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筋内脂肪量の増大が予後に与える影響の解明:高齢入院患者での検討

Research Project

Project/Area Number 20K19661
Research Category

Grant-in-Aid for Early-Career Scientists

Allocation TypeMulti-year Fund
Review Section Basic Section 59040:Nutrition science and health science-related
Research InstitutionNagoya University (2023)
Tokushima Bunri University (2020-2022)

Principal Investigator

赤澤 直紀  名古屋大学, 医学系研究科(保健), 講師 (90789603)

Project Period (FY) 2020-04-01 – 2025-03-31
Project Status Granted (Fiscal Year 2023)
Budget Amount *help
¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000)
Fiscal Year 2023: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2022: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2021: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Fiscal Year 2020: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Keywords筋内脂肪量 / 高齢入院患者 / 大腿四頭筋 / 嚥下 / 低栄養 / 超音波 / 予後 / 日常生活動作能力
Outline of Research at the Start

最近発表された世界規模の低栄養診断基準では,筋量の減少が重要な現症の一つとして位置づけられている。一方,我々はこれまでに高齢入院患者の骨格筋内における脂肪量の特徴を横断的に調査してきた。それら成果として,高齢入院患者の大腿四頭筋の筋内脂肪量の増大は,重度低栄養リスクと関連すること,さらにそれらは筋量の減少よりも,嚥下機能と歩行自立度の低下に関連することを見出した。これら結果は,筋内脂肪量の増大は,筋量の減少よりも,高齢入院患者の予後に悪影響を与える可能性を示していた。本研究では,高齢入院患者における筋内脂肪量の増大と日常生活動作能力,在宅復帰率および生存率の低下との縦断的関連性を明らかとする。

Outline of Annual Research Achievements

2018年に発表された世界規模の低栄養診断基準では,筋量の減少が,重要な現症の一つとして位置づけられている。一方,我々はこれまでに,高齢入院患者の骨格筋内における脂肪量(筋内脂肪量)の特徴を横断的に調査してきた。それら成果として,高齢入院患者の大腿四頭筋の筋内脂肪量の増大は,重度低栄養リスクと関連すること,さらにそれらは,筋量の減少よりも,嚥下機能と歩行自立度の低下に関連することを見出した。これら結果は,筋内脂肪量の増大は,筋量の減少よりも,高齢入院患者の予後に悪影響を与える可能性を示していた。本研究では,その可能性を検証するため,高齢入院患者における筋内脂肪量の増大と日常生活動作能力,在宅復帰率および生存率の低下との縦断的関連性を明らかとする。これら関連性を明らかとすることで,高齢入院患者の低栄養の議論において,筋量の減少よりも,筋内脂肪量の増大に着目する重要性を提示する。2023年度の研究成果として,高齢入院患者の入院時の大腿四頭筋の筋内脂肪量の増大が自宅復帰率の低下に関連することを明らかとした。これら知見は大腿四頭筋の筋内脂肪量を改善させる介入が自宅復帰率の改善に繋がる可能性を示したものであると考える。さらに,高齢入院患者の入院中のタンパク質摂取量の増大が大腿四頭筋の筋内脂肪量の減少に関連することを明らかにした。これら知見は高齢入院患者の大腿四頭筋の筋内脂肪量の改善には栄養介入が重要であることを示した点で非常に意義があると考える。

Current Status of Research Progress
Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

2023年度の研究成果として,次の2点が挙げられる。1点目として、高齢入院患者の入院時の大腿四頭筋の筋内脂肪量の増大が自宅復帰率の低下に関連すること、一方で入院時の大腿四頭筋の筋量は自宅復帰率には関連しないことを明らかとした。これら知見は、大腿四頭筋の筋量を改善させる介入よりも大腿四頭筋の筋内脂肪量を改善させる介入が自宅復帰率の改善に繋がる可能性を示唆したものであると考え価値あるものと考える。2点目は、高齢入院患者の入院中のタンパク質摂取量の増大が大腿四頭筋の筋内脂肪量の減少に関連すること、一方で入院中のタンパク質摂取量の変化は大腿四頭筋の筋量の変化とは関連を示さないことを明らかとした。これら知見は、大腿四頭筋の筋内脂肪量を改善させる栄養介入を模索する上で重要になると考える。本研究課題では前述の研究成果に加え、これまでに、高齢入院患者の入院時の大腿四頭筋の筋内脂肪量は筋量よりも退院時の日常生活動作能力に関連すること、高齢入院患者の入院時の大腿四頭筋の筋内脂肪量の増大は嚥下能力の回復に悪影響を与えること、高齢入院患者の入院時の低栄養リスクは入院中の大腿四頭筋の筋内脂肪量の増大に関連することを明らかにしている。これらを踏まえると、現在までの進捗としてはおおむね順調に進展していると考える。

Strategy for Future Research Activity

今後は次の3点について研究を進めていきたいと考える。第一に、高齢入院患者におけるGeriatric Nutritional Risk Indexで評価された低栄養リスクの入院中の変化が入院中の大腿四頭筋の筋内脂肪量や筋量の変化に関連するかどうかについての結果を公表する。第二に、Global Leadership Initiative on Malnutrition基準の現症型基準に従い高齢入院患者を重度低Body Mass Index(BMI)群、中等度低BMI群、標準BMI群に群分けし、それぞれの群における入院中の体重の変化が入院中の大腿四頭筋の筋内脂肪量や筋量の変化に関連するかどうかについての結果を公表する。第三に、85歳以上の高齢入院患者における入院中の大腿四頭筋の筋内脂肪量の変化が65~74歳、75~84歳の対象のそれらと比べ差異を示すのかどうかについての結果を公表する。これら研究成果は全て国際誌にて公表する予定である。これらを明らかにすることは臨床栄養領域の発展に大きく貢献すると考える。

Report

(4 results)
  • 2023 Research-status Report
  • 2022 Research-status Report
  • 2021 Research-status Report
  • 2020 Research-status Report
  • Research Products

    (28 results)

All 2024 2023 2022 2021 2020 2019

All Journal Article (27 results) (of which Peer Reviewed: 27 results,  Open Access: 5 results) Presentation (1 results)

  • [Journal Article] Increased intramuscular adipose tissue of the quadriceps at admission is more strongly related to activities of daily living recovery at discharge compared to muscle mass loss in older patients with aspiration pneumonia2024

    • Author(s)
      Akazawa Naoki、Funai Keita、Hino Toshikazu、Tsuji Ryota、Tamura Wataru、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      BMC Geriatrics

      Volume: 24 Issue: 1 Pages: 107-107

    • DOI

      10.1186/s12877-024-04718-7

    • Related Report
      2023 Research-status Report
    • Peer Reviewed
  • [Journal Article] Longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different activities of daily living levels2023

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition ESPEN

      Volume: 53 Pages: 175-181

    • DOI

      10.1016/j.clnesp.2022.12.018

    • Related Report
      2023 Research-status Report 2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass2023

    • Author(s)
      Akazawa Naoki、Funai Keita、Hino Toshikazu、Tsuji Ryota、Tamura Wataru、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Scientific Reports

      Volume: 13 Issue: 1 Pages: 10021-10021

    • DOI

      10.1038/s41598-023-37094-0

    • Related Report
      2023 Research-status Report
    • Peer Reviewed
  • [Journal Article] Increase in protein intake is related to decreasing intramuscular adipose tissue of the quadriceps in older inpatients: A longitudinal study2023

    • Author(s)
      Akazawa Naoki、Funai Keita、Hino Toshikazu、Tsuji Ryota、Tamura Wataru、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition ESPEN

      Volume: 58 Pages: 136-143

    • DOI

      10.1016/j.clnesp.2023.09.922

    • Related Report
      2023 Research-status Report
    • Peer Reviewed
  • [Journal Article] Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients2023

    • Author(s)
      Akazawa Naoki、Kishi M.、Hino T.、Tsuji R.、Tamura K.、Hioka A.、Moriyama H.
    • Journal Title

      The journal of nutrition, health & aging

      Volume: 27 Issue: 2 Pages: 103-110

    • DOI

      10.1007/s12603-023-1880-6

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Relationship between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      PLOS ONE

      Volume: 17 Issue: 2 Pages: e0263973-e0263973

    • DOI

      10.1371/journal.pone.0263973

    • Related Report
      2022 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Extracellular water-to-total body water ratio is an essential confounding factor in bioelectrical impedance analysis for sarcopenia diagnosis in women2022

    • Author(s)
      Hioka Akemi、Akazawa Naoki、Okawa Naomi、Nagahiro Shinji
    • Journal Title

      European Geriatric Medicine

      Volume: 13 Issue: 4 Pages: 789-794

    • DOI

      10.1007/s41999-022-00652-2

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to activities of daily living in older inpatients who are judged as severely low body mass index in the Global Leadership Initiative on Malnutrition criteria2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition ESPEN

      Volume: 49 Pages: 411-416

    • DOI

      10.1016/j.clnesp.2022.03.012

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Higher malnutrition risk in older inpatients who are referred to the department of rehabilitation is related to increase of intramuscular adipose tissue: A prospective study2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition

      Volume: 41 Issue: 10 Pages: 2087-2093

    • DOI

      10.1016/j.clnu.2022.08.010

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Increase in muscle mass of the quadriceps is related to decrease in intramuscular adipose tissue in convalescent stroke patients: A longitudinal study2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition ESPEN

      Volume: 51 Pages: 199-206

    • DOI

      10.1016/j.clnesp.2022.08.033

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      PLOS ONE

      Volume: 17 Issue: 10 Pages: e0275810-e0275810

    • DOI

      10.1371/journal.pone.0275810

    • Related Report
      2022 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Need for detailed analysis of quadriceps intramuscular adipose tissue and nutritional status2022

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Clinical Nutrition

      Volume: 41 Issue: 12 Pages: 3124-3125

    • DOI

      10.1016/j.clnu.2022.10.014

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Accuracy of determining sarcopenia using SARC-CalF in community-dwelling older adults aged 75 years and older2022

    • Author(s)
      Ishimoto Taisei、Hisamatsu Ken、Matsudaira Nozomi、Fujimoto Takehiro、Yano Manoka、Hashimoto Risako、Hayashi Hikaru、Toyota Yoshio、Akazawa Naoki
    • Journal Title

      Clinical Nutrition ESPEN

      Volume: 52 Pages: 317-321

    • DOI

      10.1016/j.clnesp.2022.09.012

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality2022

    • Author(s)
      Akazawa Naoki、Kishi M.、Hino T.、Tsuji R.、Tamura K.、Hioka A.、Moriyama H.
    • Journal Title

      The journal of nutrition, health & aging

      Volume: 26 Issue: 5 Pages: 495-500

    • DOI

      10.1007/s12603-022-1785-9

    • Related Report
      2022 Research-status Report
    • Peer Reviewed
  • [Journal Article] Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Journal of Cachexia, Sarcopenia and Muscle

      Volume: 12 Issue: 4 Pages: 891-899

    • DOI

      10.1002/jcsm.12713

    • Related Report
      2021 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Increased intramuscular adipose tissue of the quadriceps is related to decreased activities of daily living in patients who have had a stroke2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Nutrition

      Volume: 90 Pages: 111277-111277

    • DOI

      10.1016/j.nut.2021.111277

    • Related Report
      2021 Research-status Report
    • Peer Reviewed
  • [Journal Article] Greater Quadriceps Muscle Mass at Post-Acute Care Admission is Associated with Better Swallowing Ability at Discharge among Adults with Stroke2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Journal of the American Medical Directors Association

      Volume: 22 Issue: 12 Pages: 2486-2490

    • DOI

      10.1016/j.jamda.2021.04.019

    • Related Report
      2021 Research-status Report
    • Peer Reviewed
  • [Journal Article] Intramuscular adipose tissue of the quadriceps is more strongly related to recovery of swallowing ability than is muscle mass in older inpatients: A prospective study2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Nutrition

      Volume: 91-92 Pages: 111364-111364

    • DOI

      10.1016/j.nut.2021.111364

    • Related Report
      2021 Research-status Report
    • Peer Reviewed
  • [Journal Article] Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Journal of Cachexia, Sarcopenia and Muscle

      Volume: 12 Issue: 6 Pages: 2231-2237

    • DOI

      10.1002/jcsm.12842

    • Related Report
      2021 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Increased total body extracellular-to-intracellular water ratio in community-dwelling elderly women is associated with decreased handgrip strength and gait speed2021

    • Author(s)
      Hioka Akemi、Akazawa Naoki、Okawa Naomi、Nagahiro Shinji
    • Journal Title

      Nutrition

      Volume: 86 Pages: 111175-111175

    • DOI

      10.1016/j.nut.2021.111175

    • Related Report
      2021 Research-status Report 2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Using GLIM criteria, cutoff value for low BMI in Asian populations discriminates high or low muscle mass: A cross-sectional study2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Moriyama Hideki
    • Journal Title

      Nutrition

      Volume: 81 Pages: 110928-110928

    • DOI

      10.1016/j.nut.2020.110928

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients2021

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Moriyama Hideki
    • Journal Title

      Clinical Nutrition

      Volume: 40 Issue: 3 Pages: 1381-1387

    • DOI

      10.1016/j.clnu.2020.08.029

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients: A cross-sectional study2020

    • Author(s)
      Akazawa Naoki, Okawa Naomi, Kishi Masaki, Hino Toshikazu, Tsuji Ryota, Tamura Kimiyuki, Moriyama Hideki
    • Journal Title

      Nutrition

      Volume: 71 Pages: 110600-110600

    • DOI

      10.1016/j.nut.2019.110600

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Longitudinal Relationship Between Intramuscular Fat in the Quadriceps and Gait Independence in Convalescent Stroke Patients2020

    • Author(s)
      Ishimoto Taisei、Taniguchi Yusuke、Akazawa Naoki
    • Journal Title

      Journal of Stroke and Cerebrovascular Diseases

      Volume: 29 Issue: 11 Pages: 105287-105287

    • DOI

      10.1016/j.jstrokecerebrovasdis.2020.105287

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Relationship Between Aging and Intramuscular Adipose Tissue in Older Inpatients2020

    • Author(s)
      Akazawa Naoki、Kishi Masaki、Hino Toshikazu、Tsuji Ryota、Tamura Kimiyuki、Hioka Akemi、Moriyama Hideki
    • Journal Title

      Journal of the American Medical Directors Association

      Volume: in press Issue: 6 Pages: 1287-1291.e1

    • DOI

      10.1016/j.jamda.2020.09.017

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Journal Article] Changes in Quadriceps Thickness and Echo Intensity in Chronic Stroke Survivors: A 3-Year Longitudinal Study2020

    • Author(s)
      Akazawa N, Harada K, Okawa N, Kishi M, Tamura K, Moriyama H
    • Journal Title

      Journal of stroke and cerebrovascular diseases

      Volume: 30 Issue: 3 Pages: 105543-105543

    • DOI

      10.1016/j.jstrokecerebrovasdis.2020.105543

    • Related Report
      2020 Research-status Report
    • Peer Reviewed / Open Access
  • [Journal Article] Higher malnutrition risk is related to increased intramuscular adipose tissue of the quadriceps in older inpatients: A cross-sectional study2019

    • Author(s)
      Akazawa Naoki, Okawa Naomi, Hino Toshikazu, Tsuji Ryota, Tamura Kimiyuki, Moriyama Hideki
    • Journal Title

      Clinical Nutrition

      Volume: - Issue: 8 Pages: 2586-2592

    • DOI

      10.1016/j.clnu.2019.11.028

    • Related Report
      2020 Research-status Report
    • Peer Reviewed
  • [Presentation] 地域在住高齢女性の筋質と身体機能との関連2021

    • Author(s)
      日岡明美 , 赤澤直紀 , 大川直美 , 藤倉順子 , 永廣信治
    • Organizer
      第4回徳島県地域包括ケアシステム学会学術集会
    • Related Report
      2021 Research-status Report

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Published: 2020-04-28   Modified: 2024-12-25  

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