中老年人對肌少症的營養認知、態度、飲食行為之相關研究-以某區域醫院新陳代謝科門診病人為例

Abstract

目的：肌少症之盛行率日益攀升，向來被視為老年人常見徵狀的肌少症，近年來出現年輕化趨勢，而肌少症的影響因素除了年齡外，營養與三高疾病也是近年來較常被探討的重要因素。本研究針對有三高疾病(高血壓、高血脂或高血糖)之40歲以上中老年人的肌少症營養認知、肌少症營養態度、飲食行為做相關研究與探討。方法：運用認知-態度-行為模式為研究架構，自編結構式問卷進行資料收集，問卷內容分為個人背景(年齡、性別、教育程度、家庭收支狀況、小腿圍、握力、肌肉量)、肌少症營養認知、肌少症營養態度、飲食行為四部份，採立意取樣的方式選取臺北市某區域醫院新陳代謝科門診之病人，有效問卷共140份，所得的資料以描述性統計、獨立樣本Ｔ檢定、單因子變異數分析、斯皮爾曼等級相關分析、多元迴歸分析、羅吉斯迴歸分析做分析。結果：個人背景變項中，年齡、教育程度、身體活動量、握力、四肢骨骼肌肉量在肌少症營養認知是有顯著相關；年齡、教育程度、三高疾病數量、握力在肌少症營養態度是有顯著相關；家庭收支狀況、三高疾病數量、身體活動量在飲食行為上有顯著相關。握力、小腿圍、四肢骨骼肌肉量三者皆呈顯著正相關。肌少症營養認知與肌少症營養態度、肌少症營養態度與飲食行為皆呈顯著正相關，肌少症營養認知與飲食行為呈無顯著相關。「教育程度」為肌少症營養認知的主要預測變項，且解釋力最大；「三種三高疾病數量」為肌少症營養態度與飲食行為的主要預測變項，且解釋力最大。「身體活動量」與「小腿圍」能有效地預測肌少症的發生，而其他的個人背景變項、肌少症營養認知、肌少症營養態度與飲食行為對肌少症的發生都無顯著影響。結論：肌少症營養認知與肌少症營養態度有正相關，肌少症營養態度與飲食行為也有正相關，依照研究結果，建議若要進行肌少症相關營養衛教，可先從年齡「70歲以上」或教育程度「高中職(含)以下」開始。對於吃足夠蛋白質能有效預防肌少症有正向的態度，但卻認為是很難做到的，而在乳製品攝取上也較少，建議未來衛教內容上，可強調乳製品也是增加優質蛋白質攝取的一種方式，且容易取得。四肢骨骼肌肉量與肌少症營養認知呈顯著正相關，擁有較佳的肌少症營養認知，較不會有肌少症的發生。Objective: The prevalence of sarcopenia is increasingly rising. Traditionally viewed as a common symptom among the elderly, sarcopenia has shown a trend of affecting younger individuals in recent years. Besides age, nutrition and chronic diseases such as hypertension, hyperlipidemia, and hyperglycemia have also been important factors frequently discussed in recent studies. This research focuses on the nutritional cognition, nutritional attitudes, and dietary behaviors related to sarcopenia among middle-aged and elderly people over 40 years old with chronic diseases (hypertension, hyperlipidemia, or hyperglycemia).Methods: Using the cognitive-attitude-behavior model as the research framework, a structured questionnaire was self-developed for data collection. The questionnaire consisted of four parts: personal background (age, gender, education level, family income and expenditure status, calf circumference, grip strength, muscle mass), nutritional cognition of sarcopenia, nutritional attitudes towards sarcopenia, and dietary behaviors. A purposive sampling method was used to select patients from the outpatient metabolic department of a regional hospital in Taipei City. A total of 140 valid questionnaires were collected, and the data were analyzed using descriptive statistics, independent samples T-test, one-way ANOVA, Spearman rank correlation analysis, multiple regression analysis, and logistic regression analysis.Results: Among the personal background variables, age, education level, physical activity level, grip strength, and limb skeletal muscle mass are significantly correlated with nutritional cognition related to sarcopenia; age, education level, the number of chronic diseases (hypertension, diabetes, and hyperlipidemia), and grip strength are significantly correlated with nutritional attitudes towards sarcopenia; family income and expenditure status, the number of chronic diseases, and physical activity level are significantly correlated with dietary behavior. Grip strength, calf circumference, and limb skeletal muscle mass all show a significant positive correlation. Nutritional cognition related to sarcopenia is significantly positively correlated with nutritional attitudes towards sarcopenia, and nutritional attitudes towards sarcopenia are significantly positively correlated with dietary behavior, while nutritional cognition related to sarcopenia shows no significant correlation with dietary behavior."Education level" is the main predictive variable for nutritional cognition related to sarcopenia, with the greatest explanatory power; "the number of three chronic diseases" is the main predictive variable for nutritional attitudes and dietary behavior, with the greatest explanatory power. "Physical activity level" and "calf circumference" can effectively predict the occurrence of sarcopenia, while other personal background variables, nutritional cognition related to sarcopenia, nutritional attitudes towards sarcopenia, and dietary behavior have no significant impact on the occurrence of sarcopenia.Conclusion: There is a positive correlation between nutritional cognition of sarcopenia and nutritionalattitudes towards sarcopenia. Additionally, there is a positive correlation between nutritional attitudes towards sarcopenia and dietary behaviors. Based on the research findings, it is recommended that nutritional education related to sarcopenia should start with individuals aged"70 and above" or those with an education level of "high school or below." While there is a positive attitude towards the idea that consuming sufficient protein can effectively prevent sarcopenia, many believe it is difficult to achieve. Furthermore, there is a lower intake of dairy products, so it is suggested that future educational content should emphasize that dairy products are also a way to increase the intake of high-quality protein and are easily accessible. There is a significant positive correlation between skeletal muscle mass in the limbs and nutritional cognition of sarcopenia; having better nutritional cognition of sarcopenia is associated with a lower incidence of the condition.