Hwang An-Chun, Zhan Yu-Rui, Lee Wei-Ju, Peng Li-Ning, Chen Liang-Yu, Lin Ming-Hsien, Liu Li-Kuo, Chen Liang-Kung
From the Center for Geriatrics and Gerontology (A-cH, Y-RZ, L-NP, L-YC, M-HL, L-KL, L-KC), Taipei Veterans General Hospital; Department of Rehabilitation Medicine (Y-RZ), Taipei City Hospital Hoping Fuyou Branch; Department of Family Medicine (W-JL), Taipei Veterans General Hospital Yuanshan Branch; Aging and Health Research Center (A-cH, W-JL, L-NP, L-YC, M-HL, L-KL, L-KC); and Institute of Public Health (A-cH, W-JL, L-NP, L-YC, L-KC), National Yang Ming University, Taipei, Taiwan.
Medicine (Baltimore). 2016 May;95(22):e3809. doi: 10.1097/MD.0000000000003809.
The objective of this study is to explore the impact of aging and daily physical activities (PA) on muscle mass and muscle strength among community-dwelling people in Taiwan.The design is a cross-sectional study. Setting is a population-based community study.One thousand eight hundred thirty-nine community-dwelling people aged 50 years and older in Taiwan participated in the study.Measurements include demographic characteristics, Charlson Comorbidity Index (CCI) for multimorbidity, mini-nutritional assessment (MNA) for nutritional evaluation, functional autonomy measurement system (SMAF) for functional capacity, Chinese version mini mental state examination (MMSE), 5-item Taiwan Geriatric Depression Scale (TGDS-5), Chinese version of International Physical Activity Questionnaire (IPAQ), height-adjusted skeletal muscle index (SMI) by dual-energy X-ray absorptiometry, handgrip strength, timed 6-m walking test for usual gait speed. Laboratory measurements include testosterone, sex-hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), high-sensitivity C-reactive protein (hsCRP), 25-OH vitamin D, and insulin resistance.After adjusted for age, the lowest PA tertile was associated with multimorbidity, poorer functional capacity and nutritional status, more depressive symptoms, lower SMI and lower handgrip strength, and lower free androgen index (FAI) in men. The negative association between PA and low SMI was more significant among subjects aged younger than 65 and the association decreased with older age. For subjects aged younger than 65, moderate daily PA (Q2) group had lower risk of low SMI compared with Q1 participants (OR: 0.62, 95% CI = 0.39-0.98, P = 0.040). For muscle strength, higher daily PA was associated with lower risk of low handgrip strength after age of 65 and the effect was dose-dependent. The effect was attenuated by potential confounders during age 65 to 74, while after age 75, the result was almost unchanged in fully adjusted model (OR = 0.37, 95% CI = 0.18-0.79, P = 0.010).Older age may attenuate the protective effects of higher daily PA on preventing muscle loss, but higher daily PA continues to preserve muscle strength at different age groups, even after the age of 75. The prognostic role of daily PA may be mediated by muscle strength instead of muscle mass among people aged 75 years and older.
本研究的目的是探讨衰老和日常身体活动(PA)对台湾社区居民肌肉质量和肌肉力量的影响。该研究为横断面研究。研究背景是一项基于人群的社区研究。1839名年龄在50岁及以上的台湾社区居民参与了该研究。测量指标包括人口统计学特征、用于评估多种疾病的Charlson合并症指数(CCI)、用于营养评估的简易营养评估法(MNA)、用于评估功能能力的功能自主性测量系统(SMAF)、中文版简易精神状态检查表(MMSE)、5项台湾老年抑郁量表(TGDS - 5)、中文版国际体力活动问卷(IPAQ)、通过双能X线吸收法测量的身高调整骨骼肌指数(SMI)、握力、用于测量日常步速的6米定时步行测试。实验室测量指标包括睾酮、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEA - S)、胰岛素样生长因子 - 1(IGF - 1)、高敏C反应蛋白(hsCRP)、25 - 羟基维生素D和胰岛素抵抗。在对年龄进行调整后,最低PA三分位数与多种疾病、较差的功能能力和营养状况、更多的抑郁症状、较低的SMI和握力以及男性较低的游离雄激素指数(FAI)相关。PA与低SMI之间的负相关在65岁以下的受试者中更为显著,且这种相关性随年龄增长而降低。对于65岁以下的受试者,中度日常PA(Q2)组与Q1参与者相比,低SMI风险较低(OR:0.62,95%CI = 0.39 - 0.98,P = 0.040)。对于肌肉力量,65岁以后,较高的日常PA与低握力风险较低相关,且这种影响呈剂量依赖性。在65至74岁期间,潜在混杂因素会减弱这种影响,而在75岁以后,在完全调整模型中结果几乎不变(OR = 0.37,95%CI = 0.18 - 0.79,P = 0.010)。年龄较大可能会减弱较高日常PA对预防肌肉流失的保护作用,但较高的日常PA在不同年龄组中仍能维持肌肉力量,即使在75岁以后也是如此。在75岁及以上的人群中,日常PA的预后作用可能是通过肌肉力量而非肌肉质量来介导的。