| As the accelerating of aging around the world population,the health problems caused by the huge amount of the elderly adults have become the focus of the whole society.Skeletal muscle is the basis of human activities.But it has been suggested that after the age of 30,the skeletal muscle mass will be gradually decreasing with age.Decrease in skeletal muscle mass,strength and physical function,namely sarcopenia,is proposed as a new geriatric syndrome in recent years,it can lead to osteoporosis,fall,fracture,weakness and other agerelated diseases,and can significantly increase the rate of hospitalization,as well as mortality,therefore put the healthy of the elderly under great challenge.Many studies have shown that malnutrition,shortage of exercise,chronic inflammation,oxidative stress,dysfunction of endocrine system and other factors may play important roles in the pathogenesis of sarcopenia.T2DM is a common chronic metabolic disease in the elderly.Studies have found that type 2 diabetes would put the body under a state of chronic inflammation and oxidative stress,and can significantly reduce neuromuscular function,impede blood circulation to muscle tissue,and thus accelerate the deterioration process of skeletal muscle mass and strength in the elderly.On the other hand,the decline of skeletal muscle mass and strength,can significantly increase the the occurrence of adverse events such as fall,fracture and frailty, and further lead to lung infection,thrombosis,disability and other serious consequences.So,is there a link between diabetes and sarcopenia? What is the mechanism of skeletal muscle degeneration in T2DM? What possible factors are involved in? Whether protein supplementation and resistance training are beneficial to the skeletal muscle degeneration in the elderly?Therefore,in the first part of this study,we compared the skeletal muscle mass and strength between T2 DM patients and the Non-T2 DM elderly,and detected the serum IL-6、TNF-α、8-OHd G、HCY、IGF-1 levels of two groups,to explore the possible mechanisms of lost muscle mass and strength in diabetics.And in the second part,we collected the domestic and foreign research reports,and through the method of systematic review and meta-analysis,we evaluated the effect of protein supplementation and resistance training on the skeletal muscle mass,muscle strength and muscle function in elderly,thus provide powerful evidence for the prevention and treatment of sarcopenia in the elderly.Objectives: 1.To investigate the correlations between serum IL-6、TNF-α、8-OHd G、HCY、IGF-1 levels with skeletal muscle mass and strength,and explore the pathogenesis of sarcopenia in T2 DM elderly.2.Meta-analysis was used to systematically evaluate the effect of protein and other nutrients supplementation combined with resistance training on the skeletal muscle mass,strength and function in the elderly,and to provide more evidence for the prevention and treatment of sarcopenia.Methods: Part 1: 1.Subjects enrolled: We enrolled 120 T2 DM patients over 60-year-old,who admitted to the endocrinology department of first affiliated hospital from November,2017 to march,2018.And selected 126 Non-T2 DM elderly volunteers in the physical examination center during the same period.2.The inclusion criteria of the experimental group were: T2 DM patients admitted to the endocrinology department of our hospital from November,2017 to March,2018;60 years or older;Those who agree and accept the research program.Exclusion criteria: Patients with severe bone and joint diseases or neuromuscular diseases that affect their activities;Those who have severe diseases or organ failure,such as stroke,acute kidney failure,acute liver failure,acute respiratory failure;Patients with serious diabetic complications,including severe diabetic nephropathy and diabetic retinopathy,diabetic foot gangrene,etc;Patients with malignant tumors or similar diseases.3.The inclusion criteria of the control group were: subjects who were admitted to the physical examination center of our hospital from November,2017 to march,2018 and who were Non-T2DM;60 years or older;Those who agree and accept the research program.Exclusion criteria: patients with recent acute cardiovascular and cerebrovascular diseases and acute organ failure;Parkinson’s disease,rheumatoid arthritis,severe bone or muscle disease that affects daily physical activity;Patients with malignant tumors,hyperthyroidism and other similar diseases.4.Information gathering: we gathered the basic information including gender,age,smoking,drinking,education level,etc.And measured height,weight and BMI of the subjects,as well as the skeletal muscle mass by body composition analyzer,grip strength by electronic dynamometer respectively.5.Blood sample collection and detection: The laboratory test results of liver function,kidney function,blood lipid,blood glucose and Hb A1 C of the subjects were collected.Serum IL-6、TNF-α、8-OHd G、HCY、IGF-1 levels of subjects in the two groups were determined by Elisa.6.SPSS 20.0 software was used.The measurement data were expressed by (?)±s,two samples t-test was used for inter-group comparison.The counting data were expressed by percentage(%)and Chi-square test was used for comparison between groups.P<0.05 was considered statistically significant.Part 2: 1.Data sources: According to the predetermined search terms(’ older adults’ OR ’older population’ OR ’older people’ OR ’elderly’ OR ’aging’ OR ’senior’)AND(’nutrition’ OR ’protein’ OR ’amino acid’)AND(’resistance training’ OR ’resistance exercise’),the databases including Pubmed,MEDLINE,Embase,CNKI and wanfang database were searched.Literatures on the effect of protein supplementation combine with resistance training on skeletal muscle of the elderly were collected.2.Statistical analysis: Relevant data were extracted and statistically analyzed using the Stata12.0,Revman5.1 and other software.Results: 1.The mean muscle strength of the diabetics and the control group was 25.03±7.85 kg and 29.52±7.73 kg respectively,the muscle strength of the diabetics group was significantly lower than that of the control group(P<0.01).The skeletal muscle mass of the diabetics group was 21.36±5.46 kg,and that of the control group was 22.01±5.22 kg,there was no statistically significant difference between the two groups(P=0.998).2.Serum IGF-1 concentration in the diabetics group was significantly lower than that in the control group(IGF-1:137.11±73.32ng/ml vs 164.39±84.59ng/ml),the difference between the two groups was statistically significant(P<0.05).Serum HCY level in the diabetics group was significantly higher than that in the control group(HCY: 1.21±0.43mmol/L vs 0.91±0.63mmol/L),the difference between the two groups was statistically significant(P<0.01).The 8-OHd G level in the two groups are 3.08±0.26pg/ml,2.59±0.16pg/ml respectively,diabetics group are significantly higher than that of control group,with the P<0.01.And Serum IL-6 and TNF-α levels in the diabetics group and the control group were respectively(IL-6: 1.2±0.27pg/ml vs 1.23 ±0.41pg/ml;TNF-α: 1.43±0.55pg/ml vs 1.29±0.57pg/ml),there was no statistically significant difference between the two groups(P>0.05).3.The muscle strength of patients in the diabetes group was positively correlated with height(r=0.644,P=0.000),weight(r=0.456,P=0.000)and IGF-1 level(r=0.255,P=0.005),but it was negatively correlated with 8-OHd G(r=-0.252,P=0.006).In the diabetics group,skeletal muscle mass was positively correlated with height(r=0.841,P=0.000),weight(r=0.768,P=0.000),BMI(r=0.362,P=0.000)and IGF-1 level(r=0.209,P=0.022),but it was negatively correlated with HCY(r=-0.185,P=0.044).There was a higher skeletal muscle mass and muscle strength in the patients with higher education degree(P<0.05).And there was a lower skeletal muscle mass and strength in the diabetic male with smoking(P<0.01);lower skeletal muscle mass in the male patients with alcohol(P<0.05).4.Regression analysis showed that height and 8-OHd G were risk factors for muscle strength in diabetic patients(R2=0.457).Height and weight were risk factors for skeletal muscle mass in elderly diabetic patients(R2=0.822).5.After a systematic meta-analysis of 21 RCT trials involving 1249 participants,protein supplementation combined with resistance training was shown to be effective in increasing skeletal muscle mass [Fat-free mass(SMD: 0.23kg;95%CI: 0.09,0.38;P=0.002),Appendicular skeletal muscle mass(SMD: 0.39kg;95%CI: 0.14,0.64;P=0.003)],and muscle strength [grip strength(SMD: 0.29kg;95%CI:0.08,0.50;P=0.008),knee extension strength(SMD: 0.27kg;95%CI: 0.06,0.47;P=0.013),leg press strength(SMD: 0.33 kg;95%CI: 0.01,0.64;P=0.04)],but no significant effect was found on muscle function.Conclusions: Part 1: 1.The muscle strength is significantly lower in the diabetics group than the control,and the skeletal muscle mass as well as muscle strength are lower in women than that in men.2.Height is the influence factor of skeletal muscle mass and muscle strength in the T2 DM subjects.Weight were influence factor for skeletal muscle mass in the T2 DM patients.Age shows a negative trend with skeletal muscle mass and muscle strength in elderly diabetic patients.Lower education level,as well as smoking in the male is negatively correlated with muscle mass and muscle strength of the patients.Men with diabetes who drink alcohol are more likely to develop lower skeletal muscle mass.3.Serum 8-OHd G level has a significant negative impact on muscle strength in elderly diabetic patients,it is a main risk factor of muscle strength in the diabetics.Serum IGF-1 level was significantly positively correlated with skeletal muscle mass as well as muscle strength in elderly T2 DM patients,whereas the HCY level is negatively correlated with the skeletal muscle mass of them.Part 2: 1.When compared with resistance training group,protein supplementation combined with resistance training can significantly improve skeletal muscle mass and muscle strength in the elderly,but no significant difference of muscle function was found between the two intervention methods. |
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