Sarcopenia: revised European consensus on definition and diagnosis

Sarcopenia and frailty: An in-depth analysis of the pathophysiology and effect on liver transplant candidates

Cirrhosis represents the end stage of chronic liver disease, significantly reducing life expectancy as it progresses from a compensated to a decompensated state, leading to serious complications. Recent improvements in medical treatment have created a shift in cirrhosis management. Various causes, including hepatitis viruses, alcohol consumption, and fatty liver disease, contribute to cirrhosis and are closely linked to liver cancer. The disease develops through hepatocyte necrosis and regeneration, resulting in fibrosis and sinusoidal capillarization, leading to portal hypertension and complications such as ascites, hepatic encephalopathy, and organ dysfunction. Cirrhosis also holds an increased risk of hepatocellular carcinoma. Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography. Liver transplantation is the definitive treatment for end-stage liver disease and acute liver failure.

Evaluation of sarcopenia diagnosis strategies in Chinese community-dwelling older adults based on the 2019 Asian Working Group guidelines: a cross-sectional study

BACKGROUND

Most diagnostic studies on sarcopenia in Asia follow the 2019 Asian Working Group for Sarcopenia (AWGS) guidelines, which recommend distinct diagnostic strategies for community and hospital settings due to challenges in measuring muscle mass in community environments. This study evaluates the screening-to-diagnosis process in community-based preventive services.

METHODS

This cross-sectional study utilized a questionnaire survey to evaluate SARC-F and SARC-CalF. Measurements included calf circumference (CC), handgrip strength, gait speed and bioelectrical impedance analysis (BIA). Participants were diagnosed according to the AWGS 2019 criteria. Four scenarios simulating the screening-to-diagnosis process in a community setting were evaluated. Sensitivity, specificity, and the area under the ROC curve (AUC) were calculated to assess diagnostic performance.

RESULTS

A total of 2453 community-dwelling older adults aged ≥60 years were included. The prevalence of sarcopenia was 14.1% (345/2453), with rates of 15.4%(160/1038) in males and 13.1% (185/1415) in females. In the simulated diagnostic scenarios, the number of confirmed cases was 218 (combination,Scenario1), 211 (CC,Scenario2), 60 (SARC-CalF,Scenario3) and 21 (SARC-F,Scenario4), respectively. In the case-finding step, the sensitivity for Scenarios1 to 4 was 0.86,0.84,0.23 and 0.07, respectively; specificity was 0.57,0.58,0.93 and 0.99, respectively; and the AUCs were 0.717,0.710,0.581 and 0.530, respectively. In the assessment step, the sensitivity for Scenarios 1 to 4 was 0.73,0.73,0.74 and 0.88, respectively; specificity was 0.81,0.82,0.68 and 0.24, respectively; and the AUCs were 0.774,0.774,0.712 and 0.557,respectively. The integrated sensitivity of the case-finding and assessment steps for Scenarios 1 to 4 was 0.63,0.61,0.17 and 0.06, respectively; integrated specificity was 0.92,0.92,0.98 and 0.99, respectively; and integrated AUCs were 0.776,0.768,0.575 and 0.523, respectively. The diagnostic performance of the entire procedure was better in females than in males.

CONCLUSIONS

In the case-finding step, the CC tool demonstrated superior performance compared to the combination tool, SARC-CalF, and SARC-F. In the assessment step, the muscle strength test was consistently performed with stability. The integrated performances of the case-finding and assessment steps exhibited moderate accuracy in Scenarios 1 and 2, but low accuracy in Scenarios 3 and 4. There is a pressing need to develop more accurate and user-friendly tools to improve sarcopenia detection among community-dwelling older adults in China.

Frailty is associated with a history of falls among mobility-limited older adults-cross-sectional multivariate analysis from the BIOFRAIL study

AIM

To identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling but who have not yet fallen.

FINDINGS

Frailty and muscle strength were characteristics distinguishing between older adults with a history of falls and those absent of falls despite an increased risk of falling.

MESSAGE

Frailty should be incorporated alongside handgrip strength (HGS) and sit-to-stand (STS) tests into routine evaluations of mobility-limited older adults referred for fall assessment.

PURPOSE

We aimed to identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling, and to identify the parameter with the strongest predictive value on the risk of falling.

METHODS

Data included anthropometry, HGS, 30-s and 5-reps STS tests, maximal isometric knee extensor strength, gait speed (6 m), postural balance (tandem test), and muscle mass (BIA). Frailty was assessed using the Clinical Frailty Scale (CFS) and sarcopenia was evaluated according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines. Outcomes of falls (past year), and depression (Geriatric Depression Scale 15) were self-reported.

RESULTS

Totally, 505 mobility-limited older adults (mean age 79.7 ± 6.3 years, 64.8% females) were included. Of these, 400 (79.2%) had experienced one or more falls within the past year (fallers), while 105 (20.8%) had not experienced a fall (at risk). Patients with experienced falls were more likely to feel depressed, had reduced handgrip strength, and reduced performance in both STS tests compared to those who had not fallen. Frailty was the strongest individual parameter associated with a history of prior falls, even after adjusting for covariates such as depression and 30-s STS (aOR 3.80; 95% CI 1.70-8.50).

CONCLUSIONS

Present study identified frailty as a key factor independently associated with a history of falls in this population. Additionally, handgrip strength and STS performance were key characteristics distinguishing between older adults with a history of falls within the past 12 months and those at risk of falling.

TRIAL REGISTRATION

NCT05795556.

The Prognostic Role of Sarcopenia in Wilms Tumor: Does It Influence Surgical Outcomes and Survival?

BACKGROUND

Sarcopenia (SP) is described as a prognostic factor in adult and pediatric cancer patients. However, there are no data regarding Wilms tumor (WT). We aimed to study the association between sarcopenia and oncological outcomes in WT.

METHODS

A retrospective study of patients diagnosed with WT at our institution between 2010 and 2022 was performed. SP at diagnosis was assessed by measuring the psoas muscle area (PMA) at the L4-L5 level on computed tomography (CT)/magnetic resonance imaging (MRI), and was defined as z-score values ≤2. Demographics, complications, and outcomes were analyzed.

RESULTS

Forty-eight patients (50% male) were included, with a mean age of 44.91 ± 31.12 months. Twelve patients (25%) had SP at diagnosis versus 36 (75%) who did not. Forty-one patients (85%) underwent total nephrectomy and seven (15%) nephron-sparing surgery (NSS). No statistical differences were found in demographics, risk group, or treatment between the SP and non-sarcopenic (NSP) groups. SP was associated with a higher rate of postsurgical complications (33% for the SP-group vs. 5.6% for the NSP-group; p = 0.023) and with a higher rate of relapse (33% vs. 14%, respectively; p = 0.09). With a median follow-up of 57.75 (1.87-150.8) months, event-free survival (EFS) was lower for the SP group (84.20 ± 17.45 vs. 135.40 ± 8.65 months, respectively; p = 0,08). One patient in the SP group died. The 5-year overall survival (OS) was 89% for the SP group versus 100% for the NSP group.

CONCLUSIONS

Among our patients, SP can be considered a risk factor for complications in patients with WT and could be associated with poor outcomes, increasing the risk of relapse and decreasing EFS.

Physical and inflammatory aspects associated to respiratory sarcopenia in community-dwelling older women

To investigate the relationship between respiratory sarcopenia with physical tests and a set of inflammatory biomarkers, seventy-one older women from the community with age 75 ± 7 years and BMI 26 ± 4 kg/m² were evaluated for appendicular lean mass using Dual X-ray Absorptiometry, respiratory muscle strength using an analog manuvacuometer, physical tests using handgrip strength, timed up and go and sit to stand in chair tests, and a panel of inflammatory biomarkers was measured, containing Adiponectin, BNDF, IFN, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, Leptin, Resistin, TNF and their soluble receptors sTNFr-1 and sTNFr-2. The analyzes suggest that older women with respiratory sarcopenia also had significantly low physical function and higher concentrations of sTNFr-2 (> 2241pg/ml), additionally respiratory muscle strength was inversely associated with sTNFr-2 concentrations (MIP: β = -0.48; R² = 0.24; p < 0.001; MEP: β = -0.35; R² = 0.12; p = 0.003). These results contribute to the discussion about the pathophysiology and to the strategies for diagnosing and monitoring respiratory sarcopenia in community-dwelling older women.

Pathophysiological Mechanisms Underlying Sarcopenia and Sarcopenic Obesity: A Systematic Review and Meta-Analysis of Biomarker Evidence

Sarcopenia and sarcopenic obesity (SO) represent significant age-related muscular disorders. Their specific biomarkers and pathophysiological mechanisms remain insufficiently elucidated. This study aims to identify differential and shared biomarkers between these conditions to reveal distinct pathophysiological processes, providing a foundation for precision diagnostics and targeted interventions. We conducted a systematic review and meta-analysis of studies examining biomarkers related to sarcopenia and SO in adults aged 45 and older. Electronic and manual searches were performed in PubMed, Web of Science, Cochrane Library, and Embase up to December 2024. The quality of each study was assessed using the National Institutes of Health Quality Assessment Tool. Meta-analysis was performed when at least three studies investigated the same biomarkers in frailty and sarcopenia, calculating the pooled effect size based on the standard mean difference using a random effects model. In total, 80 studies (64 on sarcopenia and 16 on SO) were included, encompassing 36,680 older adults (aged 45 and above) from 16 countries with varying levels of development. Participants were categorized based on their setting, age, and gender distribution. Sarcopenia is characterized by lower serum triglycerides and stable HDL/LDL ratios, while SO presents with higher triglycerides and disrupted cholesterol correlation, indicating distinct metabolic interactions. Analysis of inflammatory profiles revealed significantly elevated CRP levels in SO, with WBC as a specific marker, while TNF-α was associated with sarcopenia, suggesting a subtype-specific role of chronic inflammation. Vitamin D deficiency is prevalent in both conditions and may represent a potential therapeutic target. Subgroup analyses indicated an increased risk of muscle function decline in high-risk communities in developing regions, underscoring the urgent need for early intervention. A set of shared metabolic, hematologic, and inflammatory biomarkers was identified in sarcopenia and SO. These findings address a knowledge gap in biomarker research and highlight the distinct mechanisms involved in the development of both conditions. Developing biomarker-based diagnostic algorithms is essential for optimizing personalized treatment. Subgroup analyses have also identified high-risk populations, underscoring the need for early intervention.

Diabetes and smoking are associated with dynapenic abdominal obesity in patients with chronic kidney disease: a cross-sectional study

BACKGROUND

No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD).

OBJECTIVE

Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis.

DESIGN AND SETTING

A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil.

METHODS

This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student's Mann-Whitney t-test, Pearson's chi-square test, or Fisher's exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI).

RESULTS

The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96).

CONCLUSION

Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.

Adherence to the mediterranean diet and physical activity in relation to sarcopenia: a cross-sectional epidemiological cohort study

BACKGROUND

Adoption of healthy lifestyle habits has been proposed as successful strategies to counteract sarcopenia.

AIMS

To explore the association of physical activity (PA) and adherence to the mediterranean diet (MD), individually and synergically, with sarcopenia.

METHODS

The present cross-sectional study examined data of the Toledo Study of Healthy Ageing. Data of community-dwelling adults aged 65 + years were analyzed. Sarcopenia was defined according to the Foundation for the National Institutes of Health, standardized to our population (sFNIH) and the European Working Group on Sarcopenia (EWGSOP2). PA levels (Physical Activity Scale for the Elderly, PASE) and adherence to the MD (MEDiterranean Diet Adherence Screener-MEDAS) were estimated using self-reported instruments. Binary regression models were conducted to test associations.

RESULTS

Data of 1457 individuals (mean age 74.68 ± 5.77 years; 54.91% women) were analyzed. Among them, 331 (22.72%, sFNIH) and 202 (13.86%, EWGSOP2) met sarcopenia criteria. PA levels (ORs: 0.91-0.95, p < 0.05) and adherence to the MD (ORs: 0.82-0.86, p < 0.05) were significantly and negatively associated with the prevalence of sarcopenia, regardless of the definition used. Nevertheless, no significant interactions were observed among healthy lifestyle habits. According to sarcopenia-related domains, PA levels and adherence to the MD were negatively associated with dynapenia, meanwhile, PA levels were associated with low lean mass (sFNIH) and adherence to the MD was inversely associated with poor mobility.

CONCLUSIONS

PA and adherence to the MD are independently associated with sarcopenia. Moreover, specific associations were observed between sarcopenia domains. Nevertheless, no significant interaction was observed between them.

The relationship between skeletal muscle mass and cognitive impairment in older adults: a longitudinal study based on CLHLS

Objective

To explore the relationship between skeletal muscle mass and cognitive impairment in older adults.

Methods

Based on the longitudinal survey data of the four phases of the China Older Adults Health Influencing Factors Longitudinal Survey Project from 2008 to 2018, this study used the Cox regression analysis method and the R4.3.3 software to construct a limiting cubic spline model to deeply explore the dose-response relationship between skeletal muscle mass and cognitive impairment in the older adults.

Results

In this study, 2,199 older adults (with ages ranging from 61 to 108 years, 51.7% of whom are female and 48.2% are male) were included and followed up for a decade, during which four rounds of data collection were carried out. The results showed that the proportion of new-onset cognitive impairment in men was 14.61%, while the proportion in women was 33.48%. After adjusting for confounding factors, Cox regression results showed that the larger the muscle mass group, the greater the protective effect on cognitive impairment. The results of RCS showed that the association between skeletal muscle mass and cognitive impairment in the older adults group (P overall trend <0.05, P nonlinear <0.05) showed a nonlinear increasing trend, and there were gender differences. ASMI < 7.2 kg/m2 in older men was a risk factor for cognitive impairment (HR>1); ASMI < 5.4 kg/m2 in older women was a risk factor for cognitive impairment (HR>1). This suggests that ASMI should be maintained at a high level in older men and women, respectively.

Conclusion

There is a link between skeletal muscle mass and cognitive impairment in older adults, and cognitive function can be improved through early intervention or by improving the level of skeletal muscle mass in older adults.

Phase angle as a reproducible bedside tool to assess reduced muscle mass in patients with decompensated cirrhosis and ascites: An observational cross-sectional study

BACKGROUND

Reduced muscle mass in patients with cirrhosis is linked to poor clinical outcomes. Bioimpedance analysis estimates fat mass (FM), fat-free mass (FFM), and phase angle (PhA), a marker of cell membrane integrity correlating with computed tomography-based muscle mass assessments. We hypothesized that PhA would remain stable after paracentesis.

METHODS

Bioelectrical impedance was measured in patients with cirrhosis immediately before and after paracentesis using a 256-frequency bioimpedance spectroscopy device. We assessed median paired differences (with 95% confidence intervals) for FM, FFM, and PhA. Reduced muscle mass was diagnosed using PhA thresholds of 5.4 for women and 5.6 for men, based on previous cross-sectional validation against skeletal muscle index.

RESULTS

The study included 32 participants with median age of 60 (IQR: 55-67), 60% male, median model for end stage liver disease Na (MELD-Na) score of 18 (IQR: 14-21), and median paracentesis volume of 6 liters (loss of 5.7 kg). At baseline, 97% had reduced muscle mass based on PhA thresholds. Significant differences were observed between pre-paracentesis and post-paracentesis measurements for FM and FFM (P < 0.05). PhA remained stable (P = 0.208), with a slight nonsignificant increase of 0.1° from pre-paracentesis to post-paracentesis. Sensitivity analysis showed change in reduced muscle mass diagnosis for only one participant.

CONCLUSIONS

FM and FFM levels before and after paracentesis were significantly different, suggesting that these tests would not be accurate in patients with large fluid shifts. PhA measurements were not significantly affected by ascitic fluid shifts after paracentesis, suggesting that PhA may reliably monitor muscle mass in patients, regardless of ascites.

The association between shorter disease course and sarcopenia in women with endometriosis: a retrospective analysis of NHANES 1999-2006

Endometriosis is a common gynecological disorder that is associated with chronic pelvic pain, infertility, and metabolic complications. Sarcopenia, characterized by progressive skeletal muscle loss, predominantly affects older adults. This study explored the incidence and risk factors for sarcopenia in endometriosis patients using the NHANES dataset, which included 373 participants. Endometriosis was confirmed through self-report questionnaire, and sarcopenia was diagnosed via dual-energy X-ray absorptiometry. Covariates encompassed age, race, marital status, education attainment, poverty income ratio, smoking habits, and comorbidities. Statistical analyses were conducted using SPSS version 26.0, incorporating four multivariate regression models. The average age was 40.3 and 40.0 years in endometriotic participants with and without sarcopenia, respectively. Minority ethnicity had higher odds for sarcopenia (OR 6.00, 95% CI 1.24-29.07). A disease duration of endometriosis less than five years was associated with higher sarcopenia risk (OR 4.83, 95% CI 2.57-9.09). Conversely, lower educational levels were linked to a reduced chance of developing sarcopenia (OR 0.42, 95% CI 0.21-0.86). These findings were consistent across all regression models, indicating that ethnic minority status, higher educational attainment, and shorter disease duration are significant risk factors for concurrent sarcopenia in endometriosis patients.

Multiple sclerosis is associated with worse body composition across compartments: Results from a systematic review and meta-analysis

BACKGROUND

There is conflicting evidence regarding specific differences in body composition (i.e., body fat, lean, and bone) between people with multiple sclerosis (MS) and non-MS controls. The objective of this meta-analysis was twofold: (1) quantify overall and compartment-specific differences in body composition between people with MS and controls; and (2) identify individual and disease-specific moderators of any differences in body composition between groups.

METHODS

A search of five electronic databases (MEDLINE, EMBASE, Cochrane Central, CINAHL, and Scopus) was performed by an information specialist.

RESULTS

Overall, 180 effects were derived from 37 studies, 155 (86.1 %) of which were negative, with a mean effect ∆ of -0.39 (95 %CI: -0.46, -0.32, Z = -10.86, p < 0.001) suggesting poorer overall body composition in people with MS. Disability status was significantly associated with overall effect size (β = 0.31, Z = 4.33, p < 0.0001); effects were significantly larger at higher disability levels. Regarding body fat, 55/61 (90.2 %) effects were negative, resulting in a mean effect ∆ of -0.32 (95 %CI: -0.43, -0.21, Z = -5.72, p < 0.001). With regards to lean tissue, 38/43 (88.4 %) effects were negative, with a mean effect ∆ of -0.38 (95 %CI: -0.56, -0.21, Z = -4.28, p < 0.001). Lastly, 62/76 (81.6 %) effects for bone mineral density were negative, with a mean effect ∆ of -0.44 (95 %CI: -0.55, -0.34, Z = -8.28, p < 0.001).

CONCLUSIONS

Current evidence supports poorer overall and compartment-specific body composition in people with MS, and this may be particularly relevant at higher disability. Strategies for managing body composition in MS should consider the need for maintaining lean mass and bone health, while managing obesity.

Association of Nutritional Status and Possible Sarcopenia Among Formerly Older Homeless Adults in Supportive Housing, Thailand

BACKGROUND/OBJECTIVES

Possible sarcopenia and malnutrition are critical public health concerns among older adults, particularly in vulnerable populations such as those with a history of homelessness. However, limited evidence exists on the nutritional status and muscle health of this group in Thailand.

METHODS

This study aimed to assess the nutritional status of formerly homeless older adults residing in supportive housing in Thailand and examine its association with possible sarcopenia. A cross-sectional study was conducted among 116 participants aged 50 years and older. Sociodemographic information was collected using a structured questionnaire. Nutritional status was then assessed using the Mini Nutritional Assessment short form (MNA-SF) and body mass index (BMI). Possible sarcopenia was determined based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, including low calf circumference, reduced handgrip strength, and/or low gait speed. Data were analyzed using descriptive statistics and logistic regression.

RESULTS

Of all participants, 66.4% were male, with a mean age of 59.14 years (SD = 7.791). A total of 78.4% were identified as having possible sarcopenia. Univariate analysis revealed significant associations between possible sarcopenia and malnutrition (OR = 6.111, 95% CI = 2.104-17.750), low BMI (OR = 16.784, 95% CI = 3.729-75.535), and waist circumference (OR = 0.129, 95% CI = 0.049-0.342). Multivariate logistic regression indicated that malnutrition (OR = 3.429, 95% CI = 1.093-10.763) and low BMI (OR = 11.732, 95% CI = 2.523-54.567) were significant predictors of possible sarcopenia, collectively explaining 33.8% of the variance.

CONCLUSIONS

The findings underscore a high prevalence of possible sarcopenia among formerly homeless older adults in supportive housing in Thailand and highlight poor nutritional status, particularly low BMI and malnutrition, as a key contributing factor. These results emphasize the importance of early nutritional screening and interventions to prevent or delay sarcopenia in this vulnerable population.

Food Consumption Frequency Based on the Mini Nutritional Assessment (MNA) and Its Association with Probable Sarcopenia as Measured by Handgrip Strength in a Group of Chilean Older Persons Aged 65 and over

Background/Objectives: Sarcopenia, characterized by the loss of muscle mass and strength, is prevalent in older persons and affects their quality of life. Nutritional intervention and physical activity play a key role in its prevention and treatment. This study aims to investigate the relationship between food consumption frequency as assessed through the Mini Nutritional Assessment (MNA) and probable sarcopenia, evaluated by grip strength, in Chilean older persons aged 65 or older. Methods: A correlational, cross-sectional study with a non-probabilistic sample of 155 older persons aged 65 or older was undertaken. Food consumption frequency was assessed using the MNA, and muscle strength was measured using a handgrip dynamometer. The authors analyzed the relationship between food consumption frequency, as assessed by the MNA, and the protein intake index with muscle strength. Results: Participants who consumed less than two servings of fruits and vegetables per day were 4.28 times more likely to have low muscle strength compared to those who consumed two or more servings per day (OR = 4.28; 95% CI: 1.59-11.45). No significant associations were found with the consumption of dairy products, legumes, meat, fish, poultry, or fluids. The protein intake index did not show a significant relationship with muscle strength. Conclusions: The results suggest that a diet rich in fruits and vegetables may have a protective effect on muscle strength in older persons. Promoting adequate intake of these foods could be critical in the prevention of sarcopenia in this population.

Systemic Inflammation and Disruption of the Local Microenvironment Compromise Muscle Regeneration: Critical Pathogenesis of Autoimmune-Associated Sarcopenia

Unlabelled

Sarcopenia is defined by age-related reductions in muscle mass, strength, and physiological function, and it is especially prevalent among individuals with autoimmune diseases. Autoimmune disorders, characterized by immune dysregulation, cause systemic inflammation and damage to multiple tissues through unregulated immune activity. Research indicates that autoimmune diseases negatively impact skeletal muscle functions and may worsen the progression of sarcopenia. This viewpoint comprehensively discusses the pathogenesis and potential mechanism of sarcopenia in 3 autoimmune diseases: inflammatory bowel disease, rheumatoid arthritis, and type 1 diabetes mellitus. Mechanistically, chronic immune microenvironment alterations induce compartment-specific redistribution of leukocyte subsets and cytokine networks. These perturbations disrupt critical signaling pathways governing muscle protein synthesis, satellite cell activation, and mitochondrial bioenergetics, leading to impaired regeneration and accelerated sarcopenia progression. By delineating shared and distinct pathomechanisms across these models, this analysis reframes our understanding of immune-mediated muscle wasting. Beyond mechanistic insights, it establishes a translational framework for targeted therapies and highlights emerging research directions bridging immunology and age-related musculoskeletal decline.

Prognostic effect of body roundness index on all-cause mortality among US older adults

The Body Rounds Index (BRI) is an anthropometric indicator specifically developed to evaluate an individual's obesity level, particularly emphasizing central or abdominal obesity. This study aimed to explore the relationship between BRI and all-cause mortality in older U.S. adults. The research sample comprised individuals aged 65 and older from the National Health and Nutrition Examination Survey (NHANES), eligible for mortality analyses between 1999 and 2018. We utilized Cox regression analyses, restricted cubic spline (RCS), threshold effects analysis, Kaplan-Meier curves, and subgroup analyses were conducted to assess how the BRI correlates with all-cause mortality among older adults in the U.S. To further ensure the robustness of our findings, we conducted sensitivity analyses. Among 5371 U.S. older adults (age ≥ 65), with an average age of 72.45 (standard deviation [SD]:5.65) years, 2884 (60%) were women. During the follow-up period, there were 2781 deaths from all causes among the 5371 participants. After adjusting for all covariates, a U-shaped association was identified between BRI and the all cause mortality. Compared to a BRI of less than 4.457, a BRI between 4.457 and 5.538 was associated with a 19% reduction in the likelihood of mortality from any cause (HR = 0.81, 95% CI = 0.69-0.95). A BRI between 5.538 and 6.888 was linked to a 8% reduction in mortality risk (HR = 0.92, 95% CI = 0.79-1.07), while a BRI exceeding 6.888 showed a 1% increase in this risk (HR = 1.01, 95% CI = 0.87-1.17). RCS analysis indicated a U-shaped relationship between BRI and all-cause mortality. The turning point was located at 4.546, with correlations observed both before and after this point. This NHANES-based study highlights the U-shaped relationship between BRI and all-cause mortality among U.S. older adults, suggesting that the BRI has predictive value for mortality outcomes. The findings offer compelling support for utilizing BRI as a non-invasive mortality risk screening tool.

Association of sarcopenia with all-cause and cause-specific mortality in cancer patients: development and validation of a 3-year and 5-year survival prediction model

BACKGROUND

Sarcopenia is a clinicopathological condition characterized by a decrease in muscle strength and muscle mass, playing a crucial role in the prognosis of cancer. Therefore, this study aims to investigate the association between sarcopenia and both all-cause mortality and cancer-specific mortality among cancer patients. Furthermore, we plan to develop risk prediction models using machine learning algorithms to predict 3-year and 5-year survival rates in cancer patients.

METHOD

This study included 1095 cancer patients from the National Health and Nutrition Examination Survey (NHANES) cohorts spanning 1999-2006 and 2011-2014. Initially, we used the Least Absolute Shrinkage and Selection Operator (LASSO)-Cox regression models for feature selection. Subsequently, we employed multivariable Cox regression models to investigate the association between sarcopenia and all-cause and cancer-specific mortality in cancer patients. We developed five machine learning algorithms, including Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), LightGBM, and XGBoost, to predict 3-year and 5-year survival rates and to perform risk stratification.

RESULTS

The multivariable COX regression model showed sarcopenia significantly increases the risk of all-cause mortality (HR = 1.33, 95%CI:1.05, 1.70, P = 0.0194) and cancer-specific mortality (HR = 1.67, 95%CI:1.09, 2.55, P = 0.0176) in cancer patients. Among the five machine learning algorithms developed, the LightGBM model demonstrated strong performance in the 3-year and 5-year survival prediction tasks, making it the optimal model selection. Decision curve analysis and Kaplan-Meier curves further confirmed our model's ability to identify high-risk individuals effectively.

CONCLUSIONS

Sarcopenia significantly increases the risk of mortality in cancer patients. We developed a survival prediction model for cancer patients that effectively identifies high-risk individuals, thereby providing a foundation for personalized survival assessment.

Culture-sensitive lifestyle intervention tailored to non-Western migrant older adults improves physical performance: A randomized controlled trial

OBJECTIVES

To counteract sarcopenia in non-Western migrant older adults, lifestyle interventions with increased physical activity and adequate dietary protein intake are promising. However, regular community-based lifestyle interventions often lack a culture-sensitive approach. The aim of this study was to assess the effects of a newly developed culture-sensitive lifestyle intervention on physical performance in non-Western Surinamese older adults.

DESIGN

A randomized controlled trial.

PARTICIPANTS

This study was conducted with 65 non-Western migrant participants (Surinamese, 65 ± 7 y, 91% female, 82% overweight or obese).

INTERVENTION

The participants were allocated to the culture-sensitive lifestyle intervention (n = 35) or control group (n = 30). The six-month intervention consisted of an exercise training program and a nutritional program, both adapted to the cultural and personal needs of the participants.

MEASUREMENTS

The primary outcome was physical performance, measured by 6-minute walking test. Secondary outcomes were timed-up-and-go, 30-seconds chair stand, knee-extension strength, single leg stand tests, appendicular lean soft tissue mass, fat mass, protein intake and daily physical activity. Linear mixed models were performed to assess intervention effects with significance set at p < 0.05.

RESULTS

The intervention group improved physical performance by 12% from baseline 440 ± 62 m to 6 months 492 ± 73 m compared to 8% in control group from 438 ± 93 m to 471 ± 66 m (+25.5 m, 95%CI (3.2;47.9), p = 0.027). Knee-extension strength was significantly better maintained in the intervention group from 273 ± 71 N to 270 ± 70 N, whereas the control group decreased knee-extension strength by 8% at six months from 262 ± 78 N to 240 ± 87 N (+19 N, 95%CI (1-38), p = 0.040). The intervention group significantly increased protein intake more (from 63 ± 21 to 78 ± 38 g/day) compared to the control group (from 72 ± 25 to 78 ± 29 g/day) at three months (+15 g/day, 95%CI (1;28), p = 0.035). No difference between groups was found for physical activity or the other secondary outcomes.

CONCLUSIONS

In non-Western migrant Surinamese older adults, a culture-sensitive lifestyle intervention improved physical performance, protein intake, and maintained muscle strength, presenting a promising approach to manage sarcopenia risk in this population.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT06407583).

Association between handgrip strength asymmetry and all-cause mortality in United States-based older adults: A cross-sectional study

BACKGROUND

Although handgrip strength is commonly measured in both hands for sarcopenia screening, the nonmaximum readings are frequently discarded. We aimed to evaluate whether handgrip strength asymmetry, in addition to weakness, could provide additional prognostic information in older adults.

METHODS

Participants aged ≥60 years from the 2011-2014 National Health and Nutrition Examination Survey with available handgrip strength measurements were included. Study outcomes are all-cause and cardiovascular disease mortality. Participants were categorized into the weakness-/asymmetry- (reference), weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups based on the status of handgrip weakness and asymmetry.

RESULTS

Overall, 3116 older adults (mean age, 69.47 years) were included. Weighted percentages of participants in the reference, weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups were 54.28%, 39.88%, 2.86%, and 2.97%, respectively. During a median follow-up of 79 months, 679 deaths (232 from cardiovascular causes) occurred. Compared with the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for the weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups were 1.02 (95% CI 0.84-1.24), 1.57 (95% CI 1.09-2.26), and 2.34 (95% CI 1.47-3.71), respectively, for all-cause mortality (P for trend < 0.01) and 1.19 (95% CI 0.78-1.81), 1.22 (95% CI 0.54-2.78), and 2.30 (95% CI 1.20-4.39), respectively, for cardiovascular disease mortality (P for trend = 0.03). Subgroup analysis indicated anemia and diabetes significantly modified the associations between handgrip strength and/or weakness status with all-cause and cardiovascular disease mortality.

CONCLUSION

Handgrip strength asymmetry, in addition to weakness, provided additional prognostic information for all-cause and cardiovascular mortality in older adults in the United States.

Update on the detection of frailty in older adults: a multicenter cohort machine learning-based study protocol

BACKGROUND

This study aims to investigate the relationship between muscle activation variables assessed via ultrasound and the comprehensive assessment of geriatric patients, as well as to analyze ultrasound images to determine their correlation with morbimortality factors in frail patients.

METHODS

The present cohort study will be conducted in 500 older adults diagnosed with frailty. A multicenter study will be conducted among the day care centers and nursing homes. This will be achieved through the evaluation of frail older adults via instrumental and functional tests, along with specific ultrasound images to study sarcopenia and nutrition, followed by a detailed analysis of the correlation between all collected variables.

DISCUSSION

This study aims to investigate the correlation between ultrasound-assessed muscle activation variables and the overall health of geriatric patients. It addresses the limitations of previous research by including a large sample size of 500 patients and measuring various muscle parameters beyond thickness. Additionally, it aims to analyze ultrasound images to identify markers associated with higher risk of complications in frail patients. The study involves frail older adults undergoing functional tests and specific ultrasound examinations. A comprehensive analysis of functional, ultrasound, and nutritional variables will be conducted to understand their correlation with overall health and risk of complications in frail older patients.

TRIAL REGISTRATION

The study was approved by the Research Ethics Committee of the Hospital Universitario Puerta de Hierro, Madrid, Spain (Act nº 18/2023). In addition, the study was registered with https://clinicaltrials.gov/ (NCT06218121).

Low five-repetition chair stand test and usual gait speed scores predict falls within one year in an outpatient clinic for frailty

PURPOSE

Falls in older adults increase the risk of mortality and hospitalization, particularly when physical function is low. This study aimed to determine whether low physical function and muscle mass, are also valuable for predicting falls within one year in older patients who visited an outpatient clinic for frailty.

METHODS

This prospective cohort study analyzed the registry data of 624 outpatients aged > 65 years (mean age: 77.9 ± 6.0 years; female 368, male 256). The endpoint was the incidence of falls within one year. These included the five-chair standing test (5CS), usual gait speed, short physical performance battery, handgrip strength, and skeletal muscle mass index. All of these tests were performed during the first clinic appointment. The question about fall history was asked one year after the examination, and the history of falls during the period of one year from the date of the examination. We analyzed the relationship between whether these assessments were below the cutoff values and falls within one year using multiple logistic regression analysis.

RESULTS

A total of 154 (25%) patients fell within one year. Those with a low result on the 5CS or usual gait speed had significantly higher rates of falls within one year, even after adjustment for covariates, with odds ratios [95% confidence interval] of 2.07 [1.37-3.13] and 1.68 [1.09-2.60], respectively.

CONCLUSION

Low physical function, particularly in the lower limbs, was associated with near-term fall risk. The 5CS is helpful in fall risk assessment.

The Role of the Mediterranean Diet in the Prevention of Sarcopenia and Frailty in Older Adults: A Narrative Review

Background/Objectives: Sarcopenia and frailty are interrelated conditions and have a high incidence in older adults. They contribute to increased morbidity and mortality and poor quality of life. There is emerging evidence that healthy diets such as the Mediterranean diet could delay the onset of sarcopenia and frailty. This review aims to evaluate the role of the MD in preventing these conditions. Methods: A literature search was conducted on PubMed (MEDLINE, NCBI) for English-language articles published within the last 10 years (2014-2024) using the search terms "Mediterranean diet", "frailty", "sarcopenia", and "old people". A total of 111 articles were identified, of which 36 were excluded during the initial screening. Subsequently, 75 manuscripts were assessed for eligibility. Subsequently, a further 62 articles were excluded (narrative reviews, articles not focused on the elderly population, or articles with different outcomes). Finally, 13 articles were included in the review. Results: The 13 selected studies comprised seven observational studies, three systematic reviews and meta-analyses, and three clinical trials. The findings suggest that adherence to the Mediterranean diet (MD), particularly when combined with physical activity, may improve body composition and cardiometabolic health and reduce indicators of sarcopenia in obese older adults. Furthermore, MD-based nutritional interventions were associated with improved physical functions such as balance, gait, fall risk, flexibility, and muscle strength (p < 0.05, all). The MD also demonstrated a preventive effect against frailty, particularly in pre-frail individuals. Conclusions: High adherence to the Mediterranean diet (MD) may delay the onset of sarcopenia and improve muscle function in older adults. However, the available scientific evidence is of low to moderate quality. Well-designed prospective intervention studies are needed to confirm whether the MD can modify the natural history of sarcopenia and/or frailty in older adults.

Associations of sarcopenia, sarcopenia components and sarcopenic obesity with cancer incidence: A prospective cohort study of 414,094 participants in UK Biobank

Sarcopenia is characterised by low grip strength, muscle quantity or quality, and physical performance. This study investigated the associations of sarcopenia and its components with cancer incidence. A prospective cohort study was conducted utilising data from the UK Biobank. Sarcopenia and its components were defined according to the European Working Group on Sarcopenia in Older People criteria (EWGSOP2 2019). Cox proportional hazard models adjusted for sociodemographic, lifestyle, and health-related factors were performed. Overall, 63,379 out of 414,094 study participants had an incident diagnosis of cancer during a median follow-up of 11.7 years. In total, 32,286 participants had probable sarcopenia and 934 confirmed/severe sarcopenia at recruitment. Combined probable, confirmed, and severe sarcopenia was associated with a higher risk of liver (hazard ratio [HR] = 1.65, 95% confidence interval [CI]: 1.17-2.33), haematological (HR = 1.22, 95% CI: 1.01-1.46), and colorectal cancer (HR = 1.21, 95% CI: 1.04-1.41) in males, but not in females. The components of sarcopenia were associated with a higher risk of several cancers, including low grip strength (with liver, haematological and colorectal cancer in males), low muscle mass index (oesophageal in females and oral cancer in males), and slow walking pace (liver and lung in males, lung and overall cancer in females). Compared to participants with non-sarcopenic obesity, those with sarcopenic obesity had a higher risk of colorectal cancer in males (HR = 1.31, 95% CI: 1.03-1.68). Our study suggests that sarcopenia, sarcopenia components, and sarcopenic obesity can be associated with risk for several cancers, mainly of the gastrointestinal tract and in males. Thus, early identification of sarcopenia components may benefit cancer prevention.

The prevalence of sarcopenia and its associations with weekly energy expenditure and physical activity levels in female patients with breast cancer at the time of diagnosis

BACKGROUND

Early breast cancer diagnoses have enabled better therapeutic responses and better patient prognoses. However, sarcopenia, may develop as a result of this oncological disease, through the release of inflammatory cytokines.

OBJECTIVES

Determine the prevalence of sarcopenia and associations with weekly energy expenditure and physical activity (PA) levels in female patients with breast cancer at the time of diagnosis in a reference oncology hospital.

METHODS

Cross-sectional study of patients with breast cancer stages IA to IIIC between June 2021 and June 2022. Sarcopenia was classified as "probable" when patients had low muscle strength, "confirmed" when both low strength and low muscle mass were detected, and "severe" when these two factors were associated with low physical performance. Muscle strength was assessed using dynamometry, muscle mass through calf circumference and physical performance using the Timed Up and Go test. PA level was determined by the International Physical Activity Questionnaire. Binary logistic regressions were performed between sarcopenia and PA levels, while linear regressions were performed for weekly energy expenditure.

RESULTS

Ninety-two women were evaluated. Sarcopenia prevalence was determined as probable in 5.4 % and confirmed in 14.1 % of participants. It was observed that women classified as having probable or confirmed sarcopenia were older than those who were not sarcopenic. No significant differences concerning weekly energy expenditure and PA levels between groups were observed.

CONCLUSION

Less than a quarter of the assessed patients were diagnosed with probable or confirmed sarcopenia, and none were diagnosed with severe sarcopenia. No associations were observed between sarcopenia, weekly energy expenditure or PA levels.

Sarcopenia: an Aging Perspective and Management Options

There is no doubt that sarcopenia is one of the most defining characteristics of aging that negatively impacts the people's health and quality of life. The condition is characterized by the progressive and generalized loss of muscle mass and strength, affecting physical performance. It is part of aging but can be exacerbated by pathophysiological conditions like cancer and several factors such as a sedentary lifestyle, poor nutrition, chronic diseases, falls and immobilization. Numerous cellular mechanisms have been implicated in its pathogenesis, including hormonal changes, mitochondrial dysfunctions, altered apoptotic and autophagic signaling, muscle fiber composition, and inflammatory pathways. To prevent sarcopenia, exercise is one of the most effective strategies as it has a strong influence on both anabolic and catabolic muscle pathways and helps improve skeletal muscle function. A well-rounded, multicomponent exercise program that targets muscle strength, aerobic capacity, and balance is recommended for optimal results. While nutrition is essential for muscle maintenance, relying solely on dietary interventions is unlikely to fully address sarcopenia. Therefore, a combination of adequate nutrition and regular exercise is recommended to promote muscle health and function. The purpose of this study is to review sarcopenia from an aging viewpoint and discuss the role of exercise and nutrition as prevention and management options.

mTORC1 signalling and protein synthesis are elevated in response to amino acids in human myotubes obtained from young, old, and old trained men

Ageing and reduced levels of physical activity are associated with desensitisation of skeletal muscle to the anabolic effects of amino acids. In vitro studies have indicated that many properties of skeletal muscle tissue are retained in human myotubes, including metabolic alterations associated with exercise and disease. However, the interaction between ageing and physical activity on amino acid sensing and growth has not been explored in human myotubes in vitro. Muscle-derived cells were isolated from biopsies taken from eight young (Y: 23.4 ± 1.9 yr), six older (O: 72.5 ± 5.0 yr), and nine older exercise trained (OT: 71.0 ± 4.1 yr, n = 9) men, and myotube cultures were generated and investigated for growth parameters and amino acid induced changes in mTORC1 signalling and protein synthesis. Our results indicated that muscle cell fusion was similar between groups, but myotube diameter was lower in cultures derived from O individuals. Despite this, mTORC1 signalling, as indicated by immunoblots for phosphorylation of mTORSer2448, rpS6Ser235/236, and 4E-BP1Thr37/46 increased to a similar extent in response to amino acid availability in Y, O, and OT myotubes. Furthermore, measures of protein synthesis using the SUnSET assay were increased similarly between groups after the addition of amino acids. These data suggest that skeletal muscle desensitisation to amino acids with ageing is not observed in myotubes cultured in vitro, which could be reflective of the healthy individuals tested in our study or point towards the importance of the muscle niche in the impairments in muscle metabolism in ageing.

Nutritional and Physical Rehabilitation in Post-Critical Coronavirus Disease 2019 (COVID-19) Ambulatory Patients: The NutriEcoMuscle Study

Background: The prevalence of malnutrition is high in post-intensive care unit (ICU) coronavirus disease 2019 (COVID-19) patients during hospitalization and after hospital discharge. This paper presents prospective results from the NutriEcoMuscle study, a multicenter observational study. The study aimed to evaluate changes in nutritional and functional status in post-ICU COVID-19 patients following nutritional and physical rehabilitation interventions. Secondary aims included assessing adherence to and tolerance of the oral nutritional supplement (ONS) used in the nutritional intervention. Methods: The study enrolled adults who had been admitted to the ICU due to severe COVID-19. At hospital discharge, the patients underwent a nutritional intervention based on oral nutritional supplements (ONSs) with 100% serum lactoprotein enriched with leucine and vitamin D and a physical rehabilitation program. They were followed up during three months. Performed assessments included Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, Barthel index (BI), handgrip strength and Timed Up and Go test, bioelectrical impedance analysis (BIA), nutritional ultrasound (US), and tolerance and adherence to ONS. Sample size was calculated based on handgrip strength, and parametric and non-parametric tests were used to assess differences between the baseline and three-month outcomes. Results: The study included 96 patients (71.9% male, mean age 58.8 years, mean body mass index (BMI) of 28.8 kg/m2, 36.5% obese). A total of 85 patients (62 men and 23 women) completed the 90-day follow-up. The mean weight gain after the intervention was 6.8 (SD 5.2) kg (similar in men and women; p = 0.263). The proportion of patients with malnutrition according to the SGA or GLIM criteria decreased from 100% to 11.8% and 36.4%, respectively (p < 0.00001 in both cases). The proportion of patients with functional limitations by BI decreased from 66.7% to 27.0% (p < 0.0001). Handgrip strength increased more than 40% in both men and women (p < 0.00001). The time to perform the Timed Up and Go (TUG) test decreased more than 40% in both men and women (p < 0.00001). According to BIA, the mean fat mass did not increase significantly in either men or women. The mean fat-free mass index (FFMI) increased significantly in both men and women. There were also significant increases in body cell mass, skeletal muscle mass index, and appendicular skeletal muscle mass index. The phase angle (PhA) increased significantly in both men (26.5%) and women (17.4%). In a multivariate analysis, age and baseline PhA were related to the PhA increase (adjusted R2 = 0.5573). The US study showed a significant increase in the mean measurements of muscle area, muscle circumference, X-axis, and Y-axis in the rectus femoris. Regarding abdominal fat, there were no significant increases in total, superficial, or preperitoneal adipose tissue by US. Participants engaged in a median interquartile range (IQR) of 70 (0-120) min/week of strength exercise and 60 (0-120) min/week of moderate physical exercise. The supplement was well tolerated, and poor adherence (less than 50%) was low (4% of the participants). Conclusions: A three-month intervention, including ONS and physical rehabilitation, is associated with a significant improvement in nutritional and functional status. Patients gained weight primarily by increasing their muscle mass. There was no significant increase in fat mass, as measured by BIA or US. The intervention was well tolerated and had good adherence.

Gliflozines as add-on to Arni in echocardiographic, sarcopenic and oxidative stress parameters in elderly patients with chronic heart failure

BACKGROUND

Sarcopenia is common in patients with heart failure (HF) and it is frequently associated with other comorbidities. Sarcopenia has been linked to an increased risk of major adverse cardiovascular events (MACE) in HF patients.

AIMS

The aim of the present study was to evaluate, in a cohort of older adult's patients affected by HF with reduced ejection fraction (HFrEF) and sarcopenia, already being treated with sacubitril/valsartan, the effect of add-on therapy with SGLT2i on clinical, functional abilities, muscle performance and effects on quality of life.

METHODS

We enrolled 147 outpatients. A simple linear regression analysis was performed to assess the correlation between the change in Cardiac Index (CI) and Short physical performance battery (SPPB) values, expressed as (Δ) between baseline and follow-up (ΔT0-12), and several covariates.

RESULTS

After 12 months of treatment, we observed an improvement in the inflammatory profile, moreover there was a reduction of the oxidative stress (p < 0.0001) and platelets activation (p < 0.0001) parameters. In addition, there was a significant increase in CI and global longitudinal strain and a statistically significant improvement in cognitive function, as shown by Mini-Mental State examination (MMSE) (p < 0.0001) score and SPPB (p < 0.0001). Considering ΔCI as dependent variation, Δ8-isoprotane resulted the major predictor, justifying 13.3% of its variation. When ΔSPPB was considered as dependent variable, Δ8-Isoprostane was the main predictor of ΔSPPB, justifying 54.6% of its variation.

DISCUSSION AND CONCLUSIONS

This study demonstrated that the addition of SGLT2i to therapy leads to improvements in echocardiographic and sarcopenia-related parameters and biomarkers of oxidative stress and platelet activation.

Healthy lifestyle, daytime sleepiness, and gut microbiome composition are determinants of functional strength in humans: a cross-sectional study

Age, metabolic inflammation, sleep patterns, lifestyle choices, and gut microbiome composition were investigated as factors influencing functional strength. The Northern German FoCus cohort subgroup (394 women, 233 men) was categorized into six groups based on weekly sports activity and handgrip strength (HGS) measurements. The analyses included anthropometric data, clinical biochemistry, medication, sleep duration, healthy lifestyle score (HLS), 16 S rRNA gut microbiota, serum and urine metabolomics, bile acids, and an adapted dietary inflammatory index (ADII) score. Associations were found between age, inflammation, and low functional strength, with sleep duration increasing the odds and a healthy lifestyle decreasing the risk. Urine metabolomics revealed differences in enrichment analyses. No significant differences were observed in the Chao1 and InVSimpson indices between the groups. At the genus level, some species were associated with daily sports activity, whereas others were associated with HGS measurements. Clostridium XIVa was found only in high- and medium-HGS groups, while Alistipes, Odoribacter, and Streptococcus decreased with activity. Thus, tailored lifestyle interventions may reduce the risk of poor functional strength.

Skeletal Muscle Loss During Treatment With Abiraterone in Patients With Metastatic Prostate Cancer

Background: Abiraterone acetate is an androgen-receptor pathway inhibitor commonly used for treatment of metastatic prostate cancer. The levels of androgens during treatment with abiraterone acetate with prednisone (AAP) are lower than those achieved by androgen-deprivation therapy only, potentially resulting in a high risk of skeletal muscle loss. Methods: The cohort included 43 patients treated with AAP for metastatic hormone-sensitive prostate cancer or metastatic castration-resistant prostate cancer. To detect and quantify sarcopenia, we utilized standard computer tomography (CT) imaging. Skeletal muscle mass index (SMI) was evaluated by assessing two adjacent axial sections at the level of the L3 vertebra. Results: Sarcopenia at the time of AAP initiation was present in 72.1% of patients. Body mass index (BMI) was inversely associated with the presence of sarcopenia at the time of AAP initiation. There was a statistically significant decrease in SMI over AAP treatment. Age > 75 years and the absence of previous radiotherapy were associated with a higher rate of SMI decrease during AAP therapy. Overall and progression-free survival was not significantly associated with SMI decrease during AAP therapy. Conclusions: SMI decline occurs during AAP treatment for mHSPC and mCRPC, and is more pronounced in patients over 75 years old and those without previous local treatment. There was no statistically significant association between survival outcomes and SMI decline during AAP therapy.

The Effects of Exercise Intervention in Older Adults With and Without Sarcopenia: A Systematic Review

This systematic review, conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024619693), aimed to evaluate the effects of physical exercise interventions on muscle function and fall risk in older adults with and without sarcopenia. Methods: A comprehensive search of PubMed and Web of Science databases identified 11 randomized controlled trials (RCTs) published between 2015 and 2025. A total of 792 participants (mean age 75.13 ± 4.71 years; 65.53% women, 34.47% men) were included. Interventions varied in type-strength, balance, aerobic, and multi-component programs-with a minimum duration of 8 weeks. Results: The reviewed studies showed that physical exercise interventions significantly improved neuromuscular function, physical performance, and postural control in older adults. Positive effects were observed in gait speed, stair-climbing ability, grip strength, muscle mass, and bone density. Specific modalities such as Tai Chi improved postural control and neuromuscular response; dynamic resistance and functional training increased muscle strength and improved posture; Nordic walking reduced postural sway; and multi-component and combined walking-resistance training enhanced mobility and force efficiency. Programs integrating strength and balance components yielded the most consistent benefits. However, reporting on FITT (Frequency, Intensity, Time, Type) principles was limited across studies. Conclusions: Exercise interventions are effective in improving neuromuscular outcomes and reducing fall risk in older adults, both with and without sarcopenia. The findings support the need for tailored, well-structured programs and greater methodological standardization in future research to facilitate broader clinical application and maximize health outcomes.

Exploring the Link Between Nutritional and Functional Status and Short-Term Postoperative Outcomes in Patients Undergoing Pancreatic Cancer Surgery

BACKGROUND

Patients with pancreatic cancer are at increased risk of malnutrition and functional decline. This study aimed to identify preoperative nutritional and functional risk factors associated with postoperative complications.

METHODS

Adult patients with pancreatic cancer admitted to two university surgical departments in Athens, Greece, were included. Preoperative laboratory values, nutritional status, and functional status were assessed.

RESULTS

Among 96 patients included in this study, postoperative complications occurred in 69 (71.9%). Complication rates were significantly higher in patients with severe malnutrition (87.9% vs. 62.7%, p = 0.015), low Geriatric Nutritional Risk Index (GNRI) (90.5% vs. 66.2%, p = 0.023), low handgrip strength (91.7% vs. 61.5%, p = 0.037), and low gait speed (90.5% vs. 63.6%, p = 0.027). Major complications were linked to lower hemoglobin (Hb) (11.5 ± 1.9 vs. 12.8 ± 1.7 g/dL, p = 0.001), lower hematocrit (HCT) (34.7 ± 5.4% vs. 38.4 ± 4.7%, p = 0.001), and severe malnutrition (42.4% vs. 23.7%, p = 0.05). Lower Hb, lower HCT, malnutrition, and greater waist circumference were associated with postoperative mortality. Longer hospital stays were correlated with weaker handgrip strength and slower gait speed.

CONCLUSION

Preoperative malnutrition and impaired functional status are significant predictors of adverse postoperative outcomes in pancreatic cancer surgery.

The skeletal muscle mass index is a predictor for all-cause mortality in US adults with type 2 diabetes or pre-diabetes

AIMS

To investigate the relationship between the skeletal muscle mass index (SMI) with all-cause mortality in patients with type 2 diabetes mellitus (T2DM) or pre-diabetes (pre-DM) among American adults.

METHODS

This study included 3684 patients with T2DM or pre-DM from the National Health and Nutrition Examination Survey 2011-2018.

RESULTS

Our study revealed an inverse J-shaped relationship between the SMI with all-cause mortality in US adults with T2DM or pre-DM. We determined the inflection points for all-cause mortality in patients with T2DM or pre-DM were 9.07 kg/m2 in males and 7.82 kg/m2 in females. In men, the all-cause mortality decreased by approximately 72 % (HR, 0.28; 95 % CI, 0.09-0.93) for each unit increased in the SMI below the inflection point. In women, all-cause mortality was reduced by 60 % (HR, 0.40; 95 % CI, 0.16-0.91) for each unit increased in SMI below the threshold. A reverse J-shaped SMI-mortality association emerged in patients with T2DM, contrasting with a U-shaped pattern in pre-DM individuals.

CONCLUSIONS

An inverse J-shaped association was observed between the SMI with all-cause mortality in in US adults with T2DM or pre-DM. SMI is a valuable tool for predicting all-cause mortality in patients with T2DM or pre-DM.

The cross-sectional relationship of physical frailty and cognitive impairment in older Poles: analysis of the PolSenior2 data

AIM

To assess the relation between pre-frailty and frailty, and its components on one hand and the presence, degree and components of cognitive impairment.

METHODS

This is a nationwide epidemiologic survey of health determinants in older Poles (PolSenior2). We assessed physical frailty using the approach by Fried et al. and cognitive impairment with the Mini-Mental Status Examination (MMSE). We calculated population estimates (95% CI) of conditions under study, with sampling weights to account for the complex survey design, with the age-sex post-stratification matching to the population of Poland. We used logistic regression to model cognitive impairment as function of frailty phenotype.

RESULTS

Mean (SD) age of 5378 participants (58.0% women) was 75.0 (9.4) years. Frailty was diagnosed in 23.5% of respondents, and 54.6% were pre-frail. Normal cognition was found in 51.3%, 23.0% had suspected mild cognitive impairment (MCI), and suspected: 16.3% mild, 6.5% moderate and 2.9% severe dementia. Robust phenotype was present in 35.7% normal cognition persons, 4.7% in moderate dementia, and 0.0% in severe dementia. Frailty increased from 9.2% in normal cognition to 57.4% and 85.3% in moderate dementia and severe dementia. Frailty component that was associated with abnormalities in all MMSE domains was exhaustion. In the presence of exhaustion, the best-preserved function was registration, and the most pronounced was attention deficit.

CONCLUSION

Frailty and cognitive impairment are closely associated. While exhaustion was standing out among the frailty components, it was associated with impaired orientation and attention deficits. These data may inform both the prevention and rehabilitation and nutritional counseling.

Impact of sarcopenia and obesity on mortality in older adults with SARS-CoV-2 infection: automated deep learning body composition analysis in the NAPKON-SUEP cohort

INTRODUCTION

Severe respiratory infections pose a major challenge in clinical practice, especially in older adults. Body composition analysis could play a crucial role in risk assessment and therapeutic decision-making. This study investigates whether obesity or sarcopenia has a greater impact on mortality in patients with severe respiratory infections. The study focuses on the National Pandemic Cohort Network (NAPKON-SUEP) cohort, which includes patients over 60 years of age with confirmed severe COVID-19 pneumonia. An innovative approach was adopted, using pre-trained deep learning models for automated analysis of body composition based on routine thoracic CT scans.

METHODS

The study included 157 hospitalized patients (mean age 70 ± 8 years, 41% women, mortality rate 39%) from the NAPKON-SUEP cohort at 57 study sites. A pre-trained deep learning model was used to analyze body composition (muscle, bone, fat, and intramuscular fat volumes) from thoracic CT images of the NAPKON-SUEP cohort. Binary logistic regression was performed to investigate the association between obesity, sarcopenia, and mortality.

RESULTS

Non-survivors exhibited lower muscle volume (p = 0.043), higher intramuscular fat volume (p = 0.041), and a higher BMI (p = 0.031) compared to survivors. Among all body composition parameters, muscle volume adjusted to weight was the strongest predictor of mortality in the logistic regression model, even after adjusting for factors such as sex, age, diabetes, chronic lung disease and chronic kidney disease, (odds ratio = 0.516). In contrast, BMI did not show significant differences after adjustment for comorbidities.

CONCLUSION

This study identifies muscle volume derived from routine CT scans as a major predictor of survival in patients with severe respiratory infections. The results underscore the potential of AI supported CT-based body composition analysis for risk stratification and clinical decision making, not only for COVID-19 patients but also for all patients over 60 years of age with severe acute respiratory infections. The innovative application of pre-trained deep learning models opens up new possibilities for automated and standardized assessment in clinical practice.

Role of Pectoralis Muscle Analysis in Breast Magnetic Resonance Imaging for Body Composition Evaluation Before and After Neoadjuvant Chemotherapy for Breast Cancer

Background: sarcopenia is a physical condition characterized by the loss of muscle mass and strength; it is associated with worse outcomes in oncological diseases and is recognized as an independent predictor of poor survival. The aim of our work is to evaluate the correlation between the pectoralis muscles area (PMA) calculated in breast MRI examinations and the body composition parameters assessed in CT examinations, in order to identify a threshold useful for diagnosing sarcopenia in breast cancer patients who are candidates for neoadjuvant chemotherapy (NACT), so as to be able to provide the correct nutritional counselling. Methods: we included 116 patients with non-metastatic breast cancer, who were studied with MRI before and after NACT, in the 2018-2023 period. All patients were categorized according to age, weight, height, and BMI. Using MRI scans, both before and after treatment, we measured the PMA at the level of the sternal angle of Louis and evaluated the changes caused by NACT, and we performed the same procedure for CT body composition parameters. Results: the ROC we calculated describes the ability of the PMA to discriminate sarcopenic patients from non-sarcopenic ones, identifying an optimal cut-off of 20.55, which achieves a specificity of 92%. The variations in PMA after NACT showed a strong, statistically significant association with the variations in all CT body composition parameters. Conclusions: these results introduce the possibility of also assessing body composition in breast MRI. The novelty in this study is to have estimated, on the basis of these correlations, a cut-off value that reflects the skeletal muscle index threshold for the definition of sarcopenia that is usually used.

Composite dietary antioxidant index of antioxidant vitamins and sarcopenia risk: insights from the UK biobank and NHANES cohorts

BACKGROUND

The composite dietary antioxidant index (CDAI), reflecting total dietary intake of antioxidant vitamins, may indicate overall antioxidant capacity. This study examined its association with the risk of probable sarcopenia, defined by handgrip strength, in older adults.

METHODS

Participants aged over 60 from the UK Biobank (N = 22,921) and National Health and Nutrition Evaluation Surveys (NHANES) 2011-2014 (N = 2,641) cohorts were categorized into probable sarcopenia and non-probable sarcopenia groups. Multivariable logistic regression models assessed the associations between CDAI (both continuous and quartile) and its components (vitamin A, vitamin C, vitamin E, and carotene) with probable sarcopenia risk in cohorts, with sex subgroup and sensitivity analyses to validate results.

RESULTS

The median (interquartile range) of CDAI was -0.39 (-1.88, 1.45) in the UK Biobank and -0.57 (-1.60, 0.84) in NHANES, respectively. A higher CDAI was significantly associated with a lower risk of probable sarcopenia in both cohorts. Specifically, each one-unit increase in CDAI was associated with a 2% decrease in the odds of probable sarcopenia in the UK Biobank (OR = 0.98, 95% CI = 0.97-0.998, p = 0.027) and a 13.5% decrease in NHANES (OR = 0.865, 95% CI = 0.75-0.997, p = 0.045), after full adjustment under the Sarcopenia Definition and Outcomes Consortium (SDOC) criteria. In quartile analyses, the risk of probable sarcopenia tended to decrease across higher CDAI quartiles, although the dose-response trend was not strictly linear. In the UK Biobank, multivariable-adjusted odds ratios (95% CIs) across increasing CDAI quartiles were: Q1 (reference), Q2 = 0.87 (0.78-0.97), Q3 = 0.91 (0.81-1.01), and Q4 = 0.86 (0.77-0.96). In NHANES, the trend was more pronounced: Q1 (reference), Q2 = 0.47 (0.24-0.94), Q3 = 0.39 (0.19-0.82), and Q4 = 0.46 (0.22-0.95). Additionally, higher dietary intake of carotene, one of the key antioxidant components, was independently associated with a lower risk of probable sarcopenia in both cohorts. Subgroup analyses indicated an inverse association between CDAI and probable sarcopenia risk in females across both cohorts, whereas no significant association was observed in males. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

Increased dietary intake of antioxidant vitamins may reduce the risk of probable sarcopenia in older adults, emphasizing the need for targeted prevention strategies. Further research on underlying mechanisms and sex differences is warranted.

Association between Clinical Characteristics and Sarcopenia or Sarcopenic Obesity in Crohn's Disease

Objective Crohn's disease (CD) is a chronic inflammatory bowel disease that is associated with malnutrition. Sarcopenia is a malnutrition condition characterized by skeletal muscle loss that impairs the physical function. We investigated the clinical characteristics of patients with CD with sarcopenia and sarcopenic obesity (sarcopenic-o). Methods The body composition of patients with CD was evaluated using a bioelectrical impedance analysis. The clinical characteristics of patients with sarcopenia and sarcopenic-o were analyzed, and a predictive model for sarcopenia was developed. Patients Patients with CD recruited from 2019 to 2021 were included. Results Among the 104 patients, 35 (33.7%) and 10 (9.6%) had sarcopenia and sarcopenic-o, respectively. In the sarcopenia group, the skeletal muscle index (SMI) and body mass index (BMI) were lower than those in the control group (SMI, 6.3 kg/m2 vs. 7.7 kg/m2, p<0.01; BMI, 18.8 kg/m2 vs. 22.6 kg/m2, p<0.01), whereas the Crohn's disease activity index (CDAI) was higher than in the control group (114.2 vs. 42.0, p<0.01). The predictive models of sarcopenia using the BMI and CDAI revealed high performance with areas under the receiver operating characteristic curve (AUC) of 0.87 and 0.72, respectively, and high specificity (0.94) and sensitivity (0.71), respectively. Sarcopenic-o patients could not be screened using the BMI (25 kg/m2), and the SMI and body fat percentage were negatively correlated in patients with sarcopenia (p<0.01). Conclusion Sarcopenia and sarcopenic-o are relatively common conditions among patients with CD. Sarcopenia can be predicted using the clinical parameters of BMI and CDAI. Sarcopenic-o can be a severe form of sarcopenia.

Association of the cardiometabolic index with sarcopenia among U.S. adults: NHANES 2011-2018 findings

BACKGROUND

The cardiometabolic index (CMI), initially devised as a diagnostic tool for diabetes mellitus, has evolved into a composite biomarker for evaluating metabolic syndrome and cardiovascular disease risk. In order to shed light on any possible interactions between sarcopenia and CMI, this study will look at the relationship between the two.

METHODS AND RESULTS

Data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed to investigate the possible link between sarcopenia and CMI. Among 3,185 eligible participants, the weighted prevalence of sarcopenia was 7.84%. A significant positive association emerged between CMI and sarcopenia risk, with each unit increase in CMI was linked with a 12% greater risk of sarcopenia in the fully adjusted model (OR: 1.12; 95% CI: 1.01-1.26). Moreover, dose-response relationships were evident across CMI tertiles (P for trend < 0.05). Subgroup analyses and interaction tests indicated that the positive correlation between CMI and the risk of sarcopenia differs significantly across subgroups defined by education level, sedentary time and CVD status (all P for interaction < 0.05).

CONCLUSIONS

Our findings demonstrate a robust association between elevated CMI levels and increased sarcopenia risk, suggesting CMI's potential utility as a clinical biomarker for sarcopenia risk surveillance. To confirm these results and demonstrate causality, more research is required.

Photobiomodulation therapy (PBMT) in skeletal muscle regeneration: A comprehensive review of mechanisms, clinical applications, and future directions

Photobiomodulation therapy (PBMT) emerged as a significant non-invasive method of stimulating regeneration of the skeletal muscle tissue. This review considers the pathophysiologic and molecular mechanisms of muscle repair, with a focus on the imperative of inflammation resolution, activation of satellite cells, mitochondrial ATP generation, and angiogenesis, with consideration of the role of PBMT. We systematically evaluate preclinical and clinical studies, highlighting the translational gaps caused by differences between controlled experimental models and the complex, heterogeneous nature of human muscle injuries. Variability in PBMT parameters-such as wavelength, fluence, and pulse mode-and the lack of standardized protocols are identified as major barriers to consistent therapeutic outcomes. Furthermore, we discuss the effects of PBMT in acute and chronic muscle injury models and provide an in-depth analysis of laser parameters to elucidate dose-response relationships. Future directions for research involve the application of real-time biofeedback devices, the utilization of artificial intelligence-based individualized therapeutic approaches, as well as the integration of photobiomodulation therapy with nanotechnology, biomaterials, and multiple mechanical stimulation methods. In concusion, while PBMT has significant potential for muscle regeneration therapies, its clinical application requires more complete mechanistic validation, rigorous standardization, and interdisciplinary technological development.

Identification of Target Body Composition Parameters by Dual-Energy X-Ray Absorptiometry, Bioelectrical Impedance, and Ultrasonography to Detect Older Adults With Frailty and Prefrailty Status Using a Mobile App in Primary Care Services: Descriptive Cross-Sectional Study

Background

Frailty syndrome in older adults represents a significant public health concern, characterized by a reduction in physiological reserves and an increased susceptibility to stressors. This can result in adverse health outcomes, including falls, hospitalization, disability, and mortality. The early identification and management of frailty are essential for improving quality of life and reducing health care costs. Conventional assessment techniques, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and muscle ultrasound (US), are efficacious but frequently constrained in primary care settings by financial and accessibility limitations.

Objective

The aim of this study is to analyze the differences in anthropometric characteristics, physical function, nutritional status, cognitive status, and body composition among older adults identified as frail, prefrail, or robust in primary care services using the PowerFrail mobile app. Furthermore, the study assesses the predictive capacity of body composition variables (whole-body phase angle [WBPhA] via BIA, US-measured rectus femoris muscle thickness, and DXA-derived lean mass) in identifying frailty and evaluates their feasibility for implementation in primary care.

Methods

A descriptive cross-sectional study was conducted with 94 older adult participants aged between 70 and 80 years, recruited through the Andalusian Health Service in Spain. Frailty status was classified using the PowerFrail App, which integrates muscle power assessment and provides personalized physical activity recommendations. Body composition was measured using WBPhA (BIA), muscle US, and DXA. Statistical analyses included 1-way ANOVA for group comparisons, logistic regression to investigate associations, and receiver operating characteristic curve analysis to evaluate the predictive accuracy of the body composition measures.

Results

Participants were categorized into frail (n=28), prefrail (n=33), and robust (n=33) groups. All body composition measures exhibited high specificity in detecting frailty, with varying sensitivity. Unadjusted US showed the highest specificity but low sensitivity (10.7%). WBPhA and right leg lean mass (LeanM RL) demonstrated significant predictive capabilities, especially when adjusted for age and sex, with area under the curve values ranging from 0.678 to 0.762. The adjusted LeanM RL model showed a good balance between sensitivity (35.7%) and specificity (93.9%; P=.045), indicating its potential as a reliable frailty predictor. These findings are consistent with previous research emphasizing the importance of muscle mass and cellular health in frailty assessment.

Conclusions

Body composition variables, particularly WBPhA, LeanM RL, and US, are effective predictors of frailty in older adults. The PowerFrail mobile app, combined with advanced body composition analysis, offers a practical and noninvasive method for early frailty detection in primary care settings. Integrating such technological tools can enhance the early identification and management of frailty, thereby improving health outcomes in the aging population.

Effect of Helicobacter pylori Eradication on Metabolic Parameters and Body Composition including Skeletal Muscle Mass: A Matched Case-Control Study

Background/Aims

Findings on the impact of Helicobacter pylori eradication on metabolic parameters are inconsistent. This study aimed to evaluate the effects of H. pylori eradication on metabolic parameters and body composition, including body fat mass and skeletal muscle mass.

Methods

We retrospectively reviewed the data of asymptomatic patients who underwent health screenings, including bioelectrical impedance analysis, before and after H. pylori eradication between 2005 and 2021. After matching individuals based on key factors, we compared lipid profiles, metabolic parameters, and body composition between 823 patients from the eradicated group and 823 patients from the non-eradicated groups.

Results

Blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin values were significantly lower in the eradicated group than in the non-eradicated group. However, changes in body mass index (BMI), body fat mass, appendicular skeletal muscle mass (ASM), waist circumference, and lipid profiles were not significantly different between the two groups. In a subgroup analysis of individuals aged >45 years, blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin changes were significantly lower in the eradicated group than in the non-eradicated group. BMI values were significantly higher in the eradicated group than in the non-eradicated group; however, no significant differences were observed between the two groups regarding changes in body weight, body fat mass, ASM, or waist circumference. Total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the eradicated group than in non-eradicated group.

Conclusions

H. pylori eradication significantly reduced blood pressure, glucose levels, and systemic inflammation and improved lipid profiles in patients aged >45 years. BMI, body fat mass, ASM, and waist circumference did not significantly differ between patients in the eradicated group and those in the non-eradicated group.

The influence of HIV on body composition and its relationship with physical function in mid-life women: a cross-sectional study from Zimbabwe

OBJECTIVE

Menopause-related changes in body composition and physical function are unclear in Southern Africa, particularly in the context of a generalized HIV epidemic with high antiretroviral therapy (ART) coverage.

METHOD

A total of 263 Zimbabwean women (53% women living with HIV [WLH]) aged 40-60 years provided data on menopause, ART use, anthropometry, body composition (appendicular lean mass [ALM], muscle area, fat mass), handgrip strength (HGS) and gait speed. Linear regression determined relationships between body composition and physical function, unadjusted and age-menopause-adjusted, stratified by HIV status. Univariate logistic regression investigated associations between body composition and self-reported falls.

RESULTS

WLH (96% ART established) were a median (interquartile range) 10.4 (6.4-14.5) years since diagnosis, with lower weight, body mass index, ALM, fat mass and HGS than women living without HIV (WLWOH). With menopause transition, WLH lost weight, ALM, gynoid mass and muscle area (all p-trend <0.05); however, WLWOH did not. Both WLH and WLWOH lost HGS (p-trend <0.05). ALM was positively associated with HGS in all women. In WLH, greater percentage body fat, particularly gynoid fat, was associated with increased odds of falls (1.69 [1.00-2.89], p = 0.049 and 1.72 [1.08-2.75], p = 0.023, respectively).

CONCLUSION

Women living with HIV were more likely to experience adverse changes in body composition through menopause; fat mass gains were associated with risk of falls.

Profile and risk stratification for sarcopenia in postmenopausal women

OBJECTIVE

This study aimed to assess the risk factors associated with sarcopenia and identify risk profiles through cluster analysis in postmenopausal women treated at specialized outpatient clinics.

METHODS

A retrospective cross-sectional study evaluated data from 287 postmenopausal women. Sarcopenia was determined by handgrip and gait speed testing. Cluster analysis was applied to identify risk subgroups, and logistic regression to identify factors associated with sarcopenia.

RESULTS

Sarcopenia was identified in 18.50% of women. Advanced age (odds ratio [OR] = 1.12; 95% confidence interval [CI]: 1.07-1.16; p < 0.01), number of pregnancies (OR = 1.14; 95% CI: 1.00-1.29; p = 0.04), hip Fracture Risk Assessment Tool (FRAX) (OR = 1.29; 95% CI: 1.12-1.49; p < 0.01), systemic arterial hypertension (OR = 3.20; 95% CI: 1.66-6.17; p < 0.01) and multiple comorbidities (OR = 2.46; 95% CI: 1.19-5.09, p = 0.01) were associated with higher risk for sarcopenia. Cluster analysis revealed an increased risk profile for women who were aged over 70 years, multiparous, hypertensive, with hip FRAX greater than 3% and with major fractures greater than 6%.

CONCLUSION

Postmenopausal women with sarcopenia are more likely to have fragility fractures at 10 years, to be older, multiparous and hypertensive, and to have multiple comorbidities.

Relationship between Tongue Pressure and Nutritional Status in Patients Undergoing Maintenance Hemodialysis: A Single-center Cross-sectional Study

Objectives

This study aimed to investigate tongue pressure in patients undergoing maintenance hemodialysis (MHD) and identify factors associated with tongue pressure, such as nutritional status and sarcopenia components.

Methods

This cross-sectional study included 80 outpatients undergoing MHD at our hospital between February and August 2024. Tongue pressure was measured using a tongue pressure measuring device. Patients were divided into groups of low tongue pressure (<30 kPa) and high tongue pressure (≥30 kPa). The geriatric nutritional risk index (GNRI) and the nutritional risk index for Japanese hemodialysis patients (NRI-JH) were used as nutritional indicators. To identify factors strongly associated with tongue pressure in MHD, a multiple regression analysis was performed, with tongue pressure as the dependent variable.

Results

The median age of the participants was 81.0 years. The mean tongue pressure was 29.0 kPa, and 58.8% of the patients had tongue pressure less than 30 kPa. Tongue pressure was significantly lower in the oldest age group (≥85 years) than in the younger groups (≤64 years and 65-74 years). Significant correlations were noted between tongue pressure and age, serum albumin, skeletal muscle mass index, phase angle, and handgrip strength. In the multivariate analysis, age, GNRI, and handgrip strength were independent predictors of tongue pressure.

Conclusions

This study revealed that age, handgrip strength, and GNRI were independently associated with tongue pressure in patients undergoing MHD. These factors may be used as indicators of tongue pressure in patients undergoing MHD.

Impact of Preoperative Skeletal Muscle Mass on Prognosis and Postoperative Change in Patients With Gastrointestinal Cancer

BACKGROUND

Skeletal muscle mass is a critical prognostic factor across various cancers; however, its differential impact on survival outcomes and the nature of postoperative changes remains inadequately explored. This study investigates the influence of preoperative skeletal muscle mass on survival and postoperative trends in skeletal muscle mass across gastrointestinal cancer types.

METHODS

The total psoas major muscle volume (TPV) was utilized as a skeletal muscle index, obtained from CT images of patients with gastrointestinal cancer. TPV measurements were extracted at multiple time points to assess changes over time.

RESULTS

A total of 1798 patients were included (esophageal: 554; gastric: 539; colorectal: 705). Patients with low skeletal muscle mass exhibited poorer prognoses across all cancer types. Among these, 969 patients (esophageal: 307; gastric: 278; colorectal: 384) had available postoperative follow-up CT scans at 1, 2, and 3 years. Annual decreases in TPV were observed across all cancer types; however, patients with colorectal cancer demonstrated a smaller decline in skeletal muscle mass compared to those with esophageal and gastric cancers (p < 0.05). In gastric and esophageal cancer patients, TPV was significantly lower in those with recurrence. Additionally, in gastric cancer, the reduction in TPV after distal gastrectomy was less than that observed after proximal or total gastrectomy.

CONCLUSION

This study underscores the prognostic significance of skeletal muscle mass in gastrointestinal cancer and its dynamic postoperative changes, highlighting the need for further investigation to enhance patient outcomes as the global cancer burden increases.

The association between circadian syndrome and possible sarcopenia in an aging population: A 4-year follow-up study

INTRODUCTION

Recently, circadian syndrome (CircS) is proposed as a novel risk cluster based on sleep disorder, depression, dyslipidemia, hyperglycemia, hypertension and abdominal obesity. To investigate the association between CircS and possible sarcopenia, this study was performed.

METHODS

Possible sarcopenia is defined according to Asian Working Group for Sarcopenia in 2019, which includes measures of muscle strength and physical performance. In the baseline survey, 7,905 participants aged ≥ 40 years from the China Health and Retirement Longitudinal Study were included. Multivariate logistic regression was used to evaluate the association between CircS and possible sarcopenia. Subgroup and interactive analyses were adopted to verify the findings in the overall population and identify potential interactive effects. The obese population was excluded and the missing values were interpolated using multivariate imputation by chained equations as sensitivity analyses. In addition, the participants were followed up for four years to explore the longitudinal association between CircS and incident possible sarcopenia.

RESULTS

As per one increase of CircS components, participants had a 1.11-fold (95% CI = 1.07-1.14, P < 0.001) risk of prevalent possible sarcopenia in the full model. The CircS group was associated with a 1.30-fold (95% CI = 1.17-1.44) risk of prevalent possible sarcopenia (P < 0.001). No significant interactive effects of covariates on the association between CircS and prevalent possible sarcopenia were detected (all P for interaction > 0.05). All the subgroup and sensitivity analyses supported the positive association between CircS and possible sarcopenia. In the longitudinal follow-up, the odd ratio was 1.06 (95% CI = 1.00-1.13, P < 0.05) as per one increase of CircS components in the full model. The CircS group was also found to have an elevated risk of incident possible sarcopenia (odd ratio = 1.24, 95% CI = 1.03-1.50, P < 0.05) after adjusting all the covariates.

CONCLUSIONS

CircS is a risk factor for possible sarcopenia, which may serve as a predictor of possible sarcopenia for early identification and intervention.

Automated three-dimensional body composition analysis identifies visceral adipose tissue radiodensity as a predictor of mortality and recurrence in colorectal cancer

BACKGROUND

Artificial intelligence enables automated three-dimensional (3D) volumetric body composition (BC) analysis from computed tomography (CT), opposed to single third lumbar vertebra (L3) slices alone. This study aimed to identify relationships between 3D BC and postoperative colorectal cancer (CRC) outcomes utilising Voronoi Health Analytics' Data Analysis Facilitation Suite software.

METHOD

Abdominopelvic skeletal muscle (SM), subcutaneous, and visceral adipose tissue volume and radiodensity were quantified from preoperative CT in 750 patients undergoing CRC resection. Non-contrast enhanced muscle, subcutaneous and visceral adipose tissue radiodensity (Hounsfield units) were adjusted using institution-specific correction values. Volumes were divided by abdominopelvic length, and (height)2, providing size-adjusted indices. Sex-specific cut-offs were defined for BC. Multivariate Cox regression assessed overall, and disease-free survival.

RESULTS

Sarcopenia [HR 1.389 (1.071-1.800), p = 0.013], myosteatosis [HR 1.526 (1.163-2.002), p = 0.002], visceral obesity [HR 2.020 (1.458-2.798), p <0.001], subcutaneous adipose tissue quantity depletion [HR 1.499 (1.117-2.011), p = 0.007], and elevated visceral adipose tissue radiodensity [HR 1.728 (1.171-2.548) p = 0.006] predicted poorer overall survival. Sarcopenia [HR 1.513 (1.019-2.247), p = 0.040] and elevated visceral adipose tissue radiodensity [HR 1.763 (1.148-2.708), p = 0.010] predicted disease recurrence. Elevated visceral adipose was significantly associated with T4 tumour stage [RR 1.621 (1.211-2.489), p = 0.004]; and lymphovascular invasion [RR 1.472 (1.043-2.078), p = 0.030].

CONCLUSION

As established in studies using L3 CT-slices, sarcopenia and myosteatosis in the 3D abdominopelvic region also predict CRC survival outcomes. Whilst further validation is required, elevated abdominopelvic visceral adipose tissue radiodensity is a potentially novel predictor of both mortality and recurrence. This was linked to a more aggressive tumour phenotype in this study.

Integration of resistance exercise into a multimodal approach to prehabilitation for patients with sarcopenia prior to surgery: a narrative review

Introduction

Sarcopenia describes the process of progressive, generalised loss of skeletal muscle mass and strength, and has been recognised as a predictor of postoperative complications and mortality. Prehabilitation represents a clinical strategy where patients undergo both physical and psychological strategies in order to improve their functional capacity prior to surgery. Importantly, prehabilitation programs have been considered as an area of perioperative optimisation to address sarcopenia. However, the optimal prehabilitation program regimen remains poorly characterised. Instead of suggesting a novel prehabilitation strategy for sarcopenic patients, this review seeks to characterise the best-practice modalities and methods of resistance training as a component of multimodal prehabilitation to improve patient outcomes following surgery.

Methods

A narrative review was performed following a search of Medline and Embase databases.

Results

There is significant heterogeneity in the literature regarding best-practive resistance exercise regimens for patients with sarcopenia who are awaiting surgery. Overall, the literature highlights that programs with early involvement of clinicians, dietitians, nutritionists, and psychological support programs have been shown to improve patient outcomes compared to programs that did not. Additionally, asides from muscular hypertrophy, resistance exercise programs have been shown to have a multifactorial impact on sarcopenia, synergistically improving the domains of nutrition, mental health, hormonal imbalance, and chronic inflammation. The ideal approach to resistance exercise remains poorly understood, with a paucity of evidence surrounding the best methods for delivering such regimens. Despite this, key considerations revealed by this review include the need for prehabilitation clinicians to consider key aspects of resistance training including training volume, intensity with consideration into periodisation and progressive overload. Collaboration with multidisciplinary networks such as physiotherapists, exercise physiologists and personal trainers should be considered to ensure a safe and injury-free approach to resistance exercise in prehabilitation.

Conclusion

While there remains a lack of standardisation of prehabilitation protocols, the evidence suggests that multimodal prehabilitation should be considered in evidence-based frameworks to improve patient outcomes following surgery. In particular, the ability of resistance exercises to address multiple domains relevant to sarcopenia, thereby enhancing patient outcomes beyond pure hypertrophy and playing a key role in prehabilitation.

Sarcopenia and its associated factors among hip fracture patients admitted to a North African (Egyptian) Level one trauma center, a cross-sectional study

OBJECTIVES

The study's objectives were to assess the sarcopenia prevalence in hip fracture patients admitted to a North African (Egyptian) level one specialized trauma unit and to evaluate factors associated with sarcopenia.

METHODS

This was an analytic, cross-sectional study where patients who were admitted with low-energy hip fractures and managed surgically were included. Assessment was performed using the SARC-F questionnaire, InBody device assessments (skeletal muscle mass (SMM), Fat mass, nutritional status (total water, protein, and minerals)), handgrip strength, and body mass index (BMI). Sarcopenia was diagnosed based on the revised European Working Group on Sarcopenia in Older People criteria (EWGSOP2).

RESULTS

The patients' mean age was 68 ± 8.3 years; 51.9% were females. The mean SMM was 24 ± 4.5 kg, while the mean handgrip strength was 20.55 ± 7.66 kg, sum SARC-F score was normal in 115 (85.2%) patients and abnormal in 20 (14.8%). Based on the EWGSOP2 criteria, 23 (17%) patients had sarcopenia, and 112 (83%) did not. The two groups were comparable regarding age and sex (p = 0.907 and 0.623, respectively). Sarcopenic patients had significantly lower values in BMI (21.9 vs. 25.9 kg/m2, p < 0.001), SMM (14.8 vs. 23, p < 0.001), BMR (p < 0.001), Fat mass (18.8 vs. 24.3, p = 0.003), and handgrip strength (16 vs. 20 kg, p = 0.034), however the sum SARC-F score ≥ 4 points, was higher in sarcopenic group (30.4% vs. 11.6%, p = 0.046). SMM, BMR, and fat mass showed large effect sizes (≥ 5), while the handgrip strength showed a medium effect size (0.3). There was a significant negative correlation between patients' age and handgrip strength (r = -0.394, p < 0.001), and a significant positive correlation between BMI and the SMM (r = 0.210, p = 0.014). Univariate logistic regression analysis revealed that the patient's BMI, fat mass, total water, protein, minerals, and the sum of SARC-F were significantly associated with sarcopenia development. However, on multivariate logistic regression analysis, two factors kept a significant association: the protein levels as a marker of nutritional reserve (OR = 0.044, 95%CI = 0.008 to 0.235, P < 0.001) and the sum SARC-F ≥ 4 points as a proxy for functional decline (OR = 6.365, 95%CI = 1.272 to 31.854, P = 0.024).

CONCLUSION

The sarcopenia prevalence in our hip fracture patients was 17%, where BMI, fat mass, and nutritional status had a significant negative association; on the other hand, the sum of SARC-F (≥ 4 points) had a significant positive association. However, after multivariate analysis, only protein levels and the sum of SARC-F remained significantly associated with sarcopenia.