| Background:Sarcopenia has become one of the most concerned health topics of older people.Sarcopenia could increase the risk of frailty,falls,fractures and disability,leading to the decline of life quality and the increase of mortality,which has become a serious threat to older people.The etiology of sarcopenia has been proven to be rather complex,while dietary nutrition has been recognized as one of the adjustable factors for the prevention and treatment of sarcopenia.However,the diagnose standards of sarcopenia have been continuously updated in the past decade,and there is no unified diagnose standard of sarcopenia at present.The measurement of muscle mass is complicated and inconvenient.These factors have partially limited the large-scale nutritional epidemiological studies related to sarcopenia.In recent years,several studies have associated dietary foods,such as poultry,livestock meat,vegetables,and fruits,with muscle health in older people.Dietary nutrients,such as protein,vitamins,and minerals,have also been associated with muscle health in various metabolic pathways,but the relevant results remain inconsistent.Compared with the single food or nutrient,dietary pattern may be more closely related to muscle health of older people.However,only a little amount of studies have discussed the association between dietary pattern and sarcopenia in China,and there are still lacks of scientific evidence and practical guidance of dietary pattern for the prevention and treatment of sarcopenia.Objective:1.Analyze the current dietary patterns of the older people in China,and explore the influencing factors of dietary pattern.2.Explore the associations between dietary patterns and sarcopenia,low muscle mass(LMM)of the older people in China.3.Construct a prediction model of LMM for the older people in China,to provide a practical tool for the screening and research of LMM and sarcopenia in older people.4.Screen potential biomarkers of sarcopenia from multiple circulating markers,and explore the associations between dietary patterns and biomarkers of sarcopenia.Provide scientific evidence and practical guidance of dietary nutrition,for the prevention and management of sarcopenia in the older people in China.Methods:1.Food frequency questionnaire data of 14719 subjects aged 65 years old or older in the China Adult Chronic Disease and Nutrition Surveillance(2015)were analyzed in the present study.Current dietary patterns of the older people were extracted by exploratory factor analysis.Food intake and dietary variety of different dietary patterns were also analyzed and evaluated in the present study.Major influencing factors of dietary patterns were analyzed from the multiple aspects of social economy,food consumption,nutrition and health education,and then were identified and ranked by the decision-tree model.2.Data of 861 subjects aged 65 years old or older,in the survey of Nutrition Improvement Strategy for Older People and Application in China(2018)were analyzed in the present study.Dietary patterns were extracted from three typical regions,including Guangdong,Jiangsu,and Inner Mongolia,using exploratory factor analysis.Sarcopenia in the older people was diagnosed by multiple recommended standards,including the standard of Asian Working Group for Sarcopenia in 2014(AWGS2014),the updated standard in 2019(AWGS2019),and the standard updated by European Working Group on Sarcopenia in Older People in 2019(EWGSOP2).Logistic regression and multinomial logit model were used to analyze the association between dietary pattern and sarcopenia in the older people.The differences in dietary nutrients intake among the older people were compared from the aspects of sarcopenia and dietary pattern.Restricted cubic spline(RCS)regression model was used to analyze the dose-response relationship between the energy supply ratio of macronutrients and sarcopenia in the older people.3.The prediction model of LMM was constructed basing on the general health data of the subjects in the survey of Nutrition Improvement Strategy for Older People and Application in China(2018).Receiver operating characteristic(ROC)curve and Hosmer-Lememshow goodness-of-fit test(H-L test)were used for the model evaluation.The overall status of LMM of the older people in China was predicted by the prediction model,basing on the data of the China Adult Chronic Disease and Nutrition Surveillance(2015).Distribution difference of the predicted LMM was analyzed,and the association between dietary pattern and the predicted LMM was also analyzed in the present study.4.Data from the survey of Nutrition Improvement Strategy for Older People and Application in China(2018)were analyzed in the present study.Potential biomarkers of sarcopenia in the older people in China were screened and evaluated by the logistic regression model,decision-tree model and RCS regression model.The association between dietary pattern and potential biomarker of sarcopenia was analyzed by general linear model.Results:1.Based on the data of the China Adult Chronic Disease and Nutrition Surveillance(2015),the present study found that,dietary patterns were similar between the older males and the older females in China.There were three main dietary patterns.The "traditional diet" pattern was mainly characterized with the intake of rice,pork,vegetables,aquatic products,and animal oils.The "diversified diet" pattern was mainly characterized with the intake of coarse cereals,beans,mushrooms,fungi,vegetables,fruits,milk,eggs,and snacks.The "animal foods" pattern was mainly characterized with poultry,livestock meat,animal viscera,aquatic products,and eggs.The "diversified diet" pattern showed a higher score in the dietary variety assessment,and a more balanced dietary structure.In the decision-tree model,urban area or rural area,geographic region,education level,food consumption expenditure,nutrition and health education were all identified as the influencing factors of dietary patterns in older people.The older people,who lived in rural area,with higher levels of food consumption expenditure,did not know about the Dietary Guidelines for Chinese Residents,or had not received nutrition and health education,were more inclined to choose the "traditional diet" pattern.The older people,who lived in urban area,with higher education levels,knew about the Dietary Guidelines for Chinese Residents,and had received nutrition and health education,were more inclined to choose the "diversified diet" pattern.The older people,who lived in urban area,with higher levels of food consumption expenditure,were more inclined to choose the "animal food" pattern.2.There were also three major dietary patterns,including "traditional diet" pattern,"diversified diet" pattern and "animal food" pattern,in the older people of Guangdong,Jiangsu and Inner Mongolia.The older people were classified into Q1-Q4 groups according to the quartiles of factor score in different dietary patterns,respectively.The highest prevalence of sarcopenia was found in the Q1 group of the "diversified diet"pattern(23.7%),and the lowest prevalence of sarcopenia was found in the Q4 group of the same dietary pattern(8.4%).No significant difference was observed among quartiles of the other two dietary patterns.With the reference of Q1 groups in different dietary patterns,the odds ratio(OR)and 95%confidence interval(CI)were calculated in the logistic regression model,respectively.The "diversified diet" pattern was negatively associated with sarcopenia in the older people(OR=0.33,95%CI=0.14?0.77,P-trend<0.01),while,no significant association was observed between sarcopenia and the other two dietary patterns.A significantly negative association was observed between the "diversified diet" pattern and low-grip-strength sarcopenia(OR=0.22,95%CI=0.07?0.74,P-trend<0.05).Compare with the Q4 groups of the other two dietary patterns,subjects in the Q4 group of the"diversified food" pattern showed the highest percentage of energy from carbohydrate(PEC,53.4%E,P<0.05),and the lowest percentage of energy from fat(PEF,31.2%E,P<0.05).Percentage of energy from protein(PEP,16.4%E)in the Q4 group of the"diversified diet" pattern was significantly higher than the "traditional diet" pattern(P<0.05).While,there was no significant difference between the "animal food" pattern and the "diversified diet" pattern(P>0.05).After the adjustment for potential confounders in the RCS regression model,no significant association was observed between PEC and sarcopenia in the older people;a negative association was observed between PEP and sarcopenia,the decreased risk of sarcopenia was correlated with the increase of PEP;PEF<30%E showed a significantly negative association with sarcopenia,and higher PEF(30-50%E)showed a significantly positive association with sarcopenia.3.The predication model of LMM could be constructed by age,body mass index(BMI),fasting blood glucose(FBG)and serum total cholesterol(TC).Prediction model of LMM for older males:logit(P)=2.67+0.13*age(year)-0.55*BMI(kg/m2)+0.09*FBG(mmol/L);prediction model of LMM for older females:logit(P)=5.31+0.07*age(year)-0.56*BMI(kg/m2)+0.35*TC(mmol/L).The area under the curve(AUC)was used to evaluate the discrimination of the prediction model.The AUC of male prediction model was 0.86(95%CI=0.83?0.89)and the model accuracy was 80.8%.The AUC of female predication model was 0.87(95%CI=0.84-0.90),and the model accuracy was 80.4%.The P values of H-L tests both were greater than 0.05,The results of ROC curve and H-L test indicated that the LMM prediction models of older males and females both have good discrimination and calibration.The application of nomogram could construct a visual prediction model of LMM in the older people,which may contribute to the rapid screening of LMM and sarcopenia in older people.The prediction model of LMM then was applied in the data of the China Adult Chronic Disease and Nutrition Surveillance(2015).The"traditional diet" patten was positively associated with the predicted LMM in older people(OR=1.54,95%CI=1.34?1.76,P-trend<0.01);the "diversified diet" pattern was negatively associated with the predicted LMM(OR=0.58,95%CI=0.50?0.67,P-trend<0.01);and the"animal food" pattern was also negatively associated with the predicted LMM in older people(OR=0.79,95%CI=0.69?0.91,P-trend<0.01).4.Potential biomarkers of sarcopenia in older people were screened from the multiple circulating markers of nutrition metabolism,liver function,kidney function,and inflammation.After the adjustment for potential confounders,several markers of nutrition metabolism,liver function,and kidney function,such as serum triglyceride(TG),indirect bilirubin(IBIL),and uric acid(UA)were all negatively associated with sarcopenia diagnosed with the standard of AWGS2014(OR<1,P<0.01);serum total protein(TP),y-glutamyl transpeptidase(GGT)and Cystatin C(Cys-C)were all positively associated with sarcopenia(OR>1,P<0.05).While,no significant association was observed between inflammatory markers and sarcopenia.Under the different diagnose standards of sarcopenia,IBIL was negatively associated with sarcopenia(AWGS2019:OR=0.55,95%CI=0.42?0.71,P<0.01;EWGSOP2:OR=0.67,95%CI=0.48?0.92,P<0.05);GGT was positively associated with sarcopenia(AWGS2019:OR=1.42,95%CI=1.14?1.77,P<0.01;EWGSOP2:OR=1.25,95%CI=1.06?1.49,P<0.01);and UA was negatively associated with sarcopenia(AWGS2019:OR=0.22 95%CI=0.57?0.90,P<0.01;EWGSOP2:OR=0.48,95%CI=0.35?0.66,P<0.01).Compared with UA,IBIL and GGT showed more significant association with sarcopenia in the decision-tree model.In the RCS regression model,sarcopenia was respectively and positively associated with lower levels of IBIL or higher levels of GGT.After the adjustment for potential confounders,a positive association was observed between IBIL and the "diversified diet" pattern(P-trend<0.01),while no significant association was observed between IBIL and the other two dietary patterns.GGT level was respectively and negatively associated with the "traditional diet"pattern and the"diversified diet" pattern(P-trend<0.05),while,it was positively associated with "animal.food" pattern(P-trend<0.05).Conclusion:1.Dietary patterns were similar between the older males and the older females in China.There were mainly three dietary patterns,including the "traditional diet"pattern,the"diversified diet" pattern and the "animal food" pattern.Compared with the other two dietary patterns,the "diversified diet" pattern showed better dietary variety and a more balanced dietary structure.Strengthening nutrition and health education,may increase the probability of the older people in China choosing the "diversified diet" pattern.2.The "diversified diet" pattern was negatively associated with sarcopenia in the older people,while the "traditional diet" pattern and the "animal food" pattern showed no significant association with sarcopenia.A negative association was observed between PFP and sarcopenia;PEF<30%E was negatively associated with sarcopenia,and higher PEF(30?50%E)was positively associated with sarcopenia.The present results indicated that,adhering the "diversified diet" pattern,maintaining adequate protein intake and reasonable fat intake,may be helpful for the prevention and management of sarcopenia in the older people in China.3.A stable and efficient prediction model of LMM could be constructed basing on general health indicators of older people.The prediction model was applied for the first time,in data of the China Adult Chronic Disease and Nutrition Surveillance(2015),to discuss to association between dietary pattern and muscle health of the older people in China.A significantly negative association was observed between the "diversified diet"pattern and the predicted LMM of the older people in China.It further indicated that,the"diversified diet" pattern,characterized with the intake of coarse cereals,beans,mushroom,fungi,fruits,vegetables,and milk,may decrease the risk of sarcopenia,maintain muscle health of the older people in China.4.Compared with the other circulating markers of nutrition metabolism,liver function,kidney function,and inflammation,IBIL and GGT showed closer associations with sarcopenia,and may be the potential biomarkers of sarcopenia in the older people in China.IBIL was negatively associated with sarcopenia,while,GGT was positively associated with sarcopenia.Lower levels of IBIL or higher levels of GGT was positively associated with sarcopenia,which may increase the risk of sarcopenia.The "diversified diet" pattern was positively associated with IBIL,and was negatively associated with GGT,which may be beneficial to the muscle health of the older people in China. |
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