Thiazolidinediones
有多個針對 70 或 75 歲以上老年糖尿病 人的研究指出 253-256 ， DPP-4i 對此年齡
6. 握力降低 (diminished functional
病生理與篩檢診斷 周全性老年醫學評估 衰弱
/肌少症
失智症 血管併發症與血壓
/血脂控制
血糖控制低血糖 運動、營養建議及疾病管理 參考文獻
年 長 者 隨 著 年 齡 增 加 ， 常 會 有 腸 胃 消化吸收障礙、咀嚼及吞嚥能力下降等問 題，造成食慾降低、營養攝入不足；因而 導 致 體 重 減 輕 、 肌 肉 流 失 、 沮 喪 、 記 憶 力 衰 退 等 狀 況 ， 增 加 老 人 營 養 不 良 的 風 險。若再加上糖尿病或其他慢性疾病的飲 食 限 制 ， 更 提 高 老 年 糖 尿 病 人 營 養 不 良 的風險。根據美國靜脈暨腸道營養醫學會 (American Society for Parenteral and Enteral Nutrition, ASPEN) 對成年人營 養不良的診斷，建議有下列 2 個以上條 件者
315：
1. 熱量攝取不足 (insufficient energy intake)
病生理與篩檢診斷 周全性老年醫學評估 衰弱
/肌少症
失智症 血管併發症與血壓
/血脂控制
血糖控制低血糖 運動、營養建議及疾病管理 參考文獻
案 ) 建議 51-70 歲及 71 歲以上族群每日營 養攝取量，如表 2
316。
營養素攝取量
根據衛生福利部國民健康署公布國人 膳食營養素參考攝取量 (107 年修訂版草
表 2. 國人膳食營養素參考攝取量316
51-70 歲 71 歲以上
男性 女性 男性 女性
身高 (cm) 165 153 163 150
體重 (kg) 60 52 58 50
熱量 ( 低 ) (kcal) 1,700 1,400 1,650 1,300
熱量 ( 稍低 ) (kcal) 1,950 1,600 1,900 1,500
熱量 ( 適度 ) (kcal) 2,250 1,800 2,150 1,700
熱量 ( 高 ) (kcal) 2,500 2,000 — —
蛋白質 (g) 55 50 60 50
膳食纖維 ( 適度 ) (g) 32 25 30 24
鈣 (mg) 1,000 1,000
磷 (mg) 800 800
鎂 (mg) 360 310 350 300
碘 (μg) 150 150
鐵 (mg) 10 10
維生素 A (μg RE)* 600 500 600 500
維生素 D7 (μg)# 15 15
維生素 E8 (mg α-TE)& 12 12
維生素 K (μg) 120 90 120 90
維生素 B1 (mg) 1.2 0.9 1.2 0.9
維生素 B2 (mg) 1.3 1.0 1.3 1.0
維生素 B6 (mg) 1.6 1.6
維生素 B12 (μg) 2.4 2.4
葉酸 (μg) 400 400
維生素 C (mg) 100 100
*RE 即視網醇當量 (retinol equivalent)， 1 μg RE=1 μg 視網醇 (retinol)=6 μg β- 胡蘿蔔素。
#維生素 D 以維生素 D3 (cholecalciferol) 為計量標準，1 μg=40 IU 維生素 D3。
& α-TE 即 α- 生育醇當量 (α-tocopherol equivalent)，1 mg α-TE=1 mg α-tocopherol。
病生理與篩檢診斷 周全性老年醫學評估 衰弱
/肌少症
失智症 血管併發症與血壓
/血脂控制
血糖控制低血糖 運動、營養建議及疾病管理 參考文獻
營養計畫注意事項
老年糖尿病人每年都應進行營養和飲 食的評估，並考慮其飲食喜好與習慣、宗教 和文化、健康認知、食物製備環境、牙口及 身體健康狀況，給予個人化的營養計畫與建 議，以健康、均衡的飲食型態為主，多元化 食物來源，確保攝取足夠的蛋白質、維生 素、礦物質和膳食纖維，並注意老年人易缺 乏的營養素及症狀 (表 3)
242,317。
一般建議
注射胰島素或口服磺醯脲類等降血糖 藥物者，須配合用餐時間。對吞嚥障礙的患 者，應評估吞嚥困難之因素，必要時可進行 轉診。對吞嚥能力退化的患者，則依吞嚥困 難程度，調整食物大小、質地、形狀、軟硬 度及濃稠度，少量多餐 (6–8 餐/天)，讓患者 能吃到均衡且多元化之飲食
317。
日常生活功能獨立者
• 維持健康體重，配合規律運動。
• 每餐應攝取適量的醣類食物。
• 飲食建議應避免太多飲食限制，除 非有醫學實證證明應予以限制，如 過量的糖、飲料和果汁，過量的飽 和脂肪攝取。
日常生活功能依賴者
• 鼓勵患者做適量活動，並補充足夠 水份，避免脫水。
• 必要時，由醫療人員提供適當營養 支持。
衰弱症患者
• 進行營養評估，確認營養問題，採
取適當的營養介入與追蹤。
• 患者可能需攝取更多的熱量與蛋 白質。
• 研究發現每天多補充 30 公克優質 蛋白質，並配合阻力運動訓練，可 改善衰弱老人的肌肉強度與身體活 動能力
318。
肌少症患者
• 攝取足夠熱量及 1.1–1.2 公克/公斤優 質蛋白質，並補充足夠維生素 D
319。
• 每餐需含有 25–30 公克優質蛋白質 (3 餐/天)。
• 研究發現，每天補充白胺酸 (leucine) 2.2–3.0 公克，可幫助老年人肌肉蛋白 的合成
320。
失智症患者
• 醫療人員和照顧者應了解患者實際 及潛在的飲食障礙。
• 家屬或照顧者應盡量協助患者進食。
• 對阿茲海默症患者，易缺乏維生素 B、C、Ｅ、Ｋ、及硒與鐵，需予以 適當補充。
• 目前仍缺乏單一營養素補充對減緩 認知下降或改善認知功能的相關研 究。飲食研究則著重於地中海飲食 型態與認知功能之相關性
321。
臨終照護
• 管灌餵食或靜脈營養治療，亦須滿 足患者之營養需求。
• 患者、家屬和照顧者應參與營養計
畫的決定與執行。
病生理與篩檢診斷 周全性老年醫學評估 衰弱
/肌少症
失智症 血管併發症與血壓
/血脂控制
血糖控制低血糖 運動、營養建議及疾病管理 參考文獻
表 3. 老年人易發生缺乏風險的營養素242,317
維生素 D 維生素 B12 鈣
指標
血清 25-OH Vit D 缺乏：<20 ng/mL 不足：20–30 ng/mL
尚無建議之篩檢頻率與指數。
(二甲雙胍類藥物可能影響維 生素 B12 的吸收效率)
症狀 骨頭疼痛、肌肉無力
早期無典型臨床症狀。一般 表現：疲勞、注意力不集中、
記憶力下降、抑鬱。貧血及 神 經 系 統 症 狀， 如 感 覺 異 常，肢端麻木、協調能力受 損等。若未及時治療，可能 造成不可回復之神經損傷
治療
口 服 cholecalciferol ( 維 生 素 D3) 50,000 IU/ 週，連續 8 週後再評估。達正常血清 25-OH VitD 濃 度， 則 維 持 每日 600–800 IU 的劑量
肌肉注射或口服 1–2 mg/日，
連續 8 週後，維持 1 mg/ 日
食用高鈣食物、高鈣強化食 物、補充鈣片，如碳酸鈣、
檸檬酸鈣等，每次最高劑量 500 mg
病生理與篩檢診斷 周全性老年醫學評估 衰弱
/肌少症
失智症 血管併發症與血壓
/血脂控制
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