、糖尿病史在男性參與者對肌少症有保護作用、心血管疾病史則為男性參與者肌少症之危險因子。

Introduction: Sarcopenia is characterized by age-related lean muscle mass decline and low muscle strength and/or performance. The consequences of sarcopenia are falls, fracture, disability, hospital admission or need for long-term care placement, poorer quality of life, and even mortality. The definition and diagnosis of sarcopenia remains inconsistent. In 2014, Asian Working Group for Sarcopenia (AWGS) recommended using low muscle mass plus low muscle strength and/or low physical performance to diagnose sarcopenia. The causes of sarcopenia are multifactorial, such as aging, disease, malnutrition, and inactivity, etc. Physical activity (PA) is one of the keys to preventing sarcopenia. The international physical activity questionnaire-short version (IPAQ-S) was one of questionnaires used to measure PA. The validity and reliability of the Taiwan version of IPAQ-S has been verified. In this study, our primary aim is to use the Taiwan version of IPAQ-S and the AWGS definition of sarcopenia to examine the relationship between PA and the presence of sarcopenia in older adults. Our secondary aim is to identify other associated factors of sarcopenia. Materials and methods: We designed a cross-sectional study, and questionnaires and physical examinations were used to collect information once. We recruited volunteers from those aged ≧65 years old attending an older adults’ health exam at a regional hospital in 2019. The study had been approved by the Institutional Review Board (IRB) of the regional hospital (TCHIRB-10801017) and all the participants provided written informed consent. Results: Data from 500 participants were used for the analysis. The study participants had a mean age of 73.87 years old, with 47% men and 53% women. Of the 500 participants, 106 (21.2%) participants were classified as low PA, and 394 were classified as moderate to high PA (78.8%) groups. For both genders, most female (142/265, 53.5%) and male (131/235, 55.7%) participants’ PA levels were moderate. According to the 2014 AWGS diagnostic criteria of sarcopenia, a total of 104 (20.8%) participants were classified as having sarcopenia, among whom 67 were women and 37 were men. Compared with the low PA group, for the female participants, the overall odds ratio (OR) of moderate to high PA to sarcopenia was 0.47 (95% CI: 0.24-0.90, p-value=0.024), after adjusting for age, body mass index (BMI), and albumin, triglyceride and hemoglobin levels. As for the male participants, compared with the low PA group, the overall odds ratio (OR) of moderate to high PA to sarcopenia was 0.18 (95% CI: 0.05-0.59, p-value=0.005), after adjusting for age, body mass index (BMI), alcohol drinking, history of cardiovascular disease, history of diabetes mellitus, history of hypertension, institutionalization, and hemoglobin, total cholesterol, FPG, LDL-C, HDL-C, and triglyceride levels. According to the 2019 AWGS definition of sarcopenia, a total of 138 (27.6%) participants were classified as having sarcopenia, among whom 87 were women and 51 were men. Compared with the low PA group, for the female participants, the overall odds ratio (OR) of moderate to high PA to sarcopenia was 0.52 (95% CI: 0.27-0.98, p-value=0.043), after adjusting for age, body mass index (BMI), and albumin and hemoglobin levels. As for the male participants, compared with the low PA group, the overall odds ratio (OR) of moderate to high PA to sarcopenia was 0.34 (95% CI: 0.12-0.95, p-value=0.039), after adjusting for age, body mass index (BMI), history of cardiovascular disease, history of heart disease and institutionalization. Conclusion: Regardless of whether the 2014 or the 2019 AWGS diagnostic criteria of sarcopenia was applied, a significant protective effect of physical activity on sarcopenia was found among the older adults after adjusting for confounders, especially for the male participants. Higher BMI showed protective effect on sarcopenia, while aging was a risk factor of sarcopenia. According to the 2014 AWGS diagnostic criteria of sarcopenia, a higher albumin level showed a protective effect on sarcopenia for the female participants, while a history of diabetes mellitus showed a protective effect and a history of cardiovascular disease was a risk factor of sarcopenia for the male participants.