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Article(id=1240375107735057303, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202309491, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1695830400000, receivedDateStr=2023-09-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658070739, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658070739, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658070739, creator=13701087609, updateTime=1773658070739, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1005, endPage=1011, ext={EN=ArticleExt(id=1240375108074795937, articleId=1240375107735057303, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between dietary diversity and possible sarcopenia among older adults aged 65 and over in China, columnId=1240375107953161116, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Foold Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between the dietary diversity score (DDS) and the prevalence of possible sarcopenia among the elderly.

Methods

We conducted this analysis utilizing the cross-sectional data from the Chinese longitudinal healthy longevity survey and happy family study(CLHLS-HF, wave 2018 ). A standard developed by the Asian Working Group for Sarcopenia 2019(AWGS2019) was used to assess the possibility of sarcopenia. We have constructed four new indicators of DDS as follows: total diet, animal-based diet, plant-based diet, and plant-based diet without the consumption of legume products and nuts. We used the Logistic regression analysis to evaluate the association between the DDS of the total diet, animal-based diet, plant-based diet, and plant-based diet without the intake of legume products and nuts and possible sarcopenia. These associations were statistically adjusted for a variety of potential confounders. Sensitivity analysis and subgroup analyses were performed.

Results

The analysis included 2 555 participants (mean age of 84.4 years). 1 244 (48.7％) were male and 1 311 (51.3％) were female. 1 632 elderly people had possible sarcopenia. DDS in the possible sarcopenia group was significantly lower than that in the non-sarcopenia group (P < 0.001). In our study, we found that participants with a higher DDS of the total diet (OR=0.544, 95% CI：0.405-0.732), animal-based diet (OR=0.613, 95% CI：0.423-0.888), and plant-based diet (OR=0.469, 95% CI：0.321-0.684) and plant-based diet without the consumption of legume products and nuts (OR=0.382, 95% CI：0.206-0.709) were at a lower risk of developing sarcopenia. In sensitivity analyses, the associations remained unchanged. In subgroup analysis, total diets, animal-based diet, and plant-based diet were still associated with a reduced risk of possible sarcopenia in the male population, while plant-based diet and plant-based diet without the intake of legume products and nuts were associated with a reduced risk of possible sarcopenia in the female population.

Conclusion

Taking a diversified diet may reduce the risk of developing sarcopenia. According to the findings of this study, adopting a diversified diet might reduce the risk of sarcopenia for older adults.

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目的

探讨膳食多样性评分（DDS）和老年人肌少症之间的关系。

方法

利用中国老年健康与家庭幸福调查（CLHLS-HF）2018年的调查数据进行分析。采用2019年亚洲肌少症工作组（AWGS2019）制定的标准评估肌少症。通过构建四个新的DDS指标：总体膳食、动物性膳食、植物性膳食和不包含豆制品和坚果的植物性膳食评分。采用logistic回归来分析总体膳食、动物性膳食、植物性膳食和不包含豆制品和坚果的植物性膳食的DDS与可能肌少症之间的关联。并进行混杂因素调整、亚组分析及敏感性分析。

结果

共纳入研究对象2 555名（平均年龄84.4岁），男性1 244人（48.7%），女性1 311人（51.3%）。可能肌少症患病率为63.9%（1 632/2 555），可能肌少症组的DDS明显低于非肌少症组（t=-5.216, P < 0.001）。调整混杂因素后，总体膳食（OR=0.544, 95% CI：0.405~0.732），动物性膳食（OR=0.613；95% CI：0.423~0.888），植物性膳食（OR=0.469；95% CI：0.321~0.684）和不包含豆制品和坚果的植物性膳食(OR=0.382；95% CI：0.206~0.709)与肌少症的发生风险均有关联。DDS越高发生可能肌少症的风险越低。敏感性分析显示相关性保持不变。亚组分析结果显示男性人群中总体膳食、动物性膳食和植物性膳食仍然与可能肌少症风险降低相关，而在女性人群中，植物性膳食以及不包含豆制品和坚果的植物性膳食与可能肌少症的风险降低有关。

结论

膳食多样性是老年人肌少症的保护因素，采用多样化的饮食可能会降低老年人肌少症的风险。

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朱小军，Email：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=iRoapbAj6UVz4IHzSu83JA==, magXml=K1c8DdXqCYknzmFKJhxztA==, pdfUrl=null, pdf=NPisHV8FBhrkmmIUwKVduw==, pdfFileSize=733463, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=gZV1YU+Qq+p85GIL6HL7pg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=s6jMVitFi1SV3eLIGG6CVg==, mapNumber=null, authorCompany=null, fund=null, authors=

钱鸣崎（1990—），男，本科，医师，研究方向：公共卫生

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International Journal of Sport Nutrition and Exercise Metabolism, 2018, 28(6): 674-685., articleTitle=No difference between the effects of supplementing with Soy protein versus animal protein on gains in muscle mass and strength in response to resistance exercise, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240746307246149716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, xref=null, ext=[AuthorCompanyExt(id=1240746307254538325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, companyId=1240746307246149716, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Health Management Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China), AuthorCompanyExt(id=1240746307262926933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, companyId=1240746307246149716, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=苏州大学附属第二医院健康管理中心，江苏 苏州 215004)])], figs=[ArticleFig(id=1240746310098276638, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Fig.1, caption=Forest plots of the association between DDS and possible sarcopenia based on Model 4, figureFileSmall=fql5QV/tBeC/gbwbrraQ/Q==, figureFileBig=AwUjVf4k7mg+uXQUqPdRVg==, tableContent=null), ArticleFig(id=1240746310173774118, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=图1, caption=基于模型4的DDS和可能肌少症关系的森林图

注：DDS，膳食多样性评分（dietary diversity score)；#：植物性膳食不包含豆制品和坚果；模型4：调整性别、年龄、家庭年收入、受教育水平、婚姻状况、退休前的职业、身体锻炼、吸烟、饮酒、BMI、腰围、血清维生素D3和血浆白蛋白。

, figureFileSmall=fql5QV/tBeC/gbwbrraQ/Q==, figureFileBig=AwUjVf4k7mg+uXQUqPdRVg==, tableContent=null), ArticleFig(id=1240746310303797550, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Fig.2, caption=Forest plots for subgroup analysis of the association between DDS and possible sarcopenia based on Model 4, figureFileSmall=J/1lU40l+IHrMfS9bLz/bQ==, figureFileBig=jn6wl6d0kDDs5oRUHJ9UGA==, tableContent=null), ArticleFig(id=1240746310375100722, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=图2, caption=基于模型4的DDS和可能肌少症关系亚组分析的森林图

注：DDS，膳食多样性评分(dietary diversity score)；#：植物性膳食不包含豆制品和坚果；模型4：调整性别、年龄、家庭收入、受教育水平、婚姻状况、退休前的职业、身体锻炼、吸烟、BMI、腰围、血清维生素D3和血浆白蛋白。

, figureFileSmall=J/1lU40l+IHrMfS9bLz/bQ==, figureFileBig=jn6wl6d0kDDs5oRUHJ9UGA==, tableContent=null), ArticleFig(id=1240746310475764022, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Table 1, caption=

Basic description of possible sarcopenia in the elderly people with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体
(n=2 555)		可能肌少症
(n=1 632)		无肌少症
(n=923)		χ2/tP
性别(%)28.335<0.001
男1 244(48.7)730(44.7)514(55.7)
女1 311(51.3)902(55.3)409(44.3)
年龄组 (岁)(%)739.718<0.001
65~79962(37.7)302(18.5)660(71.5)
80~991 229(48.1)979(60.0)250(27.1)
≥100364(14.2)351(21.5)13(1.4)
婚姻状态(%)354.287<0.001
已婚1 177(46.1)524(32.1)653(70.7)
未婚/离异/分居/丧偶1 378(53.9)1 108(67.9)270(29.3)
受教育水平(年)(%)148.453<0.001
01 873(73.3)1 319(80.8)554(60.0)
1~6507(19.8)256(15.7)251(27.2)
≥7175(6.8)57(3.5)118(12.8)
退休前职业(%)3.5600.059
农民1 176(46.0)774(47.4)402(43.6)
非农民1 379(54.0)858(52.6)521(56.4)
家庭年收入 (万元)5.0150.025
≥10236(9.2)135(8.3)101(10.9)
<102 319(90.8)149(91.7)822(89.1)
吸烟状态(%)21.802<0.001
从前331(13.0)197(12.1)134(14.5)
现在463(18.1)259(15.9)204(22.1)
从不1 761(68.9)1 176(72.1)585(63.4)
饮酒状态(%)28.400<0.001
从前263(10.3)166(10.2)97(10.5)
现在468(18.3)250(15.3)218(23.6)
从不1 824(71.4)1 216(74.5)608(65.9)
身体锻炼(%)66.857<0.001
从前61(2.4)44(2.7)17(1.8)
现在579(22.7)287(17.6)292(31.6)
从不1 915(75.0)1 301(79.7)614(66.5)
BMI(kg/m2)22.44±3.9121.71±3.8823.72±3.63-12.933<0.001
腰围(cm)85.00±10.7783.74±10.5387.22±10.83-7.935<0.001
小腿围(cm)30.69±5.3229.64±5.2532.54±4.93-13.702<0.001
握力最大值(kg)19.67±10.1714.57±7.1128.90±8.01-47.098<0.001
血清维生素 D3(ng/L)23.66±10.3322.44±10.2326.03±10.07-8.763<0.001
血浆白蛋白(g/L)49.31±117.4147.89±112.1751.71±125.75-0.7570.449
总DDS5.93±1.795.72±1.776.32±1.76-8.216<0.001
总DDS四分位56.668<0.001
Q1(≤5)1 032(40.4)727(44.5)305(33.0)
Q2(6)504(19.7)336(20.6)168(18.2)
Q3(7)497(19.5)298(18.3)199(21.6)
Q4(≥8)522(20.4)271(16.6)251(27.2)
), ArticleFig(id=1240746310559650103, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=表1, caption=

不同特征老年人可能肌少症基本情况描述

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体
(n=2 555)		可能肌少症
(n=1 632)		无肌少症
(n=923)		χ2/tP
性别(%)28.335<0.001
男1 244(48.7)730(44.7)514(55.7)
女1 311(51.3)902(55.3)409(44.3)
年龄组 (岁)(%)739.718<0.001
65~79962(37.7)302(18.5)660(71.5)
80~991 229(48.1)979(60.0)250(27.1)
≥100364(14.2)351(21.5)13(1.4)
婚姻状态(%)354.287<0.001
已婚1 177(46.1)524(32.1)653(70.7)
未婚/离异/分居/丧偶1 378(53.9)1 108(67.9)270(29.3)
受教育水平(年)(%)148.453<0.001
01 873(73.3)1 319(80.8)554(60.0)
1~6507(19.8)256(15.7)251(27.2)
≥7175(6.8)57(3.5)118(12.8)
退休前职业(%)3.5600.059
农民1 176(46.0)774(47.4)402(43.6)
非农民1 379(54.0)858(52.6)521(56.4)
家庭年收入 (万元)5.0150.025
≥10236(9.2)135(8.3)101(10.9)
<102 319(90.8)149(91.7)822(89.1)
吸烟状态(%)21.802<0.001
从前331(13.0)197(12.1)134(14.5)
现在463(18.1)259(15.9)204(22.1)
从不1 761(68.9)1 176(72.1)585(63.4)
饮酒状态(%)28.400<0.001
从前263(10.3)166(10.2)97(10.5)
现在468(18.3)250(15.3)218(23.6)
从不1 824(71.4)1 216(74.5)608(65.9)
身体锻炼(%)66.857<0.001
从前61(2.4)44(2.7)17(1.8)
现在579(22.7)287(17.6)292(31.6)
从不1 915(75.0)1 301(79.7)614(66.5)
BMI(kg/m2)22.44±3.9121.71±3.8823.72±3.63-12.933<0.001
腰围(cm)85.00±10.7783.74±10.5387.22±10.83-7.935<0.001
小腿围(cm)30.69±5.3229.64±5.2532.54±4.93-13.702<0.001
握力最大值(kg)19.67±10.1714.57±7.1128.90±8.01-47.098<0.001
血清维生素 D3(ng/L)23.66±10.3322.44±10.2326.03±10.07-8.763<0.001
血浆白蛋白(g/L)49.31±117.4147.89±112.1751.71±125.75-0.7570.449
总DDS5.93±1.795.72±1.776.32±1.76-8.216<0.001
总DDS四分位56.668<0.001
Q1(≤5)1 032(40.4)727(44.5)305(33.0)
Q2(6)504(19.7)336(20.6)168(18.2)
Q3(7)497(19.5)298(18.3)199(21.6)
Q4(≥8)522(20.4)271(16.6)251(27.2)
), ArticleFig(id=1240746310685479231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Table 2, caption=

Association between quartiles of DDS and possible sarcopenia among whole samples

, figureFileSmall=null, figureFileBig=null, tableContent=
DDS模型1模型2模型3模型4
总体膳食
Q11.001.001.001.00
Q20.839(0.668~1.054)0.872(0.661~1.149)0.895(0.677~1.185)0.860(0.641~1.155)
Q30.628(0.502~0.786)b0.703(0.535~0.924)b0.723(0.548~0.955)b0.783(0.585~1.042)
Q40.453(0.364~0.563)b0.528(0.401~0.694)b0.545(0.412~0.721)b0.544(0.405~0.732)b
趋势P<0.001<0.001<0.001<0.001
动物性膳食
Q11.001.001.001.00
Q20.803(0.623~1.035)0.891(0.656~1.209)0.917(0.673~1.251)0.866(0.625~1.200)
Q30.617(0.487~0.782)b0.668(0.500~0.893)b0.687(0.512~0.922)b0.701(0.514~0.955)b
Q40.440(0.334~0.579)b0.579(0.410~0.817)b0.610(0.429~0.867)b0.613(0.423~0.888)b
趋势P0.003<0.001<0.001<0.001
植物性膳食
Q11.001.001.001.00
Q20.756(0.590~0.968)b0.743(0.551~1.002)0.771(0.570~1.043)0.681(0.493~0.941)b
Q30.604(0.471~0.774)b0.651(0.479~0.884)b0.667(0.489~0.911)b0.633(0.455~0.881)b
Q40.399(0.301~0.530)b0.466(0.328~0.662)b0.502(0.352~0.718)b0.469(0.321~0.684)b
趋势P<0.001<0.001<0.001<0.001
植物性膳食a
Q11.001.001.001.00
Q20.655(0.455~0.943)b0.879(0.572~1.349)0.871(0.565~1.340)0.861(0.545~1.358)
Q30.396(0.275~0.571)b0.604(0.393~0.928)b0.627(0.407~0.967)b0.356(0.197~0.645)b
Q40.182(0.111~0.298)b0.306(0.170~0.552)b0.356(0.197~0.645)b0.382(0.206~0.709)b
趋势P<0.001<0.001<0.001<0.001
), ArticleFig(id=1240746310807114052, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=表2, caption=

总体人群DDS和可能肌少症的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
DDS模型1模型2模型3模型4
总体膳食
Q11.001.001.001.00
Q20.839(0.668~1.054)0.872(0.661~1.149)0.895(0.677~1.185)0.860(0.641~1.155)
Q30.628(0.502~0.786)b0.703(0.535~0.924)b0.723(0.548~0.955)b0.783(0.585~1.042)
Q40.453(0.364~0.563)b0.528(0.401~0.694)b0.545(0.412~0.721)b0.544(0.405~0.732)b
趋势P<0.001<0.001<0.001<0.001
动物性膳食
Q11.001.001.001.00
Q20.803(0.623~1.035)0.891(0.656~1.209)0.917(0.673~1.251)0.866(0.625~1.200)
Q30.617(0.487~0.782)b0.668(0.500~0.893)b0.687(0.512~0.922)b0.701(0.514~0.955)b
Q40.440(0.334~0.579)b0.579(0.410~0.817)b0.610(0.429~0.867)b0.613(0.423~0.888)b
趋势P0.003<0.001<0.001<0.001
植物性膳食
Q11.001.001.001.00
Q20.756(0.590~0.968)b0.743(0.551~1.002)0.771(0.570~1.043)0.681(0.493~0.941)b
Q30.604(0.471~0.774)b0.651(0.479~0.884)b0.667(0.489~0.911)b0.633(0.455~0.881)b
Q40.399(0.301~0.530)b0.466(0.328~0.662)b0.502(0.352~0.718)b0.469(0.321~0.684)b
趋势P<0.001<0.001<0.001<0.001
植物性膳食a
Q11.001.001.001.00
Q20.655(0.455~0.943)b0.879(0.572~1.349)0.871(0.565~1.340)0.861(0.545~1.358)
Q30.396(0.275~0.571)b0.604(0.393~0.928)b0.627(0.407~0.967)b0.356(0.197~0.645)b
Q40.182(0.111~0.298)b0.306(0.170~0.552)b0.356(0.197~0.645)b0.382(0.206~0.709)b
趋势P<0.001<0.001<0.001<0.001
), ArticleFig(id=1240746310899388745, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Table 3, caption=

Association between quartiles of DDS and possible sarcopenia by sex based on Model 4

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组DDS趋势P
Q1Q2Q3Q4
男性
总体膳食1.000.619(0.410~0.933)b0.552(0.366~0.833)b0.436(0.291~0.653)b<0.001
动物性膳食1.000.682(0.420~1.109)0.492(0.308~0.784)b0.378(0.222~0.644)b<0.001
植物性膳食1.000.617(0.388~0.980)b0.480(0.300~0.768)b0.412(0.242~0.700)b0.001
植物性膳食a1.000.758(0.390~1.474)0.497(0.254~0.971)b0.487(0.203~1.172)0.003
女性
总体膳食1.001.198(0.776~1.849)1.102(0.723~1.680)0.665(0.425~1.039)0.184
动物性膳食1.000.946(0.601~1.487)0.909(0.594~1.389)0.955(0.554~1.646)0.769
植物性膳食1.000.747(0.475~1.174)0.847(0.529~1.356)0.512(0.296~0.886)b0.058
植物性膳食a1.000.927(0.491~1.751)0.875(0.461~1.659)0.254(0.104~0.618)b0.017
), ArticleFig(id=1240746311041995089, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=表3, caption=

基于模型4的不同性别人群DDS和可能肌少症关系分析

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组DDS趋势P
Q1Q2Q3Q4
男性
总体膳食1.000.619(0.410~0.933)b0.552(0.366~0.833)b0.436(0.291~0.653)b<0.001
动物性膳食1.000.682(0.420~1.109)0.492(0.308~0.784)b0.378(0.222~0.644)b<0.001
植物性膳食1.000.617(0.388~0.980)b0.480(0.300~0.768)b0.412(0.242~0.700)b0.001
植物性膳食a1.000.758(0.390~1.474)0.497(0.254~0.971)b0.487(0.203~1.172)0.003
女性
总体膳食1.001.198(0.776~1.849)1.102(0.723~1.680)0.665(0.425~1.039)0.184
动物性膳食1.000.946(0.601~1.487)0.909(0.594~1.389)0.955(0.554~1.646)0.769
植物性膳食1.000.747(0.475~1.174)0.847(0.529~1.356)0.512(0.296~0.886)b0.058
植物性膳食a1.000.927(0.491~1.751)0.875(0.461~1.659)0.254(0.104~0.618)b0.017
), ArticleFig(id=1240746311142658388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=EN, label=Table 4, caption=

Sensitivity analysis of DDS with possible sarcopenia based on Model 4

, figureFileSmall=null, figureFileBig=null, tableContent=
变量DDS趋势P
Q1Q2Q3Q4
总体膳食1.000.852(0.633~1.147)0.791 (0.590~1.061)0.545(0.404~0.734)b<0.001
动物性膳食1.000.865(0.623~1.201)0.708(0.518~0.969)b0.612(0.420~0.890)b<0.001
植物性膳食1.000.679(0.490~0.942)b0.632(0.453~0.882)b0.470(0.321~0.689)b0.001
植物性膳食a1.000.825(0.519~1.310)0.644(0.405~1.026)0.373(0.200~0.696)b<0.001
), ArticleFig(id=1240746311213961561, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375107735057303, language=CN, label=表4, caption=

基于模型4的DDS和可能肌少症的关系的敏感性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量DDS趋势P
Q1Q2Q3Q4
总体膳食1.000.852(0.633~1.147)0.791 (0.590~1.061)0.545(0.404~0.734)b<0.001
动物性膳食1.000.865(0.623~1.201)0.708(0.518~0.969)b0.612(0.420~0.890)b<0.001
植物性膳食1.000.679(0.490~0.942)b0.632(0.453~0.882)b0.470(0.321~0.689)b0.001
植物性膳食a1.000.825(0.519~1.310)0.644(0.405~1.026)0.373(0.200~0.696)b<0.001
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中国65岁及以上老年人肌少症和膳食多样性关系的研究
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钱鸣崎 , 杜俏俏 , 张文雅 , 施蓉芳 , 杨海珍 , 朱小军
现代预防医学 | 营养与食品卫生 2024,51(6): 1005-1011
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现代预防医学 | 营养与食品卫生 2024, 51(6): 1005-1011
中国65岁及以上老年人肌少症和膳食多样性关系的研究
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钱鸣崎, 杜俏俏, 张文雅, 施蓉芳, 杨海珍, 朱小军
作者信息
  • 苏州大学附属第二医院健康管理中心，江苏 苏州 215004

    • 钱鸣崎（1990—），男，本科，医师，研究方向：公共卫生

通讯作者:

朱小军，Email：
Relationship between dietary diversity and possible sarcopenia among older adults aged 65 and over in China
Ming-qi QIAN, Qiao-qiao DU, Wen-ya ZHANG, Rong-fang SHI, Hai-zhen YANG, Xiao-jun ZHU
Affiliations
  • Health Management Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202309491
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摘要
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目的

探讨膳食多样性评分（DDS）和老年人肌少症之间的关系。

方法

利用中国老年健康与家庭幸福调查（CLHLS-HF）2018年的调查数据进行分析。采用2019年亚洲肌少症工作组（AWGS2019）制定的标准评估肌少症。通过构建四个新的DDS指标：总体膳食、动物性膳食、植物性膳食和不包含豆制品和坚果的植物性膳食评分。采用logistic回归来分析总体膳食、动物性膳食、植物性膳食和不包含豆制品和坚果的植物性膳食的DDS与可能肌少症之间的关联。并进行混杂因素调整、亚组分析及敏感性分析。

结果

共纳入研究对象2 555名（平均年龄84.4岁），男性1 244人（48.7%），女性1 311人（51.3%）。可能肌少症患病率为63.9%（1 632/2 555），可能肌少症组的DDS明显低于非肌少症组（t=-5.216, P < 0.001）。调整混杂因素后，总体膳食（OR=0.544, 95% CI：0.405~0.732），动物性膳食（OR=0.613；95% CI：0.423~0.888），植物性膳食（OR=0.469；95% CI：0.321~0.684）和不包含豆制品和坚果的植物性膳食(OR=0.382；95% CI：0.206~0.709)与肌少症的发生风险均有关联。DDS越高发生可能肌少症的风险越低。敏感性分析显示相关性保持不变。亚组分析结果显示男性人群中总体膳食、动物性膳食和植物性膳食仍然与可能肌少症风险降低相关，而在女性人群中，植物性膳食以及不包含豆制品和坚果的植物性膳食与可能肌少症的风险降低有关。

结论

膳食多样性是老年人肌少症的保护因素，采用多样化的饮食可能会降低老年人肌少症的风险。

膳食多样性  /  肌少症  /  植物性膳食  /  老年人
Objective

To explore the association between the dietary diversity score (DDS) and the prevalence of possible sarcopenia among the elderly.

Methods

We conducted this analysis utilizing the cross-sectional data from the Chinese longitudinal healthy longevity survey and happy family study(CLHLS-HF, wave 2018 ). A standard developed by the Asian Working Group for Sarcopenia 2019(AWGS2019) was used to assess the possibility of sarcopenia. We have constructed four new indicators of DDS as follows: total diet, animal-based diet, plant-based diet, and plant-based diet without the consumption of legume products and nuts. We used the Logistic regression analysis to evaluate the association between the DDS of the total diet, animal-based diet, plant-based diet, and plant-based diet without the intake of legume products and nuts and possible sarcopenia. These associations were statistically adjusted for a variety of potential confounders. Sensitivity analysis and subgroup analyses were performed.

Results

The analysis included 2 555 participants (mean age of 84.4 years). 1 244 (48.7％) were male and 1 311 (51.3％) were female. 1 632 elderly people had possible sarcopenia. DDS in the possible sarcopenia group was significantly lower than that in the non-sarcopenia group (P < 0.001). In our study, we found that participants with a higher DDS of the total diet (OR=0.544, 95% CI：0.405-0.732), animal-based diet (OR=0.613, 95% CI：0.423-0.888), and plant-based diet (OR=0.469, 95% CI：0.321-0.684) and plant-based diet without the consumption of legume products and nuts (OR=0.382, 95% CI：0.206-0.709) were at a lower risk of developing sarcopenia. In sensitivity analyses, the associations remained unchanged. In subgroup analysis, total diets, animal-based diet, and plant-based diet were still associated with a reduced risk of possible sarcopenia in the male population, while plant-based diet and plant-based diet without the intake of legume products and nuts were associated with a reduced risk of possible sarcopenia in the female population.

Conclusion

Taking a diversified diet may reduce the risk of developing sarcopenia. According to the findings of this study, adopting a diversified diet might reduce the risk of sarcopenia for older adults.

Dietary diversity  /  Possible sarcopenia  /  Plant-based diet  /  Elderly
钱鸣崎, 杜俏俏, 张文雅, 施蓉芳, 杨海珍, 朱小军. 中国65岁及以上老年人肌少症和膳食多样性关系的研究. 现代预防医学, 2024 , 51 (6) : 1005 -1011 . DOI: 10.20043/j.cnki.MPM.202309491
Ming-qi QIAN, Qiao-qiao DU, Wen-ya ZHANG, Rong-fang SHI, Hai-zhen YANG, Xiao-jun ZHU. Relationship between dietary diversity and possible sarcopenia among older adults aged 65 and over in China[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1005 -1011 . DOI: 10.20043/j.cnki.MPM.202309491
正文
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肌少症是一种常见的老年疾病，其特征是骨骼肌质量下降、肌力较低和/或身体表现低下，是当前老龄化社会面临的一个严重的公共卫生问题[1-4]。文献综述显示，肌少症的患病率为0.2%~86.5%，女性为0.3%~91.2%，男性为0.4%~87.7%[5]。患病率因性别、年龄、病理条件和诊断标准等因素的影响而差异较大[4]。越来越多的证据表明，肌少症与跌倒、功能残疾、虚弱和死亡等多种不良结局密切相关[5-6]。肌少症的诊断要综合考虑以下三个方面：肌肉质量、肌肉力量和肌肉功能[1,3]。这些方法需要经过培训的专业人员来执行，费时费力，不适合大规模的调查。AWGS（European Working Groupon Sarcopenia in Older People, EWGSOP） 2019提出了 “可能的肌减少症” 的概念[1]。根据AWGS 2019标准，国内29.6%的老年人被诊断为可能的肌少症[7]。
研究表明，蛋白质摄入不足，维生素D、长链多不饱和脂肪酸和抗氧化剂缺乏等饮食因素可能导致肌少症的发展[4,6]。其中蛋白质摄入不足会对老年人的肌肉合成产生负面影响[8-9]。既往的研究主要集中在单一食物成分类型与肌少症的关联，无法识别食物之间复杂的相互作用和协同效应[4,10]。为了解决以往研究的局限性，有必要研究总体饮食情况。饮食多样性是指“在给定的参考时期内摄入的不同食物或食物组的数量”，并进行膳食多样性评分（dietary diversityscore, DDS）[11-12]。DDS通过对不同的食物组计分，膳食的多样化程度越高，总分越高。DDS是公认的评估营养充足性和总体膳食质量的方便又廉价的指标，已广泛应用于大规模调查研究[12]。已证实DDS与癌症、糖尿病、代谢综合征、认知和死亡风险的相关性[11-13]。一些研究已经报道了饮食和肌少症之间的联系[14-17]。然而，这些研究数据大多是来自发达国家，尚缺乏发展中国家的证据。虽然老年人患肌少症的风险较高，但关于中国老年人膳食多样性和肌少症的研究仍然很少。本研究是基于全国范围内的数据，评估DDS与中国老年人可能肌少症患病率之间的关系，并为建立预防人群肌少症的饮食指南提供基础信息。
1 对象与方法
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1.1 数据来源
本研究数据来自中国老年健康与家庭幸福调查（Chinese longitudinal healthy longevity and happy family study，CLHLS-HF），既往研究已对 CLHLS-HF 数据进行了评估，其数据质量较高，具有良好的人群代表性[18]。所有参与者及/或其家属均获得知情同意，研究经北京大学伦理委员会批准（IRB00001052-13074）。本研究选取 CLHLS-HF 中 2018 年的调查数据，最终纳入2 555名65岁以上的老人为研究对象。
1.2 方法
收集研究对象性别、年龄、家庭年收入、受教育水平、婚姻状况、退休前的职业等社会人口学信息，身体锻炼、吸烟和饮酒状况等生活方式信息，BMI、腰围等体格检查指标以及血清维生素D3和血浆白蛋白等实验室检测指标。血样采集及检测方法：在调查时采集调查对象空腹静脉血5 ml，将离心分离出的血浆于-20℃低温保存运送，采用溴甲酚绿法测定血浆白蛋白，采用电化学发光法测定血清维生素D3。所有样品的检测均在首都医科大学临床检验中心完成。
1.3 膳食多样性的评估
利用简化食物频率问卷进行面对面询问膳食摄人情况。DDS是参照既往研究，并根据中国居民膳食指南为依据评价的，根据摄入频率计算10种食物组（谷物、蔬菜、水果、豆类产品、坚果、肉类、鸡蛋、鱼、乳制品和真菌藻类）得分[13,19]。“每天/几乎每天或经常” 食用谷类、蔬菜和水果将为该食物组记1分，其他记0分。“几乎每天或至少一周一次” 食用真菌藻类、豆制品、坚果、肉、鸡蛋、鱼、乳制品将为该食物组记1分，其他记0分。计算每个参与者的DDS，总分10分[19]。动物的食物包括四种来源：肉类、鱼类、鸡蛋和乳制品。利用动物性食物的摄入频率，计算动物性饮食的DDS，其范围0~4分。植物性食物包括六种来源：谷物、蔬菜、水果、豆制品、坚果和真菌藻类食品。根据植物性食物摄入频率，计算植物性DDS范围0~6分。不包括豆类产品和坚果的植物性饮食包括谷物、蔬菜、水果和真菌藻类，DDS评分范围为0~4分。
1.4 肌少症的评估
根据用AWGS 2019标准评估可能肌少症，包括三个组成部分：小腿围、肌肉力量或身体表现[1]。当男性小腿围<34 cm，女性小腿围<33 cm进行病例筛选，肌肉力量通过握力测力计使用双手或惯用手进行至少两次测量，取最大读数。男性和女性握力分别低于28 kg和18 kg时被认为握力低[1,3,20]。通过问卷进行身体表现的评估：“你坐在椅子上后是否可以站起来？”受访者被要求从三个回答中进行选择：“没有问题” 、“有问题” 和“不能做到”。选择“有问题” 或“不能做” 的表明身体表现较低[20]。
1.5 统计分析
使用SPSS 21.0进行统计分析。定量数据以均数±标准差（）描述，组间比较采用独立样本t检验。定性数据以例（%）表示，组间比较采用χ2检验。以DDS最低四分位数作为对照，通过控制潜在混杂因素，使用logistic回归计算DDS与可能肌少症关系的OR值。模型1：未调整混杂因素；模型2：在模型1的基础上调整性别、年龄、家庭年收入、受教育水平、婚姻状况和退休前的职业；模型3：在模型2的基础上调整身体活动、吸烟、饮酒、BMI和腰围；模型4：在模型3的基础上调整血清维生素D3和血浆白蛋白。排除长期卧床不起、痴呆或癌症的老年人进行敏感性分析。使用MedCalc 20绘制森林图。检验水准α=0.05。
2 结果
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2.1 研究对象一般特征
研究对象的特征描述见表1，可能的肌少症的患病率为63.9%（1 632/2 555）。其中男性1 244人（48.7%），女性1 311人（51.3%），已婚1 177人（46.1%）。平均年龄（84.4 ± 11.3）岁，其中65~79岁962人，80~99岁1 229人，≥100岁364人。可能肌少症的人群中BMI、腰围、小腿围、握力和维生素D3小于非肌少症人群（均P<0.001）。可能肌少症组的DDS明显低于非肌少症组（P<0.001）。
2.2 DDS和可能的肌少症的关系
采用logistic回归计算总体膳食和不同蛋白质来源的DDS与可能肌少症发生风险的关联。在模型1中，较高DDS的人群(第4个四分位数比第1四分位数)可能肌少症的患病率较低，总体膳食（OR=0.453；9.5% CI：0.364~0.563），动物性膳食（OR =0.440；95% CI：0.334~0.579），植物性膳食（OR =0.399；95% CI：0.301~0.530），植物性膳食（不包含豆制品和坚果）（OR =0.182；95% CI：0.111~0.298）与可能肌少症的患病率显著相关。在模型2中，调整了性别、年龄、家庭年收入、受教育水平、婚姻状况和退休前的职业后，这些关联仍然显著。在模型3中，进一步调整身体锻炼、吸烟、饮酒、BMI和腰围，结果显示所有关联仍然呈负相关。在模型4中，进一步调整血清维生素D3和血浆白蛋白，总体膳食（OR=0.544；95% CI：0.405~0.732），动物性膳食（OR =0.613；95% CI：0.423~0.888），植物性膳食（OR=0.469；95% CI：0.321~0.684）和不包含豆制品和坚果的植物性膳食(OR =0.382；95% CI：0.206~0.709)与可能肌少症的风险降低仍然相关。趋势分析均有意义（均趋势P<0.05）。见表2和图1。
2.3 亚组分析
基于模型4的亚组分析显示：男性人群中总体膳食（OR=0.436；95% CI：0.291~0.653）、动物性膳食（OR=0.378；95% CI：0.222~0.644）和植物性膳食（OR=0.412；95% CI：0.242~0.700）仍然与可能肌少症风险降低相关，趋势分析均有意义（均趋势P<0.05）。而女性人群中植物性膳食（OR=0.412；95% CI：0.242~0.700）和不包含豆制品和坚果的植物性膳食(OR =0.487；95% CI：0.203~1.172)与可能肌少症的风险降低有关。但植物性膳食的趋势分析显示没有统计学意义（趋势P=0.058），见表3和图2。
2.4 敏感性分析
排除了长期卧床不起、痴呆和癌症的老年人后（n=71），基于模型4的敏感分析结果显示，总体膳食（OR=0.545；95% CI：0.404~0.734）、动物性膳食（OR=0.612；95% CI：0.420~0.890），植物性膳食（OR=0.470；95% CI：0.321~0.689）和不包含豆制品和坚果的植物性膳食(OR =0.373；95% CI：0.200~0.696)与表2中的结果一致。见表4。
3 讨论
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本研究结果显示可能肌少症的老年人总体膳食、动物性膳食、植物性膳食以及不包含豆制品和坚果的植物性膳食DDS低于无肌少症的老年人。DDS越高发生可能肌少症的风险越低。既往研究表明膳食对肌少症有很大的影响，来自营养流行病学的证据表明，地中海饮食模式与肌肉功能呈正相关，膳食质量高的人通常饮食更多样化[21]。由多样性和营养充足性决定的膳食质量与肌肉质量、肌肉力量和身体表现呈正相关[19,22]。虽然膳食多样性分析不一定考虑到食物组中各食物的“健康性”，但多数饮食指南建议增加食物种类。前瞻性研究也表明，较高的DDS会使握力和步速增加，坚持多样化的饮食与老年人更健康的衰老过程有关[13]。
本研究根据中国居民膳食指南构建了新的DDS指标[3]。不同研究中DDS食物组的构成不同，可能导致研究结果不一致[12,19]。对膳食多样性的研究同时考虑了多种食物和营养素的摄入，避免了特殊营养素和食物的限制，具有更大的意义和价值[22]。关于肌少症的相关研究已证实，蛋白质、维生素D、钙、叶酸和抗氧化剂等被认为是饮食方面所必需的[4,23]。膳食蛋白质摄入与肌肉质量的正相关关系一直被报道[8-9，24]。我们的也研究表明动物蛋白质和植物蛋白质摄入与可能肌少症风险降低之间存在关联。尽管动物蛋白被认为在刺激肌肉蛋白合成方面比植物蛋白更有效，但meta分析结果表明，绝对瘦质量和肌肉力量的变化不受蛋白质来源的影响[10]。植物性蛋白质摄入量低，老年人发生肌肉质量下降的风险较高[25]。植物蛋白质质量取决于食物来源，具有与动物蛋白相当的营养价值。在饮食适量和多样性的基础上，大豆蛋白导致的肌肉质量和力量的增加与动物蛋白相似[26]。蛋白质的质量取决于氨基酸的组成及其被消化、吸收和利用的能力[10]。动物蛋白可以提供足够数量的必需氨基酸，被认为是“高质量”的蛋白质[10]。亮氨酸及其代谢物可能激活蛋白质合成的信号通路，已被证明是抗肌少症的重要成分[4,25]。通过摄入适量的不同蛋白质来改善膳食质量可能对预防肌少症至关重要。
研究中还观察到总体膳食、动物性膳食、植物性膳食DDS与可能的肌少症之间的关联及趋势分析在老年男性中有意义。女性人群中仅观察到植物性膳食和不包含豆制品和坚果的植物性膳食DDS与可能肌少症有关联，但趋势分析不显著。随着年龄增长女性性激素水平下降也可能影响肌肉质量的损失[2,4]。可能由于我们研究中的女性年龄较大，已绝经多年，性激素水平极低，可能已经失去了更多的肌肉。这些结果更加强调了在绝经前期进行饮食干预的预防作用。水果和蔬菜是抗氧化剂的主要来源，丰富的抗氧化维生素可以预防肌肉萎缩和促进肌肉再生[2]。但尚不确定水果和蔬菜的抗氧化作用是否有限。此外，由于食物制作方法的不同，来自不同国家或地区人群的研究并不总是产生相似的结果[10]。不同的饮食多样性与肌少症之间的关系有待进一步研究。
本研究的优势：首先，数据来自具有全国代表性的老年人群样本数据库，并调整了多种潜在混杂因素。其次，应用膳食总体评价指标DDS。此外，通过排除长期卧床不起、痴呆或癌症晚期的参与者进行了敏感性分析，结果保持稳定。研究的局限性：本研究中的膳食多样性是基于半定量的食物频率测量，无法提供定量膳食多样性与结局之间的关系。结局指标是流行病学调查的一部分，这可能会受到测量偏倚。由于本研究中根据AWGS 2019标准，可能肌少症评估需要测量握力的数据，CLHLS-HF 2018 年之前的调查缺少握力的结果，无法纳入无肌少症的人群进行纵向队列研究，仅能以2018年的调查数据进行横断面分析。虽然其限制了膳食多样性与可能肌少症风险之间的因果推断，但样本量较大，结果还是可信的。总之，较高的DDS与老年人肌少症的风险降低相关。有必要进行前瞻性干预研究来分析饮食多样性和肌少症风险之间的因果关系。
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doi: 10.20043/j.cnki.MPM.202309491
  • 接收时间：2023-09-28
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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    苏州大学附属第二医院健康管理中心，江苏 苏州 215004

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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