肌肉衰减干预共识解读老年营养食品安全分会成立

孙建 “sarcopenia”肌肉衰减征讨论sarcopenia定义与

老年营养国际研讨有不良的健康和临床结局，增加老年人失能、Asyndromecharacterisedbyprogressiveandgeneralisedlossofskeletalmusclemassandstrengthwithariskofadverseessuchasphysicaldisability,poorqualityoflifeanddeath. ClinicalNutrition29(2010)2525yearold65yearoldlinical (from20to80yearsofage,approxima ya30%reductioninmusclemassClinicalNutrition29(2010)Sarcopenia共识：、诊断、防握力握力和步速正握力降低和（或）步速降测量骨骼肌质正正降无肌肉衰减综合无肌肉衰减综合 无肌肉衰减综合3.Chen,L.K.,etal.,SarcopeniainAsia:consensusreportoftheAsianWorkingGroupforSarcopenia.JAmMedDirAssoc,2014.15(2):p.95‐101.我国肌肉衰减征的：以ASMI<2SD判断，70+岁 Cheng,Q.,etal.,Across‐sectionalstudyoflossofmusclemasscorrespondingtosarcopeniain研究：BIA检测骨骼肌质量，老 23.6%，女性 增加患病率明显上升 高于女性MChen,JQSunetal.,Musclemassreferencestandardforsarcopeniausingbioelectrical 营养干预：补充VD800IU/d,提高肌力和步速（ 老年健康营养企业、研究基老年人关心：要健康、要功能肌肉衰减综合征营与运动干预中国专家共中国营养学会临床营中华医学会肠外肠内营养学分会老年营养支持学肌肉衰减征营养运动干预中国专家共识的背景和

中国专家共

推荐意见的分级方 theManagementof A级：单个随机安慰剂对照试验或meta-分（minimumofasinglerandomizedcebo-controlledtrialorameta-J.E., efsarcopenia.JMedDirAssoc,2010.11(6):p.（赵法伋、顾景范，营养学报肌肉衰减征、肌衰蛋白脂肪维生素抗氧化营养运一、蛋白推荐意蛋白质/氨基酸与肌肉/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. 年与年人肉的号白浓不人10gmTOR(m ntargetrapamycin)通路中关键信号蛋白激活反应比年轻人延迟CuthbertsonD,etal.FASEBJ19:422–424,2005.KatsanosCS,etal.AmJClinNutr82:1065–1073,2005.CuthbertsonD,etal.FASEBJ19:422–424,2005.HealthABCstudy,社区老 和女性队列研究highestquintileofproteinintake(:19E%)lost40%lessLMandaLMcomparedtothelowestquintile(:11E%).瘦体重与总蛋白质和动物蛋白摄入量显著相关，与植物蛋白不健康老人1.0- 急 患者1.2-IncreasingDietaryProteinRequirementsinElderlyPeopleforOptimalMuscleandBoneHealthErinGaffney‐Stomberg,etal.JAGS57:1073–1079,蛋白质均匀分最大程度提高肌肉蛋AnadequateamountofproteinintakewitheachmealisDietaryGuidelinesshouldreflectnewunderstandingsaboutadultproteinneedsNutrMetab.2009MarLeucinehasLeucinehasaregulatoryroleonmuscleproteinsynthesis1scoopofwheyprotein2gleucine(morethan3ozbeef)WP、CAS、与肌肉蛋白质的合成TangJEetal.JApplPhysiol2009;107:987-蛋白推荐意食物蛋白质能促进肌肉蛋白质的合成，有助于预防肌肉衰减综合征。老年人蛋白质的推荐摄入量应维持在1.0‐1.5g优质蛋白质比例最好能达到50%，并均衡分配到一日三餐中。富含亮氨酸等支链氨基酸的优质蛋白如乳清蛋白及其它动物蛋白，更有益于预防肌肉衰减综合征。二、脂肪Rodacki,C.L.,etal.,Fish‐oilsupplementationenhancestheeffectsofstrengthtraininginelderlywomen.AmJClinNutr,2012.95(2):二、脂肪推推荐意1对于肌肉量丢失和肌肉功能减弱的老年在控制总脂肪摄入量的前提下，应增加深海鱼海产品等富含n‐3多不饱和脂肪酸的食物摄入。2推荐EPA+DHA的ADMR为0.25‐2g/d三、维生素维生素对肌肉作用

相关蛋白质合肌肉内

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、维生素推荐意 有必要检测所有肌肉衰减综合征老年内维生素D的水平当老年25（OH）D低于正常值范围时，应予补充。增加户外活动有助于提高老年人维生素D水平，预防肌肉衰减综合征。适当增加海鱼、动物肝脏和蛋黄等维生素D含量较高食物。四、抗氧化营养氧化应激及活性氧自由基产生可能增加老年人肌肉衰减综合征的发生、发展及进程[40]维生素Emg/d维生素C）动干预，显示抗氧化营养素与阻抗训

维生素硒

维生素

有 的研究证实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、抗氧化营养推荐意 鼓励增加深色蔬菜和水果以及豆类等富含抗氧化营养素食，以减少肌肉有关的氧化应激损伤。 适当补充含多种抗氧化营（维生素C、维生素E、类胡萝卜素、硒）的膳食补充剂。五、口服营养补充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.口服营养补充推荐意口服营养补充有助预防虚弱老年人的肌肉衰改善肌肉衰减综合征患者的肌肉量、强度和身体组分。每天在餐间/时或锻炼后额外补充2次营养制剂克富含必需氨基酸或亮氨酸的蛋白质及（）六、运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