糖尿病肌少症的營養照護

10.6666/ClinMed.201811_82(5).0117

邱哲琳；楊雀戀

肌少症（sarcopenia） ； 糖尿病（type 2 diabetes mellitus） ； 白胺酸（leucine）

臨床醫學月刊

82卷5期（2018 / 11 / 30）

642 - 645

繁體中文

肌少症與糖尿病盛行率均隨著老化上升，而兩者的發生有交互關聯，且都是造成高齡者失能重要因子，進而使生活功能及品質變差，跌倒、認知功能障礙與死亡風險等增加，因此高齡糖尿病肌少症是值得關注的健康議題。糖尿病肌少症的發生與身體肌肉量、胰島素阻抗性、糖化終產物、慢性發炎、血管病變與肥胖等因子有關，預防與治療目標為減少肌肉流失、加強肌力強度、增加胰島素敏感性、改善肥胖以及血糖控制等。營養照護上建議攝取充足的蛋白質為1-1.2公克/公斤，平均分配在三餐，並多選擇富含白胺酸的食材，及富含抗氧化物質的蔬果與全穀雜糧類、維持適當的體位、維生素D濃度偏低每日補充維生素D700-1000IU，以改善慢性發炎與提高胰島素敏感性，促進肌肉合成與功能。良好飲食及血糖控制與規律運動可有效預防與改善糖尿病肌少症。

1. Bauer, J,Biolo, G,Cederholm, T(2013).Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group.J Am Med Dir Assoc,14,542-559.
2. Bischoff-Ferrari, HA,Dawson-Hughes, B,Staehelin, HB(2009).Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials.BMJ,339,b3692.
3. Bischoff-Ferrari, HA,Dietrich, T,Orav, EJ(2004).Higher 25-hydroxyvitamin D concentrations are associated with betterlower-extremity function in both active and inactive persons aged > or =60 y.Am J Clin Nutr,80,752-758.
4. Cesari, M,Pahor, M,Bartali, B(2004).Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study.Am J Clin Nutr,79,289-294.
5. DeFronzo, RA,Tripathy, D.(2009).Skeletal muscle insulin resistance is the primary defect in type 2 diabetes.Diabetes Care,32,S157-S163.
6. Grady, D,Halloran, B,Cummings, S(1991).1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial.J Clin Endocrinol Metab,73,1111-1117.
7. Jang, HC(2016).Sarcopenia, Frailty, and Diabetes in Older Adults.Diabetes Metab J,40,182-189.
8. Katsanos, CS,Kobayashi, H,Sheffield-Moore, M(2006).A high proportion of leucine is required for optimal stimulation of the rate of muscle protein synthesis by essential amino acids in the elderly.Am J Physiol Endocrinol Metab,291,E381-E387.
9. Kelley, DE,He, J,Menshikova, EV,Ritov(2002).Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes.Diabetes,51,2944-2950.
10. Koo, BK,Roh, E,Yang, YS(2016).Difference between old and young adults in contribution of β-cell function and sarcopenia in developing diabetes mellitus.J Diabetes Investig,7,233-240.
11. Lauretani, F,Semba, RD,Bandinelli, S(2008).Low plasma carotenoids and skeletal muscle strength decline over 6 years.J Gerontol A Biol Sci Med Sci,63,376-383.
12. Leenders, M,van Loon, LJ(2011).Leucine as a pharmaconutrient to prevent and treat sarcopenia and type 2 diabetes.Nutr Rev.,69,675-689.
13. Paddon-Jones, D,Rasmussen, BB(2009).Dietary protein recommendations and the prevention of sarcopenia.Curr Opin Clin Nutr Metab Care,12,86-90.
14. Park, SW,Goodpaster,Strotmeyer, ES(2007).Accelerated loss of skeletal muscle strength in older adults with type2diabetes: the health, aging, and body composition study.Diabetes Care,30,1507-1512.
15. Payne, GW(2006).Effect of inflammation on the aging microcirculation: Impact on skeletal muscle blood flow control.Microcirculation,13,343-352.
16. Storlien, L,Oakes, ND,Kelley, DE(2004).Metabolic flexibility.Proc Nutr Soc,63,363-368.
17. Tae Nyun, K,Man Sik, P,Sae Jeong, Y(2010).Prevalence and Determinant Factors of Sarcopenia in Patients With Type 2 Diabetes: The Korean Sarcopenic Obesity Study (KSOS).Diabetes Care,33,1497-1499.
18. Taotao, W,Xiao, F,Jingjing, Z(2016).Type 2 diabetes mellitus is associated with increased risks of sarcopenia and pre-sarcopenia in Chinese elderly.Sci Rep,6,38937.

1. 黃靖惠(Jing-Huei Huang);林佩昭(Pei-Chao Lin)(2023)。運用周全性老年評估於一位急性低血糖老年人之護理經驗。高雄護理雜誌。40(1)。142-152。