肌肉萎縮

圓肩的原因可能是肩部的肌肉萎縮，正常肩部是隆起，肌肉萎縮以后，會(huì)出現(xiàn)肩膀變圓像下沉一樣，是肌肉的外形變小，應(yīng)該還是與直接的神經(jīng)損傷有關(guān)系。還有一種原因叫肌肉萎縮性頸椎病。臨床上有時(shí)候會(huì)遇到，一般頸椎病引起的圓肩是單側(cè)性，一側(cè)的肩膀變小變圓，另一側(cè)還是正常。如果兩側(cè)同時(shí)發(fā)生一般與頸椎關(guān)系不大，可能是神經(jīng)內(nèi)科方面的問題，神經(jīng)發(fā)育出現(xiàn)問題，或者是肌肉的營養(yǎng)系統(tǒng)出問題。不管是頸椎還是腰椎壓迫神經(jīng)造成，大多數(shù)是單側(cè)的，而不會(huì)雙側(cè)對(duì)稱發(fā)生。

肌少癥不但要有肌肉質(zhì)量（musclemass）減少，同時(shí)還要存在肌肉力量(mesclestrength)和/或軀體功能（phisicalperformance）的下降。糖尿病、冠心病、慢阻肺等多種疾病容易合并肌少癥，導(dǎo)致患者生存質(zhì)量下降，原發(fā)病治療困難。發(fā)現(xiàn)和治療肌少癥對(duì)于老年人尤為重要。

我們一直說腹橫肌好比腰椎保護(hù)的金腰帶，360°保護(hù)著人體腹部的組織，維護(hù)著腰椎的穩(wěn)定。那么，多裂肌是不是很重要呢？多裂肌是唯一從腰骶部跨越至背部的肌肉，其位于脊柱最內(nèi)側(cè)，覆蓋全脊柱，是附著面積最大的椎旁肌。因?yàn)槎嗔鸭〉牧€位于腰部曲線的后部，可以起到“弓弦”的作用，使脊柱保持伸展并且增加腰椎的前凸。斜行的肌纖維可以使上部身體產(chǎn)生旋轉(zhuǎn)，如果沒有多裂肌的作用，腰椎的屈曲將會(huì)被強(qiáng)制約束，防止腰椎過度屈曲出現(xiàn)損傷。同時(shí)在脊柱單純旋轉(zhuǎn)時(shí)保持直立（而不出現(xiàn)前屈）。多裂肌纖維是位于腰骶結(jié)合部(L5-S1)后方的唯一肌肉纖維，由于該部位前傾明顯，多裂肌必須產(chǎn)生足夠的拉力保證L5椎體不向前滑移超過骶骨的前緣（脊椎滑脫）。慶幸的是，多裂肌大量精確地聚集在脊椎這個(gè)部位，但是不幸的是，它經(jīng)常得不到鍛煉出現(xiàn)廢用性萎縮，而被脂肪組織滲透替代。多裂肌作為腰椎穩(wěn)定性的重要來源，其萎縮與腰椎椎間盤突出癥、腰椎椎管狹窄癥、腰椎滑脫癥等腰椎退行性疾病關(guān)系密切。TeichtahlAJ，UrquhartDM，WangY，etal.Fatinfiltrationofparaspinalmusclesisassociatedwithlowbackpain，disability，andstructuralabnormalitiesincommunity-basedadults［J］.SpineJ，2015，15（7）：1593-1601.1腰椎椎間盤突出癥在腰椎椎間盤突出癥患者中，患側(cè)多裂肌的脂肪浸潤程度高于健側(cè)、CSA小于健側(cè)；和健康組相比，患側(cè)多裂肌CSA也明顯減小、脂肪浸潤程度增加。表明椎間盤突出引起神經(jīng)根癥狀持續(xù)時(shí)間越長，肌肉神經(jīng)源性改變的風(fēng)險(xiǎn)增加。故腰椎椎間盤突出對(duì)神經(jīng)造成的壓迫損傷，會(huì)導(dǎo)致神經(jīng)所支配的多裂肌發(fā)生萎縮。haoWP，KawaguchiY，MatsuiH，etal.Histochemistryandmorphologyofthemultifidusmuscleinlumbardischerniation：comparativestudybetweendiseasedandnormalsides［J］.Spine（PhilaPa1976），2000，25（17）：2191-2199.2腰椎滑脫癥在不同節(jié)段滑脫節(jié)段多裂肌的脂肪浸潤程度明顯增高，滑脫層面的多裂肌脂肪浸潤程度顯著高于其他非滑脫層面，II度滑脫的多裂肌脂肪浸潤程度明顯高于I度滑脫。腰椎滑脫患者進(jìn)行l(wèi)ogistic回歸分析，發(fā)現(xiàn)多裂肌脂肪浸潤是促進(jìn)腰椎滑脫的一個(gè)重要因素，認(rèn)為多裂肌萎縮是退行性腰椎滑脫的一個(gè)重要原因。表明多裂肌萎縮與退行性腰椎滑脫可能互為影響。WangG，KarkiSB，XuS，etal.QuantitativeMRIandX-rayanalysisofdiscdegenerationandparaspinalmusclechangesindegenerativespondylolisthesis［J］.JBackMusculoskeletRehabil，2015，28（2）：277-285.3腰椎椎管狹窄癥腰椎椎管狹窄癥患者多裂肌脂肪浸潤的增加、腰大肌RCSA的降低與患者的機(jī)體功能降低有關(guān)（更高的疼痛評(píng)分），但多裂肌的脂肪浸潤程度與腰椎椎管狹窄程度和下腰痛持續(xù)時(shí)間無關(guān)。腰椎椎管狹窄癥患者多裂肌萎縮可降低患者的功能狀態(tài)。FortinM，Lazáryà，VargaPP，etal.Associationbetweenparaspinalmusclemorphology，clinicalsymptomsandfunctionalstatusinpatientswithlumbarspinalstenosis［J］.EurSpineJ，2017，26（10）：2543-2551.4脊柱后凸腰椎后凸患者的多裂肌萎縮程度顯著高于慢性下腰痛患者，logistic回歸分析發(fā)現(xiàn)，多裂肌CSA比其他椎旁肌CSA下降的更多，表明多裂肌的萎縮在腰椎后凸患者中更具有特異性。退行性脊柱后凸患者L2以上的多裂肌可能主要維持腰椎的曲度，L2以下的多裂肌可能主要控制腰椎的旋轉(zhuǎn)，多裂肌萎縮可能會(huì)加重胸腰椎后凸和矢狀面失衡，從而擾亂腰椎矢狀面平衡，揭示了多裂肌萎縮可能是促進(jìn)脊柱后凸發(fā)生、發(fā)展的重要因素。XiaW，F(xiàn)uH，ZhuZ，etal.Associationbetweenbackmuscledegenerationandspinal-pelvicparametersinpatientswithdegenerativespinalkyphosis［J］.BMCMusculoskeletDisord，2019，20（1）：454.因此，腰椎退行性疾病會(huì)對(duì)多裂肌形態(tài)和功能造成影響，而多裂肌萎縮也會(huì)加重腰椎退行性變。由于多裂肌與腰椎穩(wěn)定性密切相關(guān)，多裂肌良好的生理功能是減緩腰椎退行性變和獲得滿意預(yù)后的重要條件。

肌肉減少癥的病因、治療及康復(fù)鍛煉：最新研究進(jìn)展陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）什么是肌肉減少癥？肌肉減少癥這個(gè)詞的意思是“缺乏肌肉”，一旦你了解了這種情況，它就明白了。肌肉減少癥是一種與年齡相關(guān)的肌肉退化有關(guān)的疾病。它在50歲以上的人群中更相關(guān)也更常見。30歲以后，人開始失去肌肉力量。根據(jù)2004年發(fā)表在CurrentOpinioninClinicalNutritionandMetabolicCare上的一篇評(píng)論，人們往往每十年失去3%到8%的肌肉力量(1)。失去肌肉力量會(huì)降低您進(jìn)行日常活動(dòng)和日常任務(wù)的能力。它可能會(huì)增加患?xì)埣病⑹オ?dú)立性和需要護(hù)理的風(fēng)險(xiǎn)。它可能會(huì)增加跌倒、事故、受傷、骨折、住院、手術(shù)和術(shù)后并發(fā)癥的風(fēng)險(xiǎn)。考慮到住院和家庭護(hù)理的費(fèi)用，肌肉減少癥也會(huì)變得非常昂貴。根據(jù)WorldviewsonEvidence-BasedNursing發(fā)表的2016年評(píng)論，肌肉減少癥還可能縮短您的壽命(2)。根據(jù)2015年發(fā)表在《營養(yǎng)學(xué)會(huì)會(huì)刊》上的一篇評(píng)論，肌肉減少癥的發(fā)生可能是由于肌肉細(xì)胞生長（合成代謝）信號(hào)和分解信號(hào)（分解代謝）信號(hào)之間的不平衡(3)。在一個(gè)健康的身體里，你的生長激素與蛋白質(zhì)破壞酶一起工作，在肌肉生長、壓力、損傷、分解、破壞、修復(fù)和恢復(fù)的持續(xù)循環(huán)中保持你的肌肉健康和肌肉質(zhì)量穩(wěn)定。在衰老的身體中，信號(hào)之間的不平衡和對(duì)生長信號(hào)的抵抗可能會(huì)發(fā)展，這會(huì)導(dǎo)致比合成代謝和肌肉生長更多的分解代謝和肌肉損失。圖1?agingmuscle:衰老的肌肉肌肉減少癥的癥狀肌肉減少癥的癥狀可能包括：?肌肉無力，?（容易）摔倒，?步行速度減緩慢?自我報(bào)告的肌肉萎縮?難以執(zhí)行或參與正常的日常任務(wù)和活動(dòng)?運(yùn)動(dòng)時(shí)容易感到疲勞肌肉減少癥的根本原因如果您有任何健康問題，請(qǐng)務(wù)必查看問題的根本原因。如果我們著眼于問題的根本原因，我們就可以制定治療策略來解決這些問題，而不是僅僅在癥狀上貼上創(chuàng)可貼（即大家經(jīng)常說的：治標(biāo)不治本）。肌肉減少癥的根本原因可能包括：圖2?肌肉減少癥的影響與危害：25%的65歲及以上人群受到影響，60%的80歲以上人群受到影響，以肌肉萎縮和活動(dòng)減少為主要特征。（1）炎癥反應(yīng)：可導(dǎo)致的肌肉減少癥術(shù)語炎癥，也稱為炎癥老化，是指隨著年齡的增長而出現(xiàn)的炎癥反應(yīng)上調(diào)和全身低度炎癥。炎癥會(huì)加速衰老過程，并可能使一些與年齡相關(guān)的癥狀和疾病惡化。根據(jù)2013年發(fā)表在Longevity&Healthspan上的一項(xiàng)研究，炎癥可能是先天和后天免疫系統(tǒng)的結(jié)果，它可以增加體內(nèi)炎性細(xì)胞因子的產(chǎn)生(4)。這會(huì)促進(jìn)炎癥并導(dǎo)致與年齡相關(guān)的健康問題，包括肌肉衰退。2013年發(fā)表在Thorax上的一項(xiàng)研究發(fā)現(xiàn)，患有慢性阻塞性肺病(COPD)和相關(guān)慢性炎癥的患者的肌肉質(zhì)量也有所下降(5)。還有許多其他以長期慢性炎癥為特征的疾病，包括慢性感染、炎癥性腸病和自身免疫性疾病，可能會(huì)增加肌肉減少和肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2016年發(fā)表在Maturitas上的系統(tǒng)回顧和薈萃分析，較高水平的C反應(yīng)蛋白可能與慢性炎癥和肌肉減少癥有關(guān)(6)。圖3?炎癥可通過一系列復(fù)雜的機(jī)制和病理過程，影響我們身體的各個(gè)重要器官：腦心肝腎肺、肌骨皮膚、腸道和甲狀腺等。（2）蛋白質(zhì)攝入不足：可導(dǎo)致的肌肉減少癥遵循低營養(yǎng)素和高精制糖、精制油、人工成分和過度加工食品的不健康飲食會(huì)增加慢性炎癥。注意您的常量營養(yǎng)素也很重要。熱量和蛋白質(zhì)含量過低的飲食不僅會(huì)導(dǎo)致體重減輕，還會(huì)導(dǎo)致肌肉質(zhì)量下降。蛋白質(zhì)對(duì)肌肉健康、肌肉質(zhì)量和肌肉力量至關(guān)重要。蛋白質(zhì)攝入不足可能導(dǎo)致肌肉減少癥。隨著年齡的增長，許多人的牙齒和牙齦出現(xiàn)問題，吞咽困難，口味和食欲發(fā)生變化，購物和烹飪的挑戰(zhàn)也越來越大。這會(huì)增加他們無法滿足蛋白質(zhì)和熱量需求的風(fēng)險(xiǎn)。根據(jù)2015年發(fā)表在《臨床醫(yī)學(xué)研究雜志》上的一篇評(píng)論，每餐攝入25至30克蛋白質(zhì)可能有助于降低肌肉減少癥的風(fēng)險(xiǎn)(7)。圖4?蛋白質(zhì)攝入對(duì)人體的8點(diǎn)益處：①維持穩(wěn)定的血糖；②改善脂肪利用效率；③促進(jìn)肌肉重建；④提高記憶與學(xué)習(xí)能力；⑤保持積極的心態(tài)；⑥心臟正常的功能所必須；⑦減緩衰老進(jìn)程并有可能長壽；⑧改善骨密度（3）胃酸水平低：所致的肌肉減少癥胃酸是一種水狀無色液體，由胃壁形成，可促進(jìn)消化。顧名思義，胃酸是非常酸性的，它支持食物的分解以進(jìn)行適當(dāng)?shù)南Ｎ杆徇€有助于營養(yǎng)物質(zhì)的適當(dāng)吸收。胃酸水平低下顯然會(huì)導(dǎo)致消化問題。如果您的胃酸水平較低，您的身體可能無法分解和吸收食物中的蛋白質(zhì)和其他營養(yǎng)物質(zhì)。這不僅會(huì)導(dǎo)致消化問題，還會(huì)導(dǎo)致慢性炎癥和健康并發(fā)癥。根據(jù)2022年發(fā)表在《營養(yǎng)學(xué)》雜志上的一項(xiàng)研究，胃動(dòng)力差可能與老年人的肌肉減少癥有關(guān)(8)。2019年發(fā)表在《科學(xué)報(bào)告》(ScienceReports)上的一項(xiàng)研究將與低胃酸水平相關(guān)的胃食管反流病與骨骼肌衰減不良和肌肉減少癥聯(lián)系起來(9)。圖5?胃酸的7大主要功能：①殺滅食物中的病菌，達(dá)到無菌化處理；②蛋白質(zhì)分解；③激活胃蛋白酶（胃內(nèi)最重要的消化酶）；④活化內(nèi)源性因子；⑤促進(jìn)膽汁和膽酶轉(zhuǎn)運(yùn)（至十二指腸）；⑥關(guān)閉食管括約?。ㄎ傅娜肟冢员阄杆岵灰追戳髦潦彻?，造成胃食管反流病，避免食管胃酸液的化學(xué)性腐蝕、損傷）；⑦打開幽門括約?。ㄎ傅呐懦隹冢员憬?jīng)胃酸消化的食物，進(jìn)入小腸內(nèi)，便于吸收）（4）腸道菌群失調(diào)：可致肌肉減少癥您的腸道是數(shù)萬億細(xì)菌和微生物的家園。其中一些微生物對(duì)您的健康有益，而另一些則對(duì)您的健康有害。關(guān)鍵是腸道微生物失衡，有益細(xì)菌多于有害細(xì)菌。不幸的是，炎癥性飲食、不良的生活方式選擇、營養(yǎng)失衡、壓力、環(huán)境毒素和其他因素都會(huì)破壞平衡。腸道菌群失調(diào)意味著腸道微生物群失衡，有害細(xì)菌過多而有益細(xì)菌過少。腸道菌群失調(diào)會(huì)導(dǎo)致慢性炎癥和慢性嚴(yán)重健康問題的風(fēng)險(xiǎn)。它還可能增加患肌肉減少癥的風(fēng)險(xiǎn)。2018年發(fā)表在MediatorsofInflammation上的一項(xiàng)研究發(fā)現(xiàn)，腸道菌群失調(diào)可能在與年齡相關(guān)的炎癥、炎癥、肌肉老化和肌肉減少癥中發(fā)揮作用(10)。研究人員發(fā)現(xiàn)，在解決肌肉減少癥時(shí)，針對(duì)腸道菌群失調(diào)可能很重要。發(fā)表在惡病質(zhì)、肌肉減少癥和肌肉雜志（Cachexia,Sarcopenia,andMuscle）上的2021年系統(tǒng)綜述支持了這些發(fā)現(xiàn)，并發(fā)現(xiàn)腸道生態(tài)失調(diào)可能在肌肉減少癥的發(fā)展中發(fā)揮關(guān)鍵作用(11)。圖6?腸道菌群失調(diào)是腸道內(nèi)菌群的失平衡，即有益菌（益生菌，goodbacteria）減少的同時(shí)，機(jī)會(huì)致病菌（有害菌，opportunisticbacteria）大量繁殖（5）慢性壓力和睡眠質(zhì)量差：可致肌肉減少癥慢性壓力和睡眠不佳是慢性炎癥、炎癥和與年齡相關(guān)的健康問題（包括肌肉減少癥）背后的主要潛在因素。根據(jù)2018年發(fā)表在激素雜志上的一項(xiàng)研究，慢性壓力可能在身體成分失調(diào)中發(fā)揮作用，包括肌肉減少癥(12)。與健康問題相關(guān)的慢性和嚴(yán)重壓力也可能導(dǎo)致肌肉減少癥。根據(jù)2015年發(fā)表在《營養(yǎng)學(xué)會(huì)會(huì)刊》上的評(píng)論、2016年發(fā)表在《當(dāng)前胃腸病學(xué)報(bào)告》上的評(píng)論、2016年發(fā)表在《腎泌尿?qū)W月刊》上的評(píng)論和2016年發(fā)表在《營養(yǎng)學(xué)會(huì)會(huì)刊》上的評(píng)論，與慢性壓力相關(guān)的壓力肝病、慢性心力衰竭、慢性腎病和癌癥治療可能會(huì)導(dǎo)致肌肉減少和肌肉減少癥(13,14,15,16)。慢性壓力會(huì)導(dǎo)致睡眠不佳。然而，睡眠不足也會(huì)導(dǎo)致慢性壓力。睡眠不佳和慢性壓力都會(huì)增加慢性炎癥。而慢性炎癥會(huì)導(dǎo)致睡眠不佳和慢性壓力。慢性壓力、睡眠不佳和慢性壓力的循環(huán)會(huì)增加肌肉流失的風(fēng)險(xiǎn)。2017年發(fā)表在《醫(yī)學(xué)》（巴爾的摩）雜志上的一項(xiàng)橫斷面研究發(fā)現(xiàn)睡眠持續(xù)時(shí)間與肌肉減少癥之間存在聯(lián)系(17)。根據(jù)發(fā)表在《臨床醫(yī)學(xué)雜志》上的2019年系統(tǒng)評(píng)價(jià)和薈萃分析，睡眠質(zhì)量差會(huì)對(duì)肌肉減少癥產(chǎn)生負(fù)面影響(18)。圖7?慢性壓力的主要癥狀（磨牙、冷漠、注意力不能集中、易憤怒、焦慮、頭痛、肌肉緊張、胃腸道病、皮膚刺激、性欲下降、易疲勞）及其對(duì)身體的影響巨大teethgrinding,apathy,troubleconcentrating,anger,anxiety,headaches,muscletension,stomachproblems,skinirritations,decreasedsexdrive,fatigue肌肉減少癥的自然支持防治策略幸運(yùn)的是，在一些簡單的飲食、生活方式和營養(yǎng)補(bǔ)充策略的幫助下，您可以自然地改善健康。我推薦以下針對(duì)肌肉減少癥的自然支持策略：（1）抗炎營養(yǎng)計(jì)劃慢性炎癥反應(yīng)是肌肉減少癥的一些主要原因(4,5,6)。炎癥性飲食是慢性炎癥和炎癥的主要驅(qū)動(dòng)因素之一。食用精制糖和精制油會(huì)加劇炎癥并加速炎癥，這可能會(huì)導(dǎo)致肌肉減少癥。根據(jù)2020年發(fā)表在《營養(yǎng)雜志》上的一項(xiàng)研究，飲食的炎癥潛力與患肌肉減少癥的風(fēng)險(xiǎn)之間存在聯(lián)系(19)。我建議去除所有精制糖和碳水化合物、精制油、人造成分、油炸食品、垃圾食品和過度加工食品。食用富含營養(yǎng)和抗炎天然食物的飲食。多吃綠色蔬菜、香草、香料、豆芽、發(fā)酵食品、低升糖指數(shù)水果（如蘋果、香蕉、番茄、橙子等）、草飼牛肉、內(nèi)臟肉、牧場飼養(yǎng)的家禽和雞蛋、草飼動(dòng)物的黃油和酥油、野生魚和野生動(dòng)物（禁止吃國家野生動(dòng)物保護(hù)法明文保護(hù)的動(dòng)物）。盡可能吃有機(jī)食品。圖8?抑制炎癥反應(yīng)的食物（anti-inflammatoryfoods）與促進(jìn)炎癥反應(yīng)的食物（pro-inflammatoryfoods）圖8-1?精煉油Refinedoil只不過是普通油的“精煉”版本。精煉過程涉及化學(xué)物質(zhì)，這些化學(xué)物質(zhì)在一定數(shù)量上對(duì)我們的健康有害。油的“凈化”是通過用酸、堿或漂白處理來完成的。精制油也經(jīng)過中和、過濾或除臭。所有這些過程都涉及己烷等化學(xué)品Refinedoilisnothingbutthe'refined'versionofthenormaloil.Theprocessofrefininginvolveschemicals,whichincertainquantities,areharmfultoourhealth.The'purification'oftheoilisdonebytreatingitwithacid,alkaliorbybleaching.Refinedoilisalsoneutralized,filteredordeodorized.Alloftheseprocessesinvolvechemicalssuchashexane（2）優(yōu)質(zhì)蛋白質(zhì)的攝入蛋白質(zhì)攝入不足會(huì)導(dǎo)致肌肉流失并增加患肌肉減少癥的風(fēng)險(xiǎn)(7)。確保在營養(yǎng)豐富、抗炎的飲食中攝入足夠的蛋白質(zhì)。目標(biāo)是每磅體重?cái)z入0.5至1克蛋白質(zhì)。我建議您主要關(guān)注健康的動(dòng)物性蛋白質(zhì)，包括草飼牛肉、內(nèi)臟肉、牧場飼養(yǎng)的家禽和雞蛋、野生魚類和海鮮（痛風(fēng)患者需注意選擇不易影響血尿酸的食物）。如果您難以通過食物滿足蛋白質(zhì)需求，可以使用蛋白粉來幫助獲取足夠的蛋白質(zhì)。堅(jiān)果和種子可以添加額外的植物性蛋白質(zhì)。我不推薦豆類和小扁豆，尤其是不要大量食用，因?yàn)樗鼈兊奶妓衔锖亢芨?，可能?huì)導(dǎo)致消化不適。我建議避免食用谷物，因?yàn)樗鼈兒宣熧|(zhì)和碳水化合物。圖9?決定蛋白質(zhì)攝入的目標(biāo)：①體重控制減少，每日攝入蛋白量1-1.5g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要70-105g即可；②重塑肌肉，每日攝入蛋白量1.5-2.0g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要105-140g即可；③運(yùn)動(dòng)員，每日攝入蛋白量1.8-2.5g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要126-175g即可；④久坐不動(dòng)的朋友，每日攝入蛋白量1.0-1.2g/kg體重，如果您的體重是70kg，那么每天蛋白質(zhì)需要70-84g即可sedentaryindividuals（3）抗阻力訓(xùn)練缺乏運(yùn)動(dòng)和久坐不動(dòng)的生活方式會(huì)增加肌肉無力、肌肉流失和肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2015年發(fā)表在《臨床密度測定雜志》上的一篇評(píng)論，沒有充分使用肌肉是肌肉減少癥的主要驅(qū)動(dòng)因素之一(20)。根據(jù)2016年發(fā)表在《脆弱與衰老雜志》上的一篇評(píng)論，生病或受傷后臥床休息和不活動(dòng)會(huì)導(dǎo)致老年人肌肉快速流失(21)。由于不活動(dòng)和久坐不動(dòng)的生活方式導(dǎo)致的肌肉力量下降會(huì)導(dǎo)致疲勞、虛弱和力量不佳，這可能會(huì)使鍛煉變得更加困難，運(yùn)動(dòng)的動(dòng)力也會(huì)降低。這會(huì)導(dǎo)致不活動(dòng)、肌肉損失和疲勞的惡性循環(huán)。定期移動(dòng)身體，更重要的是，進(jìn)行阻力和力量訓(xùn)練對(duì)于提高肌肉力量、質(zhì)量和健康以及降低肌肉減少癥的風(fēng)險(xiǎn)至關(guān)重要。我建議每周至少進(jìn)行3到4天的阻力訓(xùn)練。嘗試復(fù)合運(yùn)動(dòng)，例如深蹲、硬拉、推舉、劃船等。與物理治療師或教練一起工作可以幫助您學(xué)習(xí)正確的形式，安全地嘗試新的練習(xí)，并有效地提高您的力量。如果您正從一段時(shí)間的受傷、疾病或不活動(dòng)中恢復(fù)過來，這可能尤為重要。如果您對(duì)阻力訓(xùn)練和鍛煉完全陌生，這也是一個(gè)不錯(cuò)的選擇。圖10?高強(qiáng)度間歇和阻力訓(xùn)練的對(duì)于肌肉減少癥明顯有益（選擇適合自己的日常鍛煉方式，量力而行）highintensityintervalandresistancetrainingbenefits（4）限時(shí)飲食或間歇性禁食限時(shí)進(jìn)食或間歇性禁食也可能有助于降低肌肉減少癥的風(fēng)險(xiǎn)。根據(jù)2014年發(fā)表在《國際健康科學(xué)雜志》(Qassim)上的一項(xiàng)研究，間歇性禁食可以減少炎癥和相關(guān)疾病的風(fēng)險(xiǎn)(22)。1988年發(fā)表在《臨床研究雜志》上的一項(xiàng)研究發(fā)現(xiàn)，間歇性禁食還可以改善人類生長激素(HGH)的分泌和水平，從而有助于改善肌肉質(zhì)量(23)。根據(jù)2019年發(fā)表在《營養(yǎng)學(xué)》雜志上的一項(xiàng)研究，間歇性禁食還可以提高支持關(guān)節(jié)和皮膚健康的膠原蛋白水平24)。我建議實(shí)行限時(shí)進(jìn)食。理想情況下，我建議在6到10小時(shí)的進(jìn)食窗口和14-18小時(shí)的禁食窗口期間進(jìn)食。如果您不熟悉限時(shí)喂食，請(qǐng)從12小時(shí)的隔夜禁食開始。晚餐后停止進(jìn)食，直到12小時(shí)后的第二天早餐才進(jìn)食。逐漸延長禁食時(shí)間，直到找到適合自己的方法。記住不要在進(jìn)食窗口期間限制自己。食用含有大量健康脂肪、足夠蛋白質(zhì)和大量微量營養(yǎng)素的抗炎全食，以滿足您的熱量和營養(yǎng)需求。圖11?7步法輕松搞定間歇性禁食（每位朋友，可以根據(jù)自己情況量力而行，而非推薦必須執(zhí)行上述禁食）：①simplefast:12hours，簡單常規(guī)的禁食12小時(shí)；②brunchfast:14hours，早午餐一起吃，禁食14小時(shí)，③crescendofast:16hours，漸進(jìn)式禁食16小時(shí)，每周2天，④cyclefast:16hours，循環(huán)禁食16小時(shí)，每周3次，⑤strongfast:18hours，增強(qiáng)禁食18小時(shí)，每天一次，⑥warriorfast:19-21hours，激進(jìn)禁食19-21小時(shí)，每天一次，⑦1dayfast:18hoursfasteachweek，徹底禁食24小時(shí)，每周一天（5）減輕壓力和改善睡眠質(zhì)量慢性壓力和睡眠不足可能會(huì)增加肌肉減少癥的風(fēng)險(xiǎn)(12,13,14,15,16,17,18)。減輕壓力水平和改善睡眠質(zhì)量可能會(huì)有所幫助。我建議練習(xí)冥想、呼吸、引導(dǎo)式放松技巧、祈禱和感恩，以降低壓力水平并更好地應(yīng)對(duì)壓力。寫日記可能有助于釋放情緒壓力并發(fā)現(xiàn)消極的心理漏洞。練習(xí)心態(tài)轉(zhuǎn)變和積極肯定?；〞r(shí)間在大自然中?；〞r(shí)間與支持你的朋友、家人和社區(qū)成員在一起。目標(biāo)是每晚睡7到9個(gè)小時(shí)。大約在同一時(shí)間睡覺和起床，以支持您的晝夜節(jié)律。睡前至少兩小時(shí)避免：①糖、②咖啡因、③過量飲食（最好是所有食物）、④酒精、⑤電子產(chǎn)品和⑥壓力過大。參加放松的活動(dòng)，例如拼圖、寫日記、閱讀、冥想、治療浴、喝涼茶，以及在晚上平靜地交談。買一張有支撐力的床、有支撐力且舒適的床墊、枕頭和床上用品、遮光窗簾和眼罩，以獲得更好的睡眠。圖12?良好夜間睡眠的方法：①床要舒適、②臥室盡量黑、③可以戴眼罩、④睡前8小時(shí)避免咖啡、⑤3小時(shí)前避免吃東西、⑥白天多曬太陽、⑦規(guī)律鍛煉，而非睡前鍛煉、⑧夜晚避免強(qiáng)亮燈環(huán)境、⑨九點(diǎn)入睡（6）改善胃酸水平胃酸水平低下也會(huì)導(dǎo)致肌肉減少癥(8,9)。改善胃酸水平至關(guān)重要。?①全天使用液體營養(yǎng)：盡量確保至少一半的膳食是液體形式，例如蛋白質(zhì)奶昔或綠色奶昔（廣東人講究的喝湯是很有道理的）。蛋白質(zhì)奶昔是預(yù)代謝的，非常容易消化，不依賴于胃酸HCL的產(chǎn)生。如果您的胃酸HCL含量較低，每天喝一到兩杯蛋白質(zhì)奶昔可能會(huì)有所幫助，以支持氨基酸的吸收，減少對(duì)消化的額外壓力，并支持健康的胃酸水平。?②使用生姜：生姜是改善消化液的最佳物質(zhì)之一。我建議每天喝2至3杯姜茶，您可以將姜精油放入水中（2至3滴放入8盎司水中）(1盎司=31g=31ml)，每天將1/2英寸的新鮮姜根放入綠汁中(1英寸=2.54厘米)，然后使用在你的食物上磨碎生姜。您還可以在飲食中加入發(fā)酵生姜，這在泡菜等亞洲菜肴中很常見。由于辛辣食物可能會(huì)引發(fā)反流問題，因此請(qǐng)確保它不會(huì)為您引發(fā)。如果是，請(qǐng)專注于其他步驟。?③進(jìn)餐時(shí)間以外的超級(jí)水合物：良好的水合作用可以幫助激活腸蠕動(dòng)并推動(dòng)內(nèi)容物通過消化系統(tǒng)，從而減少體內(nèi)的微生物發(fā)酵和毒性。這有助于維持胃酸水平。?④吃肉時(shí)少喝水：當(dāng)您吃肉或任何較重的食物時(shí)，您應(yīng)該至少在餐前30分鐘停止飲用水或其他液體，除非您需要補(bǔ)充2盎司的水，在這些進(jìn)餐期間不喝水將減少胃液的任何潛在稀釋并允許更好的消化（飯前不建議大量飲水、吃水果、冷飲或果汁等稀釋胃液的物品）。?⑤飯后不要喝水：為了實(shí)現(xiàn)最佳消化，我還建議至少在飯后30分鐘后再喝水或其他液體。這允許適當(dāng)?shù)奈杆峄顒?dòng)、殺菌和蛋白質(zhì)代謝。?⑥使用檸檬和蘋果醋：擠壓新鮮檸檬或在肉類和蔬菜上使用檸檬汁或蘋果醋有助于預(yù)先代謝食物并支持更好的消化和營養(yǎng)吸收（這可能是為何西方餐食，開胃配水，都會(huì)加上檸檬的原因）。您可以用檸檬或蘋果醋腌制食物，也可以在食用前將它們作為調(diào)料添加。再次確保蘋果醋不會(huì)引發(fā)任何反流癥狀，關(guān)注我的其他建議。?⑦開餐時(shí)吃蛋白質(zhì)食物：當(dāng)您開始進(jìn)食時(shí)，特別是當(dāng)您攝入蛋白質(zhì)時(shí)，胃會(huì)開始攪動(dòng)胃酸。雖然在他們的蛋白質(zhì)菜肴之前吃沙拉在文化上很常見，但這對(duì)您的胃酸HCL生產(chǎn)來說并不好。將蛋白質(zhì)與沙拉或蔬菜一起吃而不是之后吃是一個(gè)更好的主意。?⑧使用發(fā)酵蔬菜：酸菜、泡菜、泡菜、腌姜和其他發(fā)酵蔬菜等發(fā)酵食品都含有有機(jī)酸、酶和益生菌，有助于改善消化液分泌（韓國泡菜？但腌制的蔬菜可能會(huì)含有較多的細(xì)菌，且煙硝酸鹽含量往往過高，不建議多吃或經(jīng)常吃）。我建議您在所有較重的膳食中使用其中一種尤其是任何含蛋白質(zhì)的食物。?⑨使用發(fā)酵飲料：發(fā)酵飲料，如蘋果醋、椰子開菲爾和康普茶，具有抗菌功效，有助于減少細(xì)菌負(fù)荷，尤其是胃中的細(xì)菌，如幽門螺桿菌。保持幽門螺桿菌水平下降對(duì)于身體能夠產(chǎn)生足夠的胃酸至關(guān)重要。?⑩在最放松的時(shí)候吃最大的一餐：您的身體需要激活副交感神經(jīng)系統(tǒng)以產(chǎn)生足夠的胃酸。如果您很忙并且在旅途中，您將處于戰(zhàn)斗或逃跑的同情模式。如果您與低胃酸作斗爭，這種戰(zhàn)斗或逃跑狀態(tài)不會(huì)讓您的身體產(chǎn)生足夠的能量。飯前放松對(duì)改善胃酸分泌很重要。（心情愉快、精神壓力小時(shí)，是享用美味的大餐絕佳時(shí)機(jī)）圖13?10種改善胃酸的好方法（如上面①-⑩所述）（7）支持整體腸道健康和消化腸道菌群失調(diào)和腸道健康狀況不佳也可能增加患肌肉減少癥的風(fēng)險(xiǎn)(10,11)。我建議支持您的整體腸道健康和消化。2021年發(fā)表在《營養(yǎng)前沿》(FrontiersinNutrition)上的一項(xiàng)研究發(fā)現(xiàn)，用益生菌和消化酶靶向腸道微生物群可能有助于肌肉減少癥(25)。2022年發(fā)表在惡病質(zhì)、肌肉減少癥和肌肉雜志上的一項(xiàng)研究發(fā)現(xiàn)，補(bǔ)充益生菌可能支持腸道肌肉軸，并可能減少與年齡相關(guān)的肌肉減少癥(26)。根據(jù)2018年發(fā)表在《臨床營養(yǎng)和代謝護(hù)理當(dāng)前觀點(diǎn)》上的一篇評(píng)論，支持蛋白質(zhì)消化可能有助于減少與年齡相關(guān)的肌肉減少癥(27)。多吃富含益生菌的食物富含益生菌的食物包括酸菜、發(fā)酵香草、泡菜、開菲爾、康普茶和酸奶。然而，吃富含益生菌的食物不足以支持您的腸道菌群，尤其是當(dāng)您正在應(yīng)對(duì)腸道微生物失衡和各種慢性腸道健康問題時(shí)。益生菌可能有助于改善腸道微生物失衡和消化。我推薦使用Probiocharge1000億（藥店有一點(diǎn)商品化的非處方益生菌可以選擇：雙歧桿菌，培菲康等。在使用前請(qǐng)咨詢你的藥師或醫(yī)生。溫馨提示：益生菌不可以與抗生素等藥物同時(shí)服用，且最好用溫水送服）。為了進(jìn)一步支持您的消化，我還建議使用消化酶（乳酶生片等）。消化酶可能有助于減輕腹瀉和腸易激綜合征IBS的癥狀，這些癥狀通常與膽汁酸吸收不良有關(guān)。我推薦ProteoEnzymes來支持蛋白質(zhì)和整體消化。ProteoEnzymes?影響細(xì)胞因子和類花生酸的平衡，促進(jìn)關(guān)節(jié)舒適度并支持身體維持組織完整性的能力。它還有助于平衡免疫系統(tǒng)，降低自身免疫活性并分解體內(nèi)的致病性生物膜。ProteoEnzymes中的蛋白水解酶可以分解因受傷和組織損傷而產(chǎn)生的蛋白質(zhì)和復(fù)合物。據(jù)信，這項(xiàng)活動(dòng)有助于營養(yǎng)和氧氣的輸送，并可能有助于加快身體恢復(fù)和愈合的能力。耐酸膠囊促進(jìn)酶的全身遞送。每餐服用或根據(jù)需要服用。圖14?建議使用益生菌（必要時(shí)添加消化酶）（8）補(bǔ)充必需氨基酸獲得足夠的蛋白質(zhì)并滿足您的氨基酸需求對(duì)于減少肌肉減少癥至關(guān)重要(7)（推薦每天1-2個(gè)雞蛋）。補(bǔ)充必需氨基酸可能會(huì)有幫助。我推薦AminoStrongEssentialAminoAcids。AminoStrong?代表了使用氨基酸合成肌肉蛋白質(zhì)的突破。已經(jīng)進(jìn)行了20多項(xiàng)人體試驗(yàn)，以得出這種特定的、正在申請(qǐng)專利的氨基酸組合，具有最有效的合成代謝比例。無論您是想增強(qiáng)肌肉力量和功能，還是想防止因缺乏運(yùn)動(dòng)或衰老而導(dǎo)致的肌肉流失，AminoStrong都能以正確的比例提供正確的氨基酸，幫助您實(shí)現(xiàn)目標(biāo)并保持健康。包含AminoStrong的氨基酸(AA)配方由國際公認(rèn)的肌肉代謝和衰老以及長壽領(lǐng)域的研究人員精心開發(fā)和研究。AminoStrong專為尋求刺激肌肉蛋白質(zhì)合成、加速肌肉恢復(fù)以及促進(jìn)肌肉力量和功能的年輕人和老年人而設(shè)計(jì)。圖15?建議攝入優(yōu)質(zhì)必須氨基酸（多推薦：雞蛋、各種魚肉、牛肉）（9）考慮使用乳清蛋白獲得足夠的蛋白質(zhì)對(duì)于減少肌肉減少癥至關(guān)重要(7)。使用乳清蛋白可能會(huì)有所幫助（主要來源于雞蛋清）。我推薦乳清濃香草。強(qiáng)乳清粉是一種美味、高蛋白、低碳水化合物的功能性食品粉。它采用品質(zhì)卓越的乳清蛋白制成，這些乳清蛋白來自新西蘭無農(nóng)藥、非轉(zhuǎn)基因草場上放牧的奶牛，這里被認(rèn)為是世界上污染最少的環(huán)境之一。奶牛從不喂谷物，也沒有接受激素或抗生素治療。與其他速溶乳清配方不同，WheyStrong不含大豆。乳清蛋白由稱為氨基酸的單個(gè)“構(gòu)件”組成，用于制造酶、激素和抗體。乳清蛋白被認(rèn)為是一種完整的蛋白質(zhì)，因?yàn)樗凶銐虮壤乃斜匦璋被?，這些氨基酸是人體無法制造的，必須通過飲食獲得。它還富含半胱氨酸，有助于在體內(nèi)產(chǎn)生一種重要的抗氧化劑，即谷胱甘肽。乳清蛋白還含有大量支鏈氨基酸(BCAA)，尤其是亮氨酸。亮氨酸的重要作用是鍛煉肌肉。已發(fā)現(xiàn)乳清蛋白支持健康的身體成分。每天將30克（約一勺）混合在8盎司水或任何其他飲料中，或遵照保健醫(yī)生的指示。圖16?建議攝入乳清蛋白（主要來源于雞蛋清）小結(jié)肌肉減少癥是指與年齡相關(guān)的肌肉退化。肌肉質(zhì)量下降和肌肉減少癥可能會(huì)降低您參與日常任務(wù)和活動(dòng)的能力。它可能導(dǎo)致跌倒、受傷、住院、殘疾、喪失獨(dú)立性、護(hù)理和壽命縮短。幸運(yùn)的是，借助一些簡單的自然策略，您可以自然地改善肌肉健康。建議您遵循我針對(duì)肌肉減少癥的自然支持策略，以隨著年齡的增長保持肌肉質(zhì)量。（文中所涉及優(yōu)質(zhì)蛋白、氨基酸、乳清蛋白等，都可以在日常生活中食材中獲得，不推薦選擇進(jìn)口商品替代）WhatisSarcopeniaThewordsarcopeniameans“l(fā)ackofflesh”,whichmakessenseonceyouunderstandthecondition.Sarcopeniaisaconditionrelatedtoage-associatedmuscledegeneration.Itismorerelevantandmorecommoninthoseover50yearsofage.Aftertheageof30,peoplestartlosingtheirmusclestrength.Accordingtoa2004reviewpublishedinCurrentOpinioninClinicalNutritionandMetabolicCare,peopletendtolosebetween3to8percentoftheirmusclestrengtheachdecade(1).Losingmusclestrengthcanreduceyourabilitytoperformregulardailyactivitiesandroutinetasks.Itmayincreasetheriskofdevelopingadisability,losingindependence,andneedingcare.Itmayincreasetheriskoffalls,accidents,injuries,fractures,hospitalization,surgeries,andpost-surgerycomplications.Consideringthecostofhospitalizationandhomecare,sarcopeniacanalsobecomeverycostly.Accordingtoa2016reviewpublishedinWorldviewsonEvidence-BasedNursing,sarcopeniamayalsoshortenyourlifespan(2).Accordingtoa2015reviewpublishedinTheProceedingsoftheNutritionalSociety,sarcopeniamaydevelopbecauseoftheimbalancebetweenthesignalsformusclecellgrowth(anabolism)andsignalsforbreakdown(catabolism)(3).Inahealthybody,yourgrowthhormonesworktogetherwithprotein-destroyingenzymestokeepyourmuscleshealthyandmusclemasssteadythroughouttheongoingcycleofmusclegrowth,stress,injury,breakdown,destruction,repair,andrecovery.Inanagingbody,animbalancebetweensignalsandaresistancetogrowthsignalsmaydevelop,whichcancausemorecatabolismandmusclelossoveranabolismandmusclegrowth.SymptomsofSarcopeniaSymptomsofsarcopeniamayinclude:MuscleweaknessFallingSlowwalkingspeedSelf-reportedmusclewastingDifficultyperformingorpartakinginnormaldailytasksandactivitiesFatigueeasilyduringexertionRootCausesofSarcopeniaIfyouhaveanyhealthissues,it’simportanttolookattherootcausesoftheproblem.Ifwelookattherootcauseoftheproblem,wecandeveloptreatmentstrategiestoaddresstheminsteadofonlyputtingabandaidonthesymptoms.Therootcausesofsarcopeniamayinclude:InflammagingTheterminflammaging,alsoknownasinflamm-agingorinflamm-ageing,referstoanupregulatedinflammatoryresponseandalow-gradeinflammationthroughoutthebodythatdevelopswithadvancedage.Inflammagingcanacceleratetheagingprocessandmayworsensomeage-relatedsymptomsanddiseases.Accordingtoa2013studypublishedinLongevity&Healthspan,inflammagingmaybeaconsequenceoftheinnateandacquiredimmunesystemthatcanincreaseinflammatorycytokineproductioninthebody(4).Thiscanpromoteinflammationandcontributetoage-relatedhealthissues,includingmuscledecline.A2013studypublishedinThoraxhasfoundthatpatientswithchronicobstructivepulmonarydisease(COPD)andrelatedchronicinflammationalsohadadeclineinmusclemass(5).Therearemanyotherdiseasesthatarecharacterizedbylong-termchronicinflammation,includingchronicinfections,inflammatoryboweldiseases,andautoimmuneconditions,thatmayincreasetheriskofmusclelossandsarcopenia.Accordingtoa2016systematicreviewandmeta-analysispublishedinMaturitas,higherlevelsofC-reactiveproteinmaybeassociatedwithchronicinflammationandsarcopenia(6).InadequateProteinIntakeFollowinganunhealthydietlowinnutrientsandhighinrefinedsugar,refinedoil,artificialingredients,andoverlyprocessedfoodscanincreasechronicinflammation.Payingattentiontoyourmacronutrientsiscriticalaswell.Adiettoolowincaloriesandtoolowinproteincannotonlyresultinweightloss,butalsoinalossofmusclemass.Proteiniscriticalformusclehealth,musclemass,andmusclestrength.Aninadequateproteinintakemayleadtosarcopenia.Withaging,manypeopledevelopproblemswiththeirteethandgums,haveissuesswallowing,experiencechangesintheirtasteandappetite,andhaveincreasedchallengesshoppingandcooking.Thiscanincreasetheirriskofnotmeetingtheirproteinandcaloricneeds.Accordingtoa2015reviewpublishedintheJournalofClinicalMedicineResearch,consuming25to30gramsofproteinateachmealmayhelptolowertheriskofsarcopenia(7).PoorStomachAcidLevelsStomachacidisalsoknownasgastricacid.Itisawatery,colorlessfluidmadebyyourstomachliningtosupportdigestion.Asitsnamesuggests,stomachacidisveryacidic,whichsupportsthebreakdownoffoodforproperdigestion.Stomachacidalsohelpstheproperabsorptionofnutrients.?Poorstomachacidlevelscanclearlycauseproblemswhenitcomestodigestion.Ifyouhavepoorstomachacidlevels,yourbodymaynotbeabletobreakdownandabsorbproteinandothernutrientsfromfood.Thiscannotonlyleadtodigestiveissuesbutchronicinflammationandhealthcomplications.Accordingtoa2022studypublishedinNutrients,poorgastricmotilitymaybeassociatedwithsarcopeniainolderadults(8).A2019studypublishedinScienceReportshaslinkedgastroesophagealrefluxdisease,associatedwithlowstomachacidlevels,topoorskeletalmuscleattenuationandsarcopenia(9).GutDysbiosisYourgutishometotrillionsofbacteriaandmicrobes.Someofthesemicrobesarebeneficial,othersareharmfultoyourhealth.Thekeyistohaveagutmicrobiomeimbalance,whereyouhavemorebeneficialbacteriathanharmfulones.Unfortunately,aninflammatorydiet,poorlifestylechoices,nutrientimbalances,stress,environmentaltoxins,andotherfactorscandisruptthebalance.?Gutdysbiosismeansthatthereisanimbalanceinyourgutmicrobiome,andtherearetoomanyharmfulbacteriaandtoofewbeneficialones.Gutdysbiosiscancreatechronicinflammationandtheriskofchronicandserioushealthissues.Itmayalsoincreaseyourriskofsarcopenia.A2018studypublishedinMediatorsofInflammationhasfoundthatgutdysbiosismayplayaroleinage-relatedinflammation,inflammaging,muscleaging,andsarcopenia(10).Researchersfoundthattargetinggutdysbiosismaybeimportantwhenaddressingsarcopenia.A2021systematicreviewpublishedintheJournalofCachexia,Sarcopenia,andMusclehassupportedthesefindingsandhasfoundthatgutdysbiosismayplayacriticalroleinthedevelopmentofsarcopenia(11).ChronicStress&PoorSleepQualityChronicstressandpoorsleeparemajorunderlyingfactorsbehindchronicinflammation,inflammaging,andage-relatedhealthissues,includingsarcopenia.Accordingtoa2018studypublishedintheHormones,chronicstressmayplayaroleinbodycompositiondisorders,includingsarcopenia(12).Chronicandseriousstressrelatedtohealthissuesmayalsocontributetosarcopenia.Accordingtoa2015reviewpublishedintheProceedingsoftheNutritionalSociety,a2016reviewpublishedinCurrentGastroenterologyReports,a2016reviewpublishedinNephro-UrologyMonthly,anda2016reviewpublishedintheProceedingsoftheNutritionalSociety,stressrelatedtochronicliverdisease,chronicheartfailure,chronickidneydisease,andcancertreatmentmaycausemusclelossandsarcopenia(13,14,15,16).Chronicstresscancontributetopoorsleep.However,poorsleepcanalsocontributetochronicstress.Bothpoorsleepandchronicstresscanincreasechronicinflammation.AndchronicinflammationcancausepoorsleepandchronicstressThecycleofchronicstress,poorsleep,andchronicstresscanincreasetheriskofmuscleloss.?A2017cross-sectionalstudypublishedinMedicine(Baltimore)hasfoundalinkbetweensleepdurationandsarcopenia(17).Accordingtoa2019systematicreviewandmeta-analysispublishedintheJournalofClinicalMedicine,poorsleepqualitycannegativelyaffectsarcopenia(18).NaturalSupportStrategiesFortunately,withthehelpofsomesimpledietary,lifestyle,andsupplementstrategies,youcanimproveyourhealthnaturally.Irecommendthefollowingnaturalsupportstrategiesforsarcopenia:Anti-InflammatoryNutritionPlanChronicinflammationandinflammagingaresomeofthemainrootcausesofsarcopenia(4,5,6).Aninflammatorydietisoneofthemaindrivingfactorsofchronicinflammationandinflammaging.Consumingrefinedsugarandrefinedoilsdriveupinflammationandaccelerateinflammaging,whichmaycontributetosarcopenia.Accordingtoa2020studypublishedinNutritionJournal,thereisalinkbetweentheinflammatorypotentialofyourdietandtheriskofdevelopingsarcopenia(19).Irecommendremovingallrefinedsugarandcarbs,refinedoils,artificialingredients,deep-friedfoods,junkfoods,andoverlyprocessedfoods.Consumeadiethighinnutrientsandanti-inflammatorywholefoods.Eatplentyofgreens,vegetables,herbs,spices,sprouts,fermentedfood,lowglycemicindexfruits,grass-fedbeef,organmeat,pasture-raisedpoultryandeggs,grass-fedbutterandghee,wild-caughtfish,andwildgame.Eatorganicwheneverpossibleandavailable.OptimizeProteinIntakeInadequateproteinintakecancausemusclelossandincreaseyourriskofsarcopenia(7).Makesurethatwithinyournutrient-dense,anti-inflammatorydiet,yougetenoughproteinin.Aimfor0.5to1gramofproteinperpoundofbodyweight.Irecommendthatyoumainlyfocusonhealthyanimal-basedproteins,includinggrass-fedbeef,organmeat,pasture-raisedpoultryandeggs,wild-caughtfishandseafood,andwildgame.Ifyouhavedifficultymeetingyourproteinneedsthroughfood,youcanuseproteinpowderstohelpgetenoughprotein.Nutsandseedscanaddadditionalplant-basedproteintothemix.Idon’trecommendbeansandlentils,especiallynotinhigheramounts,astheycanbehighincarbohydratesandmaycausedigestivediscomfort.Irecommendavoidinggrainsduetotheirglutenandcarbohydratecontent.DoResistanceTraining?Inactivityandasedentarylifestylecanincreaseyourriskofmuscleweakness,muscleloss,andsarcopenia.Accordingtoa2015reviewpublishedintheJournalofClinicalDensitometry,notusingyourmusclesenoughisoneofthemaindrivingfactorsofsarcopenia(20).Accordingtoa2016reviewpublishedintheJournalofFrailtyandAging,bedrestandinactivityafteranillnessorinjurycancauserapidmusclelossinolderadults(21).?Decreasedmusclestrengthduetoinactivityandasedentarylifestylecanleadtofatigue,weakness,andpoorstrength,whichmaymakeexercisemoredifficultandmotivationtomovelow.Thiscanleadtoaviciouscycleofinactivity,muscleloss,andfatigue.Movingyourbodyregularlyand,moreimportantly,doingresistanceandstrengthtrainingworkoutsiscriticalforimprovingyourmusclestrength,mass,andhealthandreducingtheriskofsarcopenia.?Irecommendresistancetrainingatleast3to4daysaweek.Trycompoundmovementssuchassquats,deadlifts,pushpresses,rows,andsoon.Workingwithaphysicaltherapistortrainercanhelpyoulearntheproperform,trynewexercisessafely,andimproveyourstrengtheffectively.Thismaybeparticularlyimportantifyouarecomingbackfromaperiodofinjury,illness,orinactivity.It’salsoagreatoptionifyouarecompletelynewtoresistancetrainingandexercise.Time-RestrictedFeedingTime-restrictedfeedingorintermittentfastingmayalsohelpreducetheriskofsarcopenia.Accordingtoa2014studypublishedintheInternationalJournalofHealthSciences(Qassim),intermittentfastingmayreduceinflammationandtheriskofassociateddiseases(22).?A1988studypublishedintheJournalofClinicalInvestigationhasfoundthatintermittentfastingmayalsoimprovehumangrowthhormone(HGH)secretionandlevelscontributingtoimprovedmusclemass(23).Accordingtoa2019studypublishedinNutrients,intermittentfastingmayalsoimprovecollagenlevelssupportingjointandskinhealth(24).Irecommendpracticingtime-restrictedfeeding.Ideally,Irecommendeatingduringa6to10-houreatingwindowwitha14-18hourfastingwindow.Ifyouarenewtotime-restrictedfeeding,beginwitha12-hourovernightfast.Stopeatingafterdinneranddon’teatuntilbreakfastthenextday,12hourslater.Extendyourfastingwindowgraduallyuntilyoufindwhatworksforyou.Remembernottorestrictyourselfduringyoureatingwindow.Consumeanti-inflammatorywholefoodswithplentyofhealthyfats,enoughprotein,andlotsofmicronutrientstomeetyourcaloricandnutritionalneeds.ReduceStress&ImproveSleepQualityChronicstressandpoorsleepmayincreasetheriskofsarcopenia?(12,13,14,15,16,17,18).Reducingyourstresslevelsandimprovingyoursleepqualitymayhelp.Irecommendpracticingmeditation,breathwork,guidedrelaxationtechniques,prayer,andgratitudetoreduceyourstresslevelsandrespondtostressbetter.Journalingmayhelptoreleaseemotionalstressandspotnegativementalloopholes.Practicemindsetshiftsandpositiveaffirmation.Spendtimeinnature.Spendtimewithsupportivefriends,family,andcommunitymembers.Aimtoget7to9hoursofsleepanight.Gotobedandwakeuparoundthesametimetosupportyourcircadianrhythm.Avoidsugar,caffeine,heavyfood,ideallyallfood,alcohol,electronics,andstressatleasttwohoursbeforegoingtobed.Engageinrelaxingactivities,suchaspuzzles,journaling,reading,meditation,healingbaths,sippingonherbaltea,andcalmconversationsintheevening.Investinasupportivebed,supportiveandcomfortablemattress,pillows,andbedding,blackoutcurtains,andaneyemaskforbettersleep.ImproveStomachAcidLevelsPoorstomachacidlevelscanalsocontributetosarcopenia(8,9).Improvingyourstomachacidlevelsiscritical.UseLiquidNutritionThroughouttheDay:Trytomakesurethatatleasthalfofyourmealsareinaliquidform,suchasaproteinshakeorgreensmoothie.Proteinshakesarepre-metabolizedandveryeasytodigestanddonotdependuponHCLproduction.IfyouhavelowHCL,itmaybehelpfultodrinkonetotwoproteinshakesdailytosupportaminoacidabsorption,reduceextrastressonyourdigestion,andsupporthealthystomachacidlevels.UseGinger:Gingerisoneofthebestthingsforimprovingdigestivejuices.Irecommenddrinking2to3cupsofgingerteaeachday,youcanputgingeressentialoilinwater(2to3dropsin8ozofwater),?juicea?inchoffreshgingerrootinagreenjuiceeachday,andusegroundgingeronyourfoods.Youcanalsoaddfermentedgingertoyourdiet,whichiscommoninAsiandishessuchaskimchi.Sincespicyfoodscanbetriggeringforrefluxissues,makesurethatitisnottriggeringforyou.Ifitis,focusontheothersteps.SuperHydrateOutsideofMealTimes:Goodhydrationcanhelpactivatebowelmotilityandpushcontentsthroughthedigestivesystemwhichwillreducemicrobialfermentationandtoxicityinthebody.Thiscanhelptosupportyourstomachacidlevels.DrinkVeryLittleWithMeatContainingMeals:Whenyouareeatingmeatoranysortofheavierfood,youshouldstopdrinkingwaterorotherliquidsatleast30minutesbeforethemeal,exceptifyouneedtotakeasupplementwith2ouncesofwater.Holdingoffwaterduringthesemealswillreduceanypotentialdilutionofthegastricjuicesandallowforbetterdigestion.HoldOffOnWaterAfteraMeal:Toallowforoptimaldigestion,Ialsorecommendnotdrinkingwaterorotherliquidsuntilatleast30minutesafterameal.Thisallowsforproperstomachacidactivity,sterilization,andproteinmetabolism.UseLemonandAppleCiderVinegar:Squeezingfreshlemonorusinglemonjuiceorapplecidervinegaronyourmeatandvegetableshelpstopre-metabolizethefoodandsupportbetterdigestionandnutrientabsorption.YoucaneithermarinatefoodsinalemonorACVbaseorjustaddthemasadressingrightbeforeyouconsumethem.Again,makesurethatapplecidervinegarisnottriggeringanyrefluxsymptoms,focusonmyotherrecommendations.EatProteinFoodsattheBeginningoftheMeal:Thestomachwillbeginchurningoutitsstomachacidwhenyoubegineating,especiallywhenyouareconsumingprotein.Whileit’sculturallycommontoasaladbeforetheirproteindish,thisisnotgreatforyourHCLproduction.Itisamuchbetterideatoeatyourproteinwiththesaladorvegetablesinsteadofafter.UseFermentedVeggies:Fermentedfoodssuchassauerkraut,kimchi,pickles,pickledginger,andotherfermentedvegetablesallcontainorganicacids,enzymes,andprobioticswhichhelptoimprovedigestivejuicesecretions?Irecommendusingoneofthesewithallofyourheaviermealsandespeciallyanymealwithprotein.UseFermentedDrinks:Fermenteddrinkssuchasapplecidervinegar,coconutkefir,andkombuchaofferantimicrobialbenefitsandhelptoreducethebacterialload,especiallythebacteriainthestomachsuchasHPylori.KeepingHPylorilevelsdowniscriticalforthebodytobeabletoproduceenoughstomachacid.EatYourLargestMealWhenYouAreMostRelaxed:Yourbodyneedstoactivatetheparasympatheticnervoussystemtoproduceenoughstomachacids.Ifyouarebusyandonthego,youwillbeinfightorflightsympatheticmode.Ifyoustrugglewithlowstomachacid,thisfightorflightstateisnotgoingtoallowyourbodytoproduceanywherenearenough.Relaxingbeforethemealisimportanttoimprovestomachacidproduction.SupportOverallGutHealthandDigestion?Gutdysbiosisandpoorguthealthmayalsoincreaseyourriskofsarcopenia(10,11).Irecommendsupportingyouroverallguthealthanddigestion.A2021studypublishedintheFrontiersinNutritionhasfoundthattargetingagutmicrobiomewithprobioticsanddigestiveenzymesmaybehelpfulforsarcopenia(25).A2022studypublishedintheJournalofCachexia,Sarcopenia,andMusclehasfoundthatprobioticsupplementationmaysupportthegut-muscleaxisandmayreduceage-relatedsarcopenia(26).Accordingtoa2018reviewpublishedinCurrentOpinionsinClinicalNutritionandMetabolicCare,supportingproteindigestionmayhelptoreduceage-relatedsarcopenia(27).Eatplentyofprobiotic-richfoodsprobiotic-richfoodsincludingsauerkrauts,fermentedherbs,kimchi,kefir,kombucha,andyogurt.However,eatingprobiotic-richfoodsisnotenoughtosupportyourgutflora,especiallyifyouaredealingwithgutmicrobiomeimbalanceandallkindsofchronicguthealthissues.Probioticsmayhelptoimprovegutmicrobiomeimbalanceanddigestion.IrecommendusingProbiocharge100Billion.Tofurthersupportyourdigestion,Ialsorecommendtheuseofdigestiveenzymes.DigestiveenzymesmayhelptoreducesymptomsofdiarrheaandIBS,whichareoftenconnectedtobileacidmalabsorption.?IrecommendProteoEnzymestosupportproteinandoveralldigestion.ProteoEnzymes?affectcytokineandeicosanoidbalance,promotejointcomfortandsupportthebody’sabilitytomaintaintissueintegrity.?Italsohelpsbalancetheimmunesystem,reduceautoimmuneactivityandbreakdownpathogenicbiofilmsinthebody.ProteolyticenzymesinProteoEnzymesmaybreakdownproteinsandcomplexesthatcanbeproducedasaresultofinjuryandtissuedamage.Thisactivityisbelievedtoaidnutrientandoxygendeliveryandmayhelpspeedthebody’sabilitytorecoverandheal.Acid-resistantcapsulesfacilitatethesystemicdeliveryofenzymes.Takeitwitheachmealorasneeded.SupplementwithEssentialAminoAcids?Gettingadequateproteinandmeetingyouraminoacidneedsiscriticalforreducingsarcopenia(7).Supplementingwithessentialaminoacidsmayhelp.IrecommendAminoStrongEssentialAminoAcids.AminoStrong?representsabreakthroughintheuseofaminoacidsformuscleproteinsynthesis.Over20humantrialshavebeenconductedtoarriveatthisspecific,patent-pendingcombinationofaminoacidsinthemosteffectiveanabolicratios.Whetheryouwanttosupportmusclestrengthandfunctionorpreventmusclelossassociatedwithinactivityoraging,AminoStrongprovidestherightaminoacidsintherightratiostohelpyoumeetyourgoalsandstayhealthy.?Theaminoacid(AA)formulathatcomprisesAminoStrongwasmeticulouslydevelopedandstudiedbyinternationallyrecognizedresearchersinthefieldsofmusclemetabolismandaging,andlongevity.AminoStrongisdesignedforbothyoungandelderlyindividualswhoareseekingtostimulatemuscleproteinsynthesis,hastenmusclerecovery,andpromotemusclestrengthandfunction.ConsiderUsingWheyProtein?Gettingadequateproteiniscriticalforreducingsarcopenia(7).Usingwheyproteinmayhelp.IrecommendWheyStrongVanilla.WheyStrongisagreat-tasting,highprotein,lowcarbohydrate,functionalfoodpowder.Itismadewithanexceptionalqualitywheyproteinmadefromthemilkofcowsthatgrazeonpesticide-free,non-GMOgrasspasturesinNewZealand,whichareknowntobeoneoftheleastpollutedenvironmentsintheworld.Themilkingcowsareneverfedgrainandarenotsubjectedtohormoneorantibiotictreatments.Unlikeotherinstantizedwheyformulations,WheyStrongissoy-free.?Wheyproteinismadeupofindividual“buildingblocks”calledaminoacids,whichareusedtomanufactureenzymes,hormones,andantibodies.Wheyproteinisconsideredacompleteprotein,asitcontainsanadequateproportionofalltheessentialaminoacids,whicharethosethatcannotbemadebythebodyandmustbeobtainedthroughthediet.Itisalsorichincysteine,andithelpscreateanimportantantioxidantinthebody,whichisglutathione.Wheyproteinalsocontainsahighamountofbranched-chainaminoacids(BCAAs),especiallyleucine.Theimportantroleofleucineistobuildmuscles.Wheyproteinhasbeenfoundtosupporthealthybodycomposition.?Mix30grams(approximatelyonescoop)in8ouncesofwateroranyotherbeverageperdayorasdirectedbyyourhealthcarepractitioner.FinalThoughtsSarcopeniareferstoage-associatedmuscledegeneration.Losingmusclemassanddevelopingsarcopeniamaydecreaseyourabilitytoparticipateindailytasksandactivities.Itmayleadtofalls,injuries,hospitalization,disability,lossofindependence,care,andashorterlifespan.Fortunately,youcanimproveyourmusclehealthnaturallywiththehelpofsomesimplenaturalstrategies.Irecommendthatyoufollowmynaturalsupportstrategiesforsarcopeniatokeepyourmusclemassasyouage.Ifyouwanttoworkwithafunctionalhealthcoach,Irecommend?thisarticle?withtipsonhowtofindagreatcoach.?Ourwebsiteteamoffers?long-distance?functionalhealthcoachingprograms.Forfurthersupportwithyourbrainhealthandotherhealthgoals,justreachoutandourfantasticcoachesareheretosupportyourjourney.參考文獻(xiàn)SourcesinThisArticleInclude:1.VolpiE,NazemiR,FujitaS.Muscletissuechangeswithaging.CurrOpinClinNutrMetabCare.2004Jul;7(4):405-10.doi:10.1097/01.mco.0000134362.76653.b2.PMID:151924432.ChangSF,LinPL.SystematicLiteratureReviewandMeta-AnalysisoftheAssociationofSarcopeniaWithMortality.WorldviewsEvidBasedNurs.2016Apr;13(2):153-62.doi:10.1111/wvn.12147.Epub2016Feb4.PMID:268445383.MurtonAJ.Muscleproteinturnoverintheelderlyanditspotentialcontributiontothedevelopmentofsarcopenia.ProcNutrSoc.2015Nov;74(4):387-96.doi:10.1017/S0029665115000130.Epub2015Mar31.PMID:258266834.BaylisD,BartlettDB,PatelHP,RobertsHC.Understandinghowweage:insightsintoinflammaging.LongevHealthspan.2013May2;2(1):8.doi:10.1186/2046-2395-2-8.PMID:244720985.ConstantinD,MenonMK,Houchen-WolloffL,etalSkeletalmusclemolecularresponsestoresistancetraininganddietarysupplementationinCOPDThorax2013;68:625-633.LinkHere6.BanoG,TrevisanC,CarraroS,SolmiM,LuchiniC,StubbsB,ManzatoE,SergiG,VeroneseN.Inflammationandsarcopenia:Asystematicreviewandmeta-analysis.Maturitas.2017Feb;96:10-15.doi:10.1016/j.maturitas.2016.11.006.Epub2016Nov13.PMID:280415877.YanaiH.NutritionforSarcopenia.JClinMedRes.2015Dec;7(12):926-31.doi:10.14740/jocmr2361w.Epub2015Oct23.PMID:265664058.HuangHH,WangTY,YaoSF,LinPY,ChangJC,PengLN,ChenLK,YenDH.GastricMobilityandGastrointestinalHormonesinOlderPatientswithSarcopenia.Nutrients.2022Apr30;14(9):1897.doi:10.3390/nu14091897.PMID:355658649.Kim,Y.M.,Kim,JH.,Baik,S.J.etal.Associationbetweenskeletalmuscleattenuationandgastroesophagealrefluxdisease:Ahealthcheck-upcohortstudy.SciRep9,20102(2019).LinkHere10.PiccaA,FanelliF,CalvaniR,MulèG,PesceV,SistoA,PantanelliC,BernabeiR,LandiF,MarzettiE.GutDysbiosisandMuscleAging:SearchingforNovelTargetsagainstSarcopenia.MediatorsInflamm.2018Jan30;2018:7026198.doi:10.1155/2018/7026198.PMID:2968653311.LiuC,CheungWH,LiJ,ChowSK,YuJ,WongSH,IpM,SungJJY,WongRMY.Understandingthegutmicrobiotaandsarcopenia:asystematicreview.JCac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不只是瘦、弱：重視肌肉減少癥(Sarcopenia)陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）圖125歲和65歲是的上臂肌肉大體結(jié)構(gòu)、核磁共振MRI檢查結(jié)果：可見25歲時(shí)肌肉較為豐富、發(fā)達(dá)；而65歲時(shí)，肌肉已經(jīng)發(fā)生明顯萎縮，質(zhì)量變差，且MRI上可見較多量的脂肪組織細(xì)胞的浸潤，替代了原來肌肉組織。從而，會(huì)導(dǎo)致人體肌肉力量衰退，活動(dòng)量減少，平衡控制力降低，這可能也是跌倒已發(fā)生在老年人群的重要原因之一。圖230歲、50歲和80歲的肌肉（大腿前方股四頭?。┍容^：可見30歲時(shí)肌肉較為豐富、發(fā)達(dá)，圍繞在骨骼周圍；而50歲時(shí)，肌肉已經(jīng)發(fā)生較為明顯的萎縮，取而代之的是脂肪組織的浸潤，同時(shí)可見骨骼組織也出現(xiàn)了部分萎縮；80歲的肌肉組織發(fā)生了非常顯著的進(jìn)一步萎縮，脂肪組織浸潤較為明顯，骨骼組織相應(yīng)的也出現(xiàn)廣泛萎縮，而肢體周經(jīng)也出現(xiàn)一定的縮小。圖3肌肉萎縮癥的主要病因包括：①lowtestosteronelevels，低睪酮水平（雄性激素降低）；②physicallyinactive，身體活動(dòng)量低，缺乏有效體育鍛煉；③nutritionaldeficiencies，營養(yǎng)缺乏或不良；④rheumatoidarthritis，類風(fēng)濕關(guān)節(jié)炎等某些影響全身各系統(tǒng)器官與代謝的慢性疾病；⑤elder年齡增長衰老。圖4(A)蘇木精和曙紅染色，以突出年輕、健康的Wistar大鼠肌肉組織中可能發(fā)生的結(jié)構(gòu)改變。年輕健康大鼠的肌纖維組織結(jié)構(gòu)未見任何損傷。(B)年輕健康Wistar大鼠肌肉纖維周(μm)（平均值±標(biāo)準(zhǔn)差）的形態(tài)分析。在肌纖維周長(μm)(平均值±標(biāo)準(zhǔn)差)的形態(tài)分析中，年輕的健康大鼠顯示出正常的肌肉營養(yǎng)。鏡頭倍率：20×。比例尺：50μm；(C)蘇木精和伊紅染色以突出老年Wistar大鼠肌肉組織中可能發(fā)生的結(jié)構(gòu)改變。老年大鼠肌纖維組織結(jié)構(gòu)受損，表現(xiàn)為局灶性纖維化。(D)老年Wistar大鼠肌肉纖維周長(μm)(平均值±標(biāo)準(zhǔn)差)的形態(tài)學(xué)分析。在肌纖維周長(μm)（平均值±標(biāo)準(zhǔn)偏差）的形態(tài)分析中，老年大鼠表現(xiàn)出高度顯著的肌纖維萎縮，并表現(xiàn)出顯著的纖維尺寸異質(zhì)性。使用圖像采集軟件（AxioVisionRelease4.8.2-SP2Software，CarlZeissMicroscopyGmbH，Jena，Germany）考慮和計(jì)算肌肉纖維的周長。鏡頭倍率：20×。比例尺：50μm。肌肉減少癥是一個(gè)重要的健康問題，涉及肌肉體積、質(zhì)量和力量的逐漸下降。研究表明，它僅限于與年齡相關(guān)的肌肉質(zhì)量和功能的改變。文獻(xiàn)中的證據(jù)表明，低度慢性炎癥易導(dǎo)致老年人肌肉減少癥的進(jìn)展。炎癥標(biāo)志物的測量可能表明老年人在多種疾病/健康狀況下的功能限制。炎癥是干預(yù)的潛在目標(biāo)，以避免與衰老相關(guān)的肌肉無力。然而，鍛煉仍然是預(yù)防肌肉減少癥的關(guān)鍵策略。結(jié)果表明，有氧運(yùn)動(dòng)訓(xùn)練(aerobicexercisetraining,AET)或高強(qiáng)度間歇訓(xùn)練可以增強(qiáng)抗阻力訓(xùn)練RE對(duì)骨骼肌的影響。由于在某些情況下老年人不能或不愿意執(zhí)行運(yùn)動(dòng)訓(xùn)練計(jì)劃，因此正在開發(fā)替代性潛在治療方法來對(duì)抗肌肉減少癥。最近的臨床證據(jù)表明，全身振動(dòng)(WBV)和全身肌電刺激(WB-EMS)可以提高功能受損老年人的肌肉運(yùn)動(dòng)能力。后一種治療方法對(duì)于那些有單調(diào)慢性病的患者也可以在家中進(jìn)行。目前的科學(xué)貢獻(xiàn)想向科學(xué)界強(qiáng)調(diào)適應(yīng)老年人身體活動(dòng)的積極作用，作為預(yù)防或治療肌肉萎縮的一種可能的非藥物治療。即使這項(xiàng)科學(xué)貢獻(xiàn)表明了運(yùn)動(dòng)對(duì)預(yù)防和治療老年人肌肉減少癥的有益作用，仍需要進(jìn)一步研究以改善晚年的肌肉功能表現(xiàn)。肌肉減少癥定義肌肉減少癥是一種隨著衰老和/或不動(dòng)而發(fā)生的肌肉損失（肌肉萎縮）。它的特征是骨骼肌體積、質(zhì)量和強(qiáng)度的退行性喪失。肌肉損失的速度取決于運(yùn)動(dòng)水平、合并癥、營養(yǎng)和其他因素。肌肉損失與肌肉合成信號(hào)通路的變化有關(guān)。它不同于惡病質(zhì)，在惡病質(zhì)（腫瘤或感染等消耗性疾?。┲屑∪馔ㄟ^細(xì)胞因子介導(dǎo)的降解，盡管這兩種情況可能并存。肌肉減少癥被認(rèn)為是虛弱綜合征的一個(gè)組成部分。[1]肌肉減少癥可導(dǎo)致生活質(zhì)量下降、跌倒、骨折和殘疾。[2][3]肌肉減少癥是改變與人口老齡化相關(guān)的身體成分的一個(gè)因素；某些肌肉區(qū)域預(yù)計(jì)會(huì)首先受到影響，特別是大腿前部和腹部肌肉。[2][4]在人口研究中，體重指數(shù)(BMI)被認(rèn)為在老齡人口中下降，而生物電阻抗分析(BIA)顯示體脂比例上升。[5]肌肉減少癥sarcopenia一詞來自希臘語σìρξsarx，“肉體”和πεν?αpenia，“貧窮”。這是羅森伯格于1989年首次提出的，他寫道：“可能沒有任何一種與年齡相關(guān)的衰退特征能夠更顯著地影響步行、活動(dòng)能力、熱量卡路里攝入量以及整體營養(yǎng)攝入量和狀態(tài)、獨(dú)立性、呼吸等?！斌w征和癥狀肌肉減少癥的標(biāo)志是瘦肌肉量減少或肌肉萎縮。由于肥胖、脂肪量變化或水腫，身體成分的變化可能難以檢測。體重、肢體或腰圍的變化并不是肌肉質(zhì)量變化的可靠指標(biāo)。肌肉減少癥還可能導(dǎo)致力量下降、功能下降和跌倒風(fēng)險(xiǎn)增加。肌肉減少癥也可能沒有任何癥狀，直到它很嚴(yán)重并且經(jīng)常未被識(shí)別。[1]然而，研究表明，身體上部可能會(huì)發(fā)生肥大以補(bǔ)償這種瘦肌肉質(zhì)量的損失[2][6]因此，肌肉減少癥發(fā)作的一個(gè)早期指標(biāo)可能是大腿前部和腹部肌肉質(zhì)量的顯著損失。[2]病因肌肉減少癥的病因有很多，很可能是多種相互作用因素的結(jié)果。對(duì)肌肉減少癥病因的了解尚不完整，但體內(nèi)激素水平變化、行動(dòng)不便、與年齡相關(guān)的肌肉變化、營養(yǎng)和神經(jīng)退行性變化都被認(rèn)為是潛在的致病因素。[7]肌肉減少癥的程度由兩個(gè)因素決定：肌肉質(zhì)量的初始量和肌肉質(zhì)量下降的速度。由于這些因素在人群中存在差異，進(jìn)展速度和肌肉損失變得明顯的閾值是可變的。[8]不動(dòng)會(huì)顯著增加肌肉流失的速度，即使在年輕人中也是如此。其他可能增加肌肉減少癥進(jìn)展速度的因素包括營養(yǎng)攝入減少、體力活動(dòng)不足或慢性疾病。[1]此外，流行病學(xué)研究表明，早期環(huán)境（兒童及青少年時(shí)期肌肉儲(chǔ)備量）影響可能對(duì)肌肉健康產(chǎn)生長期影響。例如，低出生體重是早期環(huán)境不佳的標(biāo)志，與成年后肌肉質(zhì)量和力量下降有關(guān)。[9][10][11]病理生理學(xué)機(jī)制已經(jīng)提出了多種理論來解釋肌肉減少癥的肌肉變化機(jī)制，包括衛(wèi)星細(xì)胞募集的變化、合成代謝信號(hào)的變化、蛋白質(zhì)氧化、炎癥和發(fā)育因素。肌肉減少癥的病理變化包括肌肉組織質(zhì)量下降，反映在肌肉纖維被脂肪替代、纖維化增加、肌肉代謝變化、氧化應(yīng)激和神經(jīng)肌肉接頭退化[12]。肌纖維類型的分布在肌肉減少癥肌肉中也會(huì)發(fā)生變化，導(dǎo)致II型肌纖維或“快肌”減少，而I型肌纖維或“慢肌”肌纖維幾乎沒有減少。去神經(jīng)支配的II型纖維通常通過慢速I型纖維運(yùn)動(dòng)神經(jīng)的神經(jīng)再支配轉(zhuǎn)化為I型纖維。[13]在受傷或運(yùn)動(dòng)時(shí)未能激活衛(wèi)星細(xì)胞也被認(rèn)為是肌肉減少癥的病理生理學(xué)原因之一。[12]此外，氧化的蛋白質(zhì)會(huì)導(dǎo)致脂褐素和交聯(lián)蛋白的積累，從而導(dǎo)致骨骼肌中非收縮性物質(zhì)的積累，并導(dǎo)致肌肉減少癥。[8]一個(gè)明顯的保護(hù)因素是足夠水平的蛋白質(zhì)BNIP3，它可以防止細(xì)胞累積受損的線粒體。BNIP3的缺乏會(huì)導(dǎo)致肌肉發(fā)炎和萎縮。[14]診斷多個(gè)專家組提出了多種診斷標(biāo)準(zhǔn)，并且仍然是研究和爭論的領(lǐng)域。盡管缺乏廣泛接受的定義，肌肉減少癥在2016年被指定為ICD-10代碼(M62.84)，將其識(shí)別為一種疾病狀態(tài)。[15]當(dāng)患者的肌肉質(zhì)量至少低于相關(guān)人群平均值的兩個(gè)標(biāo)準(zhǔn)差并且行走速度較慢時(shí)，可以診斷為肌肉減少癥。[16]歐洲老年人肌肉減少癥工作組(EWGSOP)為肌肉減少癥制定了廣泛的臨床定義，指定為存在低肌肉質(zhì)量和低肌肉力量或低身體表現(xiàn)。[7]其他國際團(tuán)體提出的標(biāo)準(zhǔn)包括步行速度、6分鐘步行距離或握力等指標(biāo)。[15]單獨(dú)的握力也被提倡作為肌肉減少癥的臨床標(biāo)志物，該標(biāo)志物簡單且具有成本效益并且具有良好的預(yù)測能力，盡管它沒有提供全面的信息。[17]有一些肌肉減少癥篩查工具可以評(píng)估患者報(bào)告的日常活動(dòng)困難，例如步行、爬樓梯或從椅子上站起來，并已被證明可以預(yù)測肌肉減少癥和不良功能結(jié)果。[18]肌肉減少癥治療鍛煉運(yùn)動(dòng)仍然是肌肉減少癥的首選干預(yù)措施，但將研究結(jié)果轉(zhuǎn)化為臨床實(shí)踐具有挑戰(zhàn)性。運(yùn)動(dòng)的類型、持續(xù)時(shí)間和強(qiáng)度在研究之間是可變的，防止肌肉減少癥的標(biāo)準(zhǔn)化運(yùn)動(dòng)處方。[19]缺乏鍛煉是肌肉減少癥的一個(gè)重要危險(xiǎn)因素，鍛煉可以顯著減緩肌肉流失的速度。[20]運(yùn)動(dòng)可以成為一種有效的干預(yù)措施，因?yàn)槔匣墓趋兰”Ａ袅撕铣傻鞍踪|(zhì)的能力以響應(yīng)短期阻力運(yùn)動(dòng)。[21]老年人的漸進(jìn)式阻力訓(xùn)練可以改善身體表現(xiàn)（步態(tài)速度）和肌肉力量。[22]（鍛煉方式，大家可參考：下肢、膝關(guān)節(jié)疼痛、腫脹：說說膝關(guān)節(jié)核心肌群——股四頭肌鍛煉https://station.haodf.com/health/article?healthId=8618339876＆articleId=9391847461）藥物目前，尚無批準(zhǔn)用于治療肌肉減少癥的藥物。[23]睪酮或其他合成代謝類固醇也被研究用于治療肌肉減少癥，似乎對(duì)肌肉力量和質(zhì)量有一些積極影響，但會(huì)引起一些副作用，并引起人們對(duì)男性前列腺癌和女性男性化的擔(dān)憂。[24][25]此外，最近的研究表明，睪酮治療可能會(huì)誘發(fā)不良心血管事件。[26][27][28]DHEA和人類生長激素已被證明在這種情況下幾乎沒有影響。生長激素增加肌肉蛋白質(zhì)合成并增加肌肉質(zhì)量，但在大多數(shù)研究中不會(huì)導(dǎo)致力量和功能的增加。[24]這一點(diǎn)，以及其效應(yīng)胰島素樣生長因子1(IGF-1)類似缺乏功效，可能是由于炎癥和其他年齡變化導(dǎo)致衰老肌肉對(duì)IGF-1的局部抵抗。[24]正在研究的其他可能用于治療肌肉減少癥的藥物包括生長素釋放肽、維生素D、血管緊張素轉(zhuǎn)換酶抑制劑和二十碳五烯酸。[24][25]營養(yǎng)熱量卡路里和蛋白質(zhì)的攝入是肌肉蛋白質(zhì)合成的重要刺激物。[29]老年人可能不像年輕人那樣有效地利用蛋白質(zhì)，并且可能需要更多的蛋白質(zhì)來防止肌肉萎縮。[16]許多專家組建議將老年人的膳食蛋白質(zhì)建議增加到每天1.0-1.2克/千克體重。[30][31]確保老年人有足夠的營養(yǎng)有助于預(yù)防肌肉減少癥和虛弱，因?yàn)檫@是一種簡單、低成本的治療方法，沒有重大副作用。[32]額外補(bǔ)充物肌肉減少癥的一個(gè)組成部分是老化骨骼肌喪失對(duì)合成代謝刺激（如氨基酸）作出反應(yīng)的能力，尤其是在較低濃度時(shí)。然而，老化的肌肉保留了對(duì)較大劑量的蛋白質(zhì)或氨基酸的合成代謝反應(yīng)的能力。據(jù)報(bào)道，補(bǔ)充較大劑量的氨基酸，特別是亮氨酸可以抵消因衰老而導(dǎo)致的肌肉損失。[33]運(yùn)動(dòng)可以與補(bǔ)充氨基酸協(xié)同作用。[23]β-羥基β-甲基丁酸(HMB)是亮氨酸的代謝物，可作為刺激蛋白質(zhì)合成的信號(hào)分子。[16][23]據(jù)報(bào)道，它具有多個(gè)目標(biāo)，包括刺激mTOR和降低蛋白酶體表達(dá)。臨床試驗(yàn)始終支持使用它來防止瘦的老年人失去體重。[34][35][36]需要更多的研究來確定HMB對(duì)該年齡組肌肉力量和功能的精確影響。[35]流行病學(xué)肌肉減少癥的患病率取決于每項(xiàng)流行病學(xué)研究中使用的定義。60-70歲人群的估計(jì)患病率為5-13%，80歲以上人群的患病率增加到11-50%。這相當(dāng)于超過5000萬人，預(yù)計(jì)在未來40年內(nèi)將影響超過2億人，因?yàn)槔夏耆丝诓粩嘣黾印7]公共衛(wèi)生影響鑒于工業(yè)化人口的壽命延長和老年人口的增加，肌肉減少癥正在成為一個(gè)主要的公共衛(wèi)生問題。肌肉減少癥是許多不良后果的預(yù)兆，包括增加殘疾、跌倒和死亡率。易患肌肉減少癥的人群不動(dòng)或臥床休息會(huì)對(duì)功能結(jié)果產(chǎn)生巨大影響。在老年人中，這通常會(huì)導(dǎo)致生物儲(chǔ)備減少和對(duì)壓力源的脆弱性增加，稱為“虛弱綜合癥”。瘦體重的減少還與感染風(fēng)險(xiǎn)增加、免疫力下降和傷口愈合不良有關(guān)。伴隨肌肉萎縮的虛弱會(huì)導(dǎo)致跌倒、骨折、身體殘疾、需要機(jī)構(gòu)護(hù)理、生活質(zhì)量下降、死亡率增加和醫(yī)療費(fèi)用增加的風(fēng)險(xiǎn)增加。[16]這代表了重大的個(gè)人和社會(huì)負(fù)擔(dān)，其公共衛(wèi)生影響越來越受到認(rèn)可。[7]研究方向有很多機(jī)會(huì)可以更好地了解肌肉減少癥的原因和后果，并幫助指導(dǎo)臨床護(hù)理。這包括闡明肌肉減少癥的分子和細(xì)胞機(jī)制，按種族進(jìn)一步細(xì)化參考人群，驗(yàn)證診斷標(biāo)準(zhǔn)和臨床工具，以及跟蹤住院率、發(fā)病率和死亡率。還需要確定和研究潛在的治療方法和干預(yù)時(shí)機(jī)。[37]臨床開發(fā)中的新藥物療法包括肌肉生長抑制素和選擇性雄激素受體調(diào)節(jié)劑(SARM)。[38]非甾體選擇性雄激素受體調(diào)節(jié)劑SARM特別令人感興趣，因?yàn)樗鼈冊(cè)诓G酮對(duì)肌肉的合成代謝作用之間表現(xiàn)出顯著的選擇性，但幾乎沒有雄激素作用的證據(jù)（例如男性前列腺刺激）。[38]SarcopeniaSarcopeniaisanimportanthealthprobleminvolvingaprogressivedeclineofmusclemass,qualityandstrength.Ithasbeenshownthatitislimitedtotheage-relatedalterationofmusclemassandfunction.Evidenceinliteraturesuggeststhatlow-gradechronicinflammationpredisposestotheprogressofsarcopeniaintheelderly.Themeasurementofinflammatorymarkersmaybeindicativeoffunctionallimitationsinolderpeopleacrossseveraldiseases/healthconditions.Inflammationisapotentialtargetforinterventionstoavoidmuscularweaknessassociatedwithageing.However,exercisecontinuetobethekeystrategytopreventsarcopenia.ItwasshownthataerobicexercisetrainingAETorhigh-intensityintervaltrainingmayenhancetheeffectsofresistanceexercise(RE)onskeletalmuscle.Sinceolderadultsareunableorunwillingtoperformexercisetrainingprogramsinsomecases,alternativepotentialtreatmentapproachesarebeingdevelopedtocounterthesarcopenia.Recentclinicalevidencehasshownthatwhole-bodyvibration(WBV)andwhole-bodyelectromyostimulation(WB-EMS)canimprovemuscleexercisecapacityinfunctionallyimpairedolderpeople.Thelatterkindoftherapeutictreatmentcouldalsobecarriedoutathomeforthosepatientswhohavemonotonouschronicproblems.Thepresentscientificcontributionwouldliketoemphasizetothescientificcommunitythepositiveeffectsoftheadaptedphysicalactivityintheelderlyasapossiblenon-pharmacologictreatmenttopreventortreatmuscleatrophy.Evenifthisscientificcontributionhassuggestedthebeneficialeffectsofexerciseforthepreventionandtreatmentofsarcopeniainelderlypeople,furtherstudiesarerequiredtoimprovemuscleperformanceinlaterlife.Sarcopeniaisatypeofmuscleloss(muscleatrophy)thatoccurswithagingand/orimmobility.Itischaracterizedbythedegenerativelossofskeletalmusclemass,quality,andstrength.Therateofmusclelossisdependentonexerciselevel,co-morbidities,nutritionandotherfactors.Themusclelossisrelatedtochangesinmusclesynthesissignallingpathways.Itisdistinctfromcachexia,inwhichmuscleisdegradedthroughcytokine-mediateddegradation,althoughbothconditionsmayco-exist.Sarcopeniaisconsideredacomponentoffrailtysyndrome.[1]Sarcopeniacanleadtoreducedqualityoflife,falls,fracture,anddisability.[2][3]Sarcopeniaisafactorinchangingbodycompositionassociatedwithagingpopulations;andcertainmuscleregionsareexpectedtobeaffectedfirst,specificallytheanteriorthighandabdominalmuscles.[2][4]Inpopulationstudies,bodymassindex(BMI)isseentodecreaseinagingpopulationswhilebioelectricalimpedanceanalysis(BIA)showsbodyfatproportionrising.[5]ThetermsarcopeniaisfromGreekσ?ρξsarx,“flesh“andπεν?αpenia,“poverty“.ThiswasfirstproposedbyRosenbergin1989,whowrotethat“theremaybenosinglefeatureofage-relateddeclinethatcouldmoredramaticallyaffectambulation,mobility,calorieintake,andoverallnutrientintakeandstatus,independence,breathing,etc.“SignsandsymptomsThehallmarksignofsarcopeniaislossofleanmusclemass,ormuscleatrophy.Thechangeinbodycompositionmaybedifficulttodetectduetoobesity,changesinfatmass,oredema.Changesinweight,limborwaistcircumferencearenotreliableindicatorsofmusclemasschanges.Sarcopeniamayalsocausereducedstrength,functionaldeclineandincreasedriskoffalling.Sarcopeniamayalsohavenosymptomsuntilitissevereandisoftenunrecognized.[1]Researchhasshown,however,thathypertrophymayoccurintheupperpartsofthebodytocompensateforthislossofleanmusclemass[2][6]Therefore,oneearlyindicatoroftheonsetofsarcopeniacanbesignificantlossofmusclemassintheanteriorthighandabdominalmuscles.[2]CausesTherearemanyproposedcausesofsarcopeniaanditislikelytheresultofmultipleinteractingfactors.Understandingofthecausesofsarcopeniaisincomplete,howeverchangesinhormones,immobility,age-relatedmusclechanges,nutritionandneurodegenerativechangeshaveallbeenrecognizedaspotentialcausativefactors.[7]Thedegreeofsarcopeniaisdeterminedbytwofactors:initialamountofmusclemassandrateatwhichmusclemassdeclines.Duetovariationsinthesefactorsacrossthepopulation,therateofprogressionandthethresholdatwhichmusclelossbecomesapparentisvariable.[8]Immobilitydramaticallyincreasestherateofmuscleloss,eveninyoungerpeople.Otherfactorsthatcanincreaserateofprogressionofsarcopeniaincludedecreasednutrientintake,lowphysicalactivity,orchronicdisease.[1]Additionally,epidemiologicalresearchhasindicatedthatearlyenvironmentalinfluencesmayhavelong-termeffectsonmusclehealth.Forexample,lowbirthweight,amarkerofapoorearlyenvironment,isassociatedwithreducedmusclemassandstrengthinadultlife.[9][10][11]PathophysiologyTherearemultipletheoriesproposedtoexplainthemechanismsofmusclechangesofsarcopeniaincludingchangesinsatellitecellrecruitment,changesinanabolicsignalling,proteinoxidation,inflammation,anddevelopmentalfactors.Thepathologicchangesofsarcopeniaincludeareductioninmuscletissuequalityasreflectedinthereplacementofmusclefiberswithfat,anincreaseinfibrosis,changesinmusclemetabolism,oxidativestress,anddegenerationoftheneuromuscularjunction.[12]ThedistributionofmusclefiberstypesalsochangesinsarcopenicmusclecausingadecreaseintypeIImusclefibers,or“fasttwitch,“withlittletonodecreaseintypeImusclefibers,or“slow-twitch“musclefibers.DeinervatedtypeIIfibersareoftenconvertedtotypeIfibersbyreinnervationbyslowtypeIfibermotornerves.[13]Thefailuretoactivatesatellitecellsuponinjuryorexerciseisalsothoughttocontributetothepathophysiologyofsarcopenia.[12]Additionally,oxidizedproteinscanleadtoabuildupoflipofuscinandcross-linkedproteinscausinganaccumulationofnon-contractilematerialintheskeletalmuscleandcontributetosarcopenicmuscle.[8]AnapparentprotectivefactorissufficientlevelsoftheproteinBNIP3,whichpreventscells‘buildupofdamagedmitochondria.DeficiencyofBNIP3leadstomuscleinflammationandatrophy.[14]DiagnosisMultiplediagnosticcriteriahavebeenproposedbyvariousexpertgroupsandcontinuestobeanareaofresearchanddebate.Despitethelackofawidelyaccepteddefinition,sarcopeniawasassignedanICD-10code(M62.84)in2016,recognizingitasadiseasestate.[15]Sarcopeniacanbediagnosedwhenapatienthasmusclemassthatisatleasttwostandarddeviationsbelowtherelevantpopulationmeanandhasaslowwalkingspeed.[16]TheEuropeanWorkingGrouponSarcopeniainOlderPeople(EWGSOP)developedabroadclinicaldefinitionforsarcopenia,designatedasthepresenceoflowmusclemassandeitherlowmuscularstrengthorlowphysicalperformance.[7]Otherinternationalgroupshaveproposedcriteriathatincludemetricsonwalkingspeed,distancewalkedin6?minutes,orgripstrength.[15]Handgripstrengthalonehasalsobeenadvocatedasaclinicalmarkerofsarcopeniathatissimpleandcosteffectiveandhasgoodpredictivepower,althoughitdoesnotprovidecomprehensiveinformation.[17]Therearescreeningtoolsforsarcopeniathatassesspatientreporteddifficultyindoingdailyactivitiessuchaswalking,climbingstairsorstandingfromachairandhavebeenshowntopredictsarcopeniaandpoorfunctionaloutcomes.[18]ManagementExerciseExerciseremainstheinterventionofchoiceforsarcopenia,buttranslationofresearchfindingsintoclinicalpracticeischallenging.Thetype,durationandintensityofexercisearevariablebetweenstudies,preventingastandardizedexerciseprescriptionforsarcopenia.[19]Lackofexerciseisasignificantriskfactorforsarcopeniaandexercisecandramaticallyslowtherateofmuscleloss.[20]Exercisecanbeaneffectiveinterventionbecauseagingskeletalmuscleretainsabilitytosynthesizeproteinsinresponsetoshort-termresistanceexercise.[21]Progressiveresistancetraininginolderadultscanimprovephysicalperformance(gaitspeed)andmuscularstrength.[22]MedicationTherearecurrentlynoapprovedmedicationsforthetreatmentofsarcopenia.[23]Testosteroneorotheranabolicsteroidshavealsobeeninvestigatedfortreatmentofsarcopenia,andseemtohavesomepositiveeffectsonmusclestrengthandmass,butcauseseveralsideeffectsandraiseconcernsofprostatecancerinmenandvirilizationinwomen.[24][25]Additionally,recentstudiessuggesttestosteronetreatmentsmayinduceadversecardiovascularevents.[26][27][28]DHEAandhumangrowthhormonehavebeenshowntohavelittletonoeffectinthissetting.Growthhormoneincreasesmuscleproteinsynthesisandincreasesmusclemass,butdoesnotleadtogainsinstrengthandfunctioninmoststudies.[24]This,andthesimilarlackofefficacyofitseffectorinsulin-likegrowthfactor1(IGF-1),maybeduetolocalresistancetoIGF-1inagingmuscle,resultingfrominflammationandotheragechanges.[24]Othermedicationsunderinvestigationaspossibletreatmentsforsarcopeniaincludeghrelin,vitaminD,angiotensinconvertingenzymeinhibitors,andeicosapentaenoicacid.[24][25]NutritionIntakeofcaloriesandproteinareimportantstimuliformuscleproteinsynthesis.[29]Olderadultsmaynotutilizeproteinsoefficientlyasyoungerpeopleandmayrequirehigheramountstopreventmuscleatrophy.[16]Anumberofexpertgroupshaveproposedanincreaseindietaryproteinrecommendationsforolderagegroupsto1.0-1.2g/kgbodyweightperday.[30][31]Ensuringadequatenutritioninolderadultsisofinterestinthepreventionofsarcopeniaandfrailty,sinceitisasimple,low-costtreatmentapproachwithoutmajorsideeffects.[32]SupplementsAcomponentofsarcopeniaisthelossofabilityforagingskeletalmuscletorespondtoanabolicstimulisuchasaminoacids,especiallyatlowerconcentrations.However,agingmuscleretainstheabilityofananabolicresponsetoproteinoraminoacidsatlargerdoses.Supplementationwithlargerdosesofaminoacids,particularlyleucinehasbeenreportedtocounteractmusclelosswithaging.[33]Exercisemayworksynergisticallywithaminoacidsupplementation.[23]β-hydroxyβ-methylbutyrate(HMB)isametaboliteofleucinethatactsasasignallingmoleculetostimulateproteinsynthesis.[16][23]Itisreportedtohavemultipletargets,includingstimulatingmTORanddecreasingproteasomeexpression.Itsusetopreventthelossofleanbodymassinolderadultsisconsistentlysupportedinclinicaltrials.[34][35][36]MoreresearchisneededtodeterminethepreciseeffectsofHMBonmusclestrengthandfunctioninthisagegroup.[35]EpidemiologyTheprevalenceofsarcopeniadependsonthedefinitionusedineachepidemiologicalstudy.Estimatedprevalenceinpeoplebetweentheagesof60-70is5-13%andincreasesto11-50%inpeoplemorethan80yearsofage.Thisequatesto＞50millionpeopleandisprojectedtoaffect＞200millioninthenext40yearsgiventherisingpopulationofolderadults.[7]PublichealthimpactSarcopeniaisemergingasamajorpublichealthconcerngiventheincreasedlongevityofindustrializedpopulationsandgrowinggeriatricpopulation.Sarcopeniaisapredictorofmanyadverseoutcomesincludingincreaseddisability,fallsandmortality[citationneeded].Immobilityorbedrestinpopulationspredisposedtosarcopeniacancausedramaticimpactonfunctionaloutcomes.Intheelderly,thisoftenleadstodecreasedbiologicalreserveandincreasedvulnerabilitytostressorsknownasthe“frailtysyndrome“.Lossofleanbodymassisalsoassociatedwithincreasedriskofinfection,decreasedimmunity,andpoorwoundhealing.Theweaknessthataccompaniesmuscleatrophyleadstohigherriskoffalls,fractures,physicaldisability,needforinstitutionalcare,reducedqualityoflife,increasedmortality,andincreasedhealthcarecosts.[16]Thisrepresentsasignificantpersonalandsocietalburdenanditspublichealthimpactisincreasinglyrecognized.[7]ResearchdirectionsTherearesignificantopportunitiestobetterunderstandthecausesandconsequencesofsarcopeniaandhelpguideclinicalcare.Thisincludeselucidationofthemolecularandcellularmechanismsofsarcopenia,furtherrefinementofreferencepopulationsbyethnicgroups,validationofdiagnosticcriteriaandclinicaltools,aswellastrackingofincidenceofhospitalizationadmissions,morbidity,andmortality.Identificationandresearchonpotentialtherapeuticapproachesandtimingofinterventionsisalsoneeded.[37]Newpharmaceuticaltherapiesinclinicaldevelopmentincludemyostatinandtheselectiveandrogenreceptormodulators(SARMs).[38]NonsteriodalSARMsareofparticularinterest,giventheyexhibitsignificantselectivitybetweentheanaboliceffectsoftestosteroneonmuscle,butwithlittletonoevidenceofandrogeniceffects(suchasprostatestimulationinmen).[38]Figure4.(A)Hematoxylin＆Eosinstaininginordertohighlightpossiblestructuralalterationsinmuscletissuefromyoung,healthyWistarRats.Musclefibersofyounghealthyratdidnotshowanydamagedhistologicalstructure.ThesampleswereexaminedwithaZeissAxioplanlightmicroscope(CarlZeiss,Oberkochen,Germany)andadigitalcamera(AxioCamMRc5,CarlZeiss)wasusedtotakethepictures.Lensmagnification:20×.Scalebars:50μm;(B)Morphometricanalysisoftheperimeter(μm)(mean±SD)ofthemusclefibersfromyounghealthyWistarRats.Inthemorphometricanalysisoftheperimeter(μm)(mean±SD)ofthemusclefibers,theyounghealthyratshowsnormalmuscletrophic.Theperimeterofmusclefiberswasconsideredandcalculatedusingsoftwareforimageacquisition(AxioVisionRelease4.8.2-SP2Software,CarlZeissMicroscopyGmbH,Jena,Germany).Lensmagnification:20×.Scalebars:50μm;(C)Hematoxylin＆EosinstaininginordertohighlightpossiblestructuralalterationsinmuscletissuefromelderlyWistarRats.Musclefibersofelderlyratshowdamagedhistologicalstructureasfocalperimisiofibrosis.ThesampleswereexaminedwithaZeissAxioplanlightmicroscope(CarlZeiss,Oberkochen,Germany)andadigitalcamera(AxioCamMRc5,CarlZeiss)wasusedtotakethepictures.Lensmagnification:20×.Scalebars:50μm;(D)Morphometricanalysisoftheperimeter(μm)(mean±SD)ofthemusclefibersfromelderlyWistarRats.Inthemorphometricanalysisoftheperimeter(μm)(mean±SD)ofthemusclefibers,theelderlyratshowsahighlysignificantmusclefiberhypotrophyandexhibitsremarkablefibersizeheterogeneity.Theperimeterofmusclefiberswasconsideredandcalculatedusingsoftwareforimageacquisition(AxioVisionRelease4.8.2-SP2Software,CarlZeissMicroscopyGmbH,Jena,Germany).Lensmagnification:20×.Scalebars:50μm.FromWikipedia,thefreeencyclopediahttps://amino-ther.com/clinical-evidence/sarcopenia-and-frailty/更多參考文獻(xiàn)ReferencesPetersonSJ,MozerM(February2017).“DifferentiatingSarcopeniaandCachexiaAmongPatientsWithCancer“.NutritioninClinicalPractice.32(1):30–39.doi:10.1177/0884533616680354.PMID28124947.S2CID206555460.AtaAM,KaraM,KaymakB,OzcakarL.SarcopeniaIsNot“Love“:YouHavetoLookWhereYouLostit!.AmJPhysMedRehabil.2020;99(10):e119-e120.doi:10.1097/PHM.0000000000001391.BeaudartC,ZaariaM,PasleauF,etal:Healthoutcomesofsarcopenia:asystematicreviewandmeta-analysis.PLoSOne2017;12:e0169548AtaAM,KaraM,KaymakB,etal:Regionalandtotalmusclemass,musclestrengthandphysicalperformance:thepotentialuseofultrasoundimagingforsarcopenia.ArchGerontolGeriatr2019;83:55–60Ranasinghe,Chathuranga;Gamage,Prasanna(2013).“RelationshipbetweenBodymassindex(BMI)andbodyfatpercentage,estimatedbybioelectricalimpedance,inagroupofSriLankanadults:acrosssectionalstudy“.BMCPublicHealth.13:797.doi:10.1186/1471-2458-13-797.PMC3766672.PMID24004464.?zkal?,KaraM,TopuzS,etal:Assessmentofcoreandlowerlimbmusclesforstatic/dynamicbalanceintheolderpeople:anultrasonographicstudy.AgeAgeing2019;48:881–7Cruz-JentoftAJ,BaeyensJP,BauerJM,BoirieY,CederholmT,LandiF,etal.(July2010).“Sarcopenia:Europeanconsensusondefinitionanddiagnosis:ReportoftheEuropeanWorkingGrouponSarcopeniainOlderPeople“.AgeandAgeing.39(4):412–23.doi:10.1093/ageing/afq034.PMC2886201.PMID20392703.MarcellTJ(October2003).“Sarcopenia:causes,consequences,andpreventions“.TheJournalsofGerontology.SeriesA,BiologicalSciencesandMedicalSciences(Review).58(10):M911-6.doi:10.1093/gerona/58.10.m911.PMID14570858.SayerAA,SyddallHE,GilbodyHJ,DennisonEM,CooperC(September2004).“Doessarcopeniaoriginateinearlylife?FindingsfromtheHertfordshirecohortstudy“.TheJournalsofGerontology.SeriesA,BiologicalSciencesandMedicalSciences.59(9):M930-4.doi:10.1093/gerona/59.9.M930.PMID15472158.GaleCR,MartynCN,KellingrayS,EastellR,CooperC(January2001).“Intrauterineprogrammingofadultbodycomposition“.TheJournalofClinicalEndocrinologyandMetabolism.86(1):267–72.doi:10.1210/jcem.86.1.7155.PMID11232011.Ylih?rsil?H,KajantieE,OsmondC,ForsénT,BarkerDJ,ErikssonJG(September2007).“Birthsize,adultbodycompositionandmusclestrengthinlaterlife“.InternationalJournalofObesity.31(9):1392–9.doi:10.1038/sj.ijo.0803612.PMID17356523.RyallJG,SchertzerJD,LynchGS(August2008).“Cellularandmolecularmechanismsunderlyingage-relatedskeletalmusclewastingandweakness“.Biogerontology(Review).9(4):213–28.doi:10.1007/s10522-008-9131-0.PMID18299960.S2CID8576449.DohertyTJ(October2003).“Invitedreview:Agingandsarcopenia“.JournalofAppliedPhysiology(Review).95(4):1717–27.doi:10.1152/japplphysiol.00347.2003.PMID12970377.IrazokiA;etal.(9March2022).“Coordinationofmitochondrialandlysosomalhomeostasismitigatesinflammationandmuscleatrophyduringaging“.AgingCell.21(4):e13583.doi:10.1111/acel.13583.PMC9009131.PMID35263007.AnkerSD,MorleyJE,vonHaehlingS(December2016).“WelcometotheICD-10codeforsarcopenia“.JournalofCachexia,SarcopeniaandMuscle.7(5):512–514.doi:10.1002/jcsm.12147.PMC5114626.PMID27891296.ArgilésJM,CamposN,Lopez-PedrosaJM,RuedaR,Rodriguez-Ma?asL(September2016).“SkeletalMuscleRegulatesMetabolismviaInterorganCrosstalk:RolesinHealthandDisease“.JournaloftheAmericanMedicalDirectorsAssociation.17(9):789–96.doi:10.1016/j.jamda.2016.04.019.PMID27324808.SayerAA(August2010).“Sarcopenia“.BMJ.341(aug102):c4097.doi:10.1136/bmj.c4097.PMID20699307.S2CID220113690.MalmstromTK,MillerDK,SimonsickEM,FerrucciL,MorleyJE(March2016).“SARC-F:asymptomscoretopredictpersonswithsarcopeniaatriskforpoorfunctionaloutcomes“.JournalofCachexia,SarcopeniaandMuscle.7(1):28–36.doi:10.1002/jcsm.12048.PMC4799853.PMID27066316.SayerAA(November2014).“Sarcopeniathenewgeriatricgiant:timetotranslateresearchfindingsintoclinicalpractice“.AgeandAgeing.43(6):736–7.doi:10.1093/ageing/afu118.PMID25227204.AbateM,DiIorioA,DiRenzoD,PaganelliR,SagginiR,AbateG(September2007).“Frailtyintheelderly:thephysicaldimension“.EuropaMedicophysica.43(3):407–15.PMID17117147.YarasheskiKE(October2003).“Exercise,aging,andmuscleproteinmetabolism“.TheJournalsofGerontology.SeriesA,BiologicalSciencesandMedicalSciences(Review).58(10):M918-22.doi:10.1093/gerona/58.10.m918.PMID14570859.LiuCJ,LathamNK(July2009).“Progressiveresistancestrengthtrainingforimprovingphysicalfunctioninolderadults“.TheCochraneDatabaseofSystematicReviews(3):CD002759.doi:10.1002/14651858.cd002759.pub2.PMC4324332.PMID19588334.PhillipsSM(July2015).“Nutritionalsupplementsinsupportofresistanceexercisetocounterage-relatedsarcopenia“.AdvancesinNutrition.6(4):452–60.doi:10.3945/an.115.008367.PMC4496741.PMID26178029.SakumaK,YamaguchiA(28May2012).“Sarcopeniaandage-relatedendocrinefunction“.InternationalJournalofEndocrinol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