失智症之飲食營養狀態與代謝症候群及肌少風險之相關性探討

失智症盛行率持續上升，已造成全球的醫療負擔，且隨著高齡社會，代謝症候群者及肌少症者逐年攀升。本研究目的為失智症之飲食營養狀態與代謝症候群及肌少風險之相關性。本橫斷面研究招募50歲以上之失智症病人，依有無代謝症候群進行分組，收集基本資料與血液檢體分析血液生化值。以生物電阻抗分析法測量體組成，並利用迷你營養評估量表（mini nutritional assessment, MNA）評估營養狀態。以握力、啞鈴彎舉次數、坐姿起立及步行速率評估肌力適能；以SARC-F（strength, assistance with walking, rising from a chair, climbing stairs, and falls）量表及Ishii分數評估肌少風險。本研究共招募76名失智症之研究對象，其中44名為代謝症候群。結果顯示，代謝症候群與無代謝症候群組分別有36.4%與25.0%的研究對象處於營養不良風險；以Ishii分數評估發現分別有63.6%與68.8%的研究對象有肌少風險。代謝症候群組在「過去三個月體重下降1公斤以上」、「每天服用三種以上處方藥物」與「爬10階樓梯時，會感到一些或很困難」的人數比例顯著高於無代謝症候群組(p = 0.02)。在相關性分析結果發現，代謝症候群與全身體脂率、估計內臟脂肪面積及SARC-F分數呈顯著之正相關（p < 0.05）；MNA量表總分與體組成及肌力適能表現具顯著之相關性（p < 0.05）。在飲食攝取方面，蛋白質攝取分數與腹部肥胖、高密度脂蛋白膽固醇異常及SARC-F分數有顯著相關性（p < 0.05）；每天攝取兩份以上蔬菜或水果分數及液體攝取量分數與體組成及肌力適能具顯著之相關性（p < 0.05）。由於失智症合併代謝症候群處於高齡營養不良及肌少風險狀態，故我們建議臨床上應加強對其營養狀況與肌力之監測，以預防肌少症及相關代謝共病之發生。

The prevalence of dementia continues to rise, contributing to a growing global healthcare burden. Alongside this trend, the number of individuals with metabolic syndrome and sarcopenia is also increasing annually in aging societies. The aim of this study was to investigate the relationship between dietary nutritional status and the risks of metabolic syndrome and sarcopenia in individuals with dementia. This cross-sectional study recruited dementia patients aged 50 years and above, who were categorized into groups based on the presence or absence of metabolic syndrome. Basic demographic data and blood samples were collected to assess biochemical parameters. Body composition was evaluated using bioelectrical impedance analysis. Nutritional status was assessed with the mini nutritional assessment (MNA). Muscle strength and endurance were evaluated through handgrip strength, dumbbell curl, sit-to-stand test, and gait speed. Sarcopenia risk was assessed using the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) and Ishii scores. A total of 76 participants with dementia were included, and 44 subjects had metabolic syndrome. A total of 36.4% of patients with metabolic syndrome and 25.0% of those without metabolic syndrome were at risk of malnutrition. According to the Ishii scores, 63.6% and 68.8% of participants with and without metabolic syndrome, respectively, were at risk of sarcopenia. Participants with metabolic syndrome had significantly higher proportions reporting unintentional weight loss (>1 kg in the past 3 months), taking more than three prescribed medications daily, and experiencing difficulty climbing 10 stairs (p = 0.02). Correlation analysis revealed that metabolic syndrome was positively associated with body fat percentage, estimated visceral fat area, and SARC-F scores (p < 0.05). MNA scores were significantly correlated with muscle strength and endurance (p < 0.05). Regarding dietary intake, protein intake scores were significantly associated with abdominal obesity, abnormal high-density lipoprotein cholesterol, and SARC-F scores (p < 0.05). In addition, daily intake of two or more servings of vegetables or fruits and adequate fluid intake scores were significantly associated with body composition and muscle strength and endurance (p < 0.05). In conclusion, patients with dementia with coexisting metabolic syndrome are at increased risk of age-related malnutrition and sarcopenia; therefore, clinical monitoring of nutritional status and muscle strength should be reinforced to prevent the onset of sarcopenia and related metabolic comorbidities.