Kim YS, Lee Y, Chung YS, Lee DJ, Joo NS, Hong D, Song GE, Kim HJ, Choi YJ, Kim KM: Prevalence of Sarcopenia and Sarcopenic Obesity in the Korean Population Based on the Fourth Korean National Health and Nutritional Examination Surveys. J Gerontol A Biol Sci Med Sci. 2012 Mar 19. [Epub ahead of print]





BACKGROUND: Sarcopenia is an important factor of functional impairment related to aging. This study is conducted to investigate the prevalence of sarcopenia and sarcopenic obesity in Korean population.

METHODS: Representative Korean men (4,486) and women (5,999) aged 20 years or older were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Sarcopenia was classified into Class I defined relative skeletal muscle mass loss within 1-2 SD of the gender-specific mean for healthy young adults and Class II below 2 SD. Relative skeletal muscle mass was represented by the appendicular skeletal muscle mass adjusted by height and body weight. Sarcopenic obesity was considered present in Class II sarcopenic participants whose waist circumference was more than or equal to 90 cm for men and more than or equal to 85 cm for women, respectively.

RESULTS: The prevalence of Class II sarcopenia in the Korean elderly population was 12.4% for men and 0.1% for women by height-adjusted definition and 9.7% for men and 11.8% for women by weight-adjusted definition. The prevalence of sarcopenic obesity was 7.6% for men and 9.1% for women by weight-adjusted definition but nearly zero for men and women by height-adjusted definition. The prevalence of sarcopenia increased with age for men but for women only when applied with weight-adjusted definition.

CONCLUSIONS: The prevalence of sarcopenia and sarcopenic obesity differs by gender and definition criteria. The height-adjusted definition may tend to underestimate the prevalence of sarcopenia and sarcopenic obesity, especially in women.



Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A, Russo A, Bernabei R, Onder G: Prevalence and risk factors of sarcopenia among nursing home older residents. J Gerontol A Biol Sci Med Sci. 2012 Jan;67(1):48-55.

サルコペニアの診断基準は下記のように、European Working Group on Sarcopenia in Older People (EWGSOP)のものを用いています。筋肉量低下はBIA、筋力低下は握力、身体機能低下は4m歩行速度で評価しています。




BACKGROUND AND AIMS: Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, there are no data on sarcopenia in nursing home population. We evaluated the prevalence of sarcopenia and its association with functional and clinical status in a population of elderly persons aged 70 years and older living in nursing homes.

METHODS: This study was conducted selecting all the participants (n = 122) living in the teaching nursing homes of Catholic University of Rome who were aged 70 years and older from August 1, 2010, to September 30, 2010. The European Working Group on Sarcopenia in Older People (EWGSOP) criteria were adopted. Accordingly, diagnosis of sarcopenia required the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance.

RESULTS: Forty residents (32.8%) were identified as affected by sarcopenia. The multivariate logistic regression analysis showed a high increase in risk of sarcopenia for male residents (odds ratio [OR] 13.39; 95% confidence interval [CI] 3.51-50.63) and for residents affected by cerebrovascular disease (OR 5.16; 95% CI 1.03-25.87) or osteoarthritis (OR 7.24; 95% CI 2.02-25.95). Residents who had a body mass index higher than 21 kg/m(2) had a lower risk to be sarcopenic (OR 0.76; 95% CI 0.64-0.90) relative to those with body mass index less than 21 kg/m(2). Similarly, sarcopenia was less likely to be present among participants involved in leisure physical activity for 1 hour or more per day (OR 0.40; 95% CI 0.12-0.98).

CONCLUSIONS: The present study suggests that among participants living in nursing homes, sarcopenia is highly prevalent and it is more represented among male residents (68%) than among female residents (21%). Our findings support the hypothesis that muscle mass is strongly associated with nutritional status and physical activity in nursing homes, too.




Irwin H. Rosenberg. Sarcopenia: Origins and Clinical Relevance. J. Nutr. May 1, 1997 vol. 127 no. 5 990S-991S






This presentation reflects on the origins of the term sarcopenia. The Greek roots of the word are sarx for flesh and penia for loss. The term actually describes important changes in body composition and related functions. Clearly defining sarcopenia will allow investigators to appropriately classify patients and examine underlying pathogenic mechanisms and will allow funding agencies to appropriately target research funds to a taxonomically distinct syndrome.





Botella-Carretero JI, Iglesias B, Balsa JA, Zamarrón I, Arrieta F, Vázquez C: Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. JPEN J Parenter Enteral Nutr. 2008 Mar-Apr;32(2):120-8.






BACKGROUND: Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications. However, tolerability of supplements could be a limitation, and their universal use is not supported by the heterogeneity of previous studies, especially in patients without malnutrition.

METHODS: This study is a randomized, controlled, open, parallel, 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day, energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day, or no intervention in normally nourished or mildly undernourished patients. Outcomes were serum albumin, prealbumin, retinol-binding globulin, and body mass index, among others. Postoperative complications were also recorded.

RESULTS: Ninety patients aged 83.8 +/- 6.6 years were included. The mean ingested amount of supplements was 41.1% +/- 20.6% in the protein powder supplement group and 51.4% +/- 13.2% in the energy protein supplement group (t = 2.278, P = .027). Postoperative supplements had no effect on the nutrition status during in-hospital follow-up, as assessed by serum albumin (P = .251), prealbumin (P = .530), retinol-binding globulin (P = .552), or body mass index (P = .582). Multivariate analysis showed that length of hospital stay with an established complication until its resolution (beta = .230, P = .031), total hospital stay (beta = .450, P < .001), baseline body mass index (beta = .204, P = .045), and total daily ingested proteins per body weight (beta = .252, P = .018) were predictive variables on the change in serum albumin (R2 = 0.409, F = 11.246, P < .001).

CONCLUSIONS: Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture submitted to surgery may be of interest for patients with postoperative complications and long hospital stays



Botella-Carretero JI, Iglesias B, Balsa JA, Arrieta F, Zamarrón I, Vázquez C: Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clin Nutr. 2010 Oct;29(5):574-9.








まず一次アウトカムを検査値のみとしていることが問題です。栄養状態(MNA、SGAなど)やADL、歩行能力の変化を一次アウトカムとすべきでしょう。今回はこれらの変化は明確にされていませんが、おそらく大きな変化は認めなかったものと思われます。ベースラインのMNAは対照群18.8点、介入群18.5点とAt riskです。





BACKGROUND: Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients. This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients. Whether perioperative administration of these products is also effective and suitable is not known.

METHODS: Randomized, controlled, open, paralleled two-arms clinical trial, comparing energy-protein supplements (40 g of protein and 400 kcal per day), with no intervention in normally nourished or mildly undernourished patients. Outcomes were serum proteins, body mass index, postoperative complications among others.

RESULTS: 60 Elderly patients were included. Patients in the intervention group (n = 30) ingested 52.2 ± 12.1% of the prescribed supplements per day for 5.8 ± 1.8 days before surgery and until hospital discharge. There was a significant change in serum albumin at follow-up (F = 22.536, P < 0.001), and between the two groups (F = 5.763, P = 0.002), favouring the intervention. The same was observed for serum prealbumin (F = 6.654, P = 0.001 within subjects, F = 2.865, P = 0.045 for interaction). Logistic regression showed that only supplemented proteins per day (OR[95%CI] = 0.925[0.869-0.985]) were associated with less postoperative complications (R(2) = 0.323, χ(2) = 11.541, P = 0.003).

CONCLUSION: Perioperative supplements in geriatric patients with hip fracture submitted to surgery showed better recovery of plasma proteins. Higher daily protein intakes were associated with less postoperative complications.




D. Joe Millward: Nutrition and sarcopenia: evidence for an interaction. Proceedings of the Nutrition Society, FirstView Article : pp 1-10. The Annual Meeting of BAPEN with the Nutrition Society, Harrogate International Centre, Harrogate.29–30 November 2011





Nutritional interventions that might influence sarcopenia, as indicated by literature reporting on sarcopenia per se as well as dynapenia and frailty, are reviewed in relation to potential physiological aetiological factors, i.e. inactivity, anabolic resistance, inflammation, acidosis and vitamin D deficiency. As sarcopenia occurs in physically active and presumably well-nourished populations, it is argued that a simple nutritional aetiology is unlikely and unequivocal evidence for any nutritional influence is extremely limited. Dietary protein is probably the most widely researched nutrient but only for frailty is there one study showing evidence of an aetiological influence and most intervention studies with protein or amino acids have proved ineffective with only a very few exceptions. Fish oil has been shown to attenuate anabolic resistance of muscle protein synthesis in one study. There is limited evidence for a protective influence of antioxidants and inducers of phase 2 proteins on sarcopenia, dynapenia and anabolic resistance in human and animal studies. Also fruit and vegetables may protect against acidosis-induced sarcopenia through their provision of dietary potassium. While severe vitamin D deficiency is associated with dynapenia and sarcopenia, the evidence for a beneficial influence of increasing vitamin D status above the severe deficiency level is limited and controversial, especially in men. On this basis there is insufficient evidence for any more specific nutritional advice than that contained in the general healthy lifestyle–healthy diet message: i.e. avoiding inactivity and low intakes of food energy and nutrients and maintain an active lifestyle with a diet providing a rich supply of fruit and vegetables and frequent oily fish.



週刊医学界新聞 第2971号 2012年03月26日で、今日から使える医療統計学講座【Lesson11】同等性・非劣性の解析の記事が掲載されています。


統計学的検定で統計学的有意差を検証するには、 p<0.05が1つの目安になります。一方、統計学的に同等であることを検証するには、p>0.05は目安になりません。これはあくまで統計学的有意差を検証できなかっただけであり、これで両群が同等かどうかはまったくわかりません。









Kunihiro Sakuma and Akihiko Yamaguchi: The Recent Understanding of the Neurotrophin's Role in Skeletal Muscle Adaptation. Journal of Biomedicine and BiotechnologyVolume 2011 (2011), Article ID 201696, 12 pages doi:10.1155/2011/201696








野藤 悠,諏訪雅貴,佐々木 悠,熊谷秋三:脳由来神経栄養因子(BDNF)の役割と運動の影響.健康科学 31、p49-59


This paper summarizes the various effects of neurotrophins in skeletal muscle and how these proteins act as potential regulators of the maintenance, function, and regeneration of skeletal muscle fibers. Increasing evidence suggests that this family of neurotrophic factors influence not only the survival and function of innervating motoneurons but also the development and differentiation of myoblasts and muscle fibers. Muscle contractions (e.g., exercise) produce BDNF mRNA and protein in skeletal muscle, and the BDNF seems to play a role in enhancing glucose metabolism and may act for myokine to improve various brain disorders (e.g., Alzheimer's disease and major depression). In adults with neuromuscular disorders, variations in neurotrophin expression are found, and the role of neurotrophins under such conditions is beginning to be elucidated. This paper provides a basis for a better understanding of the role of these factors under such pathological conditions and for treatment of human neuromuscular disease.




Andreas N. Kavazis, Keith C. DeRuisseau and Donna M. Gordon: The senescent rat diaphragm does not exhibit age-related changes in caspase activities, DNA fragmentation, or myonuclear domain. European Journal of Applied Physiology DOI: 10.1007/s00421-012-2380-2 Online First




  The diaphragm muscle is essential for normal ventilation and it is chronically active throughout the lifespan. In most skeletal muscles, aging is associated with increased oxidative stress and myofiber atrophy. Since the diaphragm maintains a unique chronic contractile activity, we hypothesized that these alterations would not occur in senescent diaphragms compared to young diaphragms. In addition, we investigated whether senescence leads to altered diaphragmatic caspase activity and myonuclear domain. We harvested diaphragm muscles from 6 and 24–26 month old male Fisher 344 rats (n = 10 per group). Measurements of protein carbonyls, caspase 2, 3, 9, and 12 activities, DNA fragmentation, myofiber cross-sectional area, and myonuclear domain of diaphragm muscles were performed. No age-related changes (p > 0.05) in diaphragmatic protein oxidation or activities of caspase 2, 3, 9, and 12 were observed between groups. In addition, DNA fragmentation, as detected by the ligation-mediated polymerase chain reaction ladder assay, was not different (p > 0.05) between young and senescent diaphragms. Importantly, the cross-sectional area and myonuclear domain of diaphragm myofibers from senescent animals were also not different (p > 0.05) from young diaphragms. In conclusion, our data show that the senescent diaphragm does not atrophy or exhibit changes in select markers of the apoptotic pathway and this may be a result of the diaphragm’s unique continuous contractile activity.



Gordon S. Lynch: Sarcopenia: Age-Related Muscle Wasting and Weakness: Mechanisms and Treatments. Springer (2010/12)


Yves Rolland: Sarcopenia, An Issue of Clinics in Geriatric Medicine, 1e (The Clinics: Internal Medicine). Saunders (2011/8/29)




Jordan R. Moon, Jeffrey R. Stout: Assessments of Fat-Free Mass and Sarcopenia in Older Adults. LAP Lambert Academic Publishing (2011/04)

Alfonso J. Cruz-Jentoft, John E. Morley: Sarcopenia. Wiley (2012/10/2)



















人工透析患者の身体組成代理マーカーによる死亡率予測に関する論文を紹介します。 人工透析患者のObesity Paradoxを説明できる論文です。

Kamyar Kalantar-Zadeh, Elani Streja, Miklos Z. Molnar, Lilia R. Lukowsky, Mahesh Krishnan, Csaba P. Kovesdy and Sander Greenland: Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Patients Using Composite Ranking Score Analysis. Am. J. Epidemiol. (2012) doi: 10.1093/aje/kwr384 First published online: March 16, 2012

人工透析患者の死亡率と、dry weight(透析後体重)と血清クレアチニン値(筋肉量の代理マーカー)の変化との関連を、121,762人のコホートから後ろ向きに調査しています。


これより体重減少より血清クレアチニン低下のほうがより強い死亡の予測因子といえます。人工透析患者のObesity Paradoxは、筋肉量減少の程度で説明できる可能性があるとしています。つまり、BMIに関わらず筋肉量が多い患者ほど死亡率が低くなるといえます。

Obesity Paradoxの論文はたくさんありますが、筋肉量である程度説明できるという論文は初めて見た気がします。人工透析患者(と腎機能正常の方)では血清クレアチニン値が筋肉量のマーカーであり、この数値と変化をみることで、一定の予後予測ができるかもしれませんね。

In hemodialysis patients, lower body mass index and weight loss have been associated with higher mortality rates, a phenomenon sometimes called the obesity paradox. This apparent paradox might be explained by loss of muscle mass. The authors thus examined the relation to mortality of changes in dry weight and changes in serum creatinine levels (a muscle-mass surrogate) in a cohort of 121,762 hemodialysis patients who were followed for up to 5 years (2001–2006). In addition to conventional regression analyses, the authors conducted a ranking analysis of joint effects in which the sums and differences of the percentiles of change for the 2 measures in each patient were used as the regressors. Concordant with previous body mass index observations, lower body mass, lower muscle mass, weight loss, and serum creatinine decline were associated with higher death rates. Among patients with a discordant change, persons whose weight declined but whose serum creatinine levels increased had lower death rates than did those whose weight increased but whose serum creatinine level declined. A decline in serum creatinine appeared to be a stronger predictor of mortality than did weight loss. Assuming residual selection bias and confounding were not large, the present results suggest that a considerable proportion of the obesity paradox in dialysis patients might be explained by the amount of decline in muscle mass.




Siân Robinson, Cyrus Cooper, and Avan Aihie Sayer: Nutrition and Sarcopenia: A Review of the Evidence and Implications for Preventive Strategies. Journal of Aging Research Volume 2012 (2012), Article ID 510801, doi:10.1155/2012/510801






Prevention of age-related losses in muscle mass and strength is key to protecting physical capability in older age and enabling independent living. To develop preventive strategies, a better understanding is needed of the lifestyle factors that influence sarcopenia and the mechanisms involved. Existing evidence indicates the potential importance of diets of adequate quality, to ensure sufficient intakes of protein, vitamin D, and antioxidant nutrients. Although much of this evidence is observational, the prevalence of low nutrient intakes and poor status among older adults make this a current concern. However, as muscle mass and strength in later life are a reflection of both the rate of muscle loss and the peak attained in early life, efforts to prevent sarcopenia also need to consider diet across the lifecourse and the potential effectiveness of early interventions. Optimising diet and nutrition throughout life may be key to preventing sarcopenia and promoting physical capability in older age.



Hudson, Matthew B, et al: Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy. Critical Care Medicine: April 2012 - Volume 40 - Issue 4 - p 1254–1260, doi: 10.1097/CCM.0b013e31823c8cc9

以前の研究でcontrolled mechanical ventilation(調節呼吸)によって、横隔膜の活動性が低下して、収縮機能障害と筋繊維萎縮で横隔膜の筋力低下が生じることがわかっています。

今回は、pressure support ventilation(圧サポート)では調節呼吸より、横隔膜の機能低下を少なくすることができるという仮説を検証するために動物実験を行いました。結果ですが、両者とも酸化ストレスと蛋白分解の活性化によって、横隔膜の機能低下を認めました。


Objectives: Previous workers have demonstrated that controlled mechanical ventilation results in diaphragm inactivity and elicits a rapid development of diaphragm weakness as a result of both contractile dysfunction and fiber atrophy. Limited data exist regarding the impact of pressure support ventilation, a commonly used mode of mechanical ventilation—that permits partial mechanical activity of the diaphragm—on diaphragm structure and function. We carried out the present study to test the hypothesis that high-level pressure support ventilation decreases the diaphragm pathology associated with CMV.

Methods: Sprague-Dawley rats were randomly assigned to one of the following five groups:1) control (no mechanical ventilation); 2) 12 hrs of controlled mechanical ventilation (12CMV); 3) 18 hrs of controlled mechanical ventilation (18CMV); 4) 12 hrs of pressure support ventilation (12PSV); or 5) 18 hrs of pressure support ventilation (18PSV).

Measurements and Main Results: We carried out the following measurements on diaphragm specimens: 4-hydroxynonenal—a marker of oxidative stress, active caspase-3 (casp-3), active calpain-1 (calp-1), fiber type cross-sectional area, and specific force (sp F). Compared with the control, both 12PSV and 18PSV promoted a significant decrement in diaphragmatic specific force production, but to a lesser degree than 12CMV and 18CMV. Furthermore, 12CMV, 18PSV, and 18CMV resulted in significant atrophy in all diaphragm fiber types as well as significant increases in a biomarker of oxidative stress (4-hydroxynonenal) and increased proteolytic activity (20S proteasome, calpain-1, and caspase-3). Furthermore, although no inspiratory effort occurs during controlled mechanical ventilation, it was observed that pressure support ventilation resulted in large decrement, approximately 96%, in inspiratory effort compared with spontaneously breathing animals.

Conclusions: High levels of prolonged pressure support ventilation promote diaphragmatic atrophy and contractile dysfunction. Furthermore, similar to controlled mechanical ventilation, pressure support ventilation-induced diaphragmatic atrophy and weakness are associated with both diaphragmatic oxidative stress and protease activation. (Crit Care Med 2012; 40:–1260)

Obesity Paradoxのレビュー

Obesity Paradoxのレビュー論文(Editorial)を紹介します。

Mitja Lainscak, Stephan von Haehling, Wolfram Doehner and Stefan D. Anker: The obesity paradox in chronic disease: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle, Volume 3, Number 1, 1-4. doi: 10.1007/s13539-012-0059-5



Obesity Paradoxは、心不全(急性、慢性)、冠動脈疾患(PCI、CABG後含め)、脳卒中、ICU領域、COPD(急性増悪、安定期)、CKD、DM+心疾患で報告されています。悪液質の原因疾患が多いですが、その他でも報告されつつあります。


Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management.




Maria Chan, et al: Malnutrition (Subjective Global Assessment) Scores and Serum Albumin Levels, but not Body Mass Index Values, at Initiation of Dialysis are Independent Predictors of Mortality: A 10-Year Clinical Cohort Study. Journal of renal nutrition, http://dx.doi.org/10.1053/j.jrn.2011.11.002





今回の研究ではObesity Paradoxを認めませんでしたが、SGAで低栄養であれば生命予後が悪いということは明らかになりました。血清アルブミン値は栄養指標とはいえませんが、予後指標としてはやはり有用です。サルコペニアの有無で死亡率が異なるかどうかを知りたいですね。

To examine the associations between demographic, clinical, lifestyle, and nutritional parameters at the start of dialysis and mortality, including the combined effects on nutritional parameters, which were seldom investigated in the literature.

Ten-year retrospective clinical cohort study.

Dialysis unit of a metropolitan tertiary teaching hospital in Sydney, Australia.

Incident dialysis patients (n = 167; hemodialysis, 57.5%; male, 61.7%; age, 65.3 ± 13.6 years; diabetic, 24.5%) who commenced on a planned dialysis program.

Associations were examined between all-cause mortality and baseline demographics, including age and gender; clinical and lifestyle characteristics, including glomerular filtration rate, smoking habits, presence of comorbidities (e.g., coronary artery disease, diabetes mellitus, and peripheral vascular disease); and nutritional parameters, including body mass index (BMI), serum albumin (s-albumin) levels, and subjective global assessment score (SGA). Associations with combination values for malnutrition, s-albumin (<3.3 vs. ≥3.3 g/dL), and BMI (<26 vs. ≥26 kg/m2) were also examined.

Median survival was 54.2 months (interquartile range, 23 to 83), and 52.1% of patients were malnourished (SGA score B and C) at the start of dialysis. Advanced age (classified as >65 years, P < .0001), presence of peripheral vascular disease (P < .0001), reduced s-albumin levels (P = .01), and malnutrition scores (P = .02) independently predicted mortality. Being overweight and obese (BMI: ≥26 kg/m2) did not show any advantage on survival (P = .73). Being malnourished and overweight (or obese) was associated with a 3-fold increase in mortality risk (adjusted hazard ratio [HR], 2.96; 95% confidence interval [CI], 1.12 to 7.33; P = .02) compared with being well nourished with a BMI <26 kg/m2 (referent). Compared with being well nourished (SGA = A), being malnourished with normal or low s-albumin was associated with higher risk (HR, 2.06; 95% CI, 1.06 to 4.00; P = .03 and HR, 2.86; 95% CI, 1.65 to 4.94; P < .0001, respectively). There was no statistical difference between mortality risks through any combination of s-albumin and BMI values (P = .54).

Malnutrition and reduced s-albumin levels were found to be independent predictors of mortality, whereas being overweight and obese did not show protective effects.



Toshihiro Ansai and Yutaka Takata: Association Between Tooth Loss and Cancer Mortality in Elderly Individuals





Sarcopenia is defined as muscle power decline or decreased muscular volume with aging,
leading to decreased levels of basal metabolism and energy consumption by the whole
body, which results in lower energy intake and a decrease in synthesis of proteins in the
body. To the best of our knowledge, no study concerning the association between chewing
ability (tooth loss) and sarcopenia has been presented, though it is considered that elderly
individuals with sarcopenia may also develop the condition in the oral cavity region, which
has been supported by several reports. For example, subjects with stable occlusion, eg.,
Eichner index (EI; Eichner, 1955) Class A were shown unlikely to stumble (Yoshida, 2005).
EI, long used as an indicator of occlusal condition, are based on existing natural tooth
contacts between the maxilla and mandible in the bilateral premolar and molar regions.
Class A represents contact in all 4 support zones. Some reports have been presented
regarding associations between stable occlusion and physical fitness ability (Yamaga et al.,
2002), chewing ability and physical fitness (Takata et al., 2004), and walking speed and oral
function (Okada et al., 2011). In a recent longitudinal study of Japanese elderly subjects,
partial or complete loss of occlusion was associated with a decline in leg extensor power or
decrease in one-leg standing time with eyes open (Okuyama et al., 2011). Sarcopenia may
have a negative influence on both chewing ability and oral function. A Japanese survey of
elderly individuals (60 to 87 years old) reported that significant factors related to occlusal
power were handgrip strength in males, walking speed for 5 m in both genders, and body
muscle volume in females (Kono, 2009). These findings suggest the possibility that oral
sarcopenia induces a negative spiral of systemic health conditions including decreased levels
of appetite and activities of daily living, as well as deterioration of psychosomatic health
conditions, such as occurrence of depression, though the causal relationship remains unclear.


World Stroke Academyの嚥下障害資料

World Stroke Academyの嚥下障害資料を紹介させていただきます。下記のHPで52ページのPost Stroke Dysphagiaに関する資料を見ることができます。2010年の文献が引用されていますので、比較的新しい資料だと思います。


World Stroke AcademyはWorld Stroke Organisation (WSO)のプロジェクトで、脳卒中に関する自己学習をすることもできます。嚥下障害以外にも有益な資料があります
(For Professionalsの中に)。


最初の図はPresbyphagia(老嚥)に影響する要因が挙げられています。この中にはmuscle atrophy、つまりサルコペニアももちろんあります。また、原発性、二次性のPresbyphagia(老嚥)も記載されています。





JoAnne Robbins, Allison Duke Bridges, and Andrew Taylor: Oral, pharyngeal and esophageal motor function in aging. GI Motility online (2006) doi:10.1038/gimo39






Key Points
  • Presbyphagia refers to age-related changes in the oropharyngeal and esophageal swallowing of healthy adults.
  • Sarcopenia is age-related loss of skeletal muscle mass, organization, and strength.
  • Good health is maintained in the presence of disease-free presbyphagia.
  • Healthy persons depend on a highly automated neuromuscular sensorimotor process that coordinates chewing, swallowing, and airway protection.
  • Central and peripheral nervous system changes with age affect swallowing.
  • Oropharyngeal swallowing changes with healthy aging:
    • Slower
    • Delayed onset of airway protection and upper esophageal sphincter (UES) opening
    • Bolus adjacent to airway longer
    • Reduced lingual pressures
  • Esophageal swallowing changes with aging:
    • Duration of esophageal peristalsis is prolonged and amplitude decreases (60–80 years).
    • Esophageal contraction amplitude diminishes but function remains intact (80-90 years).
    • Reduced frequency of secondary peristalsis
    • Increased reflux events in elders
  • Although compensatory interventions are traditional, exercise is promising to remediate and perhaps prevent decline in function.
























Watkins F, Tulloch S, Bennett C, Webster B, McCarthy C: A multimodal, interdisciplinary programme for the management of cachexia and fatigue. Int J Palliat Nurs. 2012 Feb;18(2):85-90.





Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.









望月 弘彦(クローバーホスピタル消化器科)


1 栄養評価
亀井 尚(東北大学大学院医学系研究科外科病態学講座),他

2 経腸栄養管理における必要栄養量の設定について
栗原 美香(滋賀医科大学附属病院栄養治療部),他

3 消化と吸収
雨海 照祥(武庫川女子大学生活環境学部食物栄養学科)

4 経管栄養の利点と適応
丸山 道生(東京都保健医療公社大久保病院)

5 経管栄養の種類と特徴
鷲澤 尚宏(東邦大学医療センター大森病院栄養治療センター)

6 経腸栄養の種類と選択のポイント
田中 弥生(駒沢女子大学人間健康学部)


1 経鼻経管栄養
森 みさ子(聖マリアンナ医科大学横浜市西部病院看護部)

2 PEGの適応と禁忌
伊藤 明彦(草津総合病院臨床栄養センター)

3 胃瘻造設手技
小野川 靖二(JA尾道総合病院)

4 PEG造設直後の管理
小川 哲史(前橋赤十字病院)

5 胃瘻の構造とカテーテルの種類
合田 文則(香川大学医学部附属病院腫瘍センター)

6 PEG術後のスキンケア
松原 康美(北里大学東病院看護部)

7 PEGの晩期合併症
有本 之嗣(須波宗斉会病院)

8 胃瘻カテーテル交換
倉 敏郎(町立長沼病院)

9 経皮経食道胃管挿入術(PTEG/ピーテグ)
大石 英人(東京女子医科大学八千代医療センター)

10 空腸瘻
丸山 道生(東京都保健医療公社大久保病院)


1 口腔ケア(Oral Health Care)について
石井 良昌(海老名総合病院)

2 栄養剤投与時の注意点
野田 さおり(KKR高松病院看護部)

3 経管栄養で用いられる器具の管理
鷲澤 尚宏(東邦大学医療センター大森病院栄養治療センター)

4 代謝性合併症とモニタリング
大村 健二(山中温泉医療センター)

5 胃瘻からの半固形化栄養材短時間注入法
合田 文則(香川大学医学部附属病院腫瘍センター)

6 薬剤投与
倉田 なおみ(昭和大学薬学部薬剤学教室)


1 摂食・嚥下障害患者への経管栄養
 若林 秀隆(横浜市立大学附属市民総合医療センターリハビリテーション科)

 上野 理美子(横浜市立大学附属市民総合医療センターリハビリテーション部)

2 糖尿病患者への経管栄養
 谷亀 光則(東海大学医学部腎代謝内科)

 坂根 絢子(東海大学医学部付属病院看護部)

3 腎不全患者への経管栄養
 安藤 亮一(武蔵野赤十字病院)

 飯塚 久子(武蔵野赤十字病院看護部)

4 肝臓病(肝硬変)患者への経管栄養
 加藤 章信(盛岡市立病院),他

 川代 千恵子(岩手医科大学附属病院看護部)

5 COPD患者への経管栄養
 粟井 一哉(KKR高松病院)

 稲木 美香(KKR高松病院看護部)

6 ALS患者への胃瘻造設と経管栄養
 清水 俊夫(東京都立神経病院)

 新井 玉南(東京都立神経病院看護科),他

7 認知症患者への経管栄養
 鈴木 裕(国際医療福祉大学病院)

 上野 優美(横浜市立みなと赤十字病院看護部),他

8 脳卒中患者への経管栄養
 三原 千惠(海老名総合病院附属海老名メディカルサポートセンター)


9 褥瘡のある患者への経管栄養
 岡田 晋吾(北美原クリニック)

 仙石 真由美(函館五稜郭病院看護部)

10 悪性腫瘍の患者への経管栄養
 峯 真司(がん研有明病院),他

 髙瀬 鮎美(がん研有明病院看護部),他

11 小児患者への経管栄養
 高増 哲也(神奈川県立こども医療センター)

 吉橋 恭子(神奈川県立こども医療センター看護局)

12 小児外科と周術期経腸栄養管理
 千葉 正博(昭和大学藤が丘病院),他

 岩井 祐介(昭和大学藤が丘病院看護部),他


1 療養環境における違い (1)ICUにおける経腸栄養
 松田 直之(名古屋大学大学院医学系研究科救急・集中治療医学分野)

 大竹 美緒(山梨大学医学部附属病院看護部),他

 井谷 智尚(西神戸医療センター)

 向井 淳子(クローバーホスピタル看護部),他

 石塚 泉(石塚内科クリニック)

 小川 滋彦(小川医院)

 長谷川 正光(刈谷豊田総合病院高浜分院)

2 下痢/逆流への対処
 堀内 朗(昭和伊南総合病院消化器病センター)

 宮澤 靖(近森病院臨床栄養部)

 蟹江 治郎(ふきあげ内科胃腸科クリニック)

3 チームで取り組む経管栄養の安全対策:NST(Nutrition support team)
 大原 寛之(藤田保健衛生大学),他

 添野 民江(昭和大学藤が丘病院看護部),他

 田崎 亮子(KKR新別府病院栄養管理室・栄養サポート室)

 増田 修三(尾道市公立みつぎ総合病院地域医療部)

 後藤 薫(東京都立小児総合医療センター検査科)

4 在宅管理での多職種連携
 中村 悦子(市立輪島病院看護部)

 長谷川 聰(株式会社フレディタカノ薬局)

 手塚 波子(小川医院)

 菊谷 武(日本歯科大学附属病院口腔介護・リハビリテーションセンター)

5 大規模震災時に経管栄養剤をどうするか?
 田村 佳奈美(かとう内科クリニック)

【コラム】:望月 弘彦(クローバーホスピタル消化器科)





Jahnke V. [Dysphagia in the elderly]. HNO. 1991 Nov;39(11):442-4. [Article in German]

ドイツ語の論文ですので、もちろん抄録しか読んでいません…。dysphagia in the elderly ("presbyphagia") とありますが、今ではdysphagiaとpresbyphagiaは区別して考えます。




The prevalence of dysphagia in the elderly ("presbyphagia") is probably still underestimated, though this disorder represents a major geriatric problem; special attention is necessary to prevent malnutrition, dehydration and aspiration pneumonia. Primary presbyphagia due to physiological, age-related changes of the swallowing mechanism must be differentiated from secondary presbyphagia attributable to diseases which are more frequent in the elderly. Transnasal pharyngo-laryngo-fiberendoscopy, videofluoroscopy and the "modified barium swallow" are of particular value in the diagnostic approach to presbyphagia. The possibilities of treatment are limited. They are aimed at dietary adjustments, compensatory mechanisms based on the properties of the volume and consistency of the food, proper feeding position and help by other persons. Individual swallowing exercises by a speech therapist are particularly valuable. Surgical procedures for the treatment of underlying organic disorders are less often indicated in presbyphagia.


嚥下障害と低栄養の統合管理(Integrated Management of Dysphagia and Malnutrition)に関する資料を紹介します。下記のHPで確認できます。


これはSatellite Symposium Proceedings 7th EUGMS(European Union of Geriatric Medicine Society) Congressの資料です。以下の3つの項目が紹介されています。

Oropharyngeal dysphagia: A growing concern in healthcare

Pathophysiology, relevance, and natural history of oropharyngeal dysphagia among the elderly

Dysphagia and malnutrition: From screening to treatment






the EAT-10 is:
• A useful self-administered test of 10 items
• Easy to understand for the majority (95.4%) of patients
• An analogical and direct-scored test, that is quick to perform
(mean administration time of <4 minutes)
• Useful for identifying patients at risk of dysphagia, with a clear
cut-off level (a score of ≥3 is abnormal)



3番目の図は嚥下障害患者に対する栄養介入です。absolute dysphagiaは経口摂取不可能な重度の嚥下障害、relative dysphagiaは経口摂取可能な中等度~軽度の嚥下障害のようです。いずれにしても適切な栄養管理が必要です。




Humbert IA, Robbins J. Dysphagia in the elderly. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):853-66, ix-x.



論文の中にPresbyphagia versus Dysphagiaという項目があります。やや長いですがこの部分を以下、引用します。

Although the anatomical, physiological, psychological and functional changes that occur in the dynamic process we refer to as “aging” place older adults at risk for dysphagia; a healthy older adult’s swallow is not inherently impaired. Presbyphagia refers to characteristic changes in the swallowing mechanism of otherwise healthy older adults. Clinicians are becoming more aware of the need to distinguish among dysphagia, presbyphagia (an old, yet healthy, swallow) and other related diagnoses in order to avoid over diagnosing and over treating dysphagia. With the increased threat of acute illness, multiple medications, and any number of age-related conditions, older adults are more vulnerable and can cross the line from a healthy older swallow to a person with dysphagia in association with certain perturbations including acute illness, surgery, chemo radiation and other factors. Previous work has focused primarily on the anatomy and physiology of the oropharyngeal swallowing mechanism. Age effects on the temporal evolution of isometric and swallowing pressure indicate a progression of change that, when combined with naturally diminished functional reserve (the resilient ability of the body to adapt to physiological stress make the older population more susceptible to dysphagia. We review age-related changes in peripheral and central nervous system control of head and neck structures for swallowing in this paper. In addition, we briefly discuss promising strategies for neurorehabilitation of
dysphagia that are based upon the recognition that swallowing disruption may, in part, be a manifestation of “sarcopenia”, the age-related loss of skeletal muscle mass, organization and strength as well as age-related changes in sensorimotor acuity and efficiency.






The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.



D. GINOCCHIO, E. BORGHI, A. SCHINDLER: Dysphagia assessment in the elderly. Nutritional Therapy & Metabolism / Vol. 27 no. 1, pp. 9-15






この論文では、primary presbyphagia(原発性老嚥)とsecondary presbyphagia(二次性老嚥)について解説しています。primary presbyphagiaは加齢以外に要因がないもの、secondary presbyphagiaは疾患による嚥下障害があるものを意味します。






Dysphagia becomes an increasingly common problem as people age; its prevalence and the increased risk of related complications (aspiration pneumonia, dehydration, malnutrition) has brought the attention of dysphagia specialists to the elderly. Dysphagia assessment in the elderly relies primarily on the same modalities as in other age groups: history, bedside examination, fiberoptic endoscopic examination of swallowing, and videofluoroscopy. However, the elderly often show differences in anatomy and physiology, as well as in the diseases presented and the environment in which they live; specialists involved in dysphagia assessment should take these specific aspects into consideration. Modification of swallowing simply related to aging is called primary presbyphagia, while swallowing impairment due to diseases in the elderly is called secondary presbyphagia. The main characteristics of deglutition and deglutition disorders in the elderly are thus reviewed here, with special emphasis on the assessment and decision-making implications specific for this patient category.




Rofes L, Arreola V, Romea M, Palomera E, Almirall J, Cabré M, Serra-Prat M, Clavé P. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil. 2010 Aug;22(8):851-8, e230.






BACKGROUND: Oropharyngeal dysphagia is a major complaint among the elderly. Our aim was to assess the pathophysiology of oropharyngeal dysphagia in frail elderly patients (FEP).

METHODS: A total of 45 FEP (81.5 +/- 1.1 years) with oropharyngeal dysphagia and 12 healthy volunteers (HV, 40 +/- 2.4 years) were studied using videofluoroscopy. Each subject's clinical records, signs of safety and efficacy of swallow, timing of swallow response, hyoid motion and tongue bolus propulsion forces were assessed.

KEY RESULTS: Healthy volunteers presented a safe and efficacious swallow, faster laryngeal closure (0.157 +/- 0.013 s) upper esophageal sphincter opening (0.200 +/- 0.011 s), and maximal vertical hyoid motion (0.310 +/- 0.048 s), and stronger tongue propulsion forces (22.16 +/- 2.54 mN) than FEP. By contrast, 63.63% of FEP presented oropharyngeal residue, 57.10%, laryngeal penetration and 17.14%, tracheobronchial aspiration. Frail elderly patients with impaired swallow safety showed delayed laryngeal vestibule (LV) closure (0.476 +/- 0.047 s), similar bolus propulsion forces, poor functional capacity and higher 1-year mortality rates (51.7%vs 13.3%, P = 0.021) than FEP with safe swallow. Frail elderly patients with oropharyngeal residue showed impaired tongue propulsion (9.00 +/- 0.10 mN), delayed maximal vertical hyoid motion (0.612 +/- 0.071 s) and higher (56.0%vs 15.8%, P = 0.012) 1-year mortality rates than those with efficient swallow.

CONCLUSION & INFERENCES: Frail elderly patients with oropharyngeal dysphagia presented poor outcome and high mortality rates. Impaired safety of deglutition and aspirations are mainly caused by delayed LV closure. Impaired efficacy and residue are mainly related to weak tongue bolus propulsion forces and slow hyoid motion. Treatment of dysphagia in FEP should be targeted to improve these critical events.



Cosquéric G, Sebag A, Ducolombier C, Thomas C, Piette F, Weill-Engerer S. Sarcopenia is predictive of nosocomial infection in care of the elderly. Br J Nutr. 2006 Nov;96(5):895-901.








Protein-energy malnutrition and nosocomial infection (NI) are frequent in elderly patients, and a causal link between the two has often been suggested. The aim of the present study was to identify the nutritional parameters predictive of NI in elderly patients. We assessed on admission 101 patients (sixty-six women, thirty-five men, aged over 65 years) admitted to an acute care of the elderly department. Sarcopenia was detected by dual-energy X-ray absorptiometry, with appendicular skeletal muscle mass expressed with respect to body area. Weight, BMI, albuminaemia, serum transthyretin and C-reactive protein values were also determined on admission, and known risk factors, such as functional dependence and invasive biomedical material, were also evaluated. After up to 3 weeks of hospitalisation, patients were classified according to whether they had developed an NI. After 3 weeks of hospitalisation, we found that twenty-nine patients had suffered an NI, occurring after a mean of 16.1 d. Patients who were sarcopenic on admission had a significantly higher risk of contracting an NI (relative risk 2.1, 95 % CI 1.1, 3.8). None of the other morphometric or biological parameters differed significantly between the two groups of patients on admission. Patients who experienced an NI were also more likely, on admission, to have a medical device (P=0.02 to P=0.001 depending on the device), to have swallowing problems (P=0.002) or to have restricted autonomy (P<0.01). Sarcopenia on admission to an acute care of the elderly unit, as measured by X-ray absorptiometry, was therefore associated with a doubled risk of NI during the first 3 weeks of hospitalisation.



Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009 Jun-Jul;24(3):395-413.





サルコペニアによる嚥下障害に関して、比較的詳しくコメントされているレビュー論文です。今回は別のパート(Dysphagia, Nutrition and Hydration)を引用紹介します。以下、引用です。

Dysphagia, Nutrition and Hydration
Dysphagia has a profound effect on nutritional status often resulting in malnutrition and dehydration and may compromise nutrient status as a result of diminished capacity to eat or drink, anorexia or fear of eating. When dysphagia occurs in the elderly population in tandem with sarcopenia, or loss of skeletal muscle mass and strength (46), the risk for malnutrition especially protein-energy malnutrition is increased (47). Consequences of the dysphagia malnutrition relationship include: weight loss, dehydration, muscle breakdown, fatigue, aspiration pneumonia, and a general decline in functional status. Moreover, a recent study identified swallowing problems and sarcopenia as predictive of nosocomial infections in hospitalized elderly patients (48). Increased morbidity and mortality are documented outcomes of undiagnosed or untreated dysphagia that have progressed to protein-energy malnutrition (49,50).





The risk for disordered oropharyngeal swallowing (dysphagia) increases with age. Loss of swallowing function can have devastating health implications, including dehydration, malnutrition, pneumonia, and reduced quality of life. Age-related changes increase risk for dysphagia. First, natural, healthy aging takes its toll on head and neck anatomy and physiologic and neural mechanisms underpinning swallowing function. This progression of change contributes to alterations in the swallowing in healthy older adults and is termed presbyphagia, naturally diminishing functional reserve. Second, disease prevalence increases with age, and dysphagia is a comorbidity of many age-related diseases and/or their treatments. Sensory changes, medication, sarcopenia, and age-related diseases are discussed herein. Recent findings that health complications are associated with dysphagia are presented. Nutrient requirements, fluid intake, and nutrition assessment for older adults are reviewed relative to dysphagia. Dysphagia screening and the pros and cons of tube feeding as a solution are discussed. Optimal intervention strategies for elders with dysphagia ranging from compensatory interventions to more rigorous exercise approaches are presented. Compelling evidence of improved functional swallowing and eating outcomes resulting from active rehabilitation focusing on increasing strength of head and neck musculature is provided. In summary, although oropharyngeal dysphagia may be life threatening, so are some of the traditional alternatives, particularly for frail, elderly patients. Although the state of the evidence calls for more research, this review indicates that the behavioral, dietary, and environmental modifications emerging in this past decade are compassionate, promising, and, in many cases, preferred alternatives to the always present option of tube feeding.



Butler SG, et al: The Relationship of Aspiration Status With Tongue and Handgrip Strength in Healthy Older Adults. J Gerontol A Biol Sci Med Sci (2011) 66A (4): 452-458. doi: 10.1093/gerona/glq234




結果ですが、等尺性の舌筋力は前方、後方とも、誤嚥を認めた高齢者で有意に低かったです。同様に嚥下時の舌筋力も前方、後方とも、誤嚥を認めた高齢者で有意に低い結果でした。また、誤嚥の有無で握力には有意差を認めませんでしたが、舌筋力と握力には有意な関連を認めました(r =0.34)。





Background. Recently, subclinical aspiration has been identified in approximately 30% of community-dwelling older adults. Given that the tongue is a key component of the safe swallow, we hypothesized healthy older adults who aspirate will generate less tongue strength than adults who do not aspirate. Furthermore, as muscle weakness may reflect a global effect of aging, we further investigated whether tongue strength is correlated with handgrip strength.

Methods. We assessed 78 healthy community-dwelling older adults (M = 77.3 years, SD = 7.26) for aspiration status (37% aspirators) via flexible endoscopic evaluation of swallowing. Maximal isometric anterior and posterior tongue strength, anterior and posterior swallowing tongue strength, and maximum handgrip strength were measured.

Results. Isometric tongue strength was significantly lower in aspirators versus nonaspirators (p = .03) at both the anterior (463 vs 548 mmHg, respectively) and posterior lingual locations (285 vs 370 mmHg, respectively). Likewise, swallowing tongue strength was significantly lower in aspirators versus nonaspirators at both the anterior (270 vs 317 mmHg, respectively) and posterior lingual locations (220 vs 267 mmHg, respectively). There was no difference between aspirators and nonaspirators’ handgrip strength (p > .05), although handgrip strength was correlated with posterior tongue strength (r = .34, p = .005).

Conclusions. Lower anterior and posterior isometric and swallowing tongue strength were dependent on aspiration status. Lower lingual strength in healthy adults may predispose them to aspiration. The correlation between tongue and handgrip strength is consistent with the hypothesis that impaired oropharyngeal strength reflects global age-related declines in muscle strength.




Stenholm S, Tiainen K, Rantanen T, Sainio P, Heliövaara M, Impivaara O, Koskinen S. Long-term determinants of muscle strength decline: prospective evidence from the 22-year mini-Finland follow-up survey. J Am Geriatr Soc. 2012 Jan;60(1):77-85. doi: 10.1111/j.1532-5415.2011.03779.x. Epub 2011 Dec 28.





OBJECTIVES: To examine long-term changes in handgrip strength and the factors predicting handgrip strength decline.
DESIGN: Longitudinal cohort study with 22 years of follow-up.
SETTING: Population-based Mini-Finland Health Examination Survey in Finland.
PARTICIPANTS: Nine hundred sixty-three men and women aged 30 to 73 at baseline.
MEASUREMENTS: Handgrip strength was measured using a handheld dynamometer at baseline and follow-up. Information on potential risk factors, namely lifestyle and chronic conditions, and their changes throughout the follow-up were based on health interviews.
RESULTS: Based on linear mixed-effect models, midlife physically strenuous work, excess body weight, smoking, cardiovascular disease, hypertension, diabetes mellitus, and asthma predicted muscle strength decline over 22 years of follow-up (P < .05 for all). In addition, pronounced weight loss, becoming physically sedentary, persistent smoking, incident coronary heart disease, other cardiovascular disease, diabetes mellitus, chronic bronchitis, chronic back syndrome, long-lasting cardiovascular disease, hypertension, and asthma were associated with accelerated handgrip strength decline (P < .05 for all).
CONCLUSION: Lifestyle and physical health earlier in life determine rate of muscle strength decline in old age. Efforts should be made to recognize persons at risk in a timely manner and target early interventions to middle-aged persons to slow down muscle strength decline and prevent future functional limitations and disability.


Gołębiowski T, Kusztal M, Weyde W, Dziubek W, Woźniewski M, Madziarska K, Krajewska M, Letachowicz K, Strempska B, Klinger M. A Program of Physical Rehabilitation during Hemodialysis Sessions Improves the Fitness of Dialysis Patients. Kidney Blood Press Res. 2012 Feb 22;35(4):290-296. [Epub ahead of print]

E:透析中にcycle trainingを3ヶ月間行うと、


結果ですが、6分間歩行テスト、膝の伸展・屈曲の筋力はcycle trainingの前後で有意に改善しました。栄養や炎症には変化がありませんでした。有害事象は観察されませんでした。以上より、人工透析中のcycle trainingは安全で、歩行能力と下肢筋力を有意に改善させるという結論です。



Aim: The aim of the present study was to evaluate the influence of cycle exercise during hemodialysis (HD) on patients' physical proficiency, muscle strength, quality of life and selected laboratory parameters.
Patients and Methods: In a group of 29 (15 female, 14 male) HD patients (age 64.2 ± 13.1 years), 3 months of cycle training during dialysis sessions was performed. The following data were analyzed: strength of lower extremities (six-minute walk test, isokinetic knee extension, flexion peak torque), nutrition parameters (albumin, BMI), inflammation intensity (CRP, IL-6), and quality of life (SF-36v2).
Results: In the six-minute walk test, the increase in walk velocity was 4% (3.56 km/h before and 3.73 km/h after cycle training; p < 0.01). At angular velocity (AV) of 60°/s, extension peak torque in the knee joint rose by 7% and at AV of 300°/s by 4% (p = 0.04). Flexion peak torque at AV of 180°/s increased by 13% (p = 0.0005). The program does not influence nutrition or inflammation parameters. No complications directly related to exercise were observed.
Conclusion: Cycle exercise during dialysis is safe even in older HD patients with multiple comorbidities. It results in a significant increase in general patient walking ability and in a gain in lower extremity muscle strength.







In cancer patients, physical training and other physical treatment options are beneficial as a preventive procedure to maintain functional status. The activities and training interventions have to be individualized (overall level of recommendation: strong positive; mean consensus 7.92). However, most research has been done in patients treated with curative intent, and it is not clear to what extent physical training is appropriate in patients with advanced cancer/refractory cachexia.