Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: From sarcopenic obesity to cachexia
Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: From sarcopenic obesity to cachexia
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DOI：
10.1016/j.clnu.2014.03.007
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发表时间：
2014-10-01
影响因子：
6.3
通讯作者：
Muscaritoli, Maurizio
中科院分区：
文献类型：
--
作者：
Biolo, Gianni;Cederholm, Tommy;Muscaritoli, Maurizio
骨骼肌是人体中含量最丰富的组织，具有多种生理功能。然而，肌肉质量和功能并不是常规的评估。骨质疏松症的定义是骨骼肌在衰老和慢性疾病中的丢失和功能障碍。缺乏运动、炎症、年龄相关因素、厌食症和营养失衡会影响骨骼肌的变化。由于疾病的多因素特性，机制在单个受试者中很难区分。骨质疏松症包括肌肉丧失和功能障碍，导致收缩功能障碍和代谢和内分泌异常，影响全身代谢和免疫/炎症反应。在衰老和慢性病中，肌肉损失与脂肪变化有不同的代谢轨迹。食欲调节和体力活动影响能量平衡和身体脂肪质量的变化。人们对炎症介质对食欲的调节知之甚少。在一些患者中，炎症会导致食欲减退和脂肪减少，并伴有骨质疏松症。在其他情况下，尽管全身炎症被激活，但食欲仍保持不变，导致体重指数正常或增加的骨量减少。在衰老和疾病中，缺乏运动会导致骨骼减少和脂肪组织增加。在代谢轨迹的末尾，恶病质和骨质型肥胖是这两类患者的范例。癌症、慢性心力衰竭或肝硬变患者会出现恶病质前期和恶病质。类风湿性关节炎、接受辅助化疗的乳腺癌患者以及大多数慢性阻塞性肺疾病或慢性肾脏疾病患者可观察到体重指数正常或增加的骨质疏松症和骨质疏松症。在这些情况下，骨质疏松症是发病率和死亡率的一个强有力的预后因素，独立于BMI。(C)2014年爱思唯尔有限公司和欧洲临床营养和代谢学会。版权所有。
Skeletal muscle is the most abundant body tissue accounting for many physiological functions. However, muscle mass and functions are not routinely assessed. Sarcopenia is defined as skeletal muscle loss and dysfunction in aging and chronic diseases. Inactivity, inflammation, age-related factors, anorexia and unbalanced nutrition affect changes in skeletal muscle. Mechanisms are difficult to distinguish in individual subjects due to the multifactorial character of the condition. Sarcopenia includes both muscle loss and dysfunction which induce contractile impairment and metabolic and endocrine abnormalities, affecting whole-body metabolism and immune/inflammatory response. There are different metabolic trajectories for muscle loss versus fat changes in aging and chronic diseases. Appetite regulation and physical activity affect energy balance and changes in body fat mass. Appetite regulation by inflammatory mediators is poorly understood. In some patients, inflammation induces anorexia and fat loss in combination with sarcopenia. In others, appetite is maintained, despite activation of systemic inflammation, leading to sarcopenia with normal or increased BMI. Inactivity contributes to sarcopenia and increased fat tissue in aging and diseases. At the end of the metabolic trajectories, cachexia and sarcopenic obesity are paradigms of the two patient categories. Pre-cachexia and cachexia are observed in patients with cancer, chronic heart failure or liver cirrhosis. Sarcopenic obesity and sarcopenia with normal/increased BMI are observed in rheumatoid arthritis, breast cancer patients with adjuvant chemotherapy and in most of patients with COPD or chronic kidney disease. In these conditions, sarcopenia is a powerful prognostic factor for morbidity and mortality, independent of BMI. (C) 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.