目的 探讨上海市某社区老年人膳食模式与肌少症的关联及炎症在其中可能发挥的部分中介作用,为肌少症的膳食防控提供理论依据。方法 采用方便抽样,研究对象为2023-2024年上海康桥社区卫生服务中心老年人体检项目中自愿参加肌少症筛查的65周岁以上老年人;通过问卷调查收集性别、年龄等人口学信息,采用食物频率问卷收集19个食物种类过去1年的摄入频率和摄入量,采用主成分分析法确定膳食模式,将膳食模式因子得分四等分为Q1~Q4组;根据2019年亚洲肌少症工作组（AWGS2019）标准,采用握力、5次起坐时间和四肢骨骼肌肌肉质量（appendicular skeletal muscle,ASM）诊断肌少症;采集空腹血液,检测血生化和血常规指标水平;采用二元Logistic回归模型分析膳食模式与肌少症的关联,采用中介效应分析验证炎症指标中性粒细胞/淋巴细胞比值（neutrophil-lymphocyte ratio,NLR）在膳食模式与肌少症患病风险之间的中介作用。结果 纳入5 930人,肌少症患病率为5.1%;共确定5种膳食模式,分别为水产-加工肉-植物模式、蛋奶水果模式、蔬菜模式、肉类模式和精制碳水模式;二元Logistic回归分析结果显示,与因子得分最低分组（Q1）相比,蛋奶水果模式最高分组（Q4）的肌少症风险降低（OR 0.54,95%CI：0.38~0.78）,其余4种膳食模式与肌少症无统计学关联（P>0.05）;中介效应分析结果显示,NLR在蛋奶水果模式倾向性与肌少症的关联中存在显著的中介效应（中介效应比例为5.3%,P<0.001）。结论 蛋奶水果模式与社区老年人肌少症的患病风险负相关,炎症可能在蛋奶水果模式倾向性与肌少症的关联中起部分中介作用。
Abstract
Objective To explore the association between dietary patterns and sarcopenia among community-dwelling elderly in Shanghai and the potential mediating role of inflammation in this association, thereby providing a theoretical basis for the dietary prevention and control of sarcopenia. Methods Using convenience sampling, participants were adults aged 65 years and older who voluntarily participated in sarcopenia screening during the 2023-2024 elderly health examination program in Kangqiao Community Health Center, Shanghai. Demographic information was collected by questionnaires. Dietary intake over the past year was assessed using a food frequency questionnaire covering 19 food groups. Principal component analysis was applied to identify dietary patterns. Factor scores of dietary patterns were divided into quartiles (Q1~Q4). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 (AWGS2019) criteria, including handgrip strength, five-time chair stand test and appendicular skeletal muscle (ASM) mass. Fasting blood samples were collected to measure biochemical and hematological parameters. Binary logistic regression was used to analyze the association between dietary patterns and sarcopenia. Mediation analysis was conducted to examine the role of the neutrophil-to-lymphocyte ratio (NLR) in the relationship between dietary patterns and sarcopenia risk. Results A total of 5,930 participants were included, with a sarcopenia prevalence of 5.1%, including 2,734 males (46.1%) and 3,196 females (53.9%). The median age was 71 (68, 74) years. Five dietary patterns were identified, including aquatic-processed meat-plant pattern, egg-dairy-fruit pattern, vegetable pattern, meat pattern and refined carbohydrate pattern. The results of binary logistic regression analysis showed that compared with the lowest quartile (Q1) of the egg-dairy-fruit pattern, the highest quartile (Q4) was associated with a reduced risk of sarcopenia (OR=0.54, 95% CI=0.38-0.78). No significant associations were found between the other four dietary patterns and sarcopenia (P>0.05). Mediation analysis indicated that NLR played a significant mediating role in the association between the egg-dairy-fruit pattern and sarcopenia (mediation proportion=5.3%, P<0.001). Conclusion The egg-dairy-fruit pattern is negatively associated with the risk of sarcopenia among community-dwelling older adults. Inflammation may play a partial mediating role in this association.
关键词
肌少症 /
膳食模式 /
老年人 /
中介效应分析 /
中性粒细胞/淋巴细胞比值
Key words
Sarcopenia /
dietary patterns /
elderly /
mediation analysis /
neutrophil-lymphocyte ratio
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基金
上海市教育委员会AI赋能科研计划（No.SHJWAIJK241204）
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