Hagedoorn Ilse J M, den Braber Niala, Oosterwijk Milou M, Gant Christina M, Navis Gerjan, Vollenbroek-Hutten Miriam M R, van Beijnum Bert-Jan F, Bakker Stephan J L, Laverman Gozewijn D
Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands.
Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7522 NB Enschede, The Netherlands.
J Clin Med. 2020 Sep 25;9(10):3104. doi: 10.3390/jcm9103104.
In order to promote physical activity (PA) in patients with complicated type 2 diabetes, a better understanding of daily movement is required. We (1) objectively assessed PA in patients with type 2 diabetes, and (2) studied the association between muscle mass, dietary protein intake, and PA. Methods We performed cross-sectional analyses in all patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT) between November 2016 and November 2018. Patients were divided into four groups: <5000, 5000-6999, 7000-9999, ≥ 10,000 steps/day. We studied the association between muscle mass (24 h urinary creatinine excretion rate, CER) and protein intake (by Maroni formula), and the main outcome variable PA (steps/day, Fitbit Flex device) using multivariate linear regression analyses.
In the 217 included patients, the median steps/day were 6118 (4115-8638). Of these patients, 48 patients (22%) took 7000-9999 steps/day, 37 patients (17%) took ≥ 10,000 steps/day, and 78 patients (36%) took <5000 steps/day. Patients with <5000 steps/day had, in comparison to patients who took ≥10,000 steps/day, a higher body mass index (BMI) (33 ± 6 vs. 30 ± 5 kg/m, = 0.009), lower CER (11.7 ± 4.8 vs. 14.8 ± 3.8 mmol/24 h, = 0.001), and lower protein intake (0.84 ± 0.29 vs. 1.08 ± 0.22 g/kg/day, < 0.001). Both creatinine excretion (β = 0.26, < 0.001) and dietary protein intake (β = 0.31, < 0.001) were strongly associated with PA, which remained unchanged after adjustment for potential confounders.
Prevalent insufficient protein intake and low muscle mass co-exist in obese patients with low physical activity. Dedicated intervention studies are needed to study the role of sufficient protein intake and physical activity in increasing or maintaining muscle mass in patients with type 2 diabetes.
为促进2型糖尿病并发症患者的身体活动（PA），需要更好地了解日常活动情况。我们（1）客观评估了2型糖尿病患者的身体活动，（2）研究了肌肉量、膳食蛋白质摄入量与身体活动之间的关联。方法：我们对2016年11月至2018年11月纳入糖尿病与生活方式特温特队列（DIALECT）的所有患者进行了横断面分析。患者被分为四组：每天步数<5000步、5000 - 6999步、7000 - 9999步、≥10000步。我们使用多元线性回归分析研究了肌肉量（24小时尿肌酐排泄率，CER）与蛋白质摄入量（通过马罗尼公式计算）之间的关联，以及主要结局变量身体活动（每天步数，Fitbit Flex设备）。
在纳入的217例患者中，每天步数的中位数为6118步（4115 - 8638步）。其中，48例患者（22%）每天步数为7000 - 9999步，37例患者（17%）每天步数≥10000步，78例患者（36%）每天步数<5000步。与每天步数≥10000步的患者相比，每天步数<5000步的患者体重指数（BMI）更高（33±6 vs. 30±5 kg/m²，P = 0.009），CER更低（11.7±4.8 vs. 14.8±3.8 mmol/24 h，P = 0.001），蛋白质摄入量更低（0.84±0.29 vs. 1.08±0.22 g/kg/天，P<0.001）。肌酐排泄（β = 0.26，P<0.001）和膳食蛋白质摄入量（β = 0.31，P<0.001）均与身体活动密切相关，在对潜在混杂因素进行调整后仍保持不变。
身体活动不足的肥胖患者普遍存在蛋白质摄入不足和肌肉量低的情况。需要开展专门的干预研究，以探讨充足的蛋白质摄入和身体活动在增加或维持2型糖尿病患者肌肉量方面的作用。
