Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Section of Integrative Physiology and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Maturitas. 2024 Jul;185:107975. doi: 10.1016/j.maturitas.2024.107975. Epub 2024 Mar 21.
As populations age, chronic diseases accumulate, and new health conditions emerge. One noteworthy pair that warrants further evaluation is diabetes mellitus and sarcopenia, given that the latter occurs in 28 % of the population aged over 50 who have diabetes mellitus. The management of both entails nutritional interventions, making the development of unified dietary recommendations an alluring strategy. This review aims to elucidate the current recommendations for the combined management of sarcopenia and diabetes, while featuring elements that require further research. The goal of nutritional management is to improve muscle mass and strength while regulating metabolic risk and glucose levels. To ensure muscle synthesis in the elderly, recommendations align at daily calorie intake that exceeds 30 kcal/kg, with adjustments based on comorbidities. Additionally, a protein intake of at least 1-1.2 g/kg/d is essential, emphasizing both daily and per-meal intake, and can be achieved through diet or branched-amino-acids supplements. Specific considerations for diabetes include restricted protein intake in diabetic nephropathy and exploring the potential link between branched amino acids and insulin resistance. Further recommendations that both promote metabolic health and have demonstrated at least a potential to increase muscle strength include prioritizing polyunsaturated fatty acids as a fat source and maintaining adequate levels of vitamin D. Clinicians should consult their patients on dietary optimization, but evidence is insufficient to recommend additional supplementation. Lastly, an emerging challenge of diabetes and sarcopenia is sarcopenic obesity, which requires the combination of a hypocaloric diet with increased protein intake.
随着人口老龄化、慢性病积累以及新的健康问题出现，糖尿病和肌少症这一对需要进一步评估的疾病值得关注。因为在 50 岁以上患有糖尿病的人群中，有 28%的人会出现肌少症。这两种疾病的管理都需要营养干预，因此制定统一的饮食建议是一种诱人的策略。本文旨在阐明目前关于肌少症和糖尿病联合管理的建议，并突出需要进一步研究的内容。营养管理的目标是改善肌肉质量和力量，同时调节代谢风险和血糖水平。为了确保老年人的肌肉合成，建议每天的卡路里摄入量超过 30kcal/kg，并根据合并症进行调整。此外，每天摄入至少 1-1.2g/kg/d 的蛋白质至关重要，强调每天和每餐的摄入量，可以通过饮食或支链氨基酸补充剂来实现。对于糖尿病患者，具体考虑因素包括糖尿病肾病患者限制蛋白质摄入和探索支链氨基酸与胰岛素抵抗之间的潜在联系。此外，还有一些既能促进代谢健康又能增加肌肉力量的建议，包括优先选择多不饱和脂肪酸作为脂肪来源和保持足够的维生素 D 水平。临床医生应该就饮食优化问题咨询患者，但目前证据还不足以推荐额外的补充剂。最后，糖尿病和肌少症的一个新挑战是肌少症性肥胖，这需要低热量饮食与增加蛋白质摄入相结合。
