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1 特集サルコペニア, 骨格筋, 栄養, たんぱく質, アミノ酸 Ⅰ はじめに Rosenberg IH 1 Rosenberg / Rosenberg

2 2 Rosenberg Rosenberg IH The European Working Group on Sarcopenia in Older People EWGSOP 表 1 3 X m 2SD Rosenberg 表 CT 3 Ⅱ サルコペニアのメカニズム, 特に栄養との関連 EWGSOP 表表 3 II II 80 I 4 CT MRI

3 表 2 3 表 3 Sarcopenia (TNF- α, IL-6 GH, IGF-1, DHEA apoptosis D 5 6 dry weight 88 表 the Health, Aging, and Body Composition Health ABC Study g/kg / 0.72 g/kg /

4 g/kg / g/ 23.4 g/ g/ 19.9 g/ kda ribosomal protein S6 kinase p70s6k eukaryotic initiation factor 4E binding protein 1 4E BP1 the mammalian target of rapamycin mtor pathway 10 図 1 insulin like growth factor IGF 1 mtor mtor S6K anabolic threshold concept 11 図 2

5 Leucine 筋細胞内 Exercise mtor Insulin IGF-1 IRS1 PI3K AKT 血中アミノ酸量若年者たんぱく同化閾値血中アミノ酸量高齢者血同化閾値が高く中設定されているアミノ酸量高齢者時間時間時間同化閾値が高く設定されている血中アミノ酸濃度を上げるオートファジーの抑制 S6K1 4E-BP1 rps6 eif4e タンパク合成 FOXO MAFbx/ MuRF1 atrogin-1 ユビキチンプロテオゾーム系タンパク分解筋肉タンパク合成量筋肉での正常タンパク同化反応筋肉タンパク合成量たんぱく同化抵抗状態筋肉タンパク合成量若年者と同様の同化反応図 1 Ⅲ 運動と栄養 g/kg/ 1.0 g/kg/ Ⅳ ビタミン D D D 25- D D D 50nmol/L 図 2 anabolic threshold concept 11 14, 15 D 10 20µg/ D 16, 17 D 25- D 50nmol/L D 18,19 20 Ⅴ その他の栄養素 C E DNA

6 6 9 文献 1 Rosenberg IH Summary comments. Am J Clin Nutr , Sarcopenia &Frailty , Cruz Jentoft AJ, Baeyens JP, Bauer JM et al. European Working Group on Sarcopenia in Older People. Sarcopenia European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People. Age Ageing , Janssen I, Heymsfield SB, Wang ZM et al. Skeletal muscle mass and distribution in 468 men and women aged yr. J Appl Physiol , Lexell J, Henriksson Larsén K, Winblad B et al. Distribution of different fiber types in human skeletal muscles effects of aging studied in whole muscle cross sections. Muscle Nerve , Bigot A, Jacquemin V, Debacq Chainiaux F et al. Replicative aging down regulates the myogenic regulatory factors in human myoblasts. Biol Cell , Volpi E1, Mittendorfer B, Rasmussen BB et al. The response of muscle protein anabolism to combined hyperaminoacidemia and glucose induced hyperinsulinemia is impaired in the elderly. J Clin Endocrinol Metab , Houston DK, Nicklas BJ, Ding J et al. Health ABC Study Dietary protein intake is associated with lean mass change in older, community dwelling adults the Health, Aging, and Body Composition Health ABC Study. Am J Clin Nutr , ,,, 2014, p Pasiakos SM1, McClung JP Supplemental dietary leucine and the skeletal muscle anabolic response to essential amino acids. Nutr Rev , Dardevet D, Rémond D, Peyron MA et al. Muscle wasting and resistance of muscle anabolism the anabolic threshold concept for adapted nutritional strategies during sarcopenia. Scientific World Journal , Fiatarone MA, O Neill EF, Ryan ND et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med , Biolo G, Tipton KD, Klein S et al. An abundant supply of amino acids enhances the metabolic effect of exercise on muscle protein. Am J Physiol Pt 1,E , Gerdhem P, Ringsberg KA, Obrant KJ et al. Association between 25 hydroxy vitamin D levels, physical activity, muscle strength and fractures in the prospective population based OPRA Study of Elderly Women. Osteoporos Int , Stewart JW, Alekel DL, Ritland LM et al. Serum 25 hydroxyvitamin D is related to indicators of overall physical fitness in healthy postmenopausal women. Menopause , Sato Y, Iwamoto J, Kanoko T et al. Low dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke a randomized controlled trial. Cerebrovasc Dis , Lips P, Binkley N, Pfeifer M et al. Once weekly dose of 8400 IU vitamin D 3 compared with placebo effects on neuromuscular function and tolerability in older adults with vitamin D insufficiency. Am J Clin Nutr , Brunner RL, Cochrane B, Jackson RD et al. Calcium, vitamin D supplementation, and physical function in the Women s Health Initiative. J Am Diet Assoc , Glendenning P, Zhu K, Inderjeeth C et al. Effects of three monthly oral 150,000 IU cholecalciferol supplementation on falls, mobility, and muscle strength in older postmenopausal women a randomized controlled trial. J Bone Miner Res , Stockton KA, Mengersen K, Paratz JD et al. Effect of vitamin D supplementation on muscle strength a systematic review and meta analysis. Osteoporos Int , 2011

病などにより筋たんぱく分解因子である炎症性サイトカインが増加しその結果サルコペニアが発症すると考えられるこの中で我々が介入できうるものとしては合成因子の運動と栄養が挙げられるサルコペニアのアルゴリズムと有病率我々はサルコペニアの診断について SSCWD(Society on Sarc

病などにより筋たんぱく分解因子である炎症性サイトカインが増加しその結果サルコペニアが発症すると考えられるこの中で我々が介入できうるものとしては合成因子の運動と栄養が挙げられるサルコペニアのアルゴリズムと有病率我々はサルコペニアの診断について SSCWD(Society on Sarc サルコペニアと介護予防山田実京都大学大学院医学研究科人間健康科学系専攻元気な高齢者であっても無為に過ごせばサルコペニアさらには要介護状態になってゆく可能性は非常に高い現在我が国としては要介護を上手く予防しながら健康に老いていくこと (successful aging) を目指しているそこで今回はサルコペニアの発症メカニズム要因評価基準を概説するとともにその予防治療における運動