Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014

Interrupting the trajectory of frailty in dementia with Lewy bodies with anabolic exercise, dietary intervention and deprescribing of hazardous medications

An 87-year-old man with dementia with Lewy bodies, living in residential aged care, exhibited rapid functional decline and weight loss associated with injurious falls over 9 months. Independent clinicians (geriatrician and exercise physiologist) assessed him during an extended wait-list period prior to his commencement of a pilot exercise trial. The highly significant role of treatable factors including polypharmacy, sarcopenia and malnutrition as contributors to frailty and rapid functional decline in this patient are described. The results of a targeted intervention of deprescribing, robust exercise and increased caloric intake on his physical and neuropsychological health status are presented. This case highlights the need to aggressively identify and robustly treat reversible contributors to frailty, irrespective of advanced age, progressive ‘untreatable’ neurodegenerative disease and rapidly deteriorating health in such individuals. Frailty is not a contraindication to robust exercise; it is, in fact, one of the most important reasons to prescribe it.

MicroRNAs in Skeletal Muscle Aging: Current Issues and Perspectives

Skeletal muscle is one of the major organs responsible for body movements and metabolism making up approximately 40% of the total body mass. During aging, skeletal muscle exhibits a degenerative age-associated decline in mass and function termed sarcopenia. This age-associated dysfunction of skeletal muscle is a major criterion of morbidity, mortality, and overall declines of quality of life in the elderly people. Therefore, researchers have focused on identifying modulators of muscle aging process including messenger RNAs, proteins, and recently small noncoding RNAs such as microRNAs (miRNAs). In particular, miRNAs have been demonstrated to play a critical role in skeletal muscle development and homeostasis. Recent studies revealed that miRNAs were also involved in muscle aging processes and the rejuvenation of aged muscle by regulating important molecules and pathways of aging including insulin-like growth factors, nicotine-adenine dinucleotide (+)-dependent protein deacetylase sirtuin-1, telomerase reverse transcriptase, and transforming growth factor-β signaling pathway. Over the years, miRNAs have emerged as promising candidates for biomarkers of sarcopenia and targets for interventions to slow muscle aging. Here, we comprehensively review the current knowledge on the role of miRNAs in skeletal muscle aging and highlight their potential as biomarkers or therapeutic targets for skeletal muscle health.

Software for the Diagnosis of Sarcopenia in Community-Dwelling Older Adults: Design and Validation Study

BACKGROUND

The usual diagnosis of sarcopenia requires a dual-energy x-ray absorptiometry (DXA) exam, which has low accessibility in primary care for Latin American countries.

OBJECTIVE

The aim of this study is to design and validate software for mobile devices (Android, IOS) and computers, based on an adapted version of the diagnostic algorithm of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

METHODS

Follow-up exams were conducted on 430 community-dwelling Chileans 60 years and older (mean 68.2 years, SD 4.9) participating in the IsaMayor and Alexandros cohorts designed to study sarcopenia and disability associated with obesity, respectively. All the participants from the cohorts were randomly selected from the registries of primary health care centers and, for this study, must have a DXA scan at baseline. The software (HTSMayor) was designed according to an adapted version of the algorithm proposed by the EWGSOP and was divided into four phases: longitudinal validation of diagnostic algorithm of sarcopenia, alpha version, beta version, and release version. The software estimates appendicular skeletal muscle mass (ASM) using an anthropometric equation or DXA measurements with Chilean cut-off points. The predictive validation of the algorithm was estimated, comparing functional limitations (at least one activity of daily living, two instrumental activities of daily living, or three mobility limitations), falls, and osteoporosis at follow-ups in patients with and without sarcopenia at baseline, using adjusted logistic models.

RESULTS

After a median follow-up of 4.8 years (2078.4 person-years), 37 (9.9%) new cases of sarcopenia, out of the 374 patients without sarcopenia at baseline, were identified (incidence density rate=1.78 per 100 person-years). ASM estimated with the anthropometric equation showed both a high sensitivity and specificity as compared with those estimated by DXA measurements, yielding a concordance of 0.96. The diagnostic algorithm of sarcopenia considered in the software with the equation showed both a high sensitivity (82.1%) and specificity (94.9%) when compared with DXA (reference standard). Adults without sarcopenia (at baseline) showed better physical performance (after approximately 5 years) than adults with sarcopenia. Loss of functionality was greater in adults with sarcopenia (OR 5.0, 95% CI 2.2-11.4) than in adults without sarcopenia. In addition, the risks of falls (OR 2.2, 95% CI 1.1-4.3) and osteoporosis (OR 2.8, 95% CI 1.2-6.6) were higher in older persons with sarcopenia than those without sarcopenia. The measurements and results were completed for the beta and release tests with a mean time of 10 minutes and 11 minutes, respectively.

CONCLUSIONS

We developed and validated a software for the diagnosis of sarcopenia in older Chilean adults that can be used on a mobile device or a computer with good sensitivity and specificity, thus allowing for the development of programs for the prevention, delay, or reversal of this disease. To our knowledge, HTSMayor is the first software to diagnose sarcopenia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/13657.

Lactobacillus paracasei PS23 decelerated age-related muscle loss by ensuring mitochondrial function in SAMP8 mice

Sarcopenia is a common impairment in the elderly population responsible for poor outcomes later in life; it can be caused by age-related alternations. Only a few strategies have been reported to reduce sarcopenia. Lactobacillus paracasei PS23 (LPPS23) has been reported to delay some age-related disorders. Therefore, here we investigated whether LPPS23 decelerates age-related muscle loss and its underlying mechanism. Female senescence-accelerated mouse prone-8 (SAMP8) mice were divided into three groups (n=6 each): non-aging (16-week-old), control (28-week-old), and PS23 (28-week-old) groups. The control and PS23 groups were given saline and LPPS23, respectively. We evaluated the effects of LPPS23 by analyzing body weight and composition, muscle strength, protein uptake, mitochondrial function, reactive oxygen species (ROS), antioxidant enzymes, and inflammation-related cytokines. LPPS23 significantly attenuated age-related decreases of muscle mass and strength. Compared to the control group, the non-aging and PS23 groups exhibited higher mitochondrial function, IL10, antioxidant enzymes, and protein uptake. Moreover, inflammatory cytokines and ROS were lower in the non-aging and PS23 groups than the control group. Taken together, LPPS23 extenuated sarcopenia progression during aging; this effect might have been enacted by preserving the mitochondrial function via reducing age-related inflammation and ROS and by retaining protein uptake in the SAMP8 mice.

The mechanisms and treatments for sarcopenia: could exosomes be a perspective research strategy in the future?

The age-related loss of muscle mass and muscle function known as sarcopenia is a primary contributor to the problems faced by the old people. Sarcopenia has been a major public health problem with high prevalence in many countries. The related underlying molecular mechanisms of sarcopenia are not completely understood. This review is focused on the potential mechanisms and current research strategies for sarcopenia with the aim of facilitating the recognition and treatment of age-related sarcopenia. Previous studies suggested that protein synthesis and degradation, autophagy, impaired satellite cell activation, mitochondria dysfunction, and other factors associated with muscle weakness and muscle degeneration may be potential molecular pathophysiology of sarcopenia. Importantly, we also prospectively highlight that exosomes (small vesicles) as carriers can regulate muscle regeneration and protein synthesis according to recent researches. Dietary strategies and exercise represent the interventions that can also alleviate the progression of sarcopenia. At last, building on recent studies pointing to exosomes with the roles in increasing muscle regeneration, mediating the beneficial effects of exercise, and serving as messengers of intercellular communication and as carriers for research strategies of many diseases, we propose that exosomes could be a potential research direction or strategies of sarcopenia in the future.

Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure

AIMS

We studied the association between android (A) to gynoid (G) fat ratio and functional capacity (peak VO₂ ) in male patients with heart failure with reduced ejection fraction (HFrEF).

METHODS AND RESULTS

We enrolled 118 male patients with HFrEF with left ventricular ejection fraction (LVEF) <40%. Body composition (by using dual x-ray absorptiometry) and peak VO₂ (by cardiopulmonary exercise testing) were measured. Sarcopenic obesity was defined according to the Foundation for the National Institutes of Health criteria (FNIH). Blood sample for metabolic and hormonal parameters were measured. Fifteen patients (12.7%) showed sarcopenic obesity (body mass index > 25 kg/m² with FNIH index < 0.789). The median A/G ratio was 0.55. A/G ratio > 0.55 was detected in 60 patients. Relative peak VO₂ was lower in patients with A/G ratio > 0.55 than in patients with A/G ratio <0.55 (18.7 ± 5.3 vs. 22.5 ± 6.1 mL/kg/min, P < 0.001). Logistic regression analysis showed A/G ratio >0.55 to be independently associated with reduced peak VO₂ adjusted for age, body mass index, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% confidence interval 1.030-14.730, P = 0.045).

CONCLUSIONS

Body fat distribution, particularly android and gynoid fat composition, together with other cofactors, might have an important adverse role on functional capacity in male patients with HFrEF. Future studies are needed to address possible mechanisms involved in this relationship.

Multidimensional Approach to Frailty

The concept of frailty syndrome (FS) was first described in the scientific literature three decades ago. For a very long time, we understood it as a geriatric problem, recently becoming one of the dominant concepts in cardiology. It identifies symptoms of FS in one in 10 elderly people. It is estimated that in Europe, 17% of elderly people have FS. The changes in FS resemble and often overlap with changes associated with the physiological aging process of the body. Although there are numerous scientific reports confirming that FS is age correlated, it is not an unavoidable part of the aging process and does not apply only to the elderly. FS is a reversible clinical condition. To maximize benefits of frailty-reversing activities for patient with frailty, identification of its determinants appears to be fundamental. Many of the determinants of the FS have already been known: reduction in physical activity, malnutrition, sarcopenia, polypharmacy, depressive symptom, cognitive disorders, and lack of social support. This review shows that insight into FS determinants is the starting point for building both the comprehensive definition of FS and the adoption of the assessment method of FS, and then successful clinical management.

Dysregulations of mitochondrial quality control and autophagic flux at an early age lead to progression of sarcopenia in SAMP8 mice

The senescence-accelerated mouse (SAM) prone 8 (SAMP8) has been demonstrated for muscular aging research including sarcopenia, but its underlying mechanisms remain scarce. Physiological indices and histology of skeletal muscle were analyzed in SAMP8 mice at different ages. SAMP8 mice exhibited typical features of sarcopenia at 40 weeks of age and were more time-efficient than that at 88 weeks of age in bothSAM resistant 1 (SAMR1) and C57BL/6 mice. Increase in FoxO3a-mediated transcription of Atrogin-1 and MuRF1 and decrease in phosphorylated mTOR/P70^s6k were observed at week 40 in SAMP8 mice. High oxidative stress was observed from week 24 and persisted to week 40 in SAMP8 mice evidenced by overexpression of protein carbonyl groups and reduced activities of CAT, SOD, and GPx. Downregulation of genes involved in mitochondrial biogenesis (PGC-1α, Nrf-1, Tfam, Ndufs8, and Cox5b) and in mitochondrial dynamics fission (Mfn2 and Opa1) from week 24 indicated dysregulation of mitochondrial quality control in SAMP8 mice. Impaired autophagic flux was observed in SAMP8 mice evidenced by elevated Atg13 and LC3-II accompanied with the accumulation of P62 and LAMP1. Increases in inflammatory factors (IL-6 and MCP-1), adipokines (leptin and resistin), and myostatin in serum at week 32 and decline in Pax7+ satellite cell resided next to muscle fibers at week 24 implied that muscle microenvironment contributed to the progression of sarcopenia in SAMP8 mice. Our data suggest that early alterations of mitochondrial quality control and autophagic flux worsen muscle microenvironment prior to the onset of sarcopenia.

Reductive stress impairs myogenic differentiation

Myo-satellite cells regenerate and differentiate into skeletal muscle (SM) after acute or chronic injury. Changes in the redox milieu towards the oxidative arm at the wound site are known to compromise SM regeneration. Recently, we reported that abrogation of Nrf2/antioxidant signaling promotes oxidative stress and impairs SM regeneration in C57/Bl6 mice. Here, we investigated whether the activation of intracellular Nrf2 signaling favors antioxidant transcription and promotes myoblast differentiation. Satellite cell-like C2C12 myoblasts were treated with sulforaphane (SF; 1.0 & 5.0 μM) to activate Nrf2/antioxidant signaling during proliferation and differentiation (i.e. formation of myotubes/myofibers). SF-mediated Nrf2 activation resulted in increased expression of Nrf2-antioxidants (e.g. GCLC and G6PD) and augmented the production of reduced glutathione (GSH) leading to a reductive redox state. Surprisingly, this resulted in significant inhibition of myoblast differentiation, as observed from morphological changes and reduced expression of MyoD, Pax7, and Myh2, due to reductive stress (RS). Furthermore, supplementation of N-acetyl-cysteine (NAC) or GSH-ester or genetic knock-down of Keap1 (using siRNA) also resulted in RS-driven inhibition of differentiation. Interestingly, withdrawing Nrf2 activation rescued differentiation potential and formation of myotubes/myofibers from C2C12 myoblasts. Thus, abrogation of physiological ROS signaling through over-activation of Nrf2 (i.e. RS) and developing RS hampers differentiation of muscle satellite cells.

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Sulforaphane activates Nrf2 and establishes reductive stress (RS) in C2C12 myoblasts.

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RS abolishes basal ROS and significantly impede the differentiation of myoblasts.

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Augmentation of glutathione using pharmacological agents (NAC and GSH-ester) promotes RS and impairs differentiation.

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Precluding RS restores the myoblast differentiation process.

Cancer cachexia: a multifactoral disease that needs a multimodal approach

PURPOSE OF REVIEW

Cancer cachexia is a complex condition that occurs in approximately 50% of cancer patients and in 80% of those with advanced cancer. It is characterized by lean body mass loss, adipose tissue loss, altered metabolism, increased inflammation, and a decrease in quality of life. Cancer cachexia is a frustrating condition to manage and treatment requires an innovative approach. The purpose of this article is to review the current treatments for cancer cachexia and how they could be used in a multimodal approach.

RECENT FINDINGS

Cancer cachexia has many causes, but is primarily a result of reduced energy-protein intake and altered metabolism augmented by a proinflammatory state. There is not a formal consensus on diagnosing cancer cachexia, but proactive screening and assessments for malnutrition are an effective first step toward identifying high-risk patients. Treatment of cancer cachexia includes optimizing nutrition care, using appropriate pharmacological agents, preserving lean body mass, and the cooperation of the healthcare team.

SUMMARY

Cancer cachexia is a complex multifactorial condition that can only be successfully managed and treated with a multimodal approach that involves a multidisciplinary team that includes an oncology registered dietitian nutritionist and exercise physiologist that target early detection and management of cancer cachexia.

Characteristics of Appendicular Tissue Components in Patients with Rheumatoid Arthritis

Background

The purpose of this study was to identify the characteristics of appendicular lean mass (ALM) associated with rheumatoid arthritis (RA) and to analyze appendicular tissue components in patients with RA.

Methods

We prospectively reviewed of patients with RA who underwent dual energy X-ray absorptiometry in a single center. From data of 28 patients, ALM was calculated. Regression analysis was used to investigate the association between ALM and RA. Using propensity score matching, patients with RA were compared to the control group from 18,698 patients of Korea National Health and Nutrition Examination Surveys data. RA and control group were matched in a 1: 5, respectively.

Results

In regression model, there was significantly negative association between disease activity score and ALM index in patients with RA in unadjusted (β=−0.387, 95% confidence interval [CI], −0.729 to −0.045) and model adjusted for age, sex, and body mass index (β=−0.227, 95% CI, −0.451 to −0.003). In matching with age and sex, the arms fat mass and fat fraction of RA group were significantly lower than that of control group. In matching with age, sex, and body mass index, the ALM index and legs lean mass of RA group were significantly higher than control group.

Conclusions

Patients with RA have a lower ALM with higher disease activity. In addition, we found that patients with RA had different tissue component in arms and legs compared to general population.

Correlations between the Quality of Life Domains and Clinical Variables in Sarcopenic Osteoporotic Postmenopausal Women

(1) Background: both sarcopenia and osteoporosis are major health problems in postmenopausal women. The aim of the study was to evaluate the quality of life (QoL) and the associated factors for sarcopenia in osteoporotic postmenopausal women, diagnosed according to EWGSOP2 criteria. (2) Methods: the study sample comprised 122 osteoporotic postmenopausal women with low hand grip strength and was divided into two groups: group 1 (probable sarcopenia) and group 2 (sarcopenia). QoL was assessed using the validated Romanian version of SarQol questionnaire. (3) Results: the D1, D4, D5, D7 and total SarQoL scores were significantly lower in women from group 2 compared to group 1. In group 2, women older than 70 years had significant lower values for D1, D3, D4, D6 and total SarQoL scores. Age, history of falls and the presence of confirmed and severe sarcopenia were predictors for overall QoL. (4) Conclusions: the frequency of sarcopenia was relatively high in our sample, with body mass index and history of falls as predictors for sarcopenia. Older osteoporotic postmenopausal women, with previous falls and an established sarcopenia diagnosis (low muscle strength and low muscle mass), were more likely to have a decreased quality of life.

Impaired Fracture Healing in Sarco-Osteoporotic Mice Can Be Rescued by Vibration Treatment Through Myostatin Suppression

Sarcopenia is highly prevalent in fragility fracture patients and is associated with delayed healing. In this study, we investigated the effect of low-magnitude high-frequency vibration (LMHFV) on osteoporotic fracture with sarcopenia and the potential role of myostatin. Osteoporotic fractures created in sarcopenic SAMP8, non-sarcopenic SAMR1 were randomized to control or LMHFV (SAMP8, SAMR1, SAMP8-V, or SAMR1-V) groups. Healing and myostatin expression were evaluated at 2, 4, and 6 weeks post-fracture. In vitro, conditioned-media were collected from myofibers isolated from aged and young SAMP8 or C2C12 myoblasts with or without LMHFV. Osteoblastic MC3T3-E1 under osteogenic differentiation were treated with plain or conditioned-medium (±myostatin propeptide). LMHFV significantly enhanced callus formation was in non-sarcopenic SAMR1 mice; but the enhancement effect was not significant in SAMP8 mice at week 2. Myostatin expressions in callus and biceps femoris of SAMP8 group were significantly higher all groups with significant negative correlation with callus size (R²  = 0.7256; p = 0.0004). Mechanical properties (week 4) and callus remodeling (week 6) were inferior in SAMP8 versus SAMR1 and were significantly enhanced by LMHFV. Alkaline Phosphatase (ALP) and Runx2 expression of MC3T3-E1 was lower in aged myofiber compared with young, but upregulated by LMHFV or myostatin inhibition; also confirmed with C2C12. LMHFV enhanced early callus formation, microarchitecture, callus remodeling and mechanical properties of fracture healing in both SAMP8 and SAMR1; however, more effective in non-sarcopenic SAMR1 mice. Impaired fracture healing in sarcopenic SAMP8 mice is attributed by elevated myostatin expression in callus and muscle, which correlated negatively with callus formation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:277-287, 2020.

Loop diuretic use is associated with skeletal muscle wasting in patients with heart failure

BACKGROUND

Loop diuretics are widely used for the management of fluid retention in patients with heart failure (HF). Sarcopenia, defined as decreased skeletal muscle mass, is frequently present in patients with HF and is associated with poor prognosis. The effects of loop diuretics on skeletal muscle in HF patients have not been fully elucidated. Here, we investigated the impact of loop diuretics on the skeletal muscle mass in patients with HF.

METHODS

We conducted a subanalysis of a cross-sectional study from 10 hospitals evaluating 155 patients with HF (age 67 ± 13 yrs, 69% men).

RESULTS

We compared the HF patients who were treated with loop diuretics (n = 120) with the patients who were not (n = 35). The thigh and arm circumferences were significantly small in the group treated with loop diuretics compared to those not so treated (39.9 ± 4.8 vs. 43.5 ± 6.9 cm, p < 0.001 and 26.7 ± 3.5 vs. 28.9 ± 6.2 cm, p < 0.001, respectively). In a univariate analysis, higher age, lower body mass index, lower hemoglobin, and loop diuretic use were significantly associated with smaller thigh circumference. In a multivariable analysis, the use of loop diuretics was independently associated with smaller thigh circumference (β = -0.51, 95% confidence interval -0.98 to -0.046, p = 0.032).

CONCLUSION

Loop diuretics are associated with decreased thigh and arm circumferences in patients with HF, independent of the severity of HF. Our findings revealed for the first time the adverse effects of loop diuretics on skeletal muscle wasting. These findings will have a significant impact in clinical practice regarding the frequent use of loop diuretics in HF patients.

Sarcopenia and Back Muscle Degeneration as Risk Factors for Back Pain: A Comparative Study

Study Design

Case-control study.

Purpose

To investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.

Overview of Literature

The Asian Working Group for Sarcopenia recommends diagnosis using handgrip strength, gait speed, and skeletal muscle mass. However, these criteria do not strongly reflect back muscle degeneration.

Methods

Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.

Results

The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.

Conclusions

We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

The Impact of Antidiabetic Agents on Sarcopenia in Type 2 Diabetes: A Literature Review

Sarcopenia is a geriatric syndrome characterized by decline of skeletal muscle mass and function. Contributing factors include nutritional, genetic, inflammatory, and endocrinal factors. The reported prevalence of sarcopenia in type 2 diabetes mellitus is high, especially in patients with poor glycemic control. Additionally, antidiabetic agents may alter the balance between protein synthesis and degradation through various mechanisms of skeletal muscle mass regulation. This study reviewed the literature on the pathogenesis of sarcopenia in diabetes mellitus and the current understanding of whether antidiabetic agents contribute positively or negatively to sarcopenia and muscle wasting.

Validation of the Danish SARC-F in Hospitalized, Geriatric Medical Patients

OBJECTIVES

Validation of the Danish version of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) for hospitalized geriatric medical patients, compared against the original EWGSOP (European Working Group on Sarcopenia in Older People) and revised EWGSOP2 definition for sarcopenia. Additionally, investigation of the ability of SARC-F to individually identify low strength/function and muscle mass.

DESIGN

Cross-sectional analysis of data from an RCT.

SETTING

Hospital, Medical Department.

PARTICIPANTS

122 geriatric medical patients (65.6% women) ≥ 70 years of age with mixed medical conditions.

MEASUREMENTS

SARC-F screening, diagnostic assessment of sarcopenia (hand-grip strength, muscle mass measured by dual-frequency bio-impedance analysis, and 4-m usual gait speed).

RESULTS

The prevalence of risk of sarcopenia (SARC-F ≥ 4) was 48.3%, while it was diagnosed in 65.8% and 21.7%, with EWGSOP and EWGSOP2, respectively. The sensitivity, specificity, positive predictive value, negative predictive value according to EWGSOP were 50.0 %, 53.7 %, 67.2% and 36.1%, while they were 53.8 %, 53.2 %, 24.1% and 80.6%, according to EWGSOP2 (all participants). The ability of SARC-F to predict reduced strength, function, and muscle mass was modest. There was a significant negative linear, yet weak, relationship between total SARC-F score and hand-grip strength (R2=0.033) and 4-m gait speed (R2=0.111), but not muscle mass (R2=0.004).

CONCLUSION

SARC-F does not seem to be a suitable screening tool for identifying and excluding non-sarcopenic geriatric patients. Furthermore, the SARC-F score was more strongly correlated with reduced muscle strength and physical function than with low muscle mass.

Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia

Background

Sarcopenia is a decrease in skeletal muscle mass, physical performance, and muscle strength in older people. In this study, we aimed to explore the correlation between comorbidity and skeletal muscle mass and physical performance in older people.

Methods

This retrospective study included 168 subjects. Their medical history, physical function, computed tomography (CT) chest scans, and blood tests for nutrition were evaluated. The patients were divided into two groups: (1) a low muscle mass group and (2) a normal muscle mass group. Multivariate analysis of variance was used to compare multiple sets of mean vectors.

Results

Overall, 72.02% of the subjects had a low skeletal muscle index (SMI) and low gait speed. The patients with low skeletal muscle mass and physical performance were older, had more serious comorbidities, and had longer average hospitalization periods and lower albumin and hemoglobin levels. Subjects with a high Charlson comorbidity index (CCI) were more likely to be in the sarcopenic group than in the non-sarcopenic group. In addition, there was a linear correlation between the CCI and SMI (r = − 0.549, P < 0.05), and between the CCI and gait speed (r = − 0.614, P < 0.05). The area under the curve (AUC) value for low skeletal muscle mass with the CCI was 0.879.

Conclusions

We identified an independent association between comorbidity and skeletal muscle mass/physical performance by researching the correlation between the CCI and SMI/gait speed. Our results suggested that the CCI score may have important clinical diagnostic value for sarcopenia.

Effect of Sleep Quality on the Prevalence of Sarcopenia in Older Adults: A Systematic Review with Meta-Analysis

Sarcopenia is an age-related condition. However, the prevalence of sarcopenia may increase due to a range of other factors, such as sleep quality/duration. Therefore, the aim of the study is to conduct a systematic review with meta-analysis to determine the prevalence of sarcopenia in older adults based on their self-reported sleep duration. Methods: Three electronic databases were used-PubMed-Medline, Web of Science, and Cochrane Library. We included studies that measured the prevalence of sarcopenia, divided according to sleep quality and excluded studies (a) involving populations with neuromuscular pathologies, (b) not showing prevalence values (cases/control) on sarcopenia, and (c) not including classificatory models to determine sleep quality. Results: high prevalence values in older adults with both long and short sleep duration were shown. However, prevalence values were higher in those with inadequate sleep (<6-8 h or low efficiency) (OR 0.76; 95% CI (0.70-0.83); Q = 1.446; p = 0.695; test for overall effect, Z = 6.01, p < 0.00001). Likewise, higher prevalence levels were shown in men (OR 1.61; 95% CI (0.82-3.16); Q = 11.80; p = 0.0189) compared to women (OR 0.77; 95% CI (0.29-2.03); Q = 21.35; p = 0.0003). Therefore, the prevalence of sarcopenia appears to be associated with sleep quality, with higher prevalence values in older adults who have inadequate sleep.

Sarcopenic Factors May Have No Impact on Outcomes in Ovarian Cancer Patients

Although the prognostic value of sarcopenic factors, such as loss of muscle mass and quality, have been widely reported in patients with cancer during the last decade, the value in those with ovarian cancer remains unclear. Therefore, this study evaluated the prognostic impact of sarcopenic factors in patients with ovarian cancer. We retrospectively evaluated the data of 94 ovarian cancer patients who underwent surgery and chemotherapy at the Shimane University Hospital between March 2006 and 2013. Preoperative computed tomography scan at the level of the third lumbar vertebra was used to evaluate skeletal muscle volume and quality based on the skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. The impact of preoperative SMI and IMAC on outcomes was subsequently investigated. Low SMI and high IMAC were not significantly associated with disease-free survival (p = 0.329 and p = 0.3370, respectively) or poor overall survival (p = 0.921 and p = 0.988, respectively). Neither preoperative low muscle volume nor low muscle quality was a poor prognostic factor in ovarian cancer.

An exploration of the prevalence and experience of cardiac cachexia: protocol for a mixed methods cross-sectional study

BACKGROUND

Cachexia is a complex and multifactorial syndrome defined as severe weight loss and muscle wasting which frequently goes unrecognised in clinical practice [1]. It is a debilitating syndrome, resulting in patients experiencing decreased quality of life and an increased risk of premature death; with cancer cachexia alone resulting in 2 million deaths per annum [2]. Most work in this field has focused on cancer cachexia, with cardiac cachexia being relatively understudied - despite its potential prevalence and impact in patients who have advanced heart failure. We report here the protocol for an exploratory study which will: 1. focus on determining the prevalence and clinical implications of cardiac cachexia within advanced heart failure patients; and 2. explore the experience of cachexia from patients' and caregivers' perspectives.

METHODS

A mixed methods cross-sectional study. Phase 1: A purposive sample of 362 patients with moderate to severe heart failure from two Trusts within the United Kingdom will be assessed for known characteristics of cachexia (loss of weight, loss of muscle, muscle mass/strength, anorexia, fatigue and selected biomarkers), through basic measurements (i.e. mid-upper arm circumference) and use of three validated questionnaires; focusing on fatigue, quality of life and appetite. Phase 2: Qualitative semi-structured interviews with patients (n = 12) that meet criteria for cachexia, and their caregivers (n = 12), will explore their experience of this syndrome and its impact on daily life. Interviews will be digitally recorded and transcribed verbatim, prior to qualitative thematic and content analysis. Phase 3: Workshops with key stakeholders (patients, caregivers, healthcare professionals and policy makers) will be used to discuss study findings and identify practice implications to be tested in further research.

DISCUSSION

Data collected as part of this study will allow the prevalence of cardiac cachexia in a group of patients with moderate to severe heart failure to be determined. It will also provide a unique insight into the implications and personal experience of cardiac cachexia for both patients and carers. It is hoped that robust quantitative data and rich qualitative perspectives will promote crucial clinical discussions on implications for practice, including targeted interventions to improve patients' quality of life where appropriate.

Muscle Evaluation in Axial Spondyloarthritis-The Evidence for Sarcopenia

Sarcopenia is a syndrome defined as a progressive and generalized skeletal muscle disorder associated with an increased likelihood of adverse outcomes such as falls, fractures, physical disability, and death. The actual definition of sarcopenia is based on a reduction in the values of three parameters: strength, muscle mass quantity or quality, and physical performance (the determinant of severity). Muscle wasting is a common feature in several chronic diseases, such as spondyloarthritis (SpA), and significantly increases patient morbidity and mortality. Although there has been huge progress in this field over recent years, the absence of a clear definition and clear diagnostic criteria of sarcopenia has resulted in inconsistent information regarding muscle-involvement in SpA. Thus, the aim of this review is to collect relevant evidence on muscular changes occurring during the disease process from the published literature, according to the recommended tools for sarcopenia evaluation proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). In addition, data from histological, electromyography, and biochemical muscle analyses of SpA patients are also reviewed. Overall, a reduction in muscle strength with a systemic decrease in lean mass seems to be associated with a gait speed compromise. This information is usually fragmented, with no studies considering the three parameters together. This paper represents a call-to-action for the design of new studies in the future.

Exercise training counteracts urothelial carcinoma-induced alterations in skeletal muscle mitochondria phospholipidome in an animal model

Cancer associated body wasting is the cause of physical disability, reduced tolerance to anticancer therapy and reduced survival of cancer patients and, similarly to cancer, its incidence is increasing. There is no cure for this clinical condition, and the pathophysiological process involved is largely unknown. Exercise training appears as the gold standard non-pharmacological therapy for the management of this wasting syndrome. Herein we used a lipidomics approach based on liquid chromatography coupled with high-resolution mass spectrometry (LC-HR-MS) to study the effect of exercise in the modulation of phospholipids profile of mitochondria isolated from gastrocnemius muscle of a pre-clinical model of urothelial carcinoma-related body wasting (BBN induced), submitted to 13 weeks of treadmill exercise after diagnosis. Multivariate analysis showed a close relationship between the BBN exercise group and both control groups (control sedentary and control exercise), while the BBN sedentary group was significantly separated from the control groups and the BBN exercise group. Univariate statistical analysis revealed differences mainly in phosphatidylserine (PS) and cardiolipin (CL), although some differences were also observed in phosphatidylinositol (PI, LPI) and phosphatidylcholine (PC) phospholipids. PS with shorter fatty acyl chains were up-regulated in the BBN sedentary group, while the other species of PS with longer FA and a higher degree of unsaturation were down-regulated, but the BBN exercise group was mostly similar to control groups. Remarkably, exercise training prevented these alterations and had a positive impact on the ability of mitochondria to produce ATP, restoring the healthy phospholipid profile. The remodelling of mitochondria phospholipid profile in rats with urothelial carcinoma allowed confirming the importance of the lipid metabolism in mitochondria dysfunction in cancer-induced skeletal muscle remodelling. The regulation of phospholipid biosynthetic pathways observed in the BBN exercise group supported the current perspective that exercise is an adequate therapeutic approach for the management of cancer-related muscle remodeling.

["Diabesity"-Obesity and type 2 diabetes (Update 2019)]

For several years obesity and type 2 diabetes have been increasingly summarized under the name "diabesity". This is due to the fact that in most cases obesity precedes diabetes and is the most important risk factor for the worldwide increase of type 2 diabetes. The body mass index (BMI) is a very crude measure of body fatness in individuals. Even normal weight persons can have too much body fat in cases of a lack of muscle mass (sarcopenia), which is why additional measurements of waist circumference and body fatness, e. g. bioimpedance analysis (BIA), are recommended. Lifestyle management including nutrition modification and increase in physical activity are important measures for the prevention and treatment of diabetes. Regarding the treatment of type 2 diabetes, body weight is increasingly used as a secondary target parameter. The choice of anti-diabetic treatment and also concomitant treatment is increasingly influenced by body weight. The significance of anti-obesity medications in the treatment of type 2 diabetes will have to be clarified by future studies with body weight as the primary endpoint. Bariatric surgery is at present indicated with a BMI >35 kg/m² with concomitant risk factors, such as diabetes and can lead at least to partial diabetes remission but has to be incorporated into an appropriate lifelong care concept.

Development of a Mobility Diet Score (MDS) and Associations With Bone Mineral Density and Muscle Function in Older Adults

Introduction: Reduced bone mineral density (BMD) and muscle function is associated with increased risk of multiple health related issues. Diet may play a role in sustaining BMD and muscle function throughout old age, but much is still to be learned with regards to which specific food groups and dietary patterns that are important for such outcomes. The aim of the current study was to identify food groups important for both BMD and muscle function. Methods: A narrative review was performed on studies published on dietary patterns and their association with BMD and muscle function, respectively. Based on these findings, two dietary indices were constructed characterizing food groups associated with BMD and muscle function, respectively. Associations between adherence to these indices and BMD and muscle function were then investigated in a population of older community-dwelling Danes. Food groups found to be associated with both BMD and muscle function in our study population were suggested for inclusion into a common dietary index named the Mobility Diet Score. Results: In contrast to previous studies, adherence to a dietary index based on foods previously linked to BMD could not be established as important for BMD in our study population of 184 older individuals (53.3% men). We found that adhering to a dietary index characterized by higher intakes of whole grains, dairy products, fish, legumes, nuts, fruit, and vegetables is associated with faster 400 m walking speeds and an increased number of chair stands measured over a 30 s time period. Since no food group could be established as important for both BMD and muscle function in our study population, a Mobility Diet Score could not be established. However, based on our narrative review, the food groups commonly associated with improved BMD and muscle function are similar. Conclusion: Adherence to a dietary index characterized by high intakes of whole grains, dairy products, fish, legumes, nuts, fruit, and vegetables was not found to be associated with BMD in a group of community-dwelling older Danes. However, our results indicate that the adherence to such foods could be important in sustaining physical function in older individuals.

Associations between Skeletal Muscle and Myocardium in Aging: A Syndrome of "Cardio-Sarcopenia"?

OBJECTIVES

The link between skeletal muscle and heart disease remains intriguing. It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function, particularly in the presence of aging-related sarcopenia. We hypothesize that among aging adults with sarcopenia, alterations in myocardial structure and/or function may exist, resulting in a syndrome of "cardio-sarcopenia."

METHODS

Participants derived from a community cohort study underwent same-day bioimpedance body composition analysis that measured skeletal muscle in sites such as the trunk, upper limb, and lower limb, and echocardiography for assessment of myocardial structure and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria.

RESULTS

We studied a total of 378 participants, of whom 88 (23.3%) had sarcopenia. Participants with sarcopenia had smaller left ventricular (LV) sizes (lower LV internal diameter end diastole (4.1 ± .7 vs 4.5 ± .6 cm; P < .0001), lower LV internal diameter end systole (2.3 ± .5 vs 2.5 ± .4 cm; P = .010), lower LV posterior wall end diastole (.7 ± .1 vs .8 ± .1 cm; P = .0036), and lower LV posterior wall end systole (1.4 ± .3 vs 1.5 ± .2 cm; P = .0031). Sarcopenic participants also had lower LV mass (106 ± 35 vs 126 ± 53; P = .0014) and lower left atrial (LA) volume (33 ± 13 vs 36 ± 13; P = .033). Adjusting for age and diabetes mellitus, skeletal muscle mass was associated with LV diameter (β = .06; 95% confidence interval [CI] = .03-.09; P < .0001), LV mass (β = 4.04; 95% CI = 1.78-6.29; P = .001), LA diameter (β = .05; 95% CI = .01-.09; P = .007), and LA volume (β = 1.26; 95% CI = .38-2.13; P = .005). A positive linear correlation was observed between LV mass and handgrip strength (r = .25; P < .0001).

CONCLUSION

Among a community sample of older adults with preserved heart function, sarcopenia is associated with reductions in LV and LA sizes. Skeletal muscle mass was independently associated with specific indices of myocardial structure. J Am Geriatr Soc 67:2568-2573, 2019.

ADNP differentially interact with genes/proteins in correlation with aging: a novel marker for muscle aging

Activity-dependent neuroprotective protein (ADNP) is essential for embryonic development with ADNP mutations leading to syndromic autism, coupled with intellectual disabilities and motor developmental delays. Here, mining human muscle gene-expression databases, we have investigated the association of ADNP transcripts with muscle aging. We discovered increased ADNP and its paralogue ADNP2 expression in the vastus lateralis muscle of aged compared to young subjects, as well as altered expression of the ADNP and the ADNP2 genes in bicep brachii muscle of elderly people, in a sex-dependent manner. Prolonged exercise resulted in decreased ADNP expression, and increased ADNP2 expression in an age-dependent manner in the vastus lateralis muscle. ADNP expression level was further correlated with 49 genes showing age-dependent changes in muscle transcript expression. A high degree of correlation with ADNP was discovered for 24 genes with the leading gene/protein being NMNAT1 (nicotinamide nucleotide adenylyl transferase 1). Looking at correlations differentiating the young and the old muscles and comparing protein interactions revealed an association of ADNP with the cell division cycle 5-like protein (CDC5L), and an aging-muscle-related interactive pathway in the vastus lateralis. In the bicep brachii, very high correlation was detected with genes associated with immune functions as well as mitochondrial structure and function among others. Taken together, the results suggest a direct association of ADNP with muscle strength and implicate ADNP fortification in the protection against age-associated muscle wasting.

The impact of sarcopenia on health-related quality of life in elderly people: Korean National Health and Nutrition Examination Survey

BACKGROUND/AIMS

The purpose of the study is to investigate the associations between sarcopenia and health-related quality of life in elderly men and women in Korea.

METHODS

In a cross-sectional study using data from 2008 to 2011 Korean National Health and Nutrition Examination Survey, 4,937 adults aged 60 years and older who underwent a dual-energy X-ray absorptiometry scan were included in the study. Sarcopenia is defined as an appendicular skeletal muscle index of two standard deviations or more below the mean for young, healthy reference populations. The health-related quality of life was measured using the EuroQol-5 dimension questionnaire.

RESULTS

The overall prevalence of sarcopenia was 6.6% in these Korean people over the age of 60 years: 11.1% for men and 3.2% for women. Sarcopenic men tended to have lower income, lower physical activity, lower body mass index, and smaller waist circumference compared with nonsarcopenic men. Sarcopenic women tended to have higher body mass index and larger waist circumference compared with nonsarcopenic women. Sarcopenic men showed higher impairments in mobility, self-care, usual activities, and pain/discomfort compared with nonsarcopenic men. Women with sarcopenia also showed higher impairments in mobility, self-care, usual activities, and anxiety/depression compared with nonsarcopenic women. Sarcopenia showed an association with impairments in selfcare for men, and with impairments in self-care, usual activities, and anxiety/depression for women, after adjusting for other confounding factors.

CONCLUSION

There is a significant association between sarcopenia and impaired health-related quality of life in this elderly Korean population, and these results differ between men and women.

Deep learning-based muscle segmentation and quantification at abdominal CT: application to a longitudinal adult screening cohort for sarcopenia assessment

OBJECTIVE

To investigate a fully automated abdominal CT-based muscle tool in a large adult screening population.

METHODS

A fully automated validated muscle segmentation algorithm was applied to 9310 non-contrast CT scans, including a primary screening cohort of 8037 consecutive asymptomatic adults (mean age, 57.1±7.8 years; 3555M/4482F). Sequential follow-up scans were available in a subset of 1171 individuals (mean interval, 5.1 years). Muscle tissue cross-sectional area and attenuation (Hounsfield unit, HU) at the L3 level were assessed, including change over time.

RESULTS

Mean values were significantly higher in males for both muscle area (190.6±33.6 vs 133.3±24.1 cm², p<0.001) and density (34.3±11.1 HU vs 27.3±11.7 HU, p<0.001). Age-related losses were observed, with mean muscle area reduction of -1.5 cm²/year and attenuation reduction of -1.5 HU/year. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes up to the age of 70 years. Between ages 50 and 70, relative muscle attenuation decreased significantly more in females (-30.6% vs -18.0%, p<0.001), whereas relative rates of muscle area loss were similar (-8%). Between ages 70 and 90, males lost more density (-22.4% vs -7.5%) and area (-13.4% vs -6.9%, p<0.001). Of the 1171 patients with longitudinal follow-up, 1013 (86.5%) showed a decrease in muscle attenuation, 739 (63.1%) showed a decrease in area, and 1119 (95.6%) showed a decrease in at least one of these measures.

CONCLUSION

This fully automated CT muscle tool allows for both individualized and population-based assessment. Such data could be automatically derived at abdominal CT regardless of study indication, allowing for opportunistic sarcopenia detection.

ADVANCES IN KNOWLEDGE

This fully automated tool can be applied to routine abdominal CT scans for prospective or retrospective opportunistic sarcopenia assessment, regardless of the original clinical indication. Mean values were significantly higher in males for both muscle area and muscle density. Overall age-related muscle density (attenuation) loss was steeper than for muscle area for both sexes, and therefore may be a more valuable predictor of adverse outcomes.

Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation

OBJECTIVES

To determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors' influence on survival.

METHODS

Prospective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up.

RESULTS

The study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95%CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95%CI: 0.307-0.560) was associated with lower mortality.

CONCLUSIONS

Sarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients

Background

Sarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study was to assess the prevalence of these syndromes and their overlap in older medical inpatients.

Methods

Patients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated.

Results

One hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m² were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes.

Conclusions

Nearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.

Nutritional status and body fat mass: Determinants of sarcopenia in community-dwelling older adults

BACKGROUND

Sarcopenia is defined as the old age syndrome characterized by profound decline in muscle mass and function. This study aimed to investigate the prevalence of sarcopenia and its risk factors in older adults.

METHODS

Totally, 501 older people aged 65 years and older were recruited. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia (AWGS). For obtaining Skeletal Muscle mass Index (SMI), body composition was evaluated using Bioelectrical Impedance Analysis (BIA). Muscle strength and physical performance were measured by Handgrip Strength (HGS) and Gait Speed (GS), respectively. Nutritional status, physical activity level, and biochemical indicators were assessed, as well.

RESULTS

The prevalence of sarcopenia was 20.8%. Multiple logistic regression models of the predictors of decline in the components of sarcopenia showed that older age, low Body Mass Index (BMI), and serum albumin level were associated with a higher risk of low SMI. Low serum albumin level and older age were also predictive of low HGS. Besides, old age, high body fat mass, and low BMI were the risk factors of low GS. Conversely, increased Calf Circumference (CC) was protective against low SMI and GS. Finally, older age, male gender, low BMI, decreased mini-nutritional assessment score, low serum albumin level, and high body fat were associated with a higher risk of sarcopenia, whereas higher CC reduced its risk.

CONCLUSION

The prevalence of sarcopenia is high among elderly individuals. This study underlined that sarcopenia might develop in older adults with impaired nutritional status and high body fat mass. Further studies could evaluate the effects of appropriate nutritional interventions on sarcopenia management and prevention.

Plasma Transthyretin as A Biomarker of Sarcopenia in Elderly Subjects

Skeletal muscle (SM) mass, the chief component of the structural compartment belonging to lean body mass (LBM), undergoes sarcopenia with increasing age. Decreased SM in elderly persons is a naturally occurring process that may be accelerated by acute or chronic nutritional deficiencies and/or inflammatory disorders, declining processes associated with harmful complications. A recently published position paper by European experts has provided an overall survey on the definition and diagnosis of sarcopenia in elderly persons. The present review describes the additional contributory role played by the noninvasive transthyretin (TTR) micromethod. The body mass index (BMI) formula is currently used in clinical studies as a criterion of good health to detect, prevent, and follow up on the downward trend of muscle mass. The recent upsurge of sarcopenic obesity with its multiple subclasses has led to a confused stratification of SM and fat stores, prompting workers to eliminate BMI from screening programs. As a result, investigators are now focusing on indices of protein status that participate in SM growth, maturation, and catabolism that might serve to identify sarcopenia trajectories. Plasma TTR is clearly superior to all other hepatic biomarkers, showing the same evolutionary patterns as those displayed in health and disease by both visceral and structural LBM compartments. As a result, this TTR parameter maintains positive correlations with muscle mass downsizing in elderly persons. The liver synthesis of TTR is downregulated in protein-depleted states and suppressed in cytokine-induced inflammatory disorders. TTR integrates the centrally-mediated regulatory mechanisms governing the balance between protein accretion and protein breakdown, emerging as the ultimate indicator of LBM resources. This review proposes the adoption of a gray zone defined by cut-off values ranging from 200 mg/L to 100 mg/L between which TTR plasma values may fluctuate and predict either the best or the worst outcome. The best outcome occurs when appropriate dietary, medicinal and surgical decisions are undertaken, resuming TTR synthesis which manifests rising trends towards pre-stress levels. The worst occurs when all therapeutic means fail to succeed, leading inevitably to complete exhaustion of LBM and SM metabolic resources with an ensuing fatal outcome. Some patients may remain unresponsive in the middle of the gray area, combining steady clinical states with persistent stagnant TTR values. Using the serial measurement of plasma TTR values, these last patients should be treated with the most aggressive and appropriate therapeutic strategies to ensure the best outcome.

Whey protein in cancer therapy: A narrative review

Cancer remains a public health challenge in the identification and development of ideal pharmacological therapies and dietary strategies. The use of whey protein as a dietary strategy is widespread in the field of oncology. The two types of whey protein, sweet or acid, result from several processing techniques and possess distinct protein subfraction compositions. Mechanistically, whey protein subfractions have specific anti-cancer effects. Alpha-lactalbumin, human α-lactalbumin made lethal to tumor cell, bovine α-lactalbumin made lethal to tumor cell, bovine serum albumin, and lactoferrin are whey protein subfractions with potential to hinder tumor pathways. Such effects, however, are principally supported by studies performed in vitro and/or in vivo. In clinical practice, whey protein intake-induced anti-cancer effects are indiscernible. However, whey protein supplementation represents a practical, feasible, and cost-effective approach to mitigate cancer cachexia syndrome. The usefulness of whey protein is evidenced by a greater leucine content and the potential to modulate IGF-1 concentrations, representing important factors towards musculoskeletal hypertrophy. Further clinical trials are warranted and needed to establish the effects of whey protein supplementation as an adjuvant to cancer therapy.

Sarcopenia in patients with malignant pleural effusion: impact on symptoms, health status, and response to hospitalization

BACKGROUND

Malignant pleural effusion (MPE) refers to the presence of neoplastic cells in the pleural fluid and was previously associated with lung cancer, breast cancer, and lymphoma. Patients with MPE effusion have significant symptoms, diminishing their overall quality of life but little is known about the influence sarcopenia may have on their clinical presentation.

PURPOSE

To examine the prevalence of sarcopenia in patients with MPE and its relationship with symptoms, health status, and the response to hospitalization.

METHODS

Seventy-four patients with MPE underwent measurements of symptoms, health-related quality of life, and functional status upon admission, discharge, and 3 months after hospital discharge.

RESULTS

Patients with MPE and sarcopenia were symptomatic during hospitalization and at discharge. Additionally, health-related quality of life and functional status were worse in patients with MPE and sarcopenia. All measures of patients with MPE and sarcopenia were significantly poorer 3 months after hospital discharge.

CONCLUSIONS

Sarcopenia is a clinical characteristic with substantial negative effects in patients with MPE. Specific interventions may need to be provided, designed, and offered in the clinical setting.