Clinic of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
Neurological and Neurosurgical Nursing Department, Faculty of Health Sciences, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
J Physiol Pharmacol. 2020 Feb;71(1). doi: 10.26402/jpp.2020.1.02. Epub 2020 Apr 27.
Both obesity and malnutrition leading to cachexia and sarcopenia are relevant risk factors in the development of many diseases. They also increase mortality, also prolong hospitalisations and convalescence, and undoubtedly increase the cost of treatment, mostly in the elderly populations. The aim of the study was to assess the relationship between the levels of leptin and adiponectin with regard to insulin resistance and malnutrition status by studying a senior female population and to evaluate predictors of insulin resistance and malnutrition. A total of 88 elderly females were enrolled prospectively with a median age of 75 years. Anthropometric and biochemical parameters (fasting glucose, insulin, folic acid, vitamin B12 concentrations, lipid profile, complete blood count) were recorded along with a full geriatric assessment, have been made in all participants. A comprehensive nutritional phenotype has been established. Leptin and adiponectin concentrations were measured by applying immunoassay techniques. Lipid profile and other parameters were performed by biochemical methods. We observed significant decreases of albumin, alanine aminotransferase, insulin, and triglycerides concentrations with age. The risk of insulin resistance based on HOMA-IR index was decreased with age. Significantly higher concentrations of leptin, leptin-to-adiponectin ratio (LAR), hsCRP, fasting glucose, insulin in the insulin resistant subgroup in respect of normal sensitivity insulin cases were noted. The concentrations of albumin, aspartate aminotransferase, alanine aminotransferase and total cholesterol were significantly lower in those patients at risk of malnutrition than in the well-nourished subjects. LAR reached the most accurate AUC = 0.705 for insulin resistance prediction, with a cut-off value at 3.85. The greatest diagnostic power was presented by the albumin concentration with AUC = 0.761 and then LAR 0.718 in discriminating between well-nourished patients and those at risk of malnutrition. We suggest that the leptin-to-adiponectin ratio is suitable as a marker of insulin resistance and nutritional status in the elderly.
肥胖和营养不良导致恶病质和肌肉减少症，是许多疾病发生的相关危险因素。它们还会增加死亡率，延长住院时间和康复时间，无疑会增加治疗成本，尤其是在老年人群中。本研究旨在通过研究老年女性人群，评估瘦素和脂联素水平与胰岛素抵抗和营养不良状态之间的关系，并评估胰岛素抵抗和营养不良的预测因素。共前瞻性纳入 88 名老年女性，中位年龄为 75 岁。记录所有参与者的人体测量和生化参数（空腹血糖、胰岛素、叶酸、维生素 B12 浓度、血脂谱、全血细胞计数）以及全面的老年评估。建立了全面的营养表型。应用免疫测定技术测量瘦素和脂联素浓度。通过生化方法测定血脂谱和其他参数。我们观察到白蛋白、丙氨酸氨基转移酶、胰岛素和甘油三酯浓度随年龄显著下降。基于 HOMA-IR 指数的胰岛素抵抗风险随年龄降低。在胰岛素抵抗亚组中，与正常胰岛素敏感性病例相比，瘦素、瘦素与脂联素比值（LAR）、hsCRP、空腹血糖和胰岛素浓度显著升高。与营养良好的受试者相比，有营养不良风险的患者白蛋白、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶和总胆固醇浓度显著降低。LAR 预测胰岛素抵抗的 AUC 值最高为 0.705，截断值为 3.85。白蛋白浓度的诊断能力最强，AUC 值为 0.761，其次是 LAR（0.718），可区分营养良好的患者和有营养不良风险的患者。我们认为，瘦素与脂联素的比值适合作为老年患者胰岛素抵抗和营养状态的标志物。
