Hidetaka Wakabayashi, Department of Rehabilitation Medicine, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami ward, Yokohama, Kanagawa, Japan, Tel: +81-45-261-5656 Fax: +81-45-253-9955, E-mail:
J Nutr Health Aging. 2019;23(3):256-265. doi: 10.1007/s12603-018-1150-1.
Sarcopenia is a very important issue in rehabilitation medicine and nutritional care. The prevalence of sarcopenia in older people is approximately 50% in the rehabilitation setting, and also approximately 15% of inpatients without sarcopenia upon admission developed sarcopenia during hospitalization. There is a concern that secondary sarcopenia may occur iatrogenically during hospitalization. Iatrogenic sarcopenia is defined as sarcopenia caused by the activities of medical staff including doctors, nurses, or other health care professionals in healthcare facilities. Iatrogenic sarcopenia is categorized into activity-related, nutrition-related and disease-related-iatrogenic sarcopenia. Especially in acute phase hospitals, concentrating on the treatment of diseases with less attention to nutrition and activity is more likely to cause iatrogenic sarcopenia. Sarcopenic dysphagia is also an important aspect in rehabilitation medicine and nutritional care. Sarcopenic dysphagia is characterized by swallowing difficulty because of a loss of mass and function in whole-body skeletal and swallowing muscles. Sarcopenic dysphagia can be diagnosed using a 5-step algorithm for the condition. Iatrogenic sarcopenia and sarcopenic dysphagia are affected by nutrition, activity and diseases in a complex manner. Therefore, treatment of iatrogenic sarcopenia and sarcopenic dysphagia requires comprehensive interventions through nutrition management and rehabilitation. Rehabilitation nutrition is effective for preventing and treating iatrogenic sarcopenia and sarcopenic dysphagia. Rehabilitation nutrition can be practiced more effectively and comprehensively by using the rehabilitation nutrition care process, which is a systematic problem-solving method. Further research is required to verify the efficacy of rehabilitation nutrition for preventing or improving iatrogenic sarcopenia and/or sarcopenic dysphagia.
肌肉减少症是康复医学和营养护理中非常重要的问题。在康复环境中，老年人肌肉减少症的患病率约为 50%，而在没有肌肉减少症的住院患者中，约有 15%在住院期间发展为肌肉减少症。人们担心在住院期间可能会发生医源性肌肉减少症。医源性肌肉减少症是指医务人员（包括医生、护士或其他医疗机构中的其他保健专业人员）的活动导致的肌肉减少症。医源性肌肉减少症分为与活动相关、与营养相关和与疾病相关的医源性肌肉减少症。特别是在急性病医院，由于过于注重治疗疾病而较少关注营养和活动，更容易导致医源性肌肉减少症。肌肉减少性吞咽困难也是康复医学和营养护理中的一个重要方面。肌肉减少性吞咽困难的特征是由于全身骨骼和吞咽肌肉的质量和功能丧失而导致吞咽困难。可以使用该疾病的 5 步算法来诊断肌肉减少性吞咽困难。医源性肌肉减少症和肌肉减少性吞咽困难受营养、活动和疾病的复杂影响。因此，治疗医源性肌肉减少症和肌肉减少性吞咽困难需要通过营养管理和康复进行综合干预。康复营养对预防和治疗医源性肌肉减少症和肌肉减少性吞咽困难是有效的。通过使用康复营养护理流程，可以更有效地、更全面地实施康复营养，这是一种系统的解决问题的方法。需要进一步的研究来验证康复营养对预防或改善医源性肌肉减少症和/或肌肉减少性吞咽困难的疗效。
