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Article(id=1241022949797450302, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410087, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1728489600000, receivedDateStr=2024-10-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812528322, onlineDateStr=2026-03-18, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812528322, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812528322, creator=13701087609, updateTime=1773812528322, updator=13701087609, issue=Issue{id=1241022939957621542, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', 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=1773812525976, creator=13701087609, updateTime=1773815469296, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035285174219432, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035285174219433, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241022939957621542, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1044, endPage=1049, ext={EN=ArticleExt(id=1241022951454200414, articleId=1241022949797450302, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between dietary fiber and micronutrient intake and sarcopeniain patients with liver cirrhosis, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the dietary nutrition status of patients with liver cirrhosis and to explore the relationship between dietary fiber and micronutrient intake and the prevalence of sarcopenia, providing a theoretical foundation for sarcopenia prevention in this patient population.

Methods

The current study was conducted among patients with liver cirrhosis in the gastroenterology department of Sichuan Provincial People’s Hospital by purposive sampling from September 2022 to December 2023. The 24-hour dietary recall method was used to collect information on the types and quantities of food consumed by the patients. Whole-body muscle mass was measured using bioelectrical impedance analysis (BIA), and sarcopenia was diagnosed in combination with handgrip strength and 6-meter walking speed. Multiple logistic regression analysis was used to analyze the correlation between energy and nutrient intake and sarcopenia.

Results

A total of 203 patients with cirrhosis were included in the analysis, including 40.4% with sarcopenia. Negative correlations were observed between sarcopenia prevalence and the intake of dietary fiber (OR=0.85, 95% CI: 0.75-0.96), vitamin A (OR=0.87, 95% CI: 0.77-0.98), vitamin C(OR=0.91, 95% CI: 0.86-0.97), potassium (OR=0.88, 95% CI: 0.80-0.97), magnesium (OR=0.93, 95% CI: 0.87-0.99) and copper (OR=0.31, 95% CI: 0.14-0.67). Additionally, an interactive effect was identified between age and the intake of vitamin C, phosphorus, and iron (Pfor interaction<0.05).

Conclusion

Dietary fiber and micronutrient intake are closely related to sarcopenia in patients with cirrhosis. It is crucial to enhance nutritional education for patients with liver cirrhosis and their families, and to consider the use of nutritional supplements when necessary to prevent sarcopenia, particularly in the elderly.

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目的

了解肝硬化患者膳食营养现状，探究肝硬化患者膳食纤维和微量营养素摄入量与肌少症发生的相关性，为肝硬化患者的肌少症预防提供理论依据。

方法

采用立意抽样，于2022年9月至2023年12月期间选取四川省人民医院消化内科肝硬化患者为研究对象。采用24h膳食回顾法收集患者摄入的食物种类和数量信息。采用生物电阻抗法（BIA）测量全身各部位肌肉含量，结合握力和6 m步速诊断是否患有肌少症。采用多因素logistic回归分析营养素摄入量与肌少症的相关性。

结果

纳入分析的肝硬化患者共203人，肌少症患者占40.4%。控制混杂因素后，膳食纤维（OR=0.85，95% CI：0.75~0.96）、维生素A（OR=0.87，95% CI：0.77~0.98）、维生素C（OR=0.91，95% CI：0.86~0.97）、镁（OR=0.93，95% CI：0.87~0.99）、铜（OR=0.31，95% CI：0.14~0.67）、钾（OR=0.88，95% CI：0.80~0.97）摄入量与肌少症患病率呈独立负相关关系。年龄与维生素C、磷和铁摄入量具有交互效应（交互检验P <0.05）。

结论

肝硬化患者膳食纤维和微量营养素摄入量与肌少症患病密切相关。应加强对肝硬化患者及其家属的营养宣教，必要时搭配营养补充剂，以预防肌少症的发生，尤其是老年人群。

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周雪，E-mail：
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张亦奇（1994—），女，博士，医师，研究方向：临床营养

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张亦奇（1994—），女，博士，医师，研究方向：临床营养

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张亦奇（1994—），女，博士，医师，研究方向：临床营养

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Bone, 2021, 146: 115886., articleTitle=Magnesium supplementation enhances mTOR signalling to facilitate myogenic differentiation and improve aged muscle performance, refAbstract=null), Reference(id=1241022962728489223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, doi=null, pmid=null, pmcid=null, year=2024, volume=11, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[22], rfOrder=23, authorNames=Wang H, Lin P, journalName=Frontiers of Medicine, refType=null, unstructuredReference=Wang H, Lin P. Association between sarcopenia and hemoglobin level: a systematic review and meta-analysis[J]. 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Frontiers in Nutrition, 2024, 11: 1323450., articleTitle=Prospective changes in anemia are associated with the incidence and persistence of sarcopenia among older Mexican adults, refAbstract=null)], funds=[Fund(id=1241022958358024281, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, awardId=2015-HM01-00439-SF, language=CN, fundingSource=成都市科技局科技惠民技术研发项目(2015-HM01-00439-SF), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241022953081590517, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, xref=null, ext=[AuthorCompanyExt(id=1241022953085784822, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, companyId=1241022953081590517, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Clinical Nutrition Department of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610000, China), AuthorCompanyExt(id=1241022953094173431, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, companyId=1241022953081590517, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川省医学科学院·四川省人民医院临床营养科，四川　成都　610000)])], figs=[ArticleFig(id=1241022957275893768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=EN, label=Table 1, caption=

Patients’ characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=203）分组χ2值/Z值P值
无肌少症组（n=121）肌少症组（n=82）
性别(%)3.370.067
男122(60.1)79(65.3)43(52.4)
女81(39.9)42(34.7)39(47.6)
年龄(岁,%)22.57<0.001
<60103(50.7)78(64.5)25(30.5)
≥60100(49.3)43(35.5)57(69.5)
民族(%)10.350.006
汉族168(82.8)92(76.0)76(92.7)
其它35(17.2)29(24.0)6(7.3)
居住地(%)0.030.867
城市105(51.7)62(51.2)43(52.4)
乡镇98(48.3)59(48.8)39(47.6)
饮酒状况(%)0.690.407
饮酒43(21.2)93(76.9)67(81.7)
不饮酒160(78.8)28(23.1)15(18.3)
吸烟状况(%)0.210.646
吸烟53(26.1)33(27.3)20(24.4)
不吸烟150(73.9)88(72.7)62(75.6)
糖尿病(%)43(21.2)27(22.3)16(19.5)0.230.632
高血压(%)34(16.8)23(19.0)11(13.4)1.100.295
高血脂(%)16(7.9)11(9.1)5(6.1)0.600.437
ALBI分级(%)1.230.540
1级31(15.3)19(15.7)12(14.6)
2级125(61.6)71(58.7)54(65.9)
3级47(23.1)31(25.6)16(19.5)
CRP[mg/L,M(P25,P75)]5.1(1.2,15)4.2(0.9,14.5)8.2(1.4,18.3)-2.200.028
HGB[g/L,M(P25,P75)]96.5(78.0,120.8)99.0(79.8,127.0)92.5(77.0,112.5)-1.810.071
握力[kg,M(P25,P75)]19.2(14.1,26.1)22.6(17.7,29.6)15.7(11.2,20.0)-6.10<0.001
步行速度[m/s,M(P25,P75)]1.2(1.0,1.5)1.3(1.1,1.6)1.2(1.0,1.4)-2.060.040
ASMI(kg/m2,)6.7±1.27.3±1.05.7±0.8-10.84<0.001
), ArticleFig(id=1241022957452054551, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=CN, label=表1, caption=

研究对象基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群（n=203）分组χ2值/Z值P值
无肌少症组（n=121）肌少症组（n=82）
性别(%)3.370.067
男122(60.1)79(65.3)43(52.4)
女81(39.9)42(34.7)39(47.6)
年龄(岁,%)22.57<0.001
<60103(50.7)78(64.5)25(30.5)
≥60100(49.3)43(35.5)57(69.5)
民族(%)10.350.006
汉族168(82.8)92(76.0)76(92.7)
其它35(17.2)29(24.0)6(7.3)
居住地(%)0.030.867
城市105(51.7)62(51.2)43(52.4)
乡镇98(48.3)59(48.8)39(47.6)
饮酒状况(%)0.690.407
饮酒43(21.2)93(76.9)67(81.7)
不饮酒160(78.8)28(23.1)15(18.3)
吸烟状况(%)0.210.646
吸烟53(26.1)33(27.3)20(24.4)
不吸烟150(73.9)88(72.7)62(75.6)
糖尿病(%)43(21.2)27(22.3)16(19.5)0.230.632
高血压(%)34(16.8)23(19.0)11(13.4)1.100.295
高血脂(%)16(7.9)11(9.1)5(6.1)0.600.437
ALBI分级(%)1.230.540
1级31(15.3)19(15.7)12(14.6)
2级125(61.6)71(58.7)54(65.9)
3级47(23.1)31(25.6)16(19.5)
CRP[mg/L,M(P25,P75)]5.1(1.2,15)4.2(0.9,14.5)8.2(1.4,18.3)-2.200.028
HGB[g/L,M(P25,P75)]96.5(78.0,120.8)99.0(79.8,127.0)92.5(77.0,112.5)-1.810.071
握力[kg,M(P25,P75)]19.2(14.1,26.1)22.6(17.7,29.6)15.7(11.2,20.0)-6.10<0.001
步行速度[m/s,M(P25,P75)]1.2(1.0,1.5)1.3(1.1,1.6)1.2(1.0,1.4)-2.060.040
ASMI(kg/m2,)6.7±1.27.3±1.05.7±0.8-10.84<0.001
), ArticleFig(id=1241022957598855201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=EN, label=Table 2, caption=

Comparison of daily energy and nutrient intakes [M(P25，P75)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群(n=203)分组Z值P值
无肌少症组 (n=121)肌少症组 (n=82)
能量(kcal/d)1 586.5(1 031.5,2 240.3)1 506.0(1 081.2,2 048.3)1 145.3(750.0,1 499.7)-3.69<0.001
能量[kcal/(IBW·d)]24.6(17.8,34.3)26.7(20.0,36.0)22.3(15.4,30.6)-2.270.023
蛋白质供能比(%)13.5(12.0,15.7)13.8(12.2,16.1)13.1(12.0,15.4)-1.240.215
碳水化合物供能比(%)61.4(51.6,72.9)62.4(52.2,72.1)60.2(51.2,73.0)-0.040.972
脂肪供能比(%)24.9(14.4,34.1)25.4(15.4,33.1)24.7(13.5,34.4)-0.030.980
膳食纤维(g/d)5.3(3.25,7.84)6.1(4.0,9.1)4.3(2.9,6.3)-4.06<0.001
维生素A(μgRAE/d)205.0(103.6,349.5)231.9(112.0,477.6)167.2(70.4,291.3)-2.930.003
维生素B1(mg/d)0.8(0.5,11.7)0.9(0.6,1.2)0.6(0.4,0.8)-4.14<0.001
维生素B2(mg/d)0.7(0.4,1.0)0.7(0.5,1.1)0.6(0.3,0.9)-3.310.001
维生素C(mg/d)62.0(16.0,114.3)88.8(28.8,139.5)44.0(7.8,93.0)-3.67<0.001
钙(mg/d)304.8(128.1,466.5)346.7(180.5,497.4)213.3(90.5,403.5)-3.110.002
铁(mg/d)12.1(8.3,17.6)14.6(10.8,19.7)10.1(7.0,13.8)-4.99<0.001
锌(mg/d)8.1(5.3,11.1)9.1(6.6,12.5)5.8(4.3,9.6)-4.07<0.001
磷(mg/d)707.4(469.3,1 009.0)824.4(608.1,1 084.4)548.2(361.5,850.7)-4.36<0.001
钾(mg/d)992.6(532.8,1 500.0)1 176.0(788.4,1 573.2)775.0(430.5,1 180.7)-4.32<0.001
镁(mg/d)176.8(117.9,249.9)203.7(151.2,258.9)142.0(90.1,213.8)-4.33<0.001
铜(mg/d)1.2(0.8,1.7)1.3(0.9,1.9)0.9(0.6,1.2)-4.85<0.001
硒(μg/d)31.6(18.6,45.2)35.6(24.8,49.9)24.6(15.6,39.3)-3.84<0.001
), ArticleFig(id=1241022957728878629, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=CN, label=表2, caption=

每日能量和营养素摄入量比较[M(P25，P75)]

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变量总人群(n=203)分组Z值P值
无肌少症组 (n=121)肌少症组 (n=82)
能量(kcal/d)1 586.5(1 031.5,2 240.3)1 506.0(1 081.2,2 048.3)1 145.3(750.0,1 499.7)-3.69<0.001
能量[kcal/(IBW·d)]24.6(17.8,34.3)26.7(20.0,36.0)22.3(15.4,30.6)-2.270.023
蛋白质供能比(%)13.5(12.0,15.7)13.8(12.2,16.1)13.1(12.0,15.4)-1.240.215
碳水化合物供能比(%)61.4(51.6,72.9)62.4(52.2,72.1)60.2(51.2,73.0)-0.040.972
脂肪供能比(%)24.9(14.4,34.1)25.4(15.4,33.1)24.7(13.5,34.4)-0.030.980
膳食纤维(g/d)5.3(3.25,7.84)6.1(4.0,9.1)4.3(2.9,6.3)-4.06<0.001
维生素A(μgRAE/d)205.0(103.6,349.5)231.9(112.0,477.6)167.2(70.4,291.3)-2.930.003
维生素B1(mg/d)0.8(0.5,11.7)0.9(0.6,1.2)0.6(0.4,0.8)-4.14<0.001
维生素B2(mg/d)0.7(0.4,1.0)0.7(0.5,1.1)0.6(0.3,0.9)-3.310.001
维生素C(mg/d)62.0(16.0,114.3)88.8(28.8,139.5)44.0(7.8,93.0)-3.67<0.001
钙(mg/d)304.8(128.1,466.5)346.7(180.5,497.4)213.3(90.5,403.5)-3.110.002
铁(mg/d)12.1(8.3,17.6)14.6(10.8,19.7)10.1(7.0,13.8)-4.99<0.001
锌(mg/d)8.1(5.3,11.1)9.1(6.6,12.5)5.8(4.3,9.6)-4.07<0.001
磷(mg/d)707.4(469.3,1 009.0)824.4(608.1,1 084.4)548.2(361.5,850.7)-4.36<0.001
钾(mg/d)992.6(532.8,1 500.0)1 176.0(788.4,1 573.2)775.0(430.5,1 180.7)-4.32<0.001
镁(mg/d)176.8(117.9,249.9)203.7(151.2,258.9)142.0(90.1,213.8)-4.33<0.001
铜(mg/d)1.2(0.8,1.7)1.3(0.9,1.9)0.9(0.6,1.2)-4.85<0.001
硒(μg/d)31.6(18.6,45.2)35.6(24.8,49.9)24.6(15.6,39.3)-3.84<0.001
), ArticleFig(id=1241022957850513456, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=EN, label=Table 3, caption=

Logistic regression model of sarcopenia in patients with liver cirrhosis

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变量肌少症患病率 (%)模型1模型2
OR值 (95% CI)P值OR值 (95% CI)P值
膳食纤维(g/d)0.83(0.75~0.92)<0.0010.85(0.75~0.96)0.009
Q1(<3.8)55.91.001.00
Q2(3.8~7.2)39.10.59(0.27~1.31)0.1990.68(0.30~1.54)0.354
Q3(>7.2)25.80.29(0.13~0.68)0.0040.41(0.15~1.10)0.077
维生素A(100 μgRAE/d)0.85(0.75~0.96)0.0080.87(0.77~0.98)0.024
Q1(<130.3)50.01.001.00
Q2(130.3~296.0)42.60.61(0.27~1.36)0.2240.70(0.31~1.59)0.393
Q3(>296.0)28.40.27(0.12~0.61)0.0020.38(0.15~0.91)0.031
维生素C(10 mg/d)0.90(0.85~0.95)<0.0010.91(0.86~0.97)0.002
Q1(<31.0)52.91.001.00
Q2(31.0~93.0)42.90.70(0.30~1.59)0.3900.87(0.37~2.06)0.753
Q3(>93.0)24.90.28(0.12~0.62)0.0020.38(0.16~0.91)0.031
镁(10 mg/d)0.94(0.90~0.97)<0.0010.93(0.87~0.99)0.034
Q1(<139.3)58.81.001.00
Q2(133.3~231.5)36.80.45(0.20~0.99)0.0470.54(0.22~1.34)0.184
Q3(>231.5)25.40.29(0.13~0.64)0.0020.51(0.14~1.81)0.295
锌(mg/d)0.64(0.35~1.16)0.1410.96(0.66~1.38)0.809
Q1(<5.9)63.21.001.00
Q2(5.9~10.1)31.90.19(0.08~0.44)<0.0010.12(0.04~0.40)<0.001
Q3(>10.1)25.80.20(0.08~0.48)<0.0010.15(0.03~0.78)0.024
铜(mg/d)0.34(0.20~0.60)<0.0010.31(0.14~0.67)0.003
Q1(<0.9)58.01.001.00
Q2(0.9~1.4)41.80.41(0.19~0.90)0.0270.47(0.18~1.20)0.114
Q3(>1.4)20.90.16(0.07~0.41)<0.0010.20(0.05~0.75)0.017
钾(100 mg/d)0.88(0.83~0.94)<0.0010.88(0.80~0.97)0.011
Q1(<698.0)57.41.001.00
Q2(698.0~1296.7)38.20.44(0.20~0.96)0.040.49(0.20~1.19)0.114
Q3(>1296.7)25.40.17(0.07~0.40)<0.0010.21(0.06~0.70)0.012
), ArticleFig(id=1241022957997314107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=CN, label=表3, caption=

微量营养素摄入量与肌少症相关性的Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量肌少症患病率 (%)模型1模型2
OR值 (95% CI)P值OR值 (95% CI)P值
膳食纤维(g/d)0.83(0.75~0.92)<0.0010.85(0.75~0.96)0.009
Q1(<3.8)55.91.001.00
Q2(3.8~7.2)39.10.59(0.27~1.31)0.1990.68(0.30~1.54)0.354
Q3(>7.2)25.80.29(0.13~0.68)0.0040.41(0.15~1.10)0.077
维生素A(100 μgRAE/d)0.85(0.75~0.96)0.0080.87(0.77~0.98)0.024
Q1(<130.3)50.01.001.00
Q2(130.3~296.0)42.60.61(0.27~1.36)0.2240.70(0.31~1.59)0.393
Q3(>296.0)28.40.27(0.12~0.61)0.0020.38(0.15~0.91)0.031
维生素C(10 mg/d)0.90(0.85~0.95)<0.0010.91(0.86~0.97)0.002
Q1(<31.0)52.91.001.00
Q2(31.0~93.0)42.90.70(0.30~1.59)0.3900.87(0.37~2.06)0.753
Q3(>93.0)24.90.28(0.12~0.62)0.0020.38(0.16~0.91)0.031
镁(10 mg/d)0.94(0.90~0.97)<0.0010.93(0.87~0.99)0.034
Q1(<139.3)58.81.001.00
Q2(133.3~231.5)36.80.45(0.20~0.99)0.0470.54(0.22~1.34)0.184
Q3(>231.5)25.40.29(0.13~0.64)0.0020.51(0.14~1.81)0.295
锌(mg/d)0.64(0.35~1.16)0.1410.96(0.66~1.38)0.809
Q1(<5.9)63.21.001.00
Q2(5.9~10.1)31.90.19(0.08~0.44)<0.0010.12(0.04~0.40)<0.001
Q3(>10.1)25.80.20(0.08~0.48)<0.0010.15(0.03~0.78)0.024
铜(mg/d)0.34(0.20~0.60)<0.0010.31(0.14~0.67)0.003
Q1(<0.9)58.01.001.00
Q2(0.9~1.4)41.80.41(0.19~0.90)0.0270.47(0.18~1.20)0.114
Q3(>1.4)20.90.16(0.07~0.41)<0.0010.20(0.05~0.75)0.017
钾(100 mg/d)0.88(0.83~0.94)<0.0010.88(0.80~0.97)0.011
Q1(<698.0)57.41.001.00
Q2(698.0~1296.7)38.20.44(0.20~0.96)0.040.49(0.20~1.19)0.114
Q3(>1296.7)25.40.17(0.07~0.40)<0.0010.21(0.06~0.70)0.012
), ArticleFig(id=1241022958114754630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=EN, label=Table 4, caption=

Stratifed analyses of potential modifcation effect for the impact of nutrients intake on sarcopenia

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变量<60岁≥60岁交互检验P值
OR值 (95% CI)P值OR值 (95% CI)P值
维生素C (10 mg/d)0.99(0.92~1.06)0.6830.85(0.78~0.93)0.0010.011
磷 (10 mg/d)1.01(0.97~1.04)0.7130.96(0.92~0.99)0.0110.036
铁 (mg/d)0.94(0.82~1.06)0.3080.72(0.57~0.90)0.0050.044
), ArticleFig(id=1241022958219612236, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241022949797450302, language=CN, label=表4, caption=

微量营养素摄入量与肌少症关系的分层分析

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变量<60岁≥60岁交互检验P值
OR值 (95% CI)P值OR值 (95% CI)P值
维生素C (10 mg/d)0.99(0.92~1.06)0.6830.85(0.78~0.93)0.0010.011
磷 (10 mg/d)1.01(0.97~1.04)0.7130.96(0.92~0.99)0.0110.036
铁 (mg/d)0.94(0.82~1.06)0.3080.72(0.57~0.90)0.0050.044
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肝硬化患者膳食纤维和微量营养素摄入与肌肉减少症的相关性研究
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张亦奇 , 王家妮 , 卜凡 , 周雪
现代预防医学 | 营养与食品卫生 2025,52(6): 1044-1049
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现代预防医学 | 营养与食品卫生 2025, 52(6): 1044-1049
肝硬化患者膳食纤维和微量营养素摄入与肌肉减少症的相关性研究
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张亦奇, 王家妮, 卜凡, 周雪
作者信息
  • 四川省医学科学院·四川省人民医院临床营养科，四川　成都　610000

    • 张亦奇（1994—），女，博士，医师，研究方向：临床营养

通讯作者:

周雪，E-mail：
Association between dietary fiber and micronutrient intake and sarcopeniain patients with liver cirrhosis
Yi-qi ZHANG, Jia-ni WANG, Fan BU, Xue ZHOU
Affiliations
  • Clinical Nutrition Department of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610000, China
出版时间: 2025-03-25 doi: 10.20043/j.cnki.MPM.202410087
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摘要
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目的

了解肝硬化患者膳食营养现状，探究肝硬化患者膳食纤维和微量营养素摄入量与肌少症发生的相关性，为肝硬化患者的肌少症预防提供理论依据。

方法

采用立意抽样，于2022年9月至2023年12月期间选取四川省人民医院消化内科肝硬化患者为研究对象。采用24h膳食回顾法收集患者摄入的食物种类和数量信息。采用生物电阻抗法（BIA）测量全身各部位肌肉含量，结合握力和6 m步速诊断是否患有肌少症。采用多因素logistic回归分析营养素摄入量与肌少症的相关性。

结果

纳入分析的肝硬化患者共203人，肌少症患者占40.4%。控制混杂因素后，膳食纤维（OR=0.85，95% CI：0.75~0.96）、维生素A（OR=0.87，95% CI：0.77~0.98）、维生素C（OR=0.91，95% CI：0.86~0.97）、镁（OR=0.93，95% CI：0.87~0.99）、铜（OR=0.31，95% CI：0.14~0.67）、钾（OR=0.88，95% CI：0.80~0.97）摄入量与肌少症患病率呈独立负相关关系。年龄与维生素C、磷和铁摄入量具有交互效应（交互检验P <0.05）。

结论

肝硬化患者膳食纤维和微量营养素摄入量与肌少症患病密切相关。应加强对肝硬化患者及其家属的营养宣教，必要时搭配营养补充剂，以预防肌少症的发生，尤其是老年人群。

肝硬化  /  肌肉减少症  /  膳食纤维  /  微量营养素  /  老年人
Objective

To assess the dietary nutrition status of patients with liver cirrhosis and to explore the relationship between dietary fiber and micronutrient intake and the prevalence of sarcopenia, providing a theoretical foundation for sarcopenia prevention in this patient population.

Methods

The current study was conducted among patients with liver cirrhosis in the gastroenterology department of Sichuan Provincial People’s Hospital by purposive sampling from September 2022 to December 2023. The 24-hour dietary recall method was used to collect information on the types and quantities of food consumed by the patients. Whole-body muscle mass was measured using bioelectrical impedance analysis (BIA), and sarcopenia was diagnosed in combination with handgrip strength and 6-meter walking speed. Multiple logistic regression analysis was used to analyze the correlation between energy and nutrient intake and sarcopenia.

Results

A total of 203 patients with cirrhosis were included in the analysis, including 40.4% with sarcopenia. Negative correlations were observed between sarcopenia prevalence and the intake of dietary fiber (OR=0.85, 95% CI: 0.75-0.96), vitamin A (OR=0.87, 95% CI: 0.77-0.98), vitamin C(OR=0.91, 95% CI: 0.86-0.97), potassium (OR=0.88, 95% CI: 0.80-0.97), magnesium (OR=0.93, 95% CI: 0.87-0.99) and copper (OR=0.31, 95% CI: 0.14-0.67). Additionally, an interactive effect was identified between age and the intake of vitamin C, phosphorus, and iron (Pfor interaction<0.05).

Conclusion

Dietary fiber and micronutrient intake are closely related to sarcopenia in patients with cirrhosis. It is crucial to enhance nutritional education for patients with liver cirrhosis and their families, and to consider the use of nutritional supplements when necessary to prevent sarcopenia, particularly in the elderly.

Liver cirrhosis  /  Sarcopenia  /  Dietary fiber  /  Micronutrient  /  Elderly
张亦奇, 王家妮, 卜凡, 周雪. 肝硬化患者膳食纤维和微量营养素摄入与肌肉减少症的相关性研究. 现代预防医学, 2025 , 52 (6) : 1044 -1049 . DOI: 10.20043/j.cnki.MPM.202410087
Yi-qi ZHANG, Jia-ni WANG, Fan BU, Xue ZHOU. Association between dietary fiber and micronutrient intake and sarcopeniain patients with liver cirrhosis[J]. Modern Preventive Medicine, 2025 , 52 (6) : 1044 -1049 . DOI: 10.20043/j.cnki.MPM.202410087
正文
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肝硬化是慢性肝病晚期阶段的表现，发病隐匿且病程长。由于食欲减退、消化吸收功能障碍、营养流失严重、代谢率异常升高以及合成能力下降等多重因素，肝硬化患者面临较高的营养不良风险[1]。肌肉减少症简称肌少症，是一种以肌肉质量、力量和功能下降为主要特征的退行性疾病，在老年人群体中较为常见，同时也多发于恶性肿瘤、慢性肝病、糖尿病、尿毒症等慢性疾病患者，与营养不良密切相关[1]。研究表明，30％~70％的肝硬化患者合并有肌少症[1-2]。肌少症会增加肝硬化患者感染、腹水、肝性脑病、手术并发症等风险，降低其生活质量和生存率，增加等待肝移植期间的死亡风险[3]。因此，及时对肝硬化患者进行肌少症的预防和干预对于提升疾病预后，提高患者生活质量具有重要意义。
膳食营养摄入是肌少症发病的重要影响因素之一。过去针对肝硬化患者膳食摄入相关的研究显示肝硬化患者多存在特定营养素摄入不足的问题，例如蛋白质摄入不足，微量元素缺乏等[4]。目前缺乏针对四川地区肝硬化患者膳食营养现况的研究，针对肝硬化患者营养摄入与肌少症相关性的研究较少，且多聚焦于能量和蛋白质，缺乏膳食纤维和微量营养素与肌少症关系的研究[4-5]。本研究旨在了解四川地区肝硬化患者膳食营养现状，探究肝硬化患者膳食纤维和微量营养素摄入量与肌少症发生的相关性，为肝硬化患者的肌少症预防提供理论依据。
1　研究对象与方法
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1.1　研究对象
采用立意抽样，于2022年9月至2023年12月期间，选取四川省人民医院消化内科肝硬化患者为研究对象。纳入标准：①行腹部 CT 检查，符合肝硬化诊断标准；②年龄> 18岁。排除标准：①合并恶性肿瘤、结核病、甲状腺疾病、肝肾综合征、慢性肾功能衰竭、严重消化系统疾病等；②合并中至重度腹水者；③妊娠、哺乳期妇女；④病情危重或有精神疾病相关症状难以评估者；⑤管饲或接受肠内营养者；⑥长期卧床者；⑦拒绝或不配合调查者。采用横断面调查样本量计算公式N=[μα×π(1－π)]/δ2计算所需样本量。上式中N是估计样本量，α为第一类错误概率，μα为所对应的正态分布界值，π为估计的总体率，δ为容许误差。取α=0.05，μα=1.96，δ=0.07，π=0.4，计算得所需最小样本量为188人。本研究通过了四川省医学科学院·四川省人民医院涉及人的生物医学研究伦理审查[伦审（研）2024年第718号]，所有调查对象均已签署知情同意书。
1.2　研究方法
1.2.1　问卷调查
采用自行设计的问卷以面对面访谈的方式收集患者年龄、民族、吸烟、饮酒等基本信息。
1.2.2　膳食调查
采用24 h膳食回顾法调查研究对象所有食物和饮料的摄入量，膳食调查均由经统一培训的营养科医师和技师面对面进行。根据《中国食物成分表》（第6版）计算能量和各类营养素的摄入量。
1.2.3　人体成分分析
采用生物电阻抗法通过人体成分分析仪Inbody S10（韩国 Biospace公司）测定体成分。检测时空腹，排空大、小便，仅穿内衣、裤。四肢骨骼肌量=左上肢+右上肢+左下肢+右下肢骨骼肌含量，四肢肌肉指数（ASMI）=四肢骨骼肌量（kg）/身高（m）2。
1.2.4　肌少症诊断
本研究采用亚洲肌肉衰减症工作组（AWGS）2019年发布的诊断标准[6]。肌肉力量、躯体功能分别用握力和6 m步速来评价。①握力：男性<28 kg，女性<18 kg；②步行速度<1.0 m/s；③ASMI：男性<7.0，女性<5.7。符合条件③且满足条件①和（或）条件②即诊断为肌少症。
1.2.5　生化指标检测
患者均需空腹至少 8 小时，清晨抽取静脉血，所有检测均由临床医学检验中心进行。本研究中白蛋白（ALB）、总胆红素（TBIL）、血红蛋白（HGB）和C反应蛋白（CRP）的测定均于问卷调查当天或±2天内进行。ALB通过溴甲酚绿法测定，TBIL采用重氮盐法进行测定，HGB采用光学比色法测定，CRP采用免疫透射比浊法测定。
1.2.6　白蛋白-胆红素分级（ALBI）
ALBI是于2015年Johnson等[7]提出的一种新的评估肝功能的指标，旨在消除Child-Pugh评分中腹水和肝性脑病的主观因素，目前已被广泛应用于多种临床治疗评估中。计算公式为：ALBI=log10[TBIL（μmol/L）]×0.66+ALB（g/L）×（-0.085）。分为三个等级：1级（≤-2.60）、2级（>-2.60~≤-1.39）和3级（>-1.39）。
1.2.7　质量控制
于调查前统一培训调查员；在调查中对调查资料及时复查、查缺补漏；调查后对问卷进行统一编码，食物定量结果抽取10%进行核查。数据录入使用统一数据库双人双录入，随机抽查10%复核。
1.2.8　数据整理与统计分析
问卷收回后经整理及检错，采用 Epidata 3.1建立数据库，双人双录入。应用Excel 2007 对数据进行整理后采用R 3.4.3和Empower 2.0进行统计分析。定量资料符合正态分布，采用描述，不符合正态分布采用M(P25，P75)描述。符合正态分布且方差齐的定量资料组间差异比较采用Z检验，不符合正态分布采用Wilcoxon秩和检验，定性资料组间比较采用卡方检验。建立多因素非条件logistic回归模型，分析营养素摄入量与肌少症的相关性。模型1调整了年龄（岁）、性别（男/女）、饮酒量（ml）、吸烟量（支/周）、糖尿病（有/无）、CRP（mg/L）、ALBI分级，模型2在模型1的基础上进一步调整了能量摄入量（kcal/d）。分层分析在不同性别和年龄亚组比较营养素摄入量与肌少症的相关性是否有差异，交互检验采用似然比检验。检验水准α=0.05。
2　结果
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2.1　基本情况
研究对象共计203人，肌少症患者占40.4%。相较于无肌少症组，肌少症组平均年龄更高，汉族占比更高、CRP值更高，差异有统计学意义（P<0.05）。详见表1。
2.2　肌少症组与非肌少症组膳食能量及各类营养素摄入量比较
肌少症组能量、膳食纤维、维生素A、维生素B1、维生素B2、维生素C、钙、铁、锌、磷、钾、镁、铜、硒摄入量均低于无肌少症组，差异有统计学意义（P<0.05）。三大宏量营养素供能比组间差异无统计学意义（P>0.05）。见表2。
2.3　膳食纤维和微量营养素摄入量与肌少症相关性的Logistic回归分析
在仅调整了年龄、性别、饮酒量、吸烟量、糖尿病、CRP、ALBI分级（模型1）以后，膳食纤维、维生素A、维生素B1、维生素B2、维生素C、钙、磷、钾、镁、铁、铜和锰与肌少症患病率呈负相关关系（P<0.05）。在模型1基础上进一步调整能量后，膳食纤维（OR=0.85，95% CI：0.75~0.96）、维生素A（OR=0.87，95% CI：0.77~0.98）、维生素C（OR=0.91，95% CI：0.86~0.97）、镁（OR=0.93，95% CI：0.87~0.99）、铜（OR=0.31，95% CI：0.14~0.67）、钾（OR=0.88，95% CI：0.80~0.97）摄入量与肌少症患病率呈独立负相关关系。相较于维生素A、维生素C、锌、铜、钾Q1组，各营养素Q3组肌少症发生风险均降低（分别为OR=0.38，95% CI：0.15~0.91；OR=0.38，95% CI：0.16~0.91；OR=0.15，95% CI：0.03~0.78；OR=0.20，95% CI：0.05~0.75，OR=0.21，95% CI：0.06~0.70）。详见表3。
2.4　膳食纤维和微量营养素摄入量与肌少症关系的分层分析
根据性别和年龄对研究对象进行分层分析，发现维生素C、磷和铁摄入量与年龄具有交互效应（交互检验P <0.05）。在≥60岁组中，维生素C、磷和铁摄入量均与肌少症发生风险有相关性（P<0.05），而在<60岁组中，未发现维生素C、磷和铁摄入量与肌少症患病风险有相关性（P>0.05）。未发现性别与营养素摄入量之间具有交互效应（交互检验P>0.05）。详见表4。
3　讨论
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营养不良是肌少症的主要病因之一。肝硬化患者多存在食欲下降、消化吸收功能障碍、代谢异常等情况，导致能量和营养素缺乏[8]。本研究中肝硬化患者能量和绝大部分营养素摄入量均低于膳食营养素参考摄入量（DRIs），提示肝硬化患者普遍存在营养摄入不足的问题。并且年龄与维生素C、磷、铁摄入量具有交互效应，提示老年人群更容易因微量营养素摄入不足引发肌少症。老年人由于食欲减退，咀嚼和消化功能下降等原因普遍存在饮食不足的问题，肝硬化患者也多存在食欲减退的问题，因此在仅靠食物难以获取足量能量和营养素的情况下，建议患者选择口服营养补充剂进行营养补充，以预防肌少症的发生。
本研究发现在控制了能量摄入量以后，膳食纤维摄入量与肌少症患病率呈负相关关系，与既往多项研究结果一致[9-11]。有研究表明，炎症会加速肌肉蛋白质的分解，减少肌肉蛋白质的合成，而膳食纤维可通过调控肠道菌群及其代谢产物降低全身炎症水平，进而预防肌少症的发生[12]。DRIs对成年人膳食纤维推荐摄入量为25~30 g/d，而本研究中膳食纤维摄入中位数仅为5.3 g/d，远低于推荐值，提示肝硬化患者膳食纤维摄入不足的问题较为突出，应注意调整饮食结构，增加粗杂粮、蔬菜、大豆等富含膳食纤维食物的摄入量。
本研究中维生素A、维生素C、钾、镁、锌、铜与肌少症的发生风险均有独立相关性，提示保证充足的维生素和矿物质摄入对于预防肌少症有重要意义。随着年龄的增长，体内的内源性抗氧化防御系统受损，导致过量的活性氧（ROS）在体内积累，引起氧化性肌肉损伤，这可能直接或间接参与骨骼肌萎缩的过程。此外，肌肉老化过程中线粒体功能异常也与异常的ROS产生和氧化损伤有关[13]。维生素A、维生素C、锌、铁、铜均有一定的抗氧化功能，可能通过预防氧化应激降低肌少症发生风险。既往有较多研究均显示维生素C、胡萝卜素、锌等具有抗氧化功能的营养素对肌少症具有保护作用[14-16]。另外，有研究表明，人体骨骼肌中抗坏血酸浓度对维生素C摄入量高度敏感，抗坏血酸在肌肉能量代谢所必需的肉毒碱的合成中起重要作用，缺乏维生素C的个体肌肉中的肉毒碱含量下降[17]。本研究中维生素C摄入与年龄具有交互效应，提示老年人更应注意补充维生素C，增加蔬菜和水果的摄入。
锌和镁是多种酶促反应的组成部分或辅助因子。锌参与蛋白质合成，直接影响肌肉的生长和修复，还可能通过增强免疫功能、减少炎症保护肌肉细胞免受炎症介质的损伤，从而防止肌肉萎缩[18]。一项在日本开展的研究显示，血清锌是慢性肝病患者肌肉减少前期的独立预测因子[19]。镁可能通过参与核糖体功能促进肌肉蛋白质的生成，并通过参与能量代谢提升肌肉功能[20]。有研究发现补充Mg2+可诱导老年小鼠的肌源性分化，保护肌肉再生潜力和肌肉质量不受衰老影响，促进肌肉再生，并保持肌肉质量和力量[21]。
本研究发现60岁以上人群铁摄入量与肌少症患病率呈负相关关系。铁缺乏会减少氧气向肌肉的输送，进而影响肌肉的功能和恢复能力以及线粒体代谢。既往有多项研究表明血红蛋白水平与肌少症密切相关[22-23]。本研究中肝硬化患者血红蛋白中位数仅96.5 g/L，贫血率超过75%。肝硬化患者由于出血、脾功能变化、脂肪代谢紊乱等原因容易出现贫血，因此在积极治疗原发疾病的同时，患者应适当补充铁剂和维生素C，以改善贫血，提升肌肉功能。
本研究调查了四川地区肝硬化患者的膳食营养现况，探究了膳食纤维和微量营养素与肌少症的相关性，为肝硬化患者预防肌少症的策略提供了新的理论依据。但本研究也存在局限性。第一，膳食调查中没有收集食用油的摄入量，能量、脂肪和脂溶性维生素的计算量偏低。第二，缺乏对研究对象体力活动相关数据的收集，不能排除体力活动对结果的干扰。第三，样本量偏小，后续将进一步开展多中心大样本研究。
综上所述，四川地区肝硬化合并肌少症患者能量和各营养素摄入量均明显低于推荐量，存在较大的进食量不足的问题。膳食纤维、维生素A、维生素C、钾、镁、锌、铜与肌少症的发生风险均有独立相关性，且年龄与维生素C、磷和铁摄入量具有交互效应。提示肝硬化患者应重视膳食营养，保证充足的能量摄入和合理的膳食结构，必要时可口服营养补充剂以预防肌少症的发生，尤其是老年人群。
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  • 成都市科技局科技惠民技术研发项目(2015-HM01-00439-SF)
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2025年第52卷第6期
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doi: 10.20043/j.cnki.MPM.202410087
  • 接收时间：2024-10-10
  • 首发时间：2026-03-18
  • 出版时间：2025-03-25
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  • 收稿日期：2024-10-10
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成都市科技局科技惠民技术研发项目(2015-HM01-00439-SF)
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    四川省医学科学院·四川省人民医院临床营养科，四川　成都　610000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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