臺灣博碩士論文加值系統

營養不良、肌肉衰弱與肌少症是影響肌力重要因素。老人肌力不良衍生問題有無法移動、跌倒、骨折等併發症，死亡風險極高。因此，本研究將藉由瞭解老年人身體組成、飲食狀況、肌力狀態探討影響老年人肌力狀態衰退之因素。本研究採用回溯性研究，以146位老年人（平均75.8±6.8歲; 68.8％的男性）之基本資料及日常生活活動量表、飲食攝取頻率表、食慾評估表、24小時飲食回憶紀錄、迷你營養評估分數、身體組成數據、握力數據、肌力狀態等資料，探討老年人之食物選擇、營養狀況、日常生活活動量表、身體組成數據等與肌力狀態的相關性。研究，受訪者中有74.0%老人可以自由行動，慢性病者達87%（高血壓、糖尿病、心臟病與心血管疾病為前四名），食慾良好（45.9%）可以吃完套餐的有76.7%，75%受訪者仍有味覺反應，大部分維持三餐進食（87%）。受訪者之上臂與下肢肌力衰退者分別有48.6%與57.5%，64.0%、50.0%受試者左右手握力有衰弱的現象。飲食營養素攝取不足，尤其以鈣、鎂嚴重缺乏，僅3~4%達攝取需求量。老年人四肢肌力與飲食熱量、醣類、維生素C攝取量和身體質量指數、全身的骨骼肌重均呈顯著正相關；握力與飲食醣類、蛋白質及熱量之攝取量呈顯著正相關；雙手握力、肌力與迷你營養評估結果、全身的骨骼肌重呈顯著正相關。綜合以上結果推論熱量、醣類、維生素C攝取足夠及骨骼肌質量、營養狀況越好則肌力越好。

Dynapenia and sarcopenia are important factors that affect muscle strength, occurred in groups of over the age of 50. The poor muscle derives unable move, fall, fracture, and other complications and high mortality. This retrospective study to collect the basic information of individual cases and activities of daily living scale, food frequency questionnaire, simplified nutritional appetite questionnaire, 24-hour dietary recall records, mini nutritional assessment, body composition data, grip strength, muscle strength and to analyze these data, in order to explore the elderly food choice, nutritional status, daily life scale, body composition data with the strength of the state. There are 146 subjects of elderly people in this study. Statistical analysis is performed by the SPSS18.0 statistical software. The differences of personal variables and muscle strength and grip strength are analyzed by t-test and one-way ANOVA. Compare the differences by the “Scheffe method” again; Analyze nutritional intake of the elderly, mini nutrition assessment scores, upper and lower limb muscle mass and strength, grip strength by the “Pearson correlation”; Analyze important relevant factors of the elderly to affect muscle strength and grip strength degradation by the “variable multi-step Logistic regression”. The results of this study show that the upper arm and lower limb muscle strength decline 48.6% and 57.5%, and grip of left and right hands decline 64.0%, 50.0%; elderly muscle strength of limbs correlate significantly and positively with intake of carbohydrates, energy, vitamin C and also correlate significantly and positively with body mass Index and whole body skeletal muscle weight; the grip strength correlates significantly and positively with intake of the carbohydrate, protein and calorie; the grip strength of both hands correlate significantly and positively with mini-nutrition assessment results and the body's skeletal muscle weight. In summary, we infer that the muscle strength can get better by enough intakes of the calorific capacity, carbohydrates, vitamin C, and the nutritional status.

目 錄
頁次
謝誌 I
中文摘要 II
Abstract IV
目錄 VI
圖目錄 IX
表目錄 X
縮寫表 XII
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 2
第二章 文獻回顧 3
第一節 老年人的健康狀況 3
第二節 老年人的飲食與營養狀況 7
第三節 肌少症與肌力介紹 10
一、肌少症流行病學： 10
二、肌少症診斷 11
三、肌力介紹 14
四、肌力測量方法 14
五、肌力的影響因素 15
第三章 研究方法 17
第一節 研究設計 17
第二節 研究架構 18
第三節 研究對象 19
第四節 研究工具 19
一、個人基本資料 19
二、半定量飲食頻率問卷（Food frequency questionnaire,FFQ） 20
三、食慾評估表 21
四、24小時飲食回憶紀錄 （24 hour record of diet） 21
五、迷你營養評估量表 21
六、個人身體組成數據量表 22
七、肌力狀態評估 23
第五節 資料收集過程 24
第六節 資料處理及統計分析 24
第四章 研究結果 26
第一節 個案資料分析 26
一、個案基本資料分析 26
二、個案飲食頻率概況分析 27
三、個案食慾概況分析 29
四、個案飲食營養攝取概況 29
五、個案營養評估概況 30
六、個案身體骨骼肌重之概況 30
七、個案肌力狀態之概況 32
第二節 影響老年人肌力之相關變項分析 33
一、老年人肌力與基本資料之相關變項分析 33
二、肌力與飲食頻率、簡易食慾分數之相關變項分析 34
三、肌力與飲食營養攝取、迷你營養評估之相關變項分析 35
四、老年人肌力與身體組成骨骼肌重之相關變項分析 35
第三節 影響握力之相關變項分析 36
一、老年人握力與基本資料之相關變項分析 36
二、握力與飲食頻率、簡易食慾分數之相關變項分析 37
三、握力與飲食營養攝取、迷你營養評分之相關性分析 38
四、老年人握力與身體組成骨骼肌重之相關變項分析 38
第四節 老年人肌力狀態衰退與影響變項之勝算比 38
一、老年人肌力衰退與影響變項之勝算比 38
（一）上肢肌力衰退與影響變項之勝算比 39
（二）下肢肌力衰退與影響變項之勝算比 42
二、握力衰退與影響變項之勝算比 44
（一）左手握力衰退與影響變項之勝算比 44
（二）右手握力衰退與影響變項之勝算比 47
第五節 肌力狀態衰退之多變項邏輯斯迴歸分析 49
一、老年人上肢肌力衰退之重要影響變項 50
二、老年人下肢肌力衰退之重要影響變項 51
三、老年人左手握力衰退之重要影響變項 52
四、老年人右手握力衰退之重要影響變項 53
第五章 討論 55
第一節 研究對象飲食探討 55
第二節 生活活動依賴程度、營養狀態與肌力握力探討 57
第三節 老年人肌力握力衰退探討 59
第六章 結論與建議 62
第七章 圖表結果 64
第八章 參考文獻 112
附件1 IRB核准函 121
附件2受試者基本資料問卷 122
附件3 飲食頻率問卷 （FFQ） 123
附件4營養評估：Mini NutritionAssessment （ MNA） 124
附件5簡易食慾評估 1125
附件6日常生活活動功能量表 （ADL） -巴氏量表 126
附件7肌力評估表 127

圖目錄
圖1-1一種新興的老年症候群:虛弱 06
圖3-1研究架構圖 18

表目錄
表1-1 老年人肌少症的相關因子 13
表4-1 個案基本資料分析 64
表4-2 個案依賴程度分析 66
表4-3 個案飲食頻率 67
表4-4個案簡易食慾評估 69
表4-5個案飲食營養素分析 70
表4-6 個案營養攝取達需求量百分比分析 71
表4-7 個案迷你營養評估（MNA）分數分析 72
表4-8 個案之身體質量指數BMI註及體位指標分析 73
表4-9個案之骨骼肌重及偏低狀況 74
表4-10 個案肌力評估 75
表4-11個案握力值及衰弱狀況 76
表4-12 基本資料變項與肌力評分之差異比較 77
表4-13 肌力與飲食頻率、簡易食慾分數之相關分析 79
表4-14 肌力與飲食營養攝取、迷你營養評估之相關分析 80
表4-15 肌力與BMI、身體組成骨骼肌重之相關分析 81
表4-16基本資料變項與握力之差異比較 82
表4-17 握力與飲食頻率、簡易食慾分數之相關分析 84
表4-18 握力與飲食營養攝取、迷你營養評分之相關分析 86
表4-19握力與身體組成骨骼肌重之相關分析 87
表4-20 肌力與相關變項分析結果摘要總表 88
表4-21 上肢肌力衰退與相關影響變項之勝算比 90
表4-22 下肢肌力衰退與相關影響變項之勝算比 95
表4-23 握力與相關變項分析結果摘要總表 100
表4-24 左手握力衰退與相關影響變項之勝算比 102
表4-25 右手握力衰退與相關影響變項之勝算比 105
表4-26 老年人上肢肌力衰退與相關影響變項之多變項逐步邏輯斯迴歸分析 108
表4-27 老年人下肢肌力衰退與相關影響變項之多變項逐步邏輯斯迴歸分析 109
表4-28老年人左手握力衰退與相關影響變項之多變項逐步邏輯斯迴歸分析 110
表4-29老年人右手握力衰退與相關影響變項之多變項逐步邏輯斯迴歸分析 111

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