第2型糖尿病初期慢性腎臟病之飲食營養素攝取與可能肌少症風險之相關性探討

糖尿病患者有較高的風險罹患肌少症，慢性腎臟病亦是肌少症的危險因子。本研究目的為調查第2型糖尿病患者可能肌少症的流行現狀，並探討其與糖尿病初期慢性腎臟病及飲食攝取的關係。本研究為橫斷面研究，招募40至80歲的第2型糖尿病患者，以問卷訪談及病歷蒐集資料，並測量體組成及上下肢肌力。使用SARC-F量表（strength, assistance with walking, rise from a chair, climb stairs, and falls）及SARC-CalF量表（SARC and calf circumference）評估其肌少症風險。另以24小時飲食回憶法評估飲食營養素攝取情形，迷你營養評估量表（Mini Nutritional Assessment, MNA）評估營養狀況。本研究共招募76位研究對象，其中糖尿病組50位，糖尿病合併初期慢性腎臟病組26位。結果顯示，超過五成的糖尿病患者體態過重或肥胖，且糖尿病初期腎臟病組的各項肥胖指標高於糖尿病組（p < 0.05）；而糖尿病組的骨骼肌質量低於糖尿病初期腎臟病組，且低小腿圍的比例較高（p < 0.05）。在肌少風險指標方面，低握力、一年內曾經跌倒及坐姿起立表現不佳的比例，以糖尿病初期腎臟病組較高（p < 0.05）。飲食攝取方面，每公斤體重熱量及蛋白質攝取平均值在糖尿病初期腎臟病組低於糖尿病組；女性糖尿病初期腎臟病組的維生素B2、B6、葉酸及維生素C攝取量顯著低於糖尿病組（p < 0.05），但經熱量校正後則無顯著差異。在相關性分析方面，蛋白質、精胺酸、維生素B1、菸鹼素及B6與SARC-CalF量表呈顯著負相關（p < 0.05）；熱量、蛋白質、特定胺基酸攝取量、維生素B1、菸鹼素及葉酸與肌肉質量呈顯著正相關（p < 0.05）。綜合以上結果得知，營養素攝取與肌少風險及體組成具顯著相關，故我們建議臨床上對於糖尿病患者，應加強監測其熱量及營養素攝取與身體組成（體脂肪率及骨骼肌比例），以預防肥胖與肌少之發生。

Patients with diabetes mellitus are at a higher risk of developing sarcopenia, and chronic kidney disease (CKD) is also a risk factor for sarcopenia. The objective of this study was to investigate the prevalence of possible sarcopenia among patients with type 2 diabetes and to explore its relationship with early-stage CKD and dietary intake. This study was a cross-sectional investigation that recruited patients aged 40 to 80 years with type 2 diabetes, utilizing questionnaire interviews and medical record collection, along with measurements of body composition and four limb muscle strength. The SARC-F scale (strength, assistance with walking, rise from a chair, climb stairs, and falls) and the SARC-CalF scale (SARC and calf circumference) were used to assess the risk of sarcopenia. Additionally, a 24-hour dietary recall method was employed to evaluate nutrient intake, and the Mini Nutritional Assessment was used to assess nutritional status. A total of 76 subjects were recruited for this study, including 50 in the diabetes group and 26 in the diabetes group with early-stage CKD. The results indicated that over 50% of the diabetic patients were overweight or obese, and the obesity indicators in the early-stage CKD group were higher than those in the diabetes group (p < 0.05). Furthermore, the skeletal muscle mass in the diabetes group was lower than that in the early-stage CKD group, with a higher proportion of individuals exhibiting low calf circumference (p < 0.05). In terms of sarcopenia risk indicators, the proportions of low grip strength, falls, and poor performance in sit-to-stand tests were higher in the early-stage CKD group (p < 0.05). Regarding dietary intake, the average caloric and protein intake per kilogram of body weight was lower in the early-stage CKD group than in the diabetes group. Among female patients in the early-stage CKD group, the intake of vitamin B2, B6, folate, and vitamin C was significantly lower than that in the diabetes group (p < 0.05), but there are no significant differences after caloric adjustment. In correlation analyses, protein, arginine, vitamin B1, niacin, and B6 intakes showed significant negative correlations with the SARC-CalF scale (p < 0.05); caloric intake, protein, specific amino acids, vitamin B1, niacin, and folate intakes showed significant positive correlations with muscle mass (p < 0.05). In summary, the results indicated that nutrient intake was significantly associated with sarcopenia risk and body composition. Therefore, we recommended that clinical practice should enhance monitoring of caloric and nutrient intake, as well as body composition (body fat percentage and skeletal muscle mass) in diabetic patients to prevent obesity and the occurrence of sarcopenia.