在宅高齢者の食欲不振とサルコペニア

在宅高齢者における食欲不振とサルコペニアの関連をみた論文を紹介します。

Francesco Landi, Rosa Liperoti, Andrea Russo, Silvia Giovannini, Matteo Tosato, Christian Barillaro, Ettore Capoluongo, Roberto Bernabei and Graziano Onder. Association of anorexia with sarcopenia in a community-dwelling elderly population: results from the ilSIRENTE study. European Journal of Nutrition 2012, DOI: 10.1007/s00394-012-0437-y

リサーチクエスチョンは以下の通りです。

P：80歳以上の在宅高齢者で
E：食欲不振を認めると
C：食欲不振を認めない場合と比較して
O：サルコペニアが多い
D：横断研究（二次研究）

サルコペニアの有無はEWGSOPの基準で判定しています。

結果ですが、354人中、食欲不振は21%に、サルコペニアは29%に認めました。食食不振群ではサルコペニアを46.6%認めたのに対し、食欲不振がない群では24.6%にサルコペニアを認め、有意差がありました。多変量解析でも有意差を認めました。

以上より、80歳以上の高齢者では食欲不振を認めることはしばしばあり、サルコぺニアと独立して関連しているという結論です。今回の対象者は加齢によるサルコペニアの要素が強いと思われますが、食欲不振が関連しているということは、栄養によるサルコペニアの影響もあるかもしれません。

Abstract

Objective

There is increasing evidence that anorexia of aging can cause physical and mental impairment. The aim of the present study was to evaluate the relationship between anorexia and sarcopenia in elderly persons aged 80 years or older.

Methods

Data are from the baseline evaluation of 354 subjects enrolled in the ilSIRENTE study. The ilSIRENTE study is a prospective cohort study performed in the mountain community living in the Sirente geographic area (L’Aquila, Abruzzo) in Central Italy. We defined anorexia as the presence of loss of appetite and/or lower food intake. According to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, diagnosis of sarcopenia required the documentation of low muscle mass plus the documentation of either low muscle strength or low physical performance. The relationship between anorexia and sarcopenia was estimated by deriving odds ratios from the multiple logistic regression models considering sarcopenia as the dependent variable.

Results

Nearly 21 % of the study sample showed symptoms of anorexia. Using the EWGSOP-suggested algorithm, 103 subjects (29.1 %) with sarcopenia were identified. Thirty-four (46.6 %) participants were affected by sarcopenia among subjects with anorexia compared to 69 subjects [24.6 %] without anorexia (p < 0.001). After adjusting for potential confounders including age, gender, functional and cognitive impairment, physical activity, urinary incontinence, comorbidity, congestive heart failure, COPD, depression, anti-cholinergic drugs, and TNF-α plasmatic levels, participants with anorexia had a higher risk of sarcopenia compared with non-anorexic subjects (HR 1.88, 95 % CI 1.01–3.51).

Conclusions

Anorexia is common among community-dwelling older subjects in Italy. Our results suggest that among old–old subjects, anorexia is independently associated with sarcopenia.