Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
Clin Nutr. 2018 Dec;37(6 Pt A):2029-2035. doi: 10.1016/j.clnu.2017.09.010. Epub 2017 Sep 23.
BACKGROUND & AIMS: Intestinal insufficiency and intestinal failure are conditions associated with malabsorption of micro- and macronutrients. Consequently, malnutrition and ensuing alterations in body composition are common in this context and patients may have an increased risk of progressive loss of skeletal muscle mass and function (i.e. sarcopenia). We investigated the prevalence of sarcopenia in patients with intestinal insufficiency and intestinal failure and identified associated risk factors.
This was a cross-sectional study including 113 clinically stable outpatients with intestinal insufficiency or intestinal failure. Body composition was assessed using bioelectrical impedance analysis and muscle function (strength or performance) using a handheld dynamometer and a timed up-and-go test. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People criteria. Several parameters, including smoking, alcohol, and concurrent morbidities, were analyzed for association with sarcopenia.
The prevalence of sarcopenia was 53.1% (95% CI; 43.8 to 62.2) in the combined patient group. In patients with intestinal failure the prevalence of sarcopenia was 72.7% (95% CI; 59.3 to 83.0) compared to 34.5% (95% CI; 23.3 to 47.8) in those with intestinal insufficiency (OR 5.07 [95% CI; 2.27 to 11.31]; p < 0.001). Excessive alcohol consumption (OR 7.69 [95% CI; 1.50 to 39.34]; p = 0.014), intestinal failure (OR 4.16 [95% CI; 1.69 to 10.28]; p = 0.002), and inflammatory activity (OR 3.83 [95% CI; 1.06 to 12.84]; p = 0.041), were identified as independent risk factors of sarcopenia. A trend was observed for hypermetabolism in multivariate analysis (OR 7.55 [95% CI; 0.79 to 72.03]; p = 0.079).
Patients with intestinal insufficiency and intestinal failure are at immense risk of developing sarcopenia. Associated risk factors are excessive alcohol consumption, intestinal failure, and inflammatory activity.
肠吸收不良和肠衰竭是与微营养素和宏营养素吸收不良相关的病症。因此，营养不良和随之而来的身体成分改变在这种情况下很常见，患者可能有进行性骨骼肌质量和功能丧失（即肌少症）的风险增加。我们调查了肠吸收不良和肠衰竭患者中肌少症的患病率，并确定了相关的危险因素。
这是一项横断面研究，纳入了 113 例临床稳定的肠吸收不良或肠衰竭门诊患者。使用生物电阻抗分析评估身体成分，使用手持测力计和计时起立行走测试评估肌肉功能（力量或表现）。使用欧洲老年人肌少症工作组标准对肌少症进行分类。分析包括吸烟、饮酒和并存的合并症在内的多个参数，以评估与肌少症的关联。
在合并患者组中，肌少症的患病率为 53.1%（95%CI；43.8 至 62.2）。在肠衰竭患者中，肌少症的患病率为 72.7%（95%CI；59.3 至 83.0），而在肠吸收不良患者中为 34.5%（95%CI；23.3 至 47.8）（比值比 5.07[95%CI；2.27 至 11.31]；p<0.001）。过度饮酒（比值比 7.69[95%CI；1.50 至 39.34]；p=0.014）、肠衰竭（比值比 4.16[95%CI；1.69 至 10.28]；p=0.002）和炎症活动（比值比 3.83[95%CI；1.06 至 12.84]；p=0.041）被确定为肌少症的独立危险因素。在多变量分析中，观察到高代谢呈趋势（比值比 7.55[95%CI；0.79 至 72.03]；p=0.079）。
肠吸收不良和肠衰竭患者有发生肌少症的巨大风险。相关的危险因素是过度饮酒、肠衰竭和炎症活动。
