摘要： 背景 衰弱會(huì)增加老年人健康相關(guān)負(fù)面結(jié)果的風(fēng)險(xiǎn)，蛋白質(zhì)補(bǔ)充可能是一個(gè)有效改善衰弱的途徑，但目前關(guān)于蛋白質(zhì)補(bǔ)充對(duì)衰弱的影響尚有分歧。 目的 系統(tǒng)評(píng)價(jià)蛋白質(zhì)補(bǔ)充對(duì)衰弱/衰弱前期老年人肌肉質(zhì)量、肌肉力量和身體功能的影響。 方法 全面系統(tǒng)檢索中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)、維普網(wǎng)、PubMed、Web of Science、Embase、Cochrane Library、CINAHL、Medline各數(shù)據(jù)庫(kù)建庫(kù)至2022年6月發(fā)表的蛋白質(zhì)補(bǔ)充對(duì)衰弱/衰弱前期老年人肌肉質(zhì)量、肌肉力量和身體功能等方面影響的隨機(jī)對(duì)照試驗(yàn)。篩選文獻(xiàn)，對(duì)符合納排標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)、數(shù)據(jù)提取，并采用RevMan 5.4進(jìn)行Meta分析，以探討蛋白質(zhì)補(bǔ)充對(duì)衰弱/衰弱前期老年人肌肉質(zhì)量、肌肉力量和身體功能等方面的影響。且對(duì)于肌肉力量（握力）這一結(jié)局指標(biāo)，因報(bào)道文獻(xiàn)較多，本研究還根據(jù)蛋白質(zhì)補(bǔ)充量（<30 g/d亞組和≥30 g/d亞組）、衰弱狀態(tài)（衰弱前期亞組、衰弱期亞組、衰弱及衰弱前期亞組）、衰弱評(píng)估工具〔衰弱表型評(píng)估工具（FP）亞組和非FP亞組〕、人群（亞洲人亞組和歐洲人亞組）、平均年齡（70~<75歲亞組、75~<80歲亞組和80~<85歲亞組）進(jìn)行亞組分析，以進(jìn)一步探討不同亞組的蛋白質(zhì)補(bǔ)充對(duì)握力的影響。 結(jié)果 最終納入12篇文獻(xiàn)（2篇文獻(xiàn)為衰弱前期，3篇文獻(xiàn)為衰弱，7篇文獻(xiàn)為衰弱及衰弱前期），共833例衰弱/衰弱前期老年人，其中蛋白補(bǔ)充組422例、對(duì)照組411例。Meta分析結(jié)果顯示，蛋白質(zhì)補(bǔ)充可以提高衰弱/衰弱前期老年人步行速度〔MD=0.03，95%CI（0，0.06），P=0.05〕，但在改善衰弱/衰弱前期老年人肌肉質(zhì)量（四肢瘦體質(zhì)量）、肌肉力量（握力）、其他身體功能（平衡能力、站立行走試驗(yàn)、簡(jiǎn)易體能狀況量表評(píng)分）和衰弱評(píng)分方面，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；人群亞組分析顯示，亞洲人亞組的蛋白質(zhì)補(bǔ)充對(duì)握力的影響與歐洲人亞組相比，差異有統(tǒng)計(jì)學(xué)意義（χ2=5.76，P=0.02）。 結(jié)論 蛋白質(zhì)補(bǔ)充可以提高衰弱老年人的步行速度，但在改善其肌肉質(zhì)量、力量和其他身體功能方面未顯示明顯優(yōu)勢(shì)。建議進(jìn)一步開(kāi)展更長(zhǎng)補(bǔ)充時(shí)長(zhǎng)、不同蛋白質(zhì)類型、不同補(bǔ)充量、不同地區(qū)人群對(duì)不同衰弱狀態(tài)老年人影響的研究，以期尋找最佳的蛋白質(zhì)補(bǔ)充模式，為衰弱管理提供更充分的循證依據(jù)。

關(guān)鍵詞: 衰弱, 老年人, 蛋白質(zhì), 肌肉質(zhì)量, 肌肉力量, 身體功能, Meta分析

Abstract:

Background

Frailty can increase the risk of negative health-related outcomes in older adults. Protein supplementation may be an effective way to improve frailty, but there is disagreement about its effects on frailty.

Objective

To systematically evaluate the effects of protein supplementation on muscle mass, strength, and physical function in frail/pre-frail older adults.

Methods

Electronic databases of CNKI, Wanfang Data, CQVIP, PubMed, Embase, Web of Science, Cochrane Library, CINAHL and Medline were retrieved for randomized controlled trials (RCTs) of the effects of protein supplementation on muscle mass, strength and physical function in frail/pre-frail older adults published from inception to June 2022. After literature screening, the quality of eligible RCTs was evaluated, and from which relevant data were extracted. RevMan 5.4 was performed to explore the effects of protein supplementation on muscle mass, muscle strength and physical function in frail/pre-frail older adults. And for the outcome indicator of muscle strength (grip strength) , due to large amount of reported literature, this study will be based on the amount of protein supplementation (<30 g/d subgroup and≥30 g/d subgroup) , frailty status (pre-frailty subgroup, frailty subgroup, frailty and pre-frailty subgroup) , frailty assessment tool 〔frailty phenotype assessment tool (FP) subgroup and non-FP subgroup〕, population (Asian subgroup and European subgroup) , and mean age (70-<75 years subgroup, 75-<80 years subgroup, and 80-<85 years subgroup) for subgroup analysis to further explore the effect of protein supplementation on grip strength in different subgroups.

Results

A total of 12 RCTs were included (2 literatures for pre-frailty, 3 literatures for frailty, 7 literatures for frailty and pre-frailty) , with a total of 833 older adults (422 in the protein supplementation group and 411 in the control group) . Meta-analysis results showed that protein supplementation improved gait speed in frail/pre-frail older adults〔MD=0.03, 95%CI (0, 0.06) , P=0.05〕, but in improving muscle mass (appendicular lean mass) , muscle strength (grip strength) , other physical functions (assessment results of balance test, the timed up and go test, Short Physical Performance Battery) and frailty scores, the differences were not statistically significant (P>0.05) . The results of subgroup analysis showed that the effect of protein supplementation on the grip strength of the Asian population subgroup was significantly different from that of the European population subgroup in between-group comparisons (χ2=5.76, P=0.02) .

Conclusion

Protein supplementation may improve gait speed in frail/pre-frail older adults, but it does not show a significant advantage in improving their muscle mass, muscle strength and other physical functions. It is recommended to further investigate the effects of longer durations of supplementation, different types of protein supplemented, different amounts of supplementation and different regional populations on older adults with different frailty states, in order to find the best pattern of protein supplementation and provide a more sufficient evidence-based basis for frailty management.

Key words: Frailty, Aged, Protein, Muscle mass, Muscle strength, Physical function, Meta-analysis

相關(guān)知識(shí)

中國(guó)老人蛋白質(zhì)攝入偏少，專家提醒警惕老年性衰弱
老年人怎樣增強(qiáng)肌肉力量？
對(duì)抗肌肉衰老，澳維諾持續(xù)引領(lǐng)健康力
老年人怎樣增強(qiáng)肌肉力量？｜提素養(yǎng) 促健康
肌肉生長(zhǎng)與年齡無(wú)關(guān)，提高肌肉質(zhì)量，保持年輕體態(tài)與健康身體
「健康」長(zhǎng)點(diǎn)肌肉抗衰老！收好這份“全年齡增肌”指南
老年人優(yōu)質(zhì)蛋白：健康長(zhǎng)壽的關(guān)鍵密碼
11種優(yōu)質(zhì)蛋白的力量：揭秘塑造完美體態(tài)和健康體質(zhì)的秘密武器
補(bǔ)充蛋白質(zhì)?別依賴蛋白粉
蛋白質(zhì)也分“種類”？哪種蛋白質(zhì)最適合老年人食用？醫(yī)生說(shuō)出實(shí)情

網(wǎng)址: 蛋白質(zhì)補(bǔ)充對(duì)衰弱/衰弱前期老年人肌肉質(zhì)量和肌肉力量以及身體功能影響的Meta分析 http://m.u1s5d6.cn/newsview139583.html