慢性阻塞性肺病與肌少症之飲食攝取與營養狀態評估：病例對照研究

慢性阻塞性肺病為全球重要的健康議題，疾病引起的蛋白質分解、營養不良，使肌少症可能繼發於慢性阻塞性肺病。本研究目的為探討慢性阻塞性肺病與肌少症之飲食攝取量與營養狀態及衰弱肌少之相關性。本研究以病例對照組之研究設計，分別招募年齡40歲以上有無慢性阻塞性肺病之成年人，收集基本資料與血液生化數值，並測量其身體組成與肌耐力。以衰弱量表、SARC-F（strength, assistance with walking, rising from a chair, climbing stairs, and falls）、SARC-CalF（strength, assistance with walking, rising from a chair, climbing stairs, falls, and calf circumference）及Ishii分數評估其衰弱肌少狀態。另以迷你營養評估量表（mini nutritional assessment, MNA）、營養風險指數（nutritional risk index, NRI）及血清白蛋白評估營養狀態；以24小時飲食回憶法評估飲食營養素攝取情形。本研究招募111名研究對象，其中51位為慢性阻塞性肺病者，60位為對照組。結果顯示，慢性阻塞性肺病且有肌少症組之MNA量表總分、NRI指數與血清白蛋白濃度顯著低於無肌少症者及對照組（p < 0.05）；而在SARC-F、SARC-CalF及Ishii分數則顯著高於無肌少症者及對照組（p < 0.01）。在飲食營養素攝取方面，慢性阻塞性肺病且有肌少症者於熱量、粗蛋白、次亞麻油酸、支鏈胺基酸、維生素B1及鉀之攝取量顯著低於無肌少症者（p < 0.05）。在相關性分析結果顯示，研究對象之熱量和三大營養素之攝取量與MNA量表總分呈顯著正相關（p < 0.05）；另熱量、三大營養素及支鏈胺基酸之攝取量與Ishii分數呈顯著之負相關（p < 0.01）。由以上結果得知，慢性阻塞性肺病合併肌少症者處於營養不良風險狀態，且熱量、巨量營養素（尤其是蛋白質、支鏈胺基酸）及微量營養素之攝取量顯著低於無肌少症者。研究對象之飲食營養素攝取量與其營養狀況及肌少症風險間有顯著之相關性。建議未來可著重於如何透過營養介入改善慢性阻塞性肺病患者的肌少症情況，以預防或改善其肌少症或營養不良之有效性。

Chronic obstructive pulmonary disease (COPD) is a global health issue and it may induce protein catabolism and malnutrition, leading to sarcopenia. The purpose of this study was to investigate the correlation between dietary intake and nutrition and the risk of frailty and sarcopenia in COPD. This study was designed as a case-control study, and we recruited adults over 40 years old with and without COPD. The demographic and hematological data were collected in the study. We measured the participants’ body composition and muscle endurance. The SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (strength, assistance with walking, rising from a chair, climbing stairs, falls, and calf circumference), and Ishii scores were used to assess frailty and sarcopenic status. The mini nutritional assessment (MNA), nutritional risk index (NRI), and serum albumin level were used to assess the nutritional status. The 24-hour dietary recall was used to assess dietary intake. A total of 111 subjects were recruited in the present study, 51 participants were COPD and 60 without COPD participants were in the control group. The results showed that the participants with COPD and sarcopenia had significantly lower values for MNA score, NRI, and serum albumin level than those without sarcopenia and control groups (p < 0.05); meanwhile, participants with COPD and sarcopenia had significantly higher values for SARC-F, SARC-Calf, and Ishii scores than those without sarcopenia and control groups (p < 0.01). Regarding dietary data, participants with COPD and sarcopenia had significantly lower intake of calories, protein, -linolenic acid, branched-chain amino acids, vitamin B1, and potassium than those without sarcopenia (p < 0.05). In addition, the MNA score was significantly positively correlated with the intake of calories, protein, carbohydrate, and fat (p < 0.05); and the Ishii score was significantly negatively correlated with the intake of calories, protein, carbohydrate, fat, and branched-chain amino acids (p < 0.01). In conclusion, participants with COPD and sarcopenia seem to suffer from the risk of malnutrition and sarcopenia, which is associated to a lower intake of calories, protein (branched-chain amino acids), and micro-nutrients. Future studies should conduct nutritional interventions to evaluate their effectiveness in preventing sarcopenia and malnutrition in COPD.