【作者】 刘彤；

【导师】 陈思娇；

【作者基本信息】 中国医科大学 ， 老年医学， 2019， 硕士

【摘要】 目的:随着老龄化加剧,心血管病的发病率越来越高,高盐摄入是高血压发病的主要危险因素。由于老年人饮食限盐依从性较差,所以改变老年人盐味觉敏感度可能是有效的限盐措施。有动物实验表明,辣椒素可以影响小鼠盐味觉的中枢回路,通过改变脑中盐味觉的神经处理来显著降低小鼠盐喜好,增加盐味感知,增强盐味觉敏感度,从而减少每日盐摄入量。本研究旨在观察东北地区老年人的盐味觉与盐摄入量情况及其之间的相关性,并通过盐溶液中添加辣椒素测定老年人盐味觉来探索辣椒素是否增强老年人盐味觉敏感度。方法:将2017年4月至2018年9月中国医科大学附属第一医院老年心血管内科住院患者115例60-95岁老年人作为研究对象。其中90名患者完整留取24 h尿液并检测24h尿钠计算盐摄入量。盐味觉测试通过应用不同浓度Na Cl溶液测定老年人的盐阈值、盐喜好值。之后应用添加0.5μmol/L辣椒素(Na Cl+CAP)的盐溶液再次测定盐喜好,通过盐喜好值是否降低来观察盐味觉敏感度是否增加。同时对盐阈值≥50mmol/L的受试者进行Na Cl+CAP盐溶液配对差异检验,观察Na Cl+CAP溶液是否增加受试者对盐味的感知。结果:符合纳入与排除标准的研究对象共115例,其中男性73例,女性42例。年龄60-95岁,平均年龄为79.4±9.5岁。老年人盐阈值≥50mmol/L共53例(46.1%);盐喜好为75mmol/L、100mmol/L共66例(57.4%)。盐阈值≥50mmol/L、30mmol/L、10mmol/L三组在年龄、高血压病史、营养不良风险、日常生活能力下降有统计学差异(P<0.05),盐喜好50-100mmol/L组和150-250mmol/L组年龄、高血压病史、营养不良风险、日常生活能力下降有统计学差异(P<0.05)。90名留24h尿受试者的总体24h尿钠中位水平为89.2(64.9-113.7)mmol/24 h,对应食盐摄入量为7.3(5.8-9.8)g/d。年龄分组60-70岁、71-80岁、>80岁的受试者盐摄入量有统计学差异(p<0.05)。老年人盐摄入量高于我国指南推荐的6g/d摄盐标准,摄盐达标率不足50%。Spearman秩相关分析结果显示盐阈值、盐喜好与盐摄入量未见相关性(p>0.05)。辣椒素添加前后盐喜好中位水平为分别100(75-150)mmol/L和75(50-150)mmol/L,盐喜好差异具有统计学意义(P<0.01)。50-100mmol/L和150-250mmol/L组盐喜好降低人数差异具有统计学意义(p<0.05)。通过配对差异检验得出盐阈值为50mmol/L受试者中有19例(63.3%)指出Na Cl+CAP溶液的盐味强度大于单独的Na Cl溶液。盐阈值为75mmol/L受试者中有17例(73.9%)指出Na Cl+CAP溶液的盐味强度大于单独的Na Cl溶液。盐阈值为50mmol/L和75mmol/L两组间对Na Cl+CAP溶液盐味感知差异无统计学意义(p>0.05)。结论:东北地区老年人盐阈值≥50mmol/L居多;盐喜好为75mmol/L、100mmol/L居多。盐阈值、盐喜好较高的年龄较大,存在营养不良的风险高,日常生活能力下降,缺乏自理能力和独居生活能力。老年人盐摄入量>6g/d,总体、男性及女性摄盐达标率均不足50%。本研究盐阈值,盐喜好与盐摄入量无相关性,盐阈值、盐喜好不能作为评估老年心血管患者盐摄入量的简易方法。在老年人中0.5μmol/L辣椒素可以明显增加对咸味的感知,降低盐喜好,增加盐味觉敏感度。在食物中添加补充辛辣物质如辣椒素代表了一种新型的生活方式干预,并且可以适用于老年人,因此这可能是减少老年人盐摄入的有效替代方法。更多还原

【Abstract】 Objective:With the aggravation of aging,the incidence of cardiovascular diseases is increasing,and high salt intake is the main risk factor for hypertension.Due to poor dietary salt restriction compliance in the elderly,it may be an effective salt restriction measure to change the salt taste sensitivity of the elderly.Animal experiments have shown that capsaicin can affect the central circuit of salt taste in mice.By changing the neural processing of salt taste in the brain,the salt preference of mice can be significantly reduced as well as salt taste perception,thus the salt taste sensitivity can be enhanced,finally reduce the daily salt intake.The purpose of this study was to observe the correlation between salt taste and salt intake of the elderly in northeast China and explore whether capsaicin can enhance salt taste sensitivity in the elderly by adding capsaicin to salt solution.Methods: From April 2017 to September 2018,115 elderly inpatients aged 60-95 years old in the department of cardiovascular medicine of the first affiliated hospital of China medical university were selected as the study subjects.The urine of 90 patients was completely retained for 24 h that was measured for 24 h sodium to calculate the salt intake.Salt taste test was used to determine the salt threshold and salt preference of the elderly with different concentrations of Na Cl solution.Then the salt solution added with 0.5μmol/L of capsaicin(Na Cl+CAP)was used to determine the salt preference again,and the increase of salt taste sensitivity was observed by the decrease of salt preference.Meanwhile,the paired difference test of Na Cl+CAP salt solution was conducted on subjects with salt threshold≥50mmol/L to observe whether Na Cl+CAP salt solution increased the subjects’ perception of salt taste.Results: A total of 115 subjects met the inclusion and exclusion criteria,including 73 males and 42 females.The average age was 79.4±9.5 years.The salt threshold of the elderly was more than 50mmol/L,a total of 53 cases(46.1%).The preference of salt was mostly 75mmol/L and 100mmol/L,with a total of 66 cases(57.4%).The salt threshold of 50mmol/L,30mmol/L and 10mmol/L showed statistical differences in age,history of hypertension,malnutrition risk and decline in daily living ability(P<0.05),and the salt preference of 50-100mmol/L and 150-250mmol/L also showed statistical differences in age,history of hypertension,malnutrition risk and decline in daily living ability(P<0.05).The median level of 24 h sodium of 90 patients was 89.2(64.9-113.7)mmol/24 h,and the corresponding salt intake was 7.3(5.8-9.8)g/d.There were statistically significant differences in salt intake among subjects aged60-70,71-80 and >80(p<0.05).The salt intake of the elderly is higher than the 6g/d salt intake standard recommended by China’s guidelines,and the salt uptake compliance rate is less than 50%.Spearman rank correlation analysis showed no correlation between salt threshold,salt preference and salt intake(p>0.05).The median levels of salt preferences before and after the addition of capsaicin were 100(75-150)mmol/L and 75(50-150)mmol/L,respectively,with statistically significant differences in salt preferences(P<0.01).There was a statistically significant difference in the number of people with decreased salt preference between the groups of50-100mmol/L and 150-250mmol/L(p<0.05).Through paired difference test,it was found that among the subjects with a salt threshold of 50mmol/L,19(63.3%)indicated that Na Cl+CAP solution had a salinity intensity greater than that of Na Cl solution alone.Among the subjects with a salt threshold of 75mmol/L,17(73.9%)indicated that Na Cl+CAP solution had a stronger salt taste than Na Cl solution alone.The salt threshold of 50mmol/L and 75mmol/L showed no statistically significant difference in the salt taste perception of Na Cl+CAP solution between the two groups(p>0.05).Conclusion: The salt threshold of the elderly was more than 50mmol/L,Salt preference was 75mmol/L and 100mmol/L of the elderly in northeast China.People with higher salt threshold and salt preference were older,had a higher risk of malnutrition,were less capable of daily living,and lacked self-care and the ability to live alone.The salt intake of the elderly was >6g/d,and the salt uptake compliance rate of men and women was less than 50%.In this study,there was no correlation between salt preference and salt intake.In the elderly,Salt threshold and salt preference are not simple methods for assessing salt intake in elderly patients with cardiovascular disease.0.5μmol/L capsaicin can significantly increase the perception of salt taste,reduce salt preference and increase salt taste sensitivity.Adding spicy supplements such as capsaicin to foods represents a new type of lifestyle intervention that can be applied to the elderly,so it may be an effective alternative to reducing salt intake in the elderly.更多还原