林以勤LIN, YI-CHIN陳姿伶CHEN, ZI-LINGZI-LINGCHEN營養學系碩士班2026-03-242026-08-0120242024-07-09https://handle.ncl.edu.tw/11296/u69zg9https://scholars.csmu.edu.tw/handle/123456789/7182肌少症(sarcopenia)是一種與年齡相關的漸進式、全身性骨骼肌肉質量與功能下降之老年症候群，會增加跌倒、骨折、行動不良、失能及死亡率。目前對於肌少症並無有效的藥物治療，主要為改善日常飲食攝取狀況、體能活動及生活型態，以延緩年齡增加而導致之肌肉質量與力量流失。膝骨關節炎(knee osteoarthritis, KOA)為一種不可逆的膝關節內部軟骨組織隨年齡增長而漸進式退化之疾病，好發於40歲以上成年人，亦是導致全球慢性疼痛與行動不良之首要因素。慢性低度發炎可能為肌少症和膝骨關節炎之共同危險因子；隨著年齡進展使身體組成改變，全身和四肢肌肉量漸進流失，脂肪組織則日增，增加促發炎激素之合成，飲食與生活型態成為預防肌肉量流失及膝關節發炎之重要方法。本研究之目的為探討我國40歲以上中老年族群其飲食及生活型態等相關因子與肌少症和膝骨關節炎之相關性。本研究於中山醫學大學附設醫院家醫科門診招募93位40歲以上自述未確診過嚴重特殊傳染性肺炎(Coronavirus Disease 2019, COVID-19)之中老年人，以雙能量X光吸收儀(dual-energy X-ray absorptiometry, DXA)進行體組成和骨質檢測，並進行雙膝關節正面和側面X光攝影、體位測量、血液生化值檢測、肌少症功能性指標評估（包含小腿圍、手握力、五次起坐、30秒起坐、六公尺與六分鐘步行測試）及臨床量表篩檢，以結構式問卷蒐集受試者之飲食與生活型態等資料。本研究結果顯示符合肌少症定義占26.88%，患膝骨關節炎之總比例為45.16%。隨著膝骨關節炎等級增加，手握力(p=0.0304)、30秒起坐次數(p=0.0360)呈顯著下降，而五次起坐秒數則呈顯著上升(p=0.0092)。對年齡淨相關之飲食攝取，全榖雜糧、油脂與堅果種子之總攝取量與手握力呈顯著正相關(p<0.05)；豆魚蛋肉、豆類、蛋類及水果之總攝取量對於下肢肌力表現有正面幫助(p<0.05)；蔬菜之總攝取量亦與六分鐘總步行距離呈顯著正相關(p<0.05)。此外，富含鈣及維生素D食物對於下肢肌力表現亦有保護作用，特別是植物性鈣來源食物(p<0.05)。進一步分析營養素發現，維生素C攝取量與30秒起坐次數呈顯著正相關(p<0.05)；礦物質鈣、鎂和鐵之攝取量與四肢肌肉質量指數(appendicular skeletal muscle mass index, ASMI)呈顯著正相關(p<0.05)，其中鎂之攝取亦與小腿圍和手握力呈顯著正相關(p<0.05)。經邏輯式迴歸分析後，年齡(OR:1.064, 95%CI:1.016-1.115)、BMI(OR:0.714, 95%CI:0.583-0.874)、豆魚蛋肉總攝取量(OR:0.936, 95%CI:0.895-0.978)為肌少症之顯著預測因子；年齡(OR:1.127, 95%CI:1.069-1.188)、手握力(OR:0.942, 95%CI:0.897-0.990)為膝骨關節炎之顯著預測因子。生活型態方面，患肌少症及非肌少症兩組間之飲酒行為呈顯著差異(p=0.0287)，肌少症者有較高比例幾乎從不飲酒，而兩組間之體能活動量、睡眠時數、日光曝曬分數及吸菸習慣則無觀察到統計顯著差異。本研究觀察到中老年人隨著年齡增長罹患肌少症和膝蓋骨關節炎之風險呈上升之情形，且膝骨關節炎越嚴重其手握力和下肢肌力表現越差。較低總熱量、全榖雜糧、豆魚蛋肉、水果、油脂與堅果種子、植物性鈣來源食物、維生素C、鈣、鎂、鐵及體能活動缺乏與肌少症罹患風險相關。而較多的蛋類及動物性鈣來源食物攝取與膝骨關節炎罹患風險相關。透過本研究結果發現，肌少症者之血清白蛋白(albumin, Alb)、25-羥基維生素D[25-hydroxyvitamin D, 25(OH)D]濃度低於非肌少症者。於臨床上建議中老年人應定期監測與評估營養相關因子狀態，包含Alb、25(OH)D濃度以及肌肉質量與功能指標篩檢，因此較佳飲食營養素攝取與營養狀態及生活型態有助於膝關節及肌肉功能。Sarcopenia is a geriatric syndrome characterized by an age-related, progressive, and systemic decline in skeletal muscle mass and function. Sarcopenia has been linked to increased risk of falls, fractures, impaired mobility, disability, and mortality. Currently, there is no effective drug treatment for sarcopenia. The primary approach is to improve dietary intake, physical activity and lifestyle to slow down the age-related loss of muscle mass and strength. Knee osteoarthritis (KOA) is an irreversible disease characterized by the progressive degeneration of the articular cartilage with age. KOA not only commonly affects adults over 40 years old but also is a primary cause of chronic pain and impaired mobility worldwide. It has indicated that chronic low-grade inflammation may be a common risk factor for sarcopenia and KOA. As age advances, changes occur in body composition characterized by gradual loss of muscle mass in both the whole body and limbs, accompanied by increasing adipose tissue, which promotes inflammatory cytokine synthesis. Diet and lifestyle become crucial in preventing muscle loss and knee joint inflammation. Therefore, the purpose of this study was to explore the correlation between dietary intake and lifestyle factors and sarcopenia and KOA in middle-aged and elderly adults.The study was conducted between September 2022 A total of 93 middle-aged and older adults, aged 40 years or above, who self-reported that they had not been diagnosed with Coronavirus disease 2019 were recruited from the outpatient clinic of the Department of Family Medicine in Chung Shan Medical University Hospital. Body compositions including bone mass was measured by dual-energy X-ray absorptiometry. Other examinations included bilateral knee joint anterior-posterior and lateral X-ray imaging, anthropometric measurements, blood sample collection, functional assessment of sarcopenia including calf circumference, hand grip strength, five times sit-to stand test, chair-stand test in thirty seconds, six-meter and six-minute walk test and clinical assessment scales. Dietary intake of foods and nutrients and lifestyle-related information were obtained from structured frequency questionnaire and 24-hour dietary recall. The results showed that 26.88% of the participants met the criteria for sarcopenia, while the overall proportion of those with KOA was 45.16%. As the grade of knee osteoarthritis increased, hand grip strength (p=0.0304) and the number of chair-stand test in thirty seconds (p=0.0360) significantly decreased, but the seconds of five times sit-to-stand test significantly increased (p=0.0092). For age-adjusted dietary intake, the total consumption of whole grains, oils, fats, nuts and seeds showed a significant positive correlation with hand grip strength (p<0.05). Consumption of legumes, fish, eggs and meats and fruits were significantly positively correlated with lower limb muscle strength performance (p<0.05), and the consumption of vegetables was significantly positively correlated with six-minute walking distance (p<0.05). In addition, foods rich in calcium and vitamin D also exert a protective effect on lower limb muscle strength performance, especially those from plant-based sources of calcium (p<0.05). Further analysis of nutrient intake revealed significant positive correlations between vitamin C intake and the number of chair stand test in thirty seconds (p<0.05). Intakes of calcium, magnesium and iron were significantly positively correlated with appendicular skeletal muscle mass index (p<0.05), whereas magnesium intake was also significantly positively correlated with calf circumference and hand grip strength (p<0.05). In logistic regression analysis, Age (OR:1.064, 95%CI:1.016-1.115), BMI (OR:0.714, 95%CI:0.583-0.874), total consumption of legumes, fish, eggs and meats (OR:0.936, 95%CI:0.895-0.978) were significant predictors to sarcopenia. In logistic regression analysis, Age (OR:1.127, 95%CI:1.069-1.188) and hand grip strength (OR:0.942, 95%CI:0.897-0.990) were significant predictors to KOA. There was a significant difference in alcohol consumption between the sarcopenia and non-sarcopenia groups (p=0.0287), with a higher proportion of sarcopenic individuals almost never consuming alcohol, whereas no statistically significant differences were observed between the two groups in terms of physical activity level, sleep duration, sun exposure score, and smoking habits. In conclusion, we observed that the risk of sarcopenia and KOA increases with age in middle-aged and elderly adults. Additionally, the severity of KOA seems to be associated with poorer handgrip strength and lower limb muscle strength. A lower intake of total calories, whole grains, legumes, fish, eggs and meat, fruits, oils, fats, nuts and seeds, plant calcium source, vitamin C, calcium, magnesium, iron, as well as a lack of physical activity, is associated with an increased risk of sarcopenia. On the other hand, a higher intake of eggs and animal calcium source is associated with an increased risk of KOA. This study found that subjects with sarcopenia have lower serum levels of albumin (Alb) and 25-hydroxyvitamin D [25(OH)D] compared to those non-sarcopenia. It is clinically recommended that middle-aged and elderly adults regularly monitor and assess the status of nutrition-related factors, including serum Alb and 25(OH)D levels, as well as screening for muscle mass and functional indicators. Therefore, better dietary nutrient intake, nutritional status and lifestyle can help improve knee joint health and muscle function.肌少症膝骨關節炎飲食營養素生活型態sarcopeniaknee osteoarthritisdietary nutrientslifestylethesis