專題報導 2014 25 131-136 1 2,3 2,4 1 2 3 4 摘 要 The elderly Sarcopenia Frailty 1 (sarcopenia) (frailty) (geriatric syndrome) 2 (sarcopenia) 60-70 7
132 10% 80 30% 1 1989 Irwin Rosenberg sarcopenia sarx penia Baumgartner 3 Newman, Janssen 3 4 5 6 the Special Interest Group(SIG) on cachexia-anorexia in chronic wasting diseases 7 the International Working Group on Sarcopenia(IWGS) (physical performance) 8 the Society on Sarcopenia, Cachexia and Wasting Disorders ( ) 9 the European Working Group on Sarcopenia in Older People (EWGSOP) 3 X (dual energy x-ray absorptiometry, DXA) (bioeletrical impedance analysis, BIA) (magnetic resonance imaging, MRI) (computerized tomography, CT) (handgrip strength) (short physical performance battery, SPPB) (6-minute walking test) (timed get-up-and-go test) 0.8-1.0 / 5 3,10 EWGSOP (ILAS) : (appendicular muscle mass/ squared height, ASM/ht 2 ) (Lean body mass/squared height, LBM/ht 2 ) (persent skeletal muscle index, SMI%) ( ASM/ht 2, LBM/ht 2 ) ASM/ht 2 11
133 (frailty) 12 7% 25-40% 12,13 65 5%~11% 14 Rockwood (accumulation of deficiencies, Frailty Index) 15 30-70 0 1 16 210 ( ) 4 17 Fried 18 10-15 (vital signs) 19 the study of osteoporotic fracture (SOF of frailty) 15 2010 Verghese (physical performance battery, PPB) 20 2010 14 4% 3 ( ) (homeostatic mechanism)
134 19 ( ) interleukin-6(il-6) 1 dehydr oepiandrosteronesulfate(dheas) IGF-1 21 (Institute of Medicine) 70 0.8 g/kg (the European Society for Clinical Nutrition and Metabolism, ESPEN) 1-1.5 g/kg/day (glomerular filtration rate) 22 Layman 2009 (anabolic drive) 23 15 24,25 (leucine) 26 (soybeans) (cowpea) D D 27 D (25, OH(D)<30 ng/ml) D D (resistance exercise) 2009 121 28 6,700 2-3 29
135 30 31 ( ) 19,30 (threshold) (endpoint) 1. Cooper C, Dere W, Evans W, et al. Frailty and sarcopenia: definitions and outcome parameters. Osteoporos Int 2012; 23: 1839-48. 2. Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. The Medical clinics of North America 2006; 90: 837-47. 3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and ageing; 39: 412-23. 4. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998; 147: 755-63. 5. Newman AB, Kupelian V, Visser M, et al. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003; 51: 1602-9. 6. Kim TN, Yang SJ, Yoo HJ, et al. Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. Int J Obes (Lond) 2009; 33: 885-92. 7. Muscaritoli M, Anker SD, Argiles J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr 2010; 29: 154-9. 8. Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011; 12: 249-56. 9. Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12: 403-9. 10. Cederholm TE, Bauer JM, Boirie Y, Schneider SM, Sieber CC, Rolland Y. Toward a definition of sarcopenia. Clin Geriatr Med 2011; 27: 341-53. 11. Liu LK, Lee WJ, Liu CL, et al. Age-related skeletal muscle mass loss and physical performance in Taiwan: Implications to diagnostic strategy of sarcopenia in Asia. Geriatrics & gerontology international 2013; 13: 964-71. 12. Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 2002; 162: 2333-41. 13. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older communitydwelling Europeans living in 10 countries. J Gerontol A Biol Scie MedSci 2009; 64: 675-81. 14. Chen CY, Wu SC, Chen LJ, Lue BH. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr 2010; 50 (Supp l): S43-7. 15. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. The journals of gerontology Series A, Biological sciences and medical sciences 2007; 62: 722-7.
136 16. Iqbal J, Denvir M, Gunn J. Frailty assessment in elderly people. Lancet 2013; 381: 1985-6. 17. Chin APMJ, Dekker JM, Feskens EJ, Schouten EG, Kromhout D. How to select a frail elderly population? A comparison of three working definitions. Journal of clinical epidemiology 1999; 52: 1015-21. 18. Fried LP, Walston J. Frailty and Failure to Thrive. In: Hazzard W, Blass JP, Halter JB, Ouslander JG, Tinetti ME, eds. Principles of Geriatric Medicine & Gerontology. 5 ed. New York: McGraw-Hill 2003; 1487-502. 19. Fried LP, Walston JD, Ferruci L. Frailty. In: Halter JB, Ouslander JG, Tinetti ME, el al., eds. Hazzard's Geriatric Medicine and Gerontology. 6th ed. New York : McGrall-Hill 2009; 631-45. 20. Verghese J, Xue X. Identifying frailty in high functioning older adults with normal mobility. Age Ageing 2010; 39: 382-5. 21. Morley JE, Malmstrom TK. Frailty, sarcopenia, and hormones. Endocrinol Metab Clin North Am 2013; 42: 391-405. 22. Ramel A, Arnarson A, Geirsdottir OG, Jonsson PV, Thorsdottir I. Glomerular filtration rate after a 12-wk resistance exercise program with post-exercise protein ingestion in community dwelling elderly. Nutrition 2013; 29: 719-23. 23. Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutr Metabo 2009; 6: 12. 24. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am JClin Nutr 2005; 82: 1065-73. 25. Paddon-Jones D, Sheffield-Moore M, Aarsland A, Wolfe RR, Ferrando AA. Exogenous amino acids stimulate human muscle anabolism without interfering with the response to mixed meal ingestion. Am J Physiol Endocrinol Metab 2005; 288: E761-7. 26. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009; 12: 86-90. 27. Waters DL, Baumgartner RN, Garry PJ, Vellas B. Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging 2010; 5: 259-70. 28. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009: CD002759. 29. Chan DC, Tsou HH, Yang RS, et al. A pilot randomized controlled trial to improve geriatric frailty. BMC Geriatr 2012; 12: 58. 30. Ping-Hsueh Lee Y-Sl, Ding-Cheng Chan. Interventions targeting geriatric frailty: a systemic review. J Clin Gerontol Geriatr 2012; 3: 47-52. 31. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752-62. Review: Sarcopenia and Frailty Ya-Ju Wu 1, Yi-Chun Chou 2,3, and Ding-Cheng Chan 2,4 1 Division of General Internal Medicine, Hualien Tzu Chi Hospital; 2 Department of Geriatric and Gerontology, National Taiwan University Hospital; 3 Department of Family Medicine, National Taiwan University Hospital; 4 Department of Internal Medicine, National Taiwan University Hospital As the population aging, the two geriatric syndromes, sarcopenia and frailty, become more prominent. However, the definitions of these two geriatric syndromes are not unified. The core concept of sarcopenia is reduced muscle strength, muscle mass and/or decreased physical performance. Frailty is multi-system impairment associated with decreased physiological reservation and could not maintain one s daily activity compared to individuals of same age. The core presentations include body weight loss, decrease muscle strain and activity. Sarcopenia and frailty have several common causes, and possibly result in clinical adverse outcomes. Currently, adequate nutrition and exercise are effective intervention to prevent and treat these two syndromes. This review will introduce the definition of sarcopenia and frailty, association between them, and appropriate intervention. It also provides internal medicine doctors an understanding of these two syndromes. (J Intern Med Taiwan 2014; 25: 131-136)