Gaglio Alessia, Grancini Valeria, Giacchetti Federico, Mirani Marco, Orsi Emanuela, Resi Veronica
Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.
Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
Nutrients. 2025 Jan 2;17(1):172. doi: 10.3390/nu17010172.
Globally, the progressive increase in the aging population has led to social and health problems associated with age-related chronic diseases, such as type 2 diabetes mellitus (T2DM) and sarcopenia. Recent studies have highlighted that sarcopenia and diabetes have a bidirectional relationship. Nutritional therapy is a key element in the treatment of both sarcopenia and diabetes. To date, there are no nutritional guidelines for the management of sarcopenia in T2DM. The aim of this study was to evaluate the efficacy of a muscle-targeted nutritional intervention in older people with sarcopenia and type 2 diabetes based on the Italian nutrition guidelines.
A total of 211 subjects (117 M and 94 F) affected by T2DM with a mean age of 74 ± 6.0 years were screened for sarcopenia, using EWGSOP2 diagnosis criteria, and enrolled to receive personalized dietary plans with two main targets: a daily energy intake of 25-30 kcal/kg body weight and a daily protein intake of at least 1.1-1.2 g/kg body weight.
In total, 34 subjects (24 M and 10 F) were sarcopenic with a prevalence of 16%, which was higher in men. After six months of treatment, handgrip strength increased by 0.83 kg (19.57 ± 5.70 kg vs. 20.40 ± 6.10 kg, = 0.649), protein intake improved (0.91 ± 0.28 g/kg body weight vs. 1.03 ± 0.40 g/kg body weight, = 0.115), and the glycated hemoglobin decreased (7.39 ± 0.49% to 6.82 ± 0.98%, = 0.010). Seven younger subjects had an improvement of sarcopenia with a decrease in HbA1c (7.50 ± 0.59% vs. 6.91 ± 0.79, = 0.19). The difference over time in the consumption of saturated fatty acids (OR 0.6, 95% CI 0.33-1.09, = 0.096) and simple sugars (OR 0.91, 95% CI 0.80-1.01, = 0.090) appeared to be associated with an improvement of sarcopenia status. A total of 177 subjects did not meet the criteria for a diagnosis of sarcopenia, and 148 subjects were assessed. The handgrip strength (26.22 ± 9.36 vs. 26.18 ± 9.24 kg, p0.974) and the glycated hemoglobin (7.21 ± 1.07 vs. 7.27 ± 0.98%, = 0.735) remained stable over time, while protein intake at six months increased (0.81 ± 0.29 vs. 0.91 ± 0.29 g/kg body weight, = 0.024). Four people were diagnosed with sarcopenia at follow-up, with a lower handgrip strength test result. These subjects were older and had worse glycemic control (HbA1c + 0.5%).
Lifestyle modification is important to prevent or reverse the development of the disease. Nutritional therapy in this population is therefore aimed at meeting all nutritional needs and promoting better glycemic control, in terms of glycated hemoglobin, in order to reduce the development of sarcopenia. Although promising, the intervention requires validation in larger studies with control groups.
在全球范围内，人口老龄化的逐步加剧引发了与年龄相关的慢性疾病相关的社会和健康问题，如2型糖尿病（T2DM）和肌肉减少症。最近的研究强调，肌肉减少症和糖尿病存在双向关系。营养治疗是肌肉减少症和糖尿病治疗的关键要素。迄今为止，尚无针对T2DM患者肌肉减少症管理的营养指南。本研究的目的是根据意大利营养指南，评估针对肌肉减少症和2型糖尿病老年人的肌肉靶向营养干预的疗效。
使用EWGSOP2诊断标准，对总共211名平均年龄为74±6.0岁的T2DM患者（117名男性和94名女性）进行肌肉减少症筛查，并纳入接受个性化饮食计划，该计划有两个主要目标：每日能量摄入量为25-30千卡/千克体重，每日蛋白质摄入量至少为1.1-1.2克/千克体重。
共有34名受试者（24名男性和10名女性）患有肌肉减少症，患病率为16%，男性患病率更高。治疗六个月后，握力增加了0.83千克（19.57±5.70千克对20.40±6.10千克，P=0.649），蛋白质摄入量有所改善（0.91±0.28克/千克体重对1.03±0.40克/千克体重，P=0.115），糖化血红蛋白降低（7.39±0.49%至6.82±0.98%，P=0.010）。七名较年轻的受试者肌肉减少症有所改善，糖化血红蛋白降低（7.50±0.59%对6.91±0.79，P=0.19）。饱和脂肪酸（比值比0.6，95%置信区间0.33-1.09，P=0.096）和单糖（比值比0.91，95%置信区间0.80-1.01，P=0.090）随时间的消耗量差异似乎与肌肉减少症状态的改善有关。共有177名受试者不符合肌肉减少症的诊断标准，对其中148名受试者进行了评估。握力（26.22±9.36对26.18±9.24千克，P>0.974）和糖化血红蛋白（7.21±1.07对7.27±0.98%，P=0.735）随时间保持稳定，而六个月时蛋白质摄入量增加（0.81±0.29对0.91±0.29克/千克体重，P=0.024）。四名受试者在随访时被诊断为肌肉减少症，握力测试结果较低。这些受试者年龄较大，血糖控制较差（糖化血红蛋白高0.5%）。
改变生活方式对于预防或逆转疾病发展很重要。因此，该人群的营养治疗旨在满足所有营养需求，并在糖化血红蛋白方面促进更好的血糖控制，以减少肌肉减少症的发生。尽管该干预措施很有前景，但需要在有对照组的更大规模研究中进行验证。
