Sarcopenia: A Time for Action. An SCWD Position Paper

Androgens as the "old age stick" in skeletal muscle

Aging is associated with a reduction in skeletal muscle fiber size and number, leading to a decline in physical function and structural integrity-a condition known as sarcopenia. This syndrome is further characterized by elevated levels of inflammatory mediators that promote skeletal muscle catabolism and reduce anabolic signaling.Androgens are involved in various biological processes, including the maintenance, homeostasis and trophism of skeletal muscle mass. The decline in androgen levels contributes, indeed, to androgen deficiency in aging people. Such clinical syndrome exacerbates the muscle loss and fosters sarcopenia progression. Nevertheless, the mechanism(s) by which the reduction in androgen levels influences sarcopenia risk and progression remains debated and the therapeutic benefits of androgen-based interventions are still unclear. Given the significant societal and economic impacts of sarcopenia, investigating the androgen/androgen receptor axis in skeletal muscle function is essential to enhance treatment efficacy and reduce healthcare costs.This review summarizes current knowledge on the role of male hormones and their-dependent signaling pathways in sarcopenia. We also highlight the cellular and molecular features of this condition and discuss the mechanisms by which androgens preserve the muscle homeostasis. The pros and cons of clinical strategies and emerging therapies aimed at mitigating muscle degeneration and aging-related decline are also presented.

Bone and muscle mass characteristics in patients with gastroenteropancreatic neuroendocrine neoplasms

BACKGROUND

Neuroendocrine neoplasms (NEN) are rare tumors arising from neuroendocrine cells most commonly in the gastrointestinal-tract. In recent years, advancements in therapeutics have increased survival rates in patients with NEN leading to a greater clinical burden compared to the general population.

METHODS

The aim of this single-center case-control study was to investigate the incidence of low bone mass and changes in body composition in adult patients diagnosed with gastroenteropancreatic neuroendocrine tumors (GEPNET). Enrolled participants underwent measurements of bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) and body composition analysis with calculation of total fat-mass (TFM) and relative skeletal mass index (RSMI), by dual X-ray absorptiometry.

RESULTS

Ninety GEPNET patients (28 with Pancreatic-NET, 20 with small-intestine-NET, 42 with gastric-NET), and 50 age and sex-matched controls were enrolled. The mean disease duration was 5±4.4 years, the majority of patients (54/90) was classified as stage-1, and were not receiving systemic-treatment (76/90). The incidence of osteoporosis/osteopenia was threefold higher in the patients' cohort, compared to controls (OR: 3.17 95% CI 1.16-7.8, p < 0.001). Among NEN patients, gastric-NET had the lowest bone mass, especially in LS. In addition, GEPNET patients demonstrated significantly lower TFM and RSMI, compared to controls (TFM: 31.6 ± 9.6 kg vs. 38.6 ± 6.4 kg, respectively, p = 0.03; RSMI: 6.4 ± 1.1 vs. 8.2 ± 0.6, respectively, p < 0.001). Within our patients' cohort, RSMI was significantly associated with LS-BMD (rho = 0.49, p < 0.001) and TH-BMD (rho = 0.58, p < 0.001), and TFM was associated with TH-BMD (rho = 0.31, p = 0.004).

CONCLUSIONS

Patients with GEPNET even at an early stage exhibit significantly lower bone, muscle and fat mass compared to the non-NET population, highlighting the importance of continuous monitoring of the musculoskeletal system in these patients.

Development of an Algorithm to Predict Appendicular Lean Mass Index From Regional Spine and Hip Dxa Scans

INTRODUCTION

Sarcopenia is characterized by progressive muscle loss with reduced physical function and/or reduced muscle strength. Operational definitions of sarcopenia include a measurement of muscle mass, most often from dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass. Appendicular lean mass can be derived from whole-body dual-DXA scans; however, these scans are performed less commonly than hip and spine scans as part of clinical care. The objective of our study was to develop an algorithm to predict appendicular lean mass index (ALMI) from regional spine and hip dual-energy X-ray absorptiometry (DXA) scans.

METHODS

We performed a retrospective cross-sectional study using a subset of patients from the Manitoba Bone Mineral Density Registry who had hip, spine, and whole-body DXA scans at the same visit. We developed the algorithm using the following candidate covariates: age, sex, height, weight, DXA-derived spine and hip fat fraction, DXA-derived spine and hip tissue thickness. We internally validated the algorithm using the bootstrap method. Mean bootstrap parameter estimates were used as the final equation.

RESULTS

DXA scans from 676 patients were included in the analytic dataset. Mean ALMI was 6.73 (SD 1.43) kg/m2. The final predictive model included sex, age, height, weight, spine fat fraction and hip fat fraction. Sex also acted as an interaction term on weight and hip fat fraction. After bootstrap validation, model adjusted R2 was 0.863, root mean square error was 0.529 kg/m2, and AUROC to predict low ALMI per the European Working Group on Sarcopenia version 2 was 0.88.

CONCLUSION

Hip and spine DXA scans can be used to predict appendicular lean mass index. Future studies should test whether these predictions can be used to assess relationships between sarcopenia and other clinical conditions.

Effect of vitamin D, omega-3 supplementation, or a home exercise program on muscle mass and sarcopenia: DO-HEALTH trial

BACKGROUND

We aimed to investigate the effect of daily supplemental vitamin D, omega-3s, and a thrice-weekly home exercise program, alone or in combination, on change of appendicular lean muscle mass index (ALMI) and incident sarcopenia in older adults.

METHODS

This is a secondary endpoint analysis of a 3-year randomized, double-blind, placebo-controlled trial with a 2 × 2 × 2 factorial design among 2157 community-dwelling, healthy adults aged 70 + years, from 2012 to 2018 (DO-HEALTH). Participants were randomized to 2000 IU/d vitamin D and/or 1 g/d marine omega-3s and/or exercise. Change in ALMI over 3 years was calculated in all participants who underwent dual energy X-ray absorptiometry (DXA) (n = 1495) using mixed effect models. Incident sarcopenia was analyzed based on the Sarcopenia Definitions and Outcomes Consortium in all non-sarcopenic participants (n = 1940).

RESULTS

Among 1495 participants (mean age 74.9 (sd 4.4); 63.3% were women; 80.5% were at least moderately physically active at baseline) mean gait speed at baseline was 1.2 m/s (sd 0.3), mean ALMI at baseline was 6.65 (SD 0.95) in women, and 8.01 (SD 0.88) kg/m2 in men. At year 3, average change of ALMI was -0.09 (sd 0.34) kg/m2 (-1.35%) in women and - 0.17 (sd 0.33) kg/m2 (-2.0%) in men. None of the treatments individually or in combination had a benefit on ALMI change compared to control over 3 years, with omega-3s showing a small protective effect on ALMI at year 1 only (-0.021 vs. no-omega-3s -0.066 kg/m2, p = 0.001). Of 1940 non-sarcopenic participants at baseline, 88 (4.5%) developed incident sarcopenia over 3 years. None of the treatments individually or in combination reduced the odds of incident sarcopenia compared with placebo.

CONCLUSION

Among healthy, physically active older adults, ALMI and incidence of sarcopenia were not improved by treatment of daily 2000 IU vitamin D, daily 1 g omega-3s, or a simple home exercise program compared with control over 3 years.

Association between handgrip strength and muscle mass in children 6 to 10 years old

BACKGROUND AND AIMS

Sarcopenia, defined as a muscle mass loss and function, is increasingly recognized in pediatric populations, particularly in childhood obesity. Therefore, it is necessary to have measurements that can distinguish between muscle and fat mass. Methods of body composition such as Dual Energy X-ray Absorptiometry (DEXA) provide accurate assessments of body composition, but they are resource-intensive and impractical for routine monitoring in clinical or community settings. To address this, handgrip strength (HGS) may be used for assessing muscle mass. This study investigates the association between muscle mass and HGS in children aged 6-10 years.

METHODS

A cross-sectional study of 110 participants was conducted with children aged 6-10 years who could follow instructions in English, lay still for 6-7 min, and had not entered puberty. Children with disabilities that affected muscle mass or hand strength were excluded. Height, weight, mid-upper arm circumference, lean body mass (LBM), fat mass (FM), fat-free mass (FFM), and bone mineral density (BMD) were measured. Pearson correlations between all body composition measurements and HGS were conducted. The best predictors of muscle mass were determined using stepwise analysis.

RESULTS

A significant correlation between HGS and fat-free mass index (FFMI) (R = 0.39) (p < 0.001) among children aged 6-10 years and lean body mass index (LBMI) (R = 0.42) (p = 0.005) in children aged 8-10 years old was found. HGS with BMI (p < 0.0001) were the best predictors of FFMI and LBMI.

CONCLUSION

HGS was associated with muscle mass and may provide insight on body composition changes in children. Integrating HGS with BMI into routine clinical practice could enhance comprehensive evaluation of body composition.

Physical exercise for primary sarcopenia: an expert opinion

Sarcopenia is the age-related loss of skeletal muscle mass and function. Recently, research has focused on defining diagnostic criteria for this condition, now recognized as a muscle disease with a specific identifying code (ICD-10: M62.84). The diagnostic process for sarcopenia involves several stages, including the use of dedicated questionnaires and objective measurements of muscle strength and mass. According to international guidelines, therapeutic exercise is recommended to improve muscle mass, muscle strength, and physical performance. However, much of the supporting evidence comes from studies on non-sarcopenic elderly patients. Among types of therapeutic exercise, guidelines mainly emphasize muscle strengthening. The prescription of therapeutic exercise must consider the clinical and functional conditions of the patient (e.g., the presence of severe sarcopenia) and patient preferences. Muscle strengthening should target large muscle groups and include low-intensity resistance exercise for strength improvement, or high-intensity resistance exercise for additional benefits in muscle mass and function. Evidence suggests that an ideal therapeutic exercise program for sarcopenic patients should be multimodal, incorporating muscle strengthening, aerobic exercise, and balance control programs. This approach could enhance patient adherence by offering variety. Although multimodal therapeutic exercise improves muscle mass and function, these benefits can be lost during prolonged physical inactivity. Therefore, the exercise prescription must define intensity, volume (repetitions and sets), frequency, rest intervals, and duration, tailored to the type of exercise. Aerobic training programs improve endurance and optimize mitochondrial function. Balance training, important for reducing the risk of falls, should be done at least three times a week. Muscle strengthening should be done at least two days a week, starting at 50%-60% of 1 repetition maximum (RM) and progressing to 60%-80% of 1 RM, with approximately 10 exercises per session. Adopting comprehensive prescription protocols, such as those proposed in this paper, can significantly aid in the functional recovery and well-being of patients with sarcopenia.

Mid- and long-term associations between food insecurity and sarcopenia

BACKGROUND

Sarcopenia is a complex geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass, muscle strength, and physical performance. Nutritional factors, including food insecurity, have been reported to be important in the development of sarcopenia. However, evidence on the relationship between sarcopenia and food insecurity is limited, especially with longitudinal data.

AIMS

This study aimed to examine the longitudinal association between sarcopenia, severe sarcopenia, and food insecurity in a nationally representative sample of older adults in Mexico.

METHODS

We used data from the four waves (2009, 2014, 2017, 2021) of the World Health Organization Study on Global Ageing and Adult Health in Mexico. The sample consisted of 1,484 older adults aged 50 years or older. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People. Food insecurity was assessed with two questions related to frequency of eating less and hunger due to lack of food in the last 12 months.

RESULTS

Moderate (OR = 1.13; 95%CI: 1.09-1.20) and severe food insecurity (OR = 1.19; 95%CI: 1.11-1.27) significantly increased the longitudinal rates of sarcopenia or severe sarcopenia. Meanwhile, the incidence of severe food insecurity increased the cumulative incidence rate of sarcopenia and severe sarcopenia (OR = 1.91; 95%CI: 1.24-2.94).

DISCUSSION

Since food insecurity is a modifiable structural factor, the implementation of specific programs to alleviate its deleterious consequences is warranted.

CONCLUSIONS

This study shows that moderate and severe food insecurity are associated with an increase in the rates of sarcopenia and severe sarcopenia over time.

Bile acid signaling in skeletal muscle homeostasis: from molecular mechanisms to clinical applications

The intricate relationship between bile acid metabolism and skeletal muscle function has emerged as a crucial area of research in metabolic health. This review synthesizes current evidence highlighting the fundamental role of bile acids as key signaling molecules in muscle homeostasis and their therapeutic potential in muscle-related disorders. Recent advances in molecular biology and metabolomics have revealed that bile acids, beyond their classical role in lipid absorption, function as essential regulators of muscle mass and function through multiple signaling pathways, particularly via the nuclear receptor FXR and membrane receptor TGR5. Clinical studies have demonstrated significant associations between altered bile acid profiles and muscle wasting conditions, while experimental evidence has elucidated the underlying mechanisms linking bile acid signaling to muscle protein synthesis, energy metabolism, and regeneration capacity. We critically examine the emerging therapeutic strategies targeting bile acid pathways, including receptor-specific agonists, microbiome modulators, and personalized interventions based on individual bile acid profiles. Additionally, we discuss novel diagnostic approaches utilizing bile acid-based biomarkers and their potential in early detection and monitoring of muscle disorders. This review also addresses current challenges in standardization and clinical translation while highlighting promising future directions in this rapidly evolving field. Understanding the bile acid-muscle axis may provide new opportunities for developing targeted therapies for age-related muscle loss and metabolic diseases.

Effect of Resistance Training on Older Adults with Sarcopenic Obesity: A Comprehensive Systematic Review and Meta-Analysis of Blood Biomarkers, Functionality, and Body Composition

Background/Objectives: Sarcopenic obesity (SO) is a clinical condition in which there is an excess of fat mass and a loss of muscle mass, strength, and function. Its prevalence increases with age, particularly in adults over 65 years old. However, debate persists on the definition and assessment of SO. The purpose of this review is to examine the impact of resistance training on older adults with sarcopenic obesity. Methods: This review included studies investigating the effects of resistance training interventions in older adults with SO. A comprehensive literature search was conducted across six databases (PubMed, SCOPUS, Cochrane Library, Embase, EBSCO, and Web of Science), yielding 1882 articles. The risk of bias in the included studies was assessed using the PEDro scale and the GRADE system. Results: Eleven randomized clinical trials were analyzed qualitatively and nine were analyzed quantitatively. The meta-analysis demonstrated that exercise interventions revealed the positive effects of exercise mainly on physical performance ([SMD] = 0.36, [95% CI] = 0.03, 0.69, p = 0.003) and body composition ([SMD] = 0.35, [95% CI] = 0.12, 0.57, p = 0.003), with no significant differences in biomarkers ([SMD] = 0.1, [95% CI] = -0.28, 0.49, p = 0.52). Conclusions: Resistance training benefits older adults with SO, improving body composition and physical function, whereas there were no significant differences in blood biomarkers. The present review highlights the limitations of the existing evidence base. Many included studies exhibited methodological shortcomings, necessitating the cautious interpretation of findings. Future research should prioritize rigorous study designs, including larger sample sizes and extended follow-up periods, to enhance the precision and generalizability of results.

Advancing insights: a bibliometric analysis of evolutionary patterns and research frontiers in ultrasound-derived quantitative assessment of skeletal muscle

Background

Quantitative ultrasound has emerged as a promising tool for measuring skeletal muscle mass and quality. Given the growing need for early detection of muscle dysfunction and sarcopenia, this study aims to provide a comprehensive bibliometric analysis of the current state of knowledge in this field, identifying key trends, gaps, and themes to guide future research and clinical applications.

Methods

A bibliometric analysis was performed on articles retrieved from the Science Citation Index-Expanded (SCI-EXPANDED) database within the Web of Science Core Collection up to April 28, 2024. The 'bibliometrix' R package was utilized to synthesize main findings, quantify the occurrences of top keywords, and visualize international collaboration networks. Keyword co-occurrence and co-authorship were analyzed utilizing VOSviewer. Additionally, CiteSpace facilitated the identification of cited references and keywords exhibiting highest citation bursts.

Results

A total of 3,379 publications were analyzed. The United States, Japan, and China emerged as the leading contributors to this field. The European Journal of Applied Physiology was identified as the most prolific journal, and Takashi Abe was distinguished for achieving the leading H-index. "Strength" and "reliability" topped the keyword frequency list. "Insulin resistance", "impact", "shear wave elastography", "risk", and "sarcopenia" were keywords that continued to burst as of 2024, which indicated the potential emerging research topics and future frontiers.

Conclusions

This bibliometric analysis, encompassing over forty years of literature on quantitative ultrasound assessment of skeletal muscle, delineated key contributions from countries, institutions, authors, and journals. The findings highlight the utility of quantitative ultrasound as a critical tool in assessing skeletal muscle mass and function, demonstrating its global impact and research trends.

Epidermal growth factor receptor contributes to indirect regulation of skeletal muscle mass by androgen

Androgen is widely acknowledged to regulate skeletal muscle mass. However, the specific mechanism driving muscle atrophy resulting from androgen deficiency remains elusive. Systemic androgen receptor knockout (ARKO) mice exhibit reduction in both muscle strength and muscle mass while skeletal muscle fiber specific ARKO mice have decreased muscle strength without affecting skeletal muscle mass in the limbs. Therefore, androgens may indirectly regulate skeletal muscle mass through effects on non-myofibers. Considering this, our investigation focused on blood fluid factors that might play a role in the regulation of skeletal muscle mass under the influence of androgens. Using a male mouse model of sham, orchidectomy and DHT replacement, mass spectrometry for serum samples of each group identified epidermal growth factor receptor (EGFR) as a candidate protein involving the regulation of skeletal muscle mass affected by androgens. Egfr expression in both liver and epididymal white adipose tissue correlated with androgen levels. Furthermore, Egfr expression in these tissues was predominantly elevated in male compared to female mice. Interestingly, male mice exhibited significantly elevated serum EGFR concentrations compared to their female counterparts, suggesting a connection with androgen levels. Treatment of EGFR to C2C12 cells promoted phosphorylation of AKT and its downstream S6K, and enhanced the protein synthesis in vitro. Furthermore, the administration of EGFR to female mice revealed a potential role in promoting an increase in skeletal muscle mass. These findings collectively enhance our understanding of the complex interplay among androgens, EGFR, and the regulation of skeletal muscle mass.

Glomerular Filtration of Creatinine: Validation of a Novel Index of Muscle Mass Among Older Adults

RATIONALE & OBJECTIVE

Low muscle mass is common among older adults and associated with poor prognosis. Quantifying muscle mass is challenging in routine clinical practice. We hypothesized that glomerular filtration of creatinine (GFcr) reflects muscle mass, and previously proposed estimated GFcr (eGFcr), as a practical index of muscle mass in older adults. This study investigated whether measured GFcr (mGFcr) and eGFcr are similarly associated with the direct measure of muscle mass, the thigh total muscle lean area (TTMLA).

STUDY DESIGN

Cross-sectional analysis of a community-based prospective cohort.

SETTING & PARTICIPANTS

A total of 794 older adults with measured glomerular filtration rate (mGFR) and TTMLA in the AGES-Reykjavik Study.

EXPOSURE

Measured GFcr, the product of serum creatinine (Scr) and mGFR obtained using plasma iohexol clearance and eGFcr, the product of Scr and estimated glomerular filtration rate using serum cystatin C (Scys).

OUTCOME

TTMLA measured using computed tomography.

ANALYTICAL APPROACH

Sex-specific Pearson's correlation and linear regression analyses using continuous and categorical mGFcr and eGFcr. Covariates included demographic, behavioral, and clinical variables, and comorbid conditions.

RESULTS

The mean age and mGFR were 80.3±4.0 (SD) years and 62.3±16.5 (SD) mL/min/1.73m2, respectively. The lowest sex-specific tertile of mGFcr, compared with the highest tertile, was associated with a 14.6 (95% CI, 11.5-17.6) cm2/1.73m2 lower TTMLA in men, and a 7.9 (95% CI, 5.5-10.2) cm2/1.73m2 lower TTMLA in women. Significant associations were observed between eGFcr and TTMLA. Correlations of eGFcr with TTMLA were generally as strong or stronger than correlations of alternative indices derived from Scr and Scys.

LIMITATIONS

Residual confounding by measured and unmeasured variables.

CONCLUSIONS

These findings support the validity of GFcr as an index of muscle mass among older adults and the use of eGFcr as a practical alternative to mGFcr in the clinical setting.

PLAIN-LANGUAGE SUMMARY

Low muscle mass is common among older adults and is associated with poor clinical outcomes. Quantifying muscle mass is challenging in routine clinical practice. We evaluated whether glomerular filtration of creatinine (GFcr) could serve as an index of muscle mass. We performed a cross-sectional study including 794 older adults who underwent computed tomography for thigh muscle lean area as a directly measured indicator of total body muscle mass. Significant positive associations between thigh muscle lean area and both measured GFcr (serum creatinine [Scr] ×measured glomerular filtration rate [GFR]) and estimated GFcr (Scr ×estimated GFR based on serum cystatin C [Scys]), a more practical index, were shown. These findings suggest the value of using eGFcr, a simply obtained novel index in the clinical setting, to assess muscle mass among older adults.

Circulating apelin levels fail to link sarcopenia-related muscle parameters in older adults

BACKGROUND

Based on the compelling experimental evidence supporting apelin's beneficial effects on muscle metabolism, our study aimed to evaluate the role of circulating apelin levels as a biomarker for muscle health in humans.

METHODS

This investigation employed a cross-sectional design, encompassing 237 community-dwelling older adults aged ≥65 years who underwent comprehensive geriatric evaluations in South Korea. Sarcopenia diagnosis was based on Asian-specific criteria, and serum apelin concentrations were determined using enzyme immunoassay techniques.

RESULTS

Following adjustment for potential confounding factors, no significant disparities in serum apelin levels were observed between sarcopenic and non-sarcopenic individuals, nor were differences detected based on skeletal muscle mass, strength, or physical performance categories (P = 0.335 to 0.765). Furthermore, circulating apelin concentrations showed no significant correlations with any sarcopenia assessment metrics, including skeletal muscle index, grip strength, gait speed, chair stand test duration, or short physical performance battery score (P = 0.170 to 0.832). Elevations in serum apelin levels were not significantly associated with the risk of sarcopenia or compromised muscle phenotypes (P = 0.452 to 0.896). Additionally, stratification of participants into quartiles based on serum apelin concentrations revealed no significant variations in sarcopenia-related parameters across groups (P = 0.197 to 0.592).

CONCLUSION

These findings suggest that, contrary to previous studies in cellular and animal models where apelin demonstrated a protective impact on muscle homeostasis, such effects may not translate to the human context, and contribute valuable clinical evidence indicating that serum apelin may not serve as a reliable biomarker for sarcopenia.

Sarc-Global: a new sarcopenia screening tool in older adults

BACKGROUND

Sarcopenia is associated with clinical complications that increase mortality in older adults. Current screening tools, such as Sarc-F and Sarc-CalF, focus primarily on muscular performance but have limited sensitivity in identifying elderly individuals at risk of sarcopenia. The present study aims to develop a more comprehensive sarcopenia risk screening tool, Sarc-Global, which integrates additional anthropometric and clinical variables to enhance the sensitivity and accuracy of sarcopenia risk assessment in older adults.

METHODS

The aim of this cross-sectional study was to develop a sarcopenia risk screening tool, named Sarc-Global, with enhanced sensitivity, incorporating factors pertinent to the overall health of elderly individuals. Utilizing the criteria established by EWGSOP2 for diagnosing sarcopenia, we evaluated 395 community-dwelling elderly individuals. This evaluation served as a reference for assessing the efficacy of two validated questionnaires, Sarc-F and Sarc-CalF, and our newly developed Sarc-Global.

RESULTS

Multiple logistic regression revealed that Sarc-Global integrates variables such as sex, age, medication use, body mass index, arm circumference, and handgrip strength, which are significantly associated with sarcopenia (p<0.001). When combined with Sarc-CalF, these variables form the basis of the Sarc-Global model. In screening for sarcopenia risk, Sarc-Global demonstrated superior accuracy, specificity, and sensitivity (74%), outperforming Sarc-F (21%) and Sarc-CalF (34%).

CONCLUSION

Sarc-Global proves to be an effective tool for identifying elderly individuals at risk of sarcopenia.

Sarcopenia, Depressive Symptoms, and Fall Risk: Insights from a National Cohort Study in the Chinese Population

Background

Previous investigations have indicated that both sarcopenia and depressive symptoms are linked to a heightened risk of falls. However, the potential synergistic effect of these conditions on fall risk remains unclear. This study aims to assess the combined influence of sarcopenia and depressive symptoms on the occurrence of falls in the Chinese population.

Methods

The analysis included 8,405 participants from the China Health and Retirement Longitudinal Study (CHARLS), conducted from 2011 to 2015. Sarcopenia was confirmed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm consisting of muscle strength, appendicular skeletal muscle mass (ASM), and physical performance. ASM was calculated using the formula: 0.193 × weight (kg) + 0.107 × height (cm) - 4.157 × sex - 0.037 × age (years) - 2.631. The Center for Epidemiological Research Depression Scale was utilized to assess depressive symptoms, with a cut-off score of 12 points. Depressive sarcopenia is defined as the coexistence of sarcopenia and depression. Multiple logistic regression analyses were conducted to explore the associations among sarcopenia, depressive symptoms, and fall occurrences.

Results

During the four-year follow-up, 1,275 participants reported experiencing falls. A significant synergistic effect was identified between sarcopenia and depressive symptoms regarding fall risk. Compare to robust individuals, those with sarcopenia alone or depression alone had increased falls risks, but those with both conditions exhibited the highest fall risk, with adjusted odds ratios (OR) of 1.21 (95% CI 1.03, 1.42; P = 0.0174), 1.53 (95% CI 1.24, 1.88; P < 0.001), and 1.78 (95% CI 1.48, 2.15; P < 0.001), respectively.

Conclusion

The findings highlight a synergistic effect between sarcopenia and depressive symptoms on fall risk. This study highlights the importance of early detection and intervention for both conditions, especially in older and middle-aged individuals, to mitigate fall risk.

Macronutrient Utilization After Short-term Fasting in Older and Younger Men and Women, a Pilot Study

Background/Objective

While older people are more prone than younger people to periods of involuntary fasting, systematic assessment of all the three major sources of macronutrient mobilization and oxidation in the same individual older participants during short-term periods of fasting has not been previously reported. Because aging is associated with many metabolic, hormonal, and body composition changes, older humans may have different kinetics of utilization of macronutrient stores during fasting than younger ones. This pilot study aimed to generate exploratory data to test this hypothesis.

Methods/Subjects

We examined four groups of five participants each in this study, women and men, and older and younger subjects. We measured body composition by dual-energy X-ray absorptiometry (DEXA) and studied the effects of a 12-hour and a 36-hour fast on protein mobilization, lipolysis, and glucose output (substrate rates of appearance, using stable isotope tracers), as well as macronutrient oxidation.

Results

The older participants had a greater percent body fat. Respiratory exchange ratios (RER) decreased with the longer fast. In a linear mixed model analysis of the metabolic data, age was not significant as a fixed effect when added to the model, except for glycerol rate of appearance and leucine oxidation rate.

Conclusions

The effects of age and sex on mobilization and oxidation of macronutrient stores, as assessed with stable isotope tracers and indirect calorimetry, were small compared to the large overall effect of a 36-hour fast, suggesting that the macronutrient metabolic switching of older people with fasting is similar to that of younger people.

Relationship between estimated pulse wave velocity and the risk of future sarcopenia in middle-aged and older Chinese adults: evidence from the China Health and Retirement Longitudinal Study

Objective

Sarcopenia, common among older adults, is associated with adverse health outcomes. This study explores the relationship between estimated pulse wave velocity (ePWV), a marker of arterial stiffness, and sarcopenia to support the early diagnosis and prevention strategies.

Methods

Using data from two waves (2011 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS), we conducted a nationally representative cohort study. ePWV was calculated at baseline, and sarcopenia was identified based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. We used multivariate logistic regression and restricted cubic spline (RCS) analyses to investigate the ePWV-sarcopenia relationship.

Results

Among 6,639 participants followed for 4 years, 11.1% were diagnosed with sarcopenia. Initial analyses indicated a positive correlation between ePWV and sarcopenia (β = 1.35), which weakened after adjusting for confounders. RCS analysis demonstrated a non-linear relationship (P-non-linear <0.001), with sarcopenia risk peaking at an ePWV of 9.430 m/s. The highest ePWV quartile showed the lowest grip strength, the longest chair stand test time, and the highest sarcopenia prevalence (P < 0.0001).

Conclusions

In middle-aged and elderly Chinese adults, ePWV variations may be linked to sarcopenia risk, potentially serving as a predictive marker. The non-linear relationship indicates complex underlying mechanisms, meriting further research.

Plant-Derived Treatments for Different Types of Muscle Atrophy

With the development of medicine and chemistry, an increasing number of plant-derived medicines have been shown to exert beneficial therapeutic on the treatment of various physical and psychological diseases. In particular, by using physical chemistry methods, we are able to examine the chemical components of plants and the effects of these substances on the human body. Muscle atrophy (MA) is characterized by decreased muscle mass and function, is caused by multiple factors and severely affects the quality of life of patients. The multifactorial and complex pathogenesis of MA hinders drug research and disease treatment. However, phytotherapy has achieved significant results in the treatment of MA. We searched PubMed and the Web of Science for articles related to plant-derived substances and muscle atrophy. After applying exclusion and inclusion criteria, 166 and 79 articles met the inclusion criteria, respectively. A total of 173 articles were included in the study after excluding duplicates. The important role of phytoactives such as curcumin, resveratrol, and ginsenosides in the treatment of MA (e.g., maintaining a positive nitrogen balance in muscles and exerting anti-inflammatory and antioxidant effects) has been extensively studied. Unfortunately, MA dose not have to a single cause, and each cause has its own unique mechanism of injury. This review focuses on the therapeutic mechanisms of active plant components in MA and provides insights into the personalized treatment of MA.

Ergogenic Benefits of β-Hydroxy-β-Methyl Butyrate (HMB) Supplementation on Body Composition and Muscle Strength: An Umbrella Review of Meta-Analyses

BACKGROUND

β-Hydroxy-β-methyl butyrate (HMB) is a metabolite of the amino acid leucine, known for its ergogenic effects on body composition and strength. Despite these benefits, the magnitude of these effects remains unclear due to variability among studies. This umbrella review aims to synthesize meta-analyses investigating the effects of HMB on body composition and muscle strength in adults.

METHODS

A comprehensive literature search was conducted in Scopus, PubMed and Web of Science without date or language restrictions until August 2024. The study protocol was registered at Prospero (No. CRD42023402740). Included studies evaluated the effects of HMB supplementation on body mass, fat mass (FM), fat-free mass (FFM), muscle mass and performance outcomes. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated, and a random-effects model was used for meta-analysis. Standard methods assessed heterogeneity, sensitivity and publication bias. The methodological quality of included studies was assessed using the AMSTAR2 tool.

RESULTS

Eleven studies comprising 41 data sets were included, with participants aged 23-79 years. HMB supplementation significantly increased muscle mass (ES: 0.21; 95% CI: 0.06-0.35; p = 0.004), muscle strength index (ES: 0.27; 95% CI: 0.19-0.35; p < 0.001) and FFM (ES: 0.22; 95% CI: 0.11-0.34; p < 0.001). No significant changes were observed in FM (ES: 0.03; 95% CI: -0.04 to 0.35; p = 0.09) or body mass (ES: 0.09; 95% CI: -0.06 to 0.24; p = 0.22). The quality assessment revealed that five studies were of high quality, three were of low quality and three were of critically low quality.

CONCLUSIONS

HMB supplementation may benefit individuals experiencing muscular atrophy due to physiological conditions, particularly enhancing muscle mass and strength without significant changes in fat mass or body weight.

Exercise, cancer, and the cardiovascular system: clinical effects and mechanistic insights

Cardiovascular diseases and cancer are the leading causes of death in the Western world and share common risk factors. Reduced cardiorespiratory fitness (CRF) is a major determinant of cardiovascular morbidity and cancer survival. In this review we discuss cancer- induced disturbances of parenchymal, cellular, and mitochondrial function, which limit CRF and may be antagonized and attenuated through exercise training. We show the impact of CRF on cancer survival and its attenuating effects on cardiotoxicity of cancer-related treatment. Tailored exercise programs are not yet available for each tumor entity as several trials were performed in heterogeneous populations without adequate cardiopulmonary exercise testing (CPET) prior to exercise prescription and with a wide variation of exercise modalities. There is emerging evidence that exercise may be a crucial pillar in cancer treatment and a tool to mitigate cardiotoxic treatment effects. We discuss modalities of aerobic exercise and resistance training and their potential to improve CRF in cancer patients and provide an example of a periodization model for exercise training in cancer.

Frailty and comorbidities among young adult cancer survivors enrolled in an mHealth physical activity intervention trial

PURPOSE

The physical frailty phenotype identifies individuals at risk for adverse health outcomes but has rarely been assessed among young adult cancer survivors (YACS). This study describes frailty status among YACS participating in a physical activity (PA) intervention trial.

METHODS

YACS were categorized at baseline using the 5-item FRAIL scale: fatigue; weight loss; illness; ambulation; resistance. Chi-square tests compared frailty and non-cancer comorbidities by characteristics. Prevalence rates (PRs) for the independent associations between characteristics, frailty, and comorbidities were estimated using modified Poisson regression models.

RESULTS

Among 280 YACS (82% female; mean (M) age = 33.4 ± 4.8 years, M=3.7 ± 2.4 years post-diagnosis), 11% frail, 17% prefrail; the most frequent criteria were fatigue (41%), resistance (38%), and ambulation (14%). Compared to BMI < 25, higher BMI was associated with increased likelihood of frailty (BMI 25-30, PR: 2.40, 95% CI: 1.38-4.17; BMI > 30, PR: 2.95, 95% CI: 1.71-5.08). Compared to 0, ≥ 30 min/week of moderate-to-vigorous PA was associated with reduced frailty (PR: 0.39, 95% CI: 0.25-0.60). Most YACS (55%) reported ≥ 1 comorbidity, most frequently depression (38%), thyroid condition (19%), and hypertension (10%). Comorbidities were more common for women (59% vs. 37%) and current/former smokers (PR: 1.71, 95% CI: 1.29-2.28).

CONCLUSION

Prevalence of frailty and comorbidities in this sample was similar to other YACS cohorts and older adults without cancer and may be an indicator of accelerated aging and increased risk for poor outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Assessment of frailty may help identify YACS at increased risk for adverse health outcomes.

Associations Between Adherence to the Mediterranean Diet and Incident Sarcopenia in Prospective Cohort Studies

The loss of skeletal muscle mass and strength, known as sarcopenia, is prevalent in older adults and linked to an increased risk of disability, frailty, and early mortality. Muscle health is crucial for the functionality and independence of older adults. As the aging population continuously grows, finding cost-effective strategies for preventing and treating sarcopenia is an important public health priority. While nutrition is recognized as a key factor in the development of sarcopenia, its role in preventing and treating the condition is still under investigation. In recent decades, nutritional research has shifted from a focus on individual nutrients or healthy foods to examining the combination of nutrients and foods in dietary patterns, along with their potential synergistic and antagonistic effects. A balanced diet and regular participation in physical activity are essential for maintaining musculoskeletal health. One of the healthy eating patterns with the greatest evidence of multiple health benefits is the Mediterranean diet, which has also been linked to positive effects on muscle function in observational studies. However, there is a lack of intervention studies. This review explores the updated evidence from longitudinal prospective studies on associations between adherence to the Mediterranean diet and sarcopenia in order to promote preventive and intervention strategies for healthy muscle aging.

Exercise Training in Heart Failure: Current Evidence and Future Directions

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO2) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET's effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes.

Postprandial Aminoacidemia Following the Ingestion of Alternative and Sustainable Proteins in Humans: A Narrative Review

There is a pressing need to expand the production and consumption of alternative protein sources from plants, fungi, insects, and algae from both nutritional and sustainability perspectives. It is well known that the postprandial rise in plasma amino acid concentrations and subsequent muscle anabolic response is greater after the ingestion of animal-derived protein sources, such as dairy, meat, and eggs, than plant-based proteins. However, emerging evidence shows that a similar muscle anabolic response is observed-despite a lower and slower postprandial aminoacidemia-after the ingestion of alternative protein sources compared with animal-derived protein sources. Therefore, a comprehensive analysis of plasma amino acid kinetics after the ingestion of alternative protein sources would play a significant role in recognizing and identifying the anabolic properties of these protein sources, allowing for the implementation of the best nutritional intervention strategies, contributing to more sustainable food production, and developing new medical nutritional products with optimal impacts on muscle mass, strength, and function, both in terms of health and disease. Therefore, this narrative review is focused on postprandial amino acid kinetics (the area under the curve, peak, and time to reach the peak concentration of amino acids) based on experimental randomized controlled trials performed in young and older adults following the ingestion of different novel, sustainable, and alternative protein sources.

Association between immune cells, inflammatory cytokines, and sarcopenia: Insights from a Mendelian randomization analysis

BACKGROUND

Recent studies have suggested a possible link between sarcopenia, immune dysregulation, and chronic inflammation, although the specific immune components implicated remain unclear. This investigation employs Mendelian Randomization (MR) to explore the reciprocal relationship between immune cells, inflammatory markers, and sarcopenia.

METHOD

We performed two-sample and multivariate MR analyses using publicly accessible genome-wide association studies (GWAS) summary statistics. Our analyses included 731 immune cells, 41 inflammatory cytokines, and sarcopenia related traits (appendicular lean mass [ALM], low hand-grip strength [LHS], and walking pace [WP]), with additional sensitivity analyses conducted to confirm the findings.

RESULTS

After false discovery rate (FDR) correction, significant associations were found between ten immune traits and ALM, with the CD127 marker in the Treg panel showing consistent positive correlation across four sites. In contrast, NKT%lymphocyte negatively correlated with WP (OR = 0.99, P = 0.023). In terms of inflammatory cytokines, macrophage colony-stimulating factor (MCSF) (OR = 1.03, P = 0.024) and hepatocyte growth factor (HGF) (OR = 1.03, P = 0.002) demonstrated positive associations with ALM, while interleukin-16 (IL-16) (OR = 0.99, P = 0.006) was inversely related. The reverse Mendelian randomization analysis found no direct causal links between sarcopenia traits and immune or inflammatory markers. Sensitivity analyses underscored the findings' resilience to pleiotropy, and adjusting for inter-trait dynamics weakened these relationships in the multivariable MR analysis.

CONCLUSION

Our study reveals causal associations between specific immune phenotypes, inflammatory cytokines, and sarcopenia, providing insight into the development of sarcopenia and potential treatment strategies.

Is Sarcopenia Associated with Worse Outcomes Following Ventral Hernia Repair? A Systematic Review and Meta-Analysis

Background: The concept of preoperative prehabilitation has garnered attention as a means to manage the comorbidities of patients undergoing ventral hernia repair (VHR). In this regard, some comorbidities have been studied as potential risk factors for postoperative complications following VHR, such as diabetes, immunosuppression, and smoking. However, evidence regarding the impact of sarcopenia, defined by reduced muscle mass and highly associated with frailty syndrome, remains a gap. We aimed to perform a systematic review and meta-analysis analyzing the impact of sarcopenia on VHR outcomes. Methods: Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science were searched for studies analyzing the impact of sarcopenia on VHR from inception until April 2024. Outcomes assessed were recurrence, surgical site occurrences (SSO), surgical site infection (SSI), and hospital length of stay (LOS). Data analysis was done using RStudio 4.1.2 Software. Results: The initial search yielded 263 results, of which 172 were screened after the exclusion of the duplicates. The full-text review was done for eight studies, of which three were included after applying the eligibility criteria. Our sample comprised 275 patients, of which 79 (28,7%) presented with sarcopenia. All included studies used radiological muscle findings to define sarcopenia. Our analysis showed no differences in recurrence rates between patients with sarcopenia and controls (risk ratios [RR]: 1.24; 95% confidence interval [CI]: 0.79-1.94; P = .35). Furthermore, no differences were found in SSI (RR: 0.7; 95% CI: 0.39-1.25.; P = .23). Interestingly, a higher SSO rate was noted for patients without sarcopenia (95% CI: 0.35-0.96; P = .04). No differences were found in LOS (mean difference 4.7 hours; 95% CI: -0.67 to 10.1; P = .4). Conclusion: Our analysis showed no differences were found in recurrence, SSI, and LOS following VHR in patients with sarcopenia. Furthermore, there was a reduced SSO for patients with sarcopenia.

Comparison of the performance of instruments for screening sarcopenia in older adults

AIM

To compare the performance of the SARC-F and SARCCalf questionnaires in sarcopenia screening and their relationship with clinical and sociodemographic aspects of older adults.

METHODS

Analytical cross-sectional study carried out with 739 elderly people in the community. Clinical, sociodemographic, anthropometric data and screening for signs suggestive of sarcopenia were obtained using the SARC-F and SARCCalf.

RESULTS

Evaluation by method showed a difference in the proportion of positive results for the SARC-F regarding female sex (71.7; p = 0.001), among older adults who did not have a partner (49.7; p < 0.001), and osteoarticular diseases (13.4; p < 0.001). On the other hand, the SARCCalf identified a higher proportion of positive results among older adults at risk of malnutrition (12.2; p < 0.001).

CONCLUSION

The performance of the instruments varied according to the clinical and sociodemographic characteristics of the population, and it is up to professionals to consider these aspects when using them.

Grip-Strength-Lean-Mass Index (GSLMI) as a valuable tool for sarcopenia diagnosis and survival prognosis in cancer patients: a nationwide multicenter cohort study

OBJECTIVES

To identify whether the Grip-Strength-Lean-Mass Index (GSLMI) can precisely diagnose sarcopenia and predict prognosis for cancer patients in clinical settings.

DESIGN

A nationwide multicenter cohort study.

SETTING AND PARTICIPANTS

8,831 inpatients aged 18 years and older, histologically diagnosed with cancer and receiving anti-cancer therapy.

MEASUREMENTS

The GSLMI is the ratio of hand grip strength (HGS) divided by lean mass (LM), calculated by the formula: GSLMI = HGS (kg) / LM (kg). Kaplan-Meier curves and Cox models were used to estimate the association between the GSLMI and survival.

RESULTS

A total of 3,071 (48.40%) male and 3,274 (51.60%) female patients were enrolled in the study. The prevalence of GLIS-defined sarcopenia was 2,646 (41.70%). The optimal sex-specific thresholds with the best diagnostic performance to identify a low GSLMI were determined to be <0.61 for males and <0.47 for females based on the ROC curves. According to Kaplan-Meier curves, patients with a high GSLMI exhibited better overall survival than those with a low GSLMI (HR = 0.664, 95%CI = 0.604-0.729, log-rank P < 0.001). Multivariable survival analysis revealed that the GSLMI showed an independent association with a lower hazard of death as a continuous variable (HR = 0.70, 95% CI = 0.51-0.96).

CONCLUSIONS

The GSLMI may serve as a novel diagnostic tool for identifying sarcopenia and may have prognostic value for cancer patients. Using the GSLMI represents a feasible and promising option for better managing the health of patients with cancer.

Development and clinical application of bioelectrical impedance analysis method for body composition assessment

Obesity, which is characterized by excessive body fat, increases the risk of chronic diseases, such as type 2 diabetes, cardiovascular diseases, and certain cancers. Sarcopenia, a decline in muscle mass, is also associated with many chronic disorders and is therefore a major concern in aging populations. Body composition analysis is important in the evaluation of obesity and sarcopenia because it provides information about the distribution of body fat and muscle mass. It is also useful for monitoring nutritional status, disease severity, and the effectiveness of interventions, such as exercise, diet, and drugs, and thus helps assess overall health and longevity. Computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry are commonly used for this purpose. However, they have limitations, such as high cost, long measurement time, and radiation exposure. Instead, bioelectrical impedance analysis (BIA), which was introduced several decades ago and has undergone significant technological advancements, can be used. It is easily accessible, affordable, and importantly, poses no radiation risk, making it suitable for use in hospitals, fitness centers, and even at home. Herein, we review the recent technological developments and clinical applications of BIA to provide an updated understanding of BIA technology and its strengths and limitations.

Dose-Limiting Toxicities of Paclitaxel in Breast Cancer Patients: Studying Interactions Between Pharmacokinetics, Physical Activity, and Body Composition-A Protocol for an Observational Cohort Study

Background/Objectives: Paclitaxel (PTX), a commonly used chemotherapy for breast cancer (BC), is associated with dose-limiting toxicities (DLTs) such as peripheral neuropathy and neutropenia. These toxicities frequently lead to dose reductions, treatment delays, or therapy discontinuation, negatively affecting patients' quality of life and clinical outcomes. Current dosing strategies based on body surface area (BSA) fail to account for individual variations in body composition (skeletal muscle mass (SMM) and adipose tissue (AT) mass) and physical activity (PA), which can influence drug metabolism and toxicity. This study aims to explore the relationships between PTX pharmacokinetics, body composition, and PA to predict DLTs. Methods: This single-group observational cohort study will recruit 40 female BC patients undergoing PTX treatment. Data collection will include plasma PTX concentrations, body composition assessments (using dual X-ray absorptiometry and bioelectrical impedance analysis), PA measurements (via accelerometers), and questionnaires to assess BC-related health-related quality of life, chemotherapy-induced peripheral neuropathy, and neutropenia during the PTX schedule using validated questionnaires. Dose-limiting toxicities will be graded according to the Common Terminology Criteria for Adverse Events v5.0 (grade 3 or higher). This protocol is designed to develop a population-based PK-PD model that predicts the occurrence of chemotherapy-induced peripheral neuropathy and neutropenia in women with stage II or III BC undergoing PTX therapy, focusing on explanatory outcomes related to SMM, AT mass, and PA.

Exploring the association between pro-inflammatory mediators and sarcopenia in cancer patients through different diagnostic tools: a narrative review

Background and Objective

Sarcopenia, characterized by the progressive loss of skeletal muscle mass (MM) and muscle function, is a common and debilitating condition in cancer patients, significantly impacting their quality of life, treatment outcomes, and overall survival. The pathophysiology of sarcopenia is multifactorial, involving metabolic, hormonal, and inflammatory changes. Recent research highlights the role of chronic inflammation in the development and progression of sarcopenia, with pro-inflammatory cytokines being key mediators of muscle catabolism. The primary objective of this study was to assess the role of pro-inflammatory cytokines in identifying sarcopenia among cancer patients. As a secondary objective, we aim to investigate whether the methods used for assessing sarcopenia, both imaging and functional, align with established guidelines.

Methods

A search of the Web of Science was conducted for English-language articles published since 2005, with the following terms: "Cancer" AND "Sarcopenia" AND "Pro-inflammatory cytokine*" OR "Interleukin*". Inclusion criteria included peer-reviewed controlled trials, observational studies, case reports, and case series. To avoid redundancy, articles with results which were included in systematic reviews, narrative reviews, or scoping reviews were excluded from this review.

Key Content and Findings

The analysis of 10 selected papers, including 1,138 cancer patients, revealed a lack of assessment of muscle strength (MS) and muscle functional performance in most of the studies on sarcopenia, contradicting the comprehensive nature of sarcopenia that includes MM, MS, and muscle functionality. There is no standardization of pro-inflammatory mediators for sarcopenia identification.

Conclusions

Future research should focus on establishing cutoff points for inflammatory mediators and identifying which cytokines are linked to sarcopenia. Given the complexity of sarcopenia in different cancers, new projects should investigate whether cytokine expression depends on the tumor type. Moreover, considering that the majority of the study population comprised elderly individuals with primary sarcopenia, it is crucial to discern the extent to which the findings are influenced by age versus cancer-related factors.

Serum creatinine to cystatin C ratio in relation to heart failure with preserved ejection fraction

BACKGROUND

Sarcopenia was recognized to be one of the common comorbidities in heart failure (HF). The sarcopenia index (SI), based on serum creatinine to cystatin C ratio, was developed as a simple tool to evaluate skeletal muscle mass but has not been well-studied in the correlation of left ventricular ejection fraction (LVEF). The aim of this study is to analyze the SI in patients with HF, especially patients with HF with preserved ejection fraction (HFpEF), and to develop a prediction model for HFpEF.

METHODS

The training cohort included 229 hospitalized patients with HF and 73 healthy controls (HCs) from the Third Affiliated Hospital of Soochow University between December 2019 and February 2022. An additional 78 patients with HF hospitalized at the same hospital between March 2022 to June 2023 were considered as an external validation cohort. Binary logistic regression model was used to analyze the influence factors of HFpEF. A prediction model was constructed and optimized based on the least absolute shrinkage and selection operator (LASSO), displayed by Nomogram and verified internally by Bootstrap with 500 resamples.

RESULTS

SI was significantly different between the HF and HC groups (67.95 ± 13.07 vs. 98.57 ± 31.51) and had a significant negative correlation with LVEF. Multivariate logistic regression demonstrated that SI (OR 0.948, 95% CI 0.914-0.983, P = 0.004) was independently associated with HFpEF. The area under the curve (AUC) for the nomogram constructed based on SI was 0.902. The calibration curve was approximately distributed along the reference line in Bootstrap and the decision curve analysis demonstrated significantly better net benefit in the model. The external validation proved the good predictive performance of the model.

CONCLUSIONS

Lower SI is an independent factor associated with hospitalized patients with HF, especially patients with HFpEF. A prediction nomogram based on SI has good predictive power for HFpEF.

TRIAL REGISTRATION

The study was registered with the China Clinical Trials Centre Registry (registration number: ChiCTR2200063401).

Serum concentrations of different or multiple vitamins and Sarcopenia risk among US adults: insights from NHANES

BACKGROUND

The relationship between serum concentrations of different or multiple vitamins and sarcopenia remains underexplored. This investigation evaluates potential links between serum concentrations of different or multiple vitamins and sarcopenia prevalence among adults in the United States.

METHODS

Utilizing a cross-sectional design, this research draws from the National Health and Nutrition Examination Survey (NHANES) dataset of 2003-2006, encompassing 5,060 participants with comprehensive serum vitamin A, E, B9, B12, C, and D concentrations, alongside sarcopenia and covariate measurements. Participant stratification into distinct vitamin co-exposure clusters was achieved through K-means clustering. Analytical models, including weighted logistic regression, restricted cubic splines (RCS), weighted quantile sum regression (WQS), quantile g-computation (Q-gcomp), and Bayesian kernel machine regression (BKMR), were employed to evaluate the association between serum concentrations of different or multiple vitamins and sarcopenia risk, with an emphasis on nonlinearity.

RESULTS

In this study, sarcopenia was detected in 681 individuals (13.46%). Logistic regression results did not demonstrate any linear association between individual vitamin levels and sarcopenia risk (PFDR > 0.05). Contrastingly, the RCS model unveiled significant non-linear relationships for vitamins A and D (P_non-linear < 0.05). The K-means clustering results showed that participants in high-level vitamin exposure group had lower sarcopenia risk compared with those in low-level vitamin exposure group (OR (95% CI): 0.582 (0.397, 0.852)). Additionally, higher serum concentrations of different or multiple vitamins correlated inversely with sarcopenia risk (P_trend = 0.002). This inverse association was corroborated by WQS, Q-gcomp, and theBKMR models and remained consistent upon sensitivity analysis.

CONCLUSIONS

This study elucidates an inverse correlation between serum concentrations of different or multiple vitamins and sarcopenia risk, emphasizing a non-linear association, particularly with suboptimal vitamin D concentrations. Given the limitations of the NHANES study, further researches are required to clarify the existence of these relationships.

Prediction of Fragility Fractures and Mortality in a Cohort of Geriatric Patients

BACKGROUND

Risk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death.

METHODS

We assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow-ups until the occurrence of further fractures or death. Dual-energy X-ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia.

RESULTS

The mean age was 81 years (70-95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872-0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973-0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192-5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052-1.151; p < 0.001), in men (HR 6.464, CI 3.141-13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009-1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976-0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900-0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018-0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836-0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971-0.997; p = 0.015).

CONCLUSIONS

In a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters.

Dietary patterns, malnutrition, muscle loss and sarcopenia in cancer survivors: findings from the UK Biobank

PURPOSE

To identify dietary patterns derived from protein, polyunsaturated fatty acids (PUFA) and vitamin D and examine associations with malnutrition, low muscle mass and sarcopenia in cancer survivors.

METHODS

This cross-sectional study included cancer survivors (n = 2415) from the UK Biobank (age [mean ± SD] 59.7 ± 7.1 years; 60.7% female). The Oxford WebQ 24-h dietary assessment estimated food and nutrient intakes. Reduced rank regression derived dietary patterns (response variables: protein [g/kg/day], PUFA [g/day] and vitamin D [μg/day]). Adjusted logistic regression analysis examined associations between dietary patterns and malnutrition, low muscle mass and sarcopenia.

RESULTS

Three dietary patterns were identified: (i) 'high oily fish and nuts', characterised by higher oily fish and nuts and seeds intake; (ii) 'low oily fish', characterised by lower oily fish intake and higher potato intake; and (iii) 'meat and dairy', characterised by higher intake of meat, poultry and dairy. Eighteen percent of participants were malnourished, 5% had low muscle mass and 6.5% had sarcopenia. Odds of being malnourished were significantly lower with adherence to a 'high oily fish and nuts' pattern (OR: 0.57; 95% CI: 0.50, 0.65) and 'low oily fish' pattern (OR: 0.81; 95% CI: 0.73, 0.90). The 'meat and dairy' pattern was not associated with malnutrition. No dietary patterns were associated with low muscle mass or sarcopenia.

CONCLUSIONS

Energy-rich dietary patterns were associated with lower odds of malnutrition in cancer survivors but did not influence muscle mass or sarcopenia risk.

IMPLICATIONS FOR CANCER SURVIVORS

Better understanding of dietary patterns may improve cancer-related outcomes for cancer survivors.

Associations between gut microbiota and sarcopenia or its defining parameters in older adults: A systematic review

Altered gut microbiota (GM) potentially contribute to development or worsening of sarcopenia through a gut-muscle axis. This systematic review aims to compare GM between persons with sarcopenia or low sarcopenia-defining parameters (muscle mass, strength, and physical performance) to those with preserved muscle status, as well as to clarify possible associations between sarcopenia (-defining parameters) and relative abundance (RA) of GM-taxa or GM-(α- or β) diversity indices, in order to clarify whether there is robust evidence of the existence of a GM signature for sarcopenia. This systematic review was conducted according to the PRISMA-reporting guideline and pre-registered on PROSPERO (CRD42021259597). PubMed, Web of Science, Embase, ClinicalTrials.gov, and Cochrane library were searched until 20 July 2023. Included studies reported on GM and sarcopenia or its defining parameters. Observational studies were included with populations of mean age ≥50 years. Thirty-two studies totalling 10 781 persons (58.56% ♀) were included. Thirteen studies defined sarcopenia as a construct. Nineteen studies reported at least one sarcopenia-defining parameter (muscle mass, strength or physical performance). Studies found different GM-taxa at multiple levels to be significantly associated with sarcopenia (n = 4/6), muscle mass (n = 13/14), strength (n = 7/9), and physical performance (n = 3/3); however, directions of associations were heterogeneous and also conflicting for specific GM-taxa. Regarding β-diversity, studies found GM of persons with sarcopenia, low muscle mass, or low strength to cluster differently compared with persons with preserved muscle status. α-diversity was low in persons with sarcopenia or low muscle mass as compared with those with preserved muscle status, indicating low richness and diversity. In line with this, α-diversity was significantly and positively associated with muscle mass (n = 3/4) and muscle strength (n = 2/3). All reported results were significant (P < 0.05). Persons with sarcopenia and low muscle parameters have less rich and diverse GM and can be separated from persons with preserved muscle mass and function based on GM-composition. Sarcopenia and low muscle parameters are also associated with different GM-taxa at multiple levels, but results were heterogeneous and no causal conclusions could be made due to the cross-sectional design of the studies. This emphasizes the need for uniformly designed cross-sectional and longitudinal trials with appropriate GM confounder control in large samples of persons with sarcopenia and clearly defined core outcome sets in order to further explore changes in GM-taxa and to determine a sarcopenia-specific GM-signature.

The association between inflammatory cytokines and sarcopenia-related traits: a bi-directional Mendelian randomization study

BACKGROUND

Sarcopenia is among the most common musculoskeletal illnesses, yet its underlying biochemical mechanisms remain incompletely understood. Identifying the relationship of inflammatory cytokines with sarcopenia components would help understand the etiology of sarcopenia. We performed a bi-directional Mendelian randomization study to explore the causal relationship between 41 inflammatory cytokines and sarcopenia-related traits.

METHODS

The study was performed in two stages using bidirectional dual-sample Mendelian randomization. We obtained aggregated statistical data on inflammatory factors, low grip strength, and ALM from genome-wide association studies. To explore the causal association between exposure and outcomes, we primarily utilized the inverse variance weighted strategy. Furthermore, we conducted sensitivity analyses through the use of Mendelian randomization (MR) Egger, weighted median and simple mode methods. To evaluate robustness of the results and to identify and adjust for horizontal pleiotropy, we performed the MR Pleiotropy RESidual Sum and Outlier test, the MR Egger intercept test, and a leave-one-out analysis.

RESULTS

The results displayed a potential association between interleukin-10 (OR: 1.046, 95% CI: 1.002-1.093, p = 0.042) and vascular endothelial growth factor (OR: 1.024, 95% CI: 1.001-1.047, p = 0.038) and the risk of low hand-grip strength. Moreover, interferon gamma-induced protein 10 (OR: 1.010, 95% CI: 1.000-1.019, p = 0.042) and macrophage colony-stimulating factor (OR: 1.010, 95% CI: 1.003-1.017, p = 0.003) were significantly linked to a higher risk of ALM.

CONCLUSION

We identified a causal relationship between multiple inflammatory factors and sarcopenia-related traits. Our study offers valuable insights into innovative methods for the sarcopenia prevention and treatment by regulating inflammatory factors.

Muscle aging and sarcopenia: The pathology, etiology, and most promising therapeutic targets

Sarcopenia is a progressive muscle wasting disorder that severely impacts the quality of life of elderly individuals. Although the natural aging process primarily causes sarcopenia, it can develop in response to other conditions. Because muscle function is influenced by numerous changes that occur with age, the etiology of sarcopenia remains unclear. However, recent characterizations of the aging muscle transcriptional landscape, signaling pathway disruptions, fiber and extracellular matrix compositions, systemic metabolomic and inflammatory responses, mitochondrial function, and neurological inputs offer insights and hope for future treatments. This review will discuss age-related changes in healthy muscle and our current understanding of how this can deteriorate into sarcopenia. As our elderly population continues to grow, we must understand sarcopenia and find treatments that allow individuals to maintain independence and dignity throughout an extended lifespan.

Sarcopenia Is a Prognostic Factor of Adverse Effects and Mortality in Patients With Tumour: A Systematic Review and Meta-Analysis

BACKGROUND

The relationship between sarcopenia and the prognosis of patients with tumours who received radio- and/or chemotherapy still needs to be determined. In this study, we aim to investigate the relationship between sarcopenia and adverse effects and mortality in patients with tumours that received radio- and/or chemotherapy, stratified by study design, tumour category, the method sarcopenia assessed, treatment options, study location and among other factors.

METHODS

PubMed, Web of Science and Embase were searched from inception to 15 August 2024, without language restrictions and with a manual search of references for additional articles retrieval. Cohort studies of ≥ 100 patients with tumours that evaluated the association between sarcopenia or muscle mass and the adverse effects or overall survival induced by radio- and/or chemotherapy were included.

RESULTS

Thirty-nine studies were included, involving 8966 patients with tumours, including 3383 patients with sarcopenia. The pooled prevalence of sarcopenia in patients with tumours was 0.42 (95% CI 0.36-0.48, p < 0.001) overall. The prevalence of sarcopenia is higher in Oceania patients 0.60 (95% CI 0.28-0.89, p < 0.001), those with reproductive tumour 0.57 (95% CI 0.30-0.83, p < 0.001), and sarcopenia assessed by the lumbar-skeletal muscle index 0.46 (95% CI 0.39-0.53, p < 0.001) than in other subgroups, but not show significant differences in sex. Sarcopenia was associated with an increased risk of adverse effects in patients who received radio- and/or chemotherapy, with a relative risk (RR) of 1.44 (95% CI 1.21-1.71, p < 0.001). Retrospective studies (RR = 1.49; 95% CI 1.24-1.79; p < 0.001), sarcopenia assessed by other methods (RR = 2.98; 95% CI 1.52-5.87; p < 0.001), and patients in Europe (RR = 1.92; 95% CI 1.15-3.22; p = 0.013), received chemoradiotherapy (RR = 1.47; 95% CI 1.23-1.76; p < 0.001), and with head and neck tumours (RR = 1.54; 95% CI 1.17-2.01; p = 0.010) had higher relative risk than other subgroups. Sarcopenia was also associated with reduced overall survival in patients with tumours, with a pooled hazard ratio (HR) of 1.66 (95% CI 1.40-1.96, p < 0.001). Prospective studies (HR = 1.72; 95% CI 0.97-3.07; p = 0.065), sarcopenia assessed by the cervical-skeletal muscle index (HR = 2.66; 95% CI 1.73-4.09; p < 0.001), and patients in Asia (HR = 1.91; 95% CI 1.50-2.42; p < 0.001), received chemoradiotherapy (HR = 1.85; 95% CI 1.46-2.45; p < 0.001) and with head and neck tumours (HR = 2.35; 95% CI 1.88-2.95; p < 0.001) had higher HR than other subgroups.

CONCLUSIONS

Sarcopenia was associated with a higher risk of adverse effects and mortality in patients with tumours received radio- and/or chemotherapy.

Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey

PURPOSE

Our study aims to examine perceptions of sarcopenia among doctors and patients for improved management strategies in the future.

METHODS

We analyzed nine matched items from separate surveys involving 80 community-based primary care doctors, recruited online (55%) and offline (45%), and 80 community-dwelling older patients who visited 6 of the 80 primary care clinics in South Korea.

RESULTS

Doctors had a mean age of 58.3 ± 9.1 years, with 17.5% women; patients had a mean age of 74.1 ± 6.1 years, with 61.3% women. Twenty-eight patients (35.4%) had heard of sarcopenia, while only 19 doctors (23.8%) knew the diagnostic criteria of sarcopenia. Patients were more likely to believe they had sarcopenia than doctors assumed their patients had sarcopenia (patients, 35%; doctors, 16.9%; P = 0.0039). Patients desired more exercise and nutritional education than doctors reported they could provide (all P < 0.01). More patients preferred regular text messages for exercise or nutritional education (for exercise: patients 16.5%, doctors 5.8%, P = 0.0428; for nutrition: patients 17.1%, doctors 4.4%, P = 0.0154). Many patients were unaware of available community services for sarcopenia management (patients 48.8%, doctors 10.0%, P < 0.001).

CONCLUSION

Both patients and doctors in community-based primary care clinics lacked awareness of sarcopenia. Significant discrepancies existed between the exercise and nutritional education patients desired and what doctors could provide. These findings can inform the development of sarcopenia management programs in primary care clinics.

Association between serum albumin with geriatric nutritional risk index and osteopenia in Chinese elderly men: a nested case-control study

BACKGROUND AND OBJECTIVES

Malnutrition is associated with a higher risk of osteoporosis. We aim to assess the relationship between serum albumin with geriatric nutritional risk index and osteopenia in Chinese elderly men.

METHODS AND STUDY DESIGN

This is a nested case-control study from a prospective cohort enrolled 1109 individuals who were followed for seven years. Demographic data, medical history, signs and symptoms, and laboratory parameters were collected and analysed. Nutritional status and Geriatric Nutritional Risk Index (GNRI) were assessed. The nutrition-related indexes predictive value for osteopenia development was analyzed through multivariate Cox regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC). Kaplan-Meier (K-M) method was further used to find the nutritional status level in the elderly men.

RESULTS

The ALB and GNRI correlated with the risk of osteopenia in Chinese elderly men. After adjusting for all covariates, people with higher ALB level (HR: 0.821; 95% CI: 0.790-0.852) and higher GNRI score (HR: 0.889; 95% CI: 0.869-0.908) had a smaller risk of osteopenia. ROC analysis showed that the AUC for ALB was 0.729 (p<0.05) and for the GNRI score was 0.731 (p<0.05). K-M curve indicated a significant difference in ALB level (p<0.001) and GNRI score (p<0.001) in the respective subgroups.

CONCLUSIONS

This study found that lower ALB level and lower GNRI score are associated with a higher prevalence of osteopenia among elderly men in China.

An integrative review of cancer-related cachexia and sarcopenia: A different focus in malignant hematology

Introduction/background

An improved understanding of cancer-related cachexia and sarcopenia among patients with hematologic malignancies can improve their health outcomes. Patients with hematologic malignancies are affected by cancer-related cachexia and sarcopenia, but this aspect of their care is rarely studied. This review aims to increase awareness and knowledge of cancer-related cachexia and sarcopenia for patients with hematologic malignancies through a comprehensive synthesis of current research.

Methods

An integrative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science databases were searched for studies published between 2012 and 2022 using search terms of hematologic malignancies and cancer-related cachexia or sarcopenia.

Results

Twenty-nine studies were examined with data on 5,687 patients, primarily diffuse large B-cell lymphoma.

Conclusion

The results are grouped by themes identified in the studies of cancer-related cachexia and sarcopenia in hematologic cancers. The major themes identified were health outcomes, patient identification, transplant effects, and sex differences. Cancer-related cachexia and sarcopenia are associated with decreased overall survival and progression-free survival, similar to solid tumors. Cancer-related cachexia and sarcopenia reduce tolerance to chemotherapy and increase hematologic toxicities. With this effect, biomarkers and cachexia prognostic scores are available to improve patient identification, prognostication, and support. These affected individuals will benefit from increased awareness by the healthcare team to tailor care and mitigate the deleterious effects of the condition.

The effect of resistance training on patients with secondary sarcopenia: a systematic review and meta-analysis

To analyse the effectiveness of resistance training on secondary sarcopenia, we conducted a meta-analysis to elucidate the effects of resistance training (RT) on muscle strength (handgrip strength [HGS]), muscle mass (Skeletal muscle mass index [SMI]), and physical function (Gait speed [GS]) in patients with secondary sarcopenia. All studies published between 2015 and January 2024 on the effects of resistance training on patients with secondary sarcopenia were retrieved from 6 electronic databases: PubMed, Web of Science Core Collection, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) Core journals and the Wanfang Database. Two researchers independently extracted and evaluated studies that met the inclusion and exclusion criteria. Finally, 12 randomized controlled trials were included. Pooled analyses of baseline data and results were performed using Review Manager 5.3 with standardized mean variance (SMD) and random effects model. The study included 12 randomized controlled trials involving 639 patients (mean age 57.28 ± 2.66 to 79.6 ± 5.4 years). There are five types of complications among the patients: obesity, type 2 diabetes, Alzheimer's disease, hemodiaysis, and pancreatic cancer. Compared with the control group, RT effectively improved HGS [SMD = 2.47, 95% CI (1.50, 3.43), p < 0.01, I2 = 94%]; SMI [SMD = 0.94, 95% CI (0.52, 1.36), p < 0.01, I2 = 56%]; and GS [SMD = 2.18, 95% CI (-0.01, 4.37), p ≥ 0.05, I2 = 97%]. Further subgroup analysis of the results showed that the intervention effect on grip strength was greater for non-elastic band resistance [SMD = 2.40, 95% CI (1.05, 3.75), p < 0.01, I2 = 94%] than for elastic band resistance (EBRT) [SMD = 1.22, 95% CI (-0.14, 2.58), p < 0.01, I2 = 95%]. The intervention effect of RT on grip strength is more significant in patients with T2D [SMD = 0.59, 95%CI (0.26-0.93, p < 0.01, I2 = 27%] and obesity [SMD = 0.74, 95%CI (0.32-1.15, p < 0.01, I2 = 0%]. For patients with secondary sarcopenia, Resistance training (RT) can effectively enhance muscle strength and muscle mass; however, it does not significantly improve physical function. Different RT intervention methods have different effects on patients, such as elastic band training and non-elastic band training (bounce ball RT; equipment RT, etc.). Different types of complications may influence the effectiveness of RT intervention.

Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts health outcomes in older adults. This review explores the evolving landscape of sarcopenia research, with a particular focus on its unique characteristics in Asian populations and emerging pharmaceutical interventions. Recent studies have revealed distinct patterns of muscle mass decline in Asian adults, particularly in women, challenging the universal application of global sarcopenia diagnostic criteria. The Asian Working Group for Sarcopenia has proposed region-specific diagnostic criteria, acknowledging these ethnic variations. Prevalence estimates of sarcopenia vary widely, ranging from 10% to 40% in community-dwelling older adults. For specific chronic conditions, the prevalence of sarcopenia is notably higher, reaching 35% for cardiovascular diseases and 24.5% for chronic kidney disease. Sarcopenia is strongly associated with various chronic conditions, increasing the risk of falls by 1.5 to 3 times and significantly increasing mortality risk by 29% to 51%. Current management strategies primarily involve resistance exercise and nutritional interventions, with a recommended daily protein intake of at least 1.2 g/kg to maintain muscle health. Pharmaceutical development has gained significant momentum, with over 20 compounds in various stages of clinical trials. These include myostatin inhibitors, selective androgen receptor modulators, ghrelin receptor agonists, mesenchymal stem cell therapy, and follistatin gene therapy. However, the unique dietary patterns, cultural contexts, and potentially distinct drug responses in Asian populations necessitate tailored interventions and Asia-specific clinical trials. Future directions include refining Asian-specific diagnostic criteria, conducting large-scale epidemiological studies across multiple Asian countries, developing culturally appropriate interventions, integrating sarcopenia management into chronic disease care, and advancing pharmaceutical research with a focus on Asian populations. In conclusion, sarcopenia emerges as a critical nexus in the aging process, intricately linked with multiple organ systems and chronic conditions, underscoring the imperative for its recognition as a cornerstone in person-centered care and the holistic management of age-related health challenges.

Medical imaging in cancer cachexia

Cancer cachexia, often referred to as "wasting syndrome," is characterized by fatigue, weakness, and involuntary weight loss. This syndrome is concomitant with progressive skeletal muscle atrophy with or without adipose tissue loss and is frequently accompanied by systemic inflammation. Understanding the complexities of cancer cachexia is crucial for early detection and intervention, and it is also paramount for enhancing patient outcomes. Medical imaging, comprising diverse imaging modalities, plays a pivotal role in this context, facilitating the diagnosis and surveillance assessment of both the disease extent and the body composition changes that offer valuable information and insights into disease progression. This article provides a comprehensive discourse of the pathophysiological mechanisms and clinical manifestations of cancer cachexia as well as the role of medical imaging in this setting. Particular emphasis is placed on contemporary multidisciplinary and translational research efforts for the development of diagnostic and treatment tools, aiming to mitigate the devastating consequences of cancer cachexia.

Sarcopenia in cirrhosis: From pathophysiology to interventional therapy

Sarcopenia, characterized by the loss of skeletal muscle mass and function, is a significant complication in patients with cirrhosis. This condition not only exacerbates the overall morbidity and mortality associated with liver disease but also complicates patient management, increasing the risk of hospitalization, infections, and hepatic encephalopathy. Despite its clinical significance, sarcopenia in cirrhotic patients remains underdiagnosed and undertreated. This review aims to summarize current knowledge on the pathophysiology of sarcopenia in cirrhosis, including mechanisms such as altered metabolism, hormonal imbalances, and inflammation. Additionally, we explore diagnostic challenges and discuss emerging therapeutic strategies, including nutritional support, exercise, and pharmacological interventions. By highlighting the gaps in existing research and proposing directions for future studies, this review seeks to improve the management and outcomes of cirrhotic patients affected by sarcopenia.

Iron homeostasis and ferroptosis in human diseases: mechanisms and therapeutic prospects

Iron, an essential mineral in the body, is involved in numerous physiological processes, making the maintenance of iron homeostasis crucial for overall health. Both iron overload and deficiency can cause various disorders and human diseases. Ferroptosis, a form of cell death dependent on iron, is characterized by the extensive peroxidation of lipids. Unlike other kinds of classical unprogrammed cell death, ferroptosis is primarily linked to disruptions in iron metabolism, lipid peroxidation, and antioxidant system imbalance. Ferroptosis is regulated through transcription, translation, and post-translational modifications, which affect cellular sensitivity to ferroptosis. Over the past decade or so, numerous diseases have been linked to ferroptosis as part of their etiology, including cancers, metabolic disorders, autoimmune diseases, central nervous system diseases, cardiovascular diseases, and musculoskeletal diseases. Ferroptosis-related proteins have become attractive targets for many major human diseases that are currently incurable, and some ferroptosis regulators have shown therapeutic effects in clinical trials although further validation of their clinical potential is needed. Therefore, in-depth analysis of ferroptosis and its potential molecular mechanisms in human diseases may offer additional strategies for clinical prevention and treatment. In this review, we discuss the physiological significance of iron homeostasis in the body, the potential contribution of ferroptosis to the etiology and development of human diseases, along with the evidence supporting targeting ferroptosis as a therapeutic approach. Importantly, we evaluate recent potential therapeutic targets and promising interventions, providing guidance for future targeted treatment therapies against human diseases.

The role of algae, fungi, and insect-derived proteins and bioactive peptides in preventive and clinical nutrition

The current global trend in the nutrition, epidemiologic and demographic transitions collectively alarms the need to pursue a sustainable protein diet that respects ecosystem and biodiversity from alternative sources, such as algae, fungi and edible insects. Then, changing the nutrition reality is extremely important to impede the global syndemic of obesity, undernutrition and climate change. This review aims to synthesize the published literature on the potential roles of alternative proteins and their derived bioactive peptides in preventive and clinical nutrition, identify research gaps and inform future research areas. Google Scholar and PubMed databases from their inception up to 30 June 2024 were searched using keywords to access pertinent articles published in English language for the review. Overall, proteins derived from algae, fungi, and edible insects are high-quality proteins as animal sources and demonstrate significant potential as a sustainable source of bioactive peptides, which are metabolically potent and have negligible adverse effects. They show promise to prevent and treat diseases associated with oxidative stress, obesity, diabetes, cancer, cardiovascular disease (especially hypertension), and neurodegenerative diseases. Given the abundance of algae, fungi and insect peptides performed in vitro or in vivo animals, further clinical studies are needed to fully establish their safety, efficacy and practical application in preventive and clinical nutrition. Additionally, social and behavioral change communication strategies would be important to increase health awareness of nutritional benefits and promote consumer acceptance of alternative protein sources.

Exploring SGLT-2 inhibitors and sarcopenia in FAERS: a post-marketing surveillance study

BACKGROUND

The sodium-dependent glucose transporters 2 inhibitors (SGLT-2i) is associated with body weight loss but the composition of the losing weight remains unclear.

RESEARCH DESIGN AND METHODS

Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi- item gamma Poisson shrinker (MGPS) algorithms, were employed to quantify the signals of SGLT-2i-associated musculoskeletal and connective tissue disorders AEs.

RESULTS

The search retrieved a total of 3,206 cases of musculoskeletal and connective tissue disorder-related AEs during the reporting period. This included 1,061 cases for Canagliflozin, 1,052 cases for Dapagliflozin, 1,074 cases for Empagliflozin, and 19 cases for Ertugliflozin. Fifteen preferred terms (PTs) with significant disproportionality were retained. No musculoskeletal and connective tissue system-related AE signals were reported for Ertugliflozin. We identified a risk of muscle necrosis with Canagliflozin use, a risk of sarcopenia with Dapagliflozin use, and a chance of muscle atrophy with Dapagliflozin and Empagliflozin prescriptions. Most cases occurred within the first month after SGLT-2i initiation, and AEs can persist beyond 360 days of use.

CONCLUSIONS

Our study identified potential new musculoskeletal and connective tissue disorder-related AE signals associated with SGLT-2 inhibitors.

Impact of Sarcopenia on Treatment Outcomes and Toxicity in Locally Advanced Rectal Cancer

Background and Objectives: Sarcopenia, a condition characterized by muscle mass loss, is prevalent in up to 68% of rectal cancer patients and has been described as a negative prognostic factor, impacting overall survival and tumor response. While there are extensive data on rectal cancer globally, only a handful of studies have evaluated the role of sarcopenia in locally advanced rectal cancer (LARC). Our study aimed to investigate the relationship between sarcopenia, overall response rate, and toxicity in patients who underwent total neoadjuvant treatment (TNT) for LARC. Materials and Methods: We performed a retrospective study of patients with rectal cancer treated with TNT and surgery with curative intent between 2021 and 2023 at Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca. Sarcopenia was assessed on MRI images by measuring the psoas muscle area (PMA) at the level of the L4 vertebra before and after neoadjuvant therapy. The primary endpoints were the overall complete response rate (oCR) and acute toxicity. Results: This study included 50 patients with LARC. The oCR rate was 18% and was significantly associated with post-treatment sarcopenia (OR 0.08, p = 0.043). Patients who did not achieve a clinical or pathologic complete response had, on average, an 8% muscle loss during neoadjuvant therapy (p = 0.022). Cystitis and thrombocytopenia were significantly associated with post-treatment sarcopenia (p = 0.05 and p = 0.049). Conclusions: Sarcopenia and loss of psoas muscle during neoadjuvant therapy were negatively associated with tumor response in locally advanced rectal cancer. Thrombocytopenia and cystitis are more frequent in sarcopenic than non-sarcopenic patients undergoing neoadjuvant chemoradiation for rectal cancer.