de Jong N, Chin A Paw M J, de Groot L C, de Graaf C, Kok F J, van Staveren W A
Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, Dreÿenlaan 6703 HA Wageningen, The Netherlands.
J Nutr. 1999 Nov;129(11):2028-36. doi: 10.1093/jn/129.11.2028.
A decline in dietary intake due to inactivity and, consequently, development of a suboptimal nutritional status is a major problem in frail elderly people. However, benefits of micronutrient supplementation, all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly. A 17-wk randomized controlled trial was performed in 145 free-living frail elderly people (43 men, 102 women, mean age, 78 +/- 5.7 y). Based on a 2 x 2 factorial design, subjects were assigned to one of the following: 1) nutrient-dense foods, 2) exercise, 3) both (1) and (2) or 4) a control group. Foods were enriched with micronutrients, frequently characterized as deficient [25-100% of the recommended daily allowance (RDA)] in elderly people. Exercises focused on skill training, including strength, endurance, coordination and flexibility. Dietary intake, blood vitamin levels and nutritional and health indicators, including (pre)albumin, ferritin, transferrin, C-reactive protein, hemoglobin and lymphocytes were measured. At baseline, 28% of the total population had an energy intake below 6.3 MJ, up to a maximum of 93% having vitamin intakes below two thirds of the Dutch RDA. Individual deficiencies in blood at baseline ranged from 3% for erythrocyte glutathione reductase-alpha to 39% for 25-hydroxy vitamin D and 42% for vitamin B-12. These were corrected after 17 wk in the two groups receiving the nutrient-dense foods, whereas no significant changes were observed in the control or exercise group. Biochemical and hematologic indicators at baseline were within the reference ranges (mean albumin, 46 g/L; prealbumin, 0.25 g/L; hemoglobin, 8.6 mmol/L) and were not affected by any of the interventions. The long-term protective effects of nutrient supplementation and exercise, by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values, require further investigation. Other indicative functional variables for suboptimal nutritional status, in addition to those currently selected, should also be explored.
因活动减少导致饮食摄入量下降，进而出现营养状况欠佳，这是体弱老年人面临的一个主要问题。然而，微量营养素补充、全面体育锻炼或两者结合对体弱老年受试者营养和健康状况的功能生化及血液学指标的益处尚未得到充分测试。对145名自由生活的体弱老年人（43名男性，102名女性，平均年龄78±5.7岁）进行了一项为期17周的随机对照试验。基于2×2析因设计，受试者被分配到以下组之一：1）营养丰富的食物组，2）运动组，3）同时进行（1）和（2）的组或4）对照组。食物中富含微量营养素，这些微量营养素在老年人中常被认为缺乏[占推荐每日摄入量（RDA）的25 - 100%]。运动侧重于技能训练，包括力量、耐力、协调性和灵活性。测量了饮食摄入量、血液维生素水平以及营养和健康指标，包括（前）白蛋白、铁蛋白、转铁蛋白、C反应蛋白、血红蛋白和淋巴细胞。在基线时，总人群中有28%的能量摄入量低于6.3兆焦耳，维生素摄入量低于荷兰RDA三分之二的比例最高可达93%。基线时血液中的个体缺乏情况从红细胞谷胱甘肽还原酶-α的3%到25-羟基维生素D的39%以及维生素B-12的42%不等。在接受营养丰富食物的两组中，这些情况在17周后得到了纠正，而对照组或运动组未观察到显著变化。基线时的生化和血液学指标在参考范围内（平均白蛋白46克/升；前白蛋白0.25克/升；血红蛋白8.6毫摩尔/升），且不受任何干预措施的影响。通过维持最佳营养水平从而降低出现临界生化值的初始几率，营养补充和运动的长期保护作用需要进一步研究。除了目前所选的指标外，还应探索其他表明营养状况欠佳的功能性变量。
