サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムは筋力及び身体機能を改善させる
目的：サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムの，筋力，身体機能，及び骨格筋量への影響を検証すること．方法：伊勢赤十字病院，糖尿病代謝内科に通院している65歳以上の糖尿病患者を対象とした．サルコペニアの診断はAsian Working Group for Sarcopenia 2019を元に行った．四肢骨格筋量の測定は多周波生体電気インピーダンス法，筋力は握力，身体機能は5回椅子立ち上がり検査でそれぞれ評価した．多面的治療プログラム（蛋白質摂取量の適正化，レジスタンストレーニング，及びサルコペニアに関する患者教育）開始前と12週後に，筋力，身体機能，四肢骨格筋指数，及びその他...
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| Published in | 日本老年医学会雑誌 Vol. 58; no. 1; pp. 143 - 151 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
25.01.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.58.143 |
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| Abstract | 目的：サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムの，筋力，身体機能，及び骨格筋量への影響を検証すること．方法：伊勢赤十字病院，糖尿病代謝内科に通院している65歳以上の糖尿病患者を対象とした．サルコペニアの診断はAsian Working Group for Sarcopenia 2019を元に行った．四肢骨格筋量の測定は多周波生体電気インピーダンス法，筋力は握力，身体機能は5回椅子立ち上がり検査でそれぞれ評価した．多面的治療プログラム（蛋白質摂取量の適正化，レジスタンストレーニング，及びサルコペニアに関する患者教育）開始前と12週後に，筋力，身体機能，四肢骨格筋指数，及びその他パラメーターを評価し，前後比較した．統計処理には対応のあるt検定を用いた．結果：14例（男性3人，女性11人）が本研究の解析対象となった．平均年齢は74.4±4.7歳であった．多面的治療プログラムにより，握力（男性：23.2±5.6 kgから25.6±5.5 kg，P=0.014，女性：15.5±5.0 kgから18.9±5.0 kg，P＜0.001），及び5回椅子立ち上がりテスト（11.2±2.5秒から8.6±1.7秒，P＝0.002）の有意な改善を認めた．また，HbA1c（8.1±0.7%から7.7±0.9%，P＝0.004）の有意な低下も認められた．一方，四肢骨格筋指数の増加傾向はあったものの有意差は認めなかった．結論：サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムにより，筋力及び身体機能の改善が認められた． |
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| AbstractList | 目的：サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムの，筋力，身体機能，及び骨格筋量への影響を検証すること．方法：伊勢赤十字病院，糖尿病代謝内科に通院している65歳以上の糖尿病患者を対象とした．サルコペニアの診断はAsian Working Group for Sarcopenia 2019を元に行った．四肢骨格筋量の測定は多周波生体電気インピーダンス法，筋力は握力，身体機能は5回椅子立ち上がり検査でそれぞれ評価した．多面的治療プログラム（蛋白質摂取量の適正化，レジスタンストレーニング，及びサルコペニアに関する患者教育）開始前と12週後に，筋力，身体機能，四肢骨格筋指数，及びその他パラメーターを評価し，前後比較した．統計処理には対応のあるt検定を用いた．結果：14例（男性3人，女性11人）が本研究の解析対象となった．平均年齢は74.4±4.7歳であった．多面的治療プログラムにより，握力（男性：23.2±5.6 kgから25.6±5.5 kg，P=0.014，女性：15.5±5.0 kgから18.9±5.0 kg，P＜0.001），及び5回椅子立ち上がりテスト（11.2±2.5秒から8.6±1.7秒，P＝0.002）の有意な改善を認めた．また，HbA1c（8.1±0.7%から7.7±0.9%，P＝0.004）の有意な低下も認められた．一方，四肢骨格筋指数の増加傾向はあったものの有意差は認めなかった．結論：サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムにより，筋力及び身体機能の改善が認められた． |
| Author | 東, 謙太郎 白倉, 由隆 村田, 和也 大久保, 薫 金児, 竜太郎 今高, 加奈子 藤原, 僚子 勝田, 真衣 井田, 諭 |
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| References | 21) Yamada M, Arai H: Predictive Value of Frailty Scores for Healthy Life Expectancy in Community-Dwelling Older Japanese Adults. J Am Med Dir Assoc 2015; 16 (11): 1002.e7-1002.11. 28) Ibáñez J, Gorostiaga EM, Alonso AM, Forga L, Argüelles I, Larrión JL, et al.: Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complications 2008; 22 (2): 112-118. 9) Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, et al.: Health ABC Study. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 2008; 87 (1): 150-155. 11) Zhu LY, Chan R, Kwok T, Cheng KC, Ha A, Woo J: Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: a randomized controlled trial. Age Ageing 2019; 48 (2): 220-228. 7) Sinclair AJ, Abdelhafiz AH, Rodriguez-Manas L: Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complications 2017; 31 (9): 1465-1473. 4) Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al.: Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48 (1): 16-31. 12) Lee J, Kim D, Kim C: Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis. Diabetes Ther 2017; 8 (3): 459-473. 16) Toyoshima K, Araki A, Tamura Y, Iritani O, Ogawa S, Kozaki K, et al.: Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions. Geriatr Gerontol Int 2018; 18 (10): 1458-1462. 8) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al.: Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6): 393-403. 6) Sinclair A, Dunning T, Rodriguez-Manas L: Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015; 3 (4): 275-285. 15) Van Ancum JM, Meskers CGM, Reijnierse EM, Yeung SSY, Jonkman NH, Trappenburg MC, et al.: Lack of Knowledge Contrasts the Willingness to Counteract Sarcopenia Among Community-Dwelling Adults. J Aging Health 2019; 898264319852840. 2) 日本糖尿病学会・日本老年医学会編・著: 高齢者糖尿病治療ガイド2018, 文光堂, 東京, 2018. 14) Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I: Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci 2012; 67 (11): 1259-1265. 26) Hsu KJ, Liao CD, Tsai MW, Chen CN: Effects of Exercise and Nutritional Intervention on Body Composition, Metabolic Health, and Physical Performance in Adults with Sarcopenic Obesity: A Meta-Analysis. Nutrients 2019; 11 (9): 2163. 10) Bao W, Sun Y, Zhang T, Zou L, Wu X, Wang D, et al.: Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis. Aging Dis 2020; 11 (4): 863-873. 23) Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A: Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005; 21 (4): 498-503. 27) Cohen J: Statistical Power Analyses for Behavioral Sciences, ed 2, Lawrence Erlbaum, Hillsdale, 1988, chapt 2. 17) Ida S, Murata K, Nakadachi D, Ishihara Y, Imataka K, Uchida A, et al.: Development of a Japanese version of the SARC-F for diabetic patients: an examination of reliability and validity. Aging Clin Exp Res 2017; 29 (5): 935-942. 20) Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14 (5): 377-381. 18) 日本糖尿病学会 (編): 糖尿病治療ガイド2018-2019, 文光堂, 2018. 19) サルコペニア・フレイルを合併したCKDの食事療法検討ワーキンググループ: 日本腎臓学会 サルコペニア・フレイルを合併した保存期CKDの食事療法の提言. 日本透析医学会雑誌 2019; 52 (7): 401-431. 3) Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L: Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care 2015; 38 (1): 82-90. 24) Tsuchiya A, Ikeda S, Ikegami N, Nishimura S, Sakai I, Fukuda T, et al.: Estimating an EQ-5D population value set: the case of Japan. Health Econ 2002; 11 (4): 341-353. 29) Therkelsen KE, Pedley A, Hoffmann U, Fox CS, Murabito JM: Intramuscular fat and physical performance at the Framingham Heart Study. Age (Dordr) 2016; 38 (2): 31. 13) Chen SM, Shen FC, Chen JF, Chang WD, Chang NJ: Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial. Int J Environ Res Public Health 2019; 17 (1): 224. 5) Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al.: Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21 (3): 300-307.e2. 25) Ishii S, Chang C, Tanaka T, Kuroda A, Tsuji T, Akishita M, et al.: The Association between Sarcopenic Obesity and Depressive Symptoms in Older Japanese Adults. PLoS One 2016; 11 (9): e0162898. 30) Beaudry KM, Devries MC: Nutritional Strategies to Combat Type 2 Diabetes in Aging Adults: The Importance of Protein. Front Nutr 2019; 6: 138. 1) World Health Organisation (WHO): Global Report on Diabetes. Geneva: World Health Organisation, 2016. http://www.who.int. (accessed 2020-8-1). 22) Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y: Measurement of competence: reliability and validity of the TMIG Index of Competence. Arch Gerontol Geriatr 1991; 13 (2): 103-116. |
| References_xml | – reference: 6) Sinclair A, Dunning T, Rodriguez-Manas L: Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol 2015; 3 (4): 275-285. – reference: 19) サルコペニア・フレイルを合併したCKDの食事療法検討ワーキンググループ: 日本腎臓学会 サルコペニア・フレイルを合併した保存期CKDの食事療法の提言. 日本透析医学会雑誌 2019; 52 (7): 401-431. – reference: 30) Beaudry KM, Devries MC: Nutritional Strategies to Combat Type 2 Diabetes in Aging Adults: The Importance of Protein. Front Nutr 2019; 6: 138. – reference: 1) World Health Organisation (WHO): Global Report on Diabetes. Geneva: World Health Organisation, 2016. http://www.who.int. (accessed 2020-8-1). – reference: 7) Sinclair AJ, Abdelhafiz AH, Rodriguez-Manas L: Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complications 2017; 31 (9): 1465-1473. – reference: 9) Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, et al.: Health ABC Study. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 2008; 87 (1): 150-155. – reference: 10) Bao W, Sun Y, Zhang T, Zou L, Wu X, Wang D, et al.: Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis. Aging Dis 2020; 11 (4): 863-873. – reference: 2) 日本糖尿病学会・日本老年医学会編・著: 高齢者糖尿病治療ガイド2018, 文光堂, 東京, 2018. – reference: 13) Chen SM, Shen FC, Chen JF, Chang WD, Chang NJ: Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial. Int J Environ Res Public Health 2019; 17 (1): 224. – reference: 4) Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al.: Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48 (1): 16-31. – reference: 24) Tsuchiya A, Ikeda S, Ikegami N, Nishimura S, Sakai I, Fukuda T, et al.: Estimating an EQ-5D population value set: the case of Japan. Health Econ 2002; 11 (4): 341-353. – reference: 23) Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A: Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition 2005; 21 (4): 498-503. – reference: 21) Yamada M, Arai H: Predictive Value of Frailty Scores for Healthy Life Expectancy in Community-Dwelling Older Japanese Adults. J Am Med Dir Assoc 2015; 16 (11): 1002.e7-1002.11. – reference: 14) Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I: Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci 2012; 67 (11): 1259-1265. – reference: 25) Ishii S, Chang C, Tanaka T, Kuroda A, Tsuji T, Akishita M, et al.: The Association between Sarcopenic Obesity and Depressive Symptoms in Older Japanese Adults. PLoS One 2016; 11 (9): e0162898. – reference: 26) Hsu KJ, Liao CD, Tsai MW, Chen CN: Effects of Exercise and Nutritional Intervention on Body Composition, Metabolic Health, and Physical Performance in Adults with Sarcopenic Obesity: A Meta-Analysis. Nutrients 2019; 11 (9): 2163. – reference: 5) Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al.: Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21 (3): 300-307.e2. – reference: 20) Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14 (5): 377-381. – reference: 27) Cohen J: Statistical Power Analyses for Behavioral Sciences, ed 2, Lawrence Erlbaum, Hillsdale, 1988, chapt 2. – reference: 15) Van Ancum JM, Meskers CGM, Reijnierse EM, Yeung SSY, Jonkman NH, Trappenburg MC, et al.: Lack of Knowledge Contrasts the Willingness to Counteract Sarcopenia Among Community-Dwelling Adults. J Aging Health 2019; 898264319852840. – reference: 17) Ida S, Murata K, Nakadachi D, Ishihara Y, Imataka K, Uchida A, et al.: Development of a Japanese version of the SARC-F for diabetic patients: an examination of reliability and validity. Aging Clin Exp Res 2017; 29 (5): 935-942. – reference: 3) Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L: Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care 2015; 38 (1): 82-90. – reference: 22) Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y: Measurement of competence: reliability and validity of the TMIG Index of Competence. Arch Gerontol Geriatr 1991; 13 (2): 103-116. – reference: 8) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al.: Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346 (6): 393-403. – reference: 11) Zhu LY, Chan R, Kwok T, Cheng KC, Ha A, Woo J: Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: a randomized controlled trial. Age Ageing 2019; 48 (2): 220-228. – reference: 16) Toyoshima K, Araki A, Tamura Y, Iritani O, Ogawa S, Kozaki K, et al.: Development of the Dementia Assessment Sheet for Community-based Integrated Care System 8-items, a short version of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items, for the assessment of cognitive and daily functions. Geriatr Gerontol Int 2018; 18 (10): 1458-1462. – reference: 18) 日本糖尿病学会 (編): 糖尿病治療ガイド2018-2019, 文光堂, 2018. – reference: 29) Therkelsen KE, Pedley A, Hoffmann U, Fox CS, Murabito JM: Intramuscular fat and physical performance at the Framingham Heart Study. Age (Dordr) 2016; 38 (2): 31. – reference: 28) Ibáñez J, Gorostiaga EM, Alonso AM, Forga L, Argüelles I, Larrión JL, et al.: Lower muscle strength gains in older men with type 2 diabetes after resistance training. J Diabetes Complications 2008; 22 (2): 112-118. – reference: 12) Lee J, Kim D, Kim C: Resistance Training for Glycemic Control, Muscular Strength, and Lean Body Mass in Old Type 2 Diabetic Patients: A Meta-Analysis. Diabetes Ther 2017; 8 (3): 459-473. |
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| Title | サルコペニア合併高齢糖尿病患者に対する多面的治療プログラムは筋力及び身体機能を改善させる |
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| ispartofPNX | 日本老年医学会雑誌, 2021/01/25, Vol.58(1), pp.143-151 |
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