Perna Simone, Peroni Gabriella, Faliva Milena Anna, Bartolo Arianna, Naso Maurizio, Miccono Alessandra, Rondanelli Mariangela
Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona di Pavia, University of Pavia, Via Emilia 12, Pavia, Italy.
Department of Clinical Sciences, Faculty of Medicine and Surgery, University of Milano, Milan, Italy.
Aging Clin Exp Res. 2017 Dec;29(6):1249-1258. doi: 10.1007/s40520-016-0701-8. Epub 2017 Feb 23.
The aim of this study is to identify the prevalence, assess the metabolic profile, and key differences (versus healthy) in a cohort of subjects with sarcopenia (S) and in sarcopenic obesity (SO) hospitalized elderly.
A standardized comprehensive geriatric assessment was performed. We enrolled 639 elderly subjects (196 men, 443 women) with a mean age of 80.90 ± 7.77 years. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences between groups.
The prevalence of (S) was 12.42% in women and 23.47% in men. (SO) was 8.13% in women and 22.45% in men. Data showed that either groups had a functional impairment (Barthel index < 50 points). (S) had the mean value of erythrocyte sedimentation rate (ESR) (>15 mm/h), CPR (>0.50 mg/dl) homocysteine (>12 micromol/l), and hemoglobin (<12 g/dl). Ferritin level over the range (>145 mcg/dl) was detected in either cohort (due to inflammation). (SO) had glycemia (>110 mg/dl). Key differences in (S) cohort (versus healthy) were a reduction in functional impairment (p < 0.001), an increase in white blood cell (p < 0.01), a decrease in iron level (p < 0.05), in electrolytes balance (Na: p < 0.01 and Cl: p < 0.01), and tyroid function (TSH: p < 0.001). In addition, (S) had higher state of inflammation (erythrocyte sedimentation rate: p < 0.05 and C-reactive protein: p < 0.01), and an increase of risk of fractures (FRAX: OR 1.07; p < 0.001), risk of malnutrition (mini nutritional assessment: p < 0.001), and risk of edema (extra cellular water: p < 0.001). In (SO) cohort, an increase in white blood cell (p < 0.001) and erythrocyte sedimentation rate (p < 0.05) was observed.
(S) subjects appears more vulnerable than (SO). Sarcopenia is closely linked to an increase in the risk of hip-femur fractures, inflammation, edema, and malnutrition. The (SO) subjects seem to benefit from the "obesity paradox."
本研究旨在确定住院老年肌少症（S）患者和肌少症肥胖（SO）患者的患病率，评估其代谢状况以及与健康人群的关键差异。
进行了标准化的综合老年评估。我们纳入了639名老年受试者（196名男性，443名女性），平均年龄为80.90±7.77岁。采用方差分析和调整协变量的多项逻辑回归分析来评估组间差异。
女性中S的患病率为12.42%，男性为23.47%。女性中SO的患病率为8.13%，男性为22.45%。数据显示两组均存在功能障碍（Barthel指数<50分）。S组的红细胞沉降率（ESR）（>15mm/h）、C反应蛋白（CPR）（>0.50mg/dl）、同型半胱氨酸（>12微摩尔/升）和血红蛋白（<12g/dl）均值较高。两组均检测到铁蛋白水平超出范围（>145微克/分升）（由于炎症）。SO组血糖（>110mg/dl）较高。S组（与健康人群相比）的关键差异在于功能障碍减少（p<0.001）、白细胞增加（p<0.01）、铁水平降低（p<0.05）、电解质平衡（钠：p<0.01，氯：p<0.01）和甲状腺功能（促甲状腺激素：p<0.001）。此外，S组炎症状态较高（红细胞沉降率：p<0.05，C反应蛋白：p<0.01），骨折风险增加（FRAX：OR 1.07；p<0.001）、营养不良风险增加（微型营养评定：p<0.001）和水肿风险增加（细胞外液：p<0.001）。在SO组中，观察到白细胞增加（p<0.001）和红细胞沉降率增加（p<0.05）。
S组受试者似乎比SO组更脆弱。肌少症与髋部骨折、炎症、水肿和营养不良风险增加密切相关。SO组受试者似乎受益于“肥胖悖论”。
