Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta-analysis

Impact of COPD and sarcopenia on all-cause and respiratory mortality in US adults: NHANES 1999-2018

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) and sarcopenia (SAR) are major public health problems in aging societies, as they share common pathophysiological mechanisms and are associated with serious health consequences. We estimated the impact of COPD and SAR on all-cause and respiratory mortalities in the US adult population.

METHODS

The study analyzed data from the National Health and Nutrition Examination Surveys (NHANES), a representative sample of the US population. Participants aged 20 years or older who had reported whole-body dual X-ray absorptiometry data and data required for the diagnosis of COPD were included. Participants were divided into four groups based on the presence of COPD and SAR.

RESULTS

Compared to the COPD-/SAR - group, the COPD-/SAR+, COPD+/SAR-, and COPD+/SAR + groups all demonstrated increased all-cause mortality with Hazard Ratios (HRs) of 1.33 (95% CI 1.20-1.48), 1.51 (95% CI 1.21-1.88), and 1.87 (95% CI 1.32-2.66), respectively. In addition, both the COPD+/SAR - and COPD+/SAR + groups demonstrated increased respiratory mortality with HRs of 5.16 (95% CI 2.96-9.01), and 8.69 (95% CI 3.95-19.1) compared to the COPD-/SAR - group.

CONCLUSIONS

The coexistence of COPD and SAR additively increased the risk of all-cause and respiratory mortality. Individuals with one of these diseases may need to be treated more carefully to prevent the development of the other disease and thus reduce mortality.

Association Between the Visceral Fat-to-Muscle Ratio and Severe Exacerbation of COPD: A Prospective Cohort Study

BACKGROUND AND OBJECTIVE

An imbalanced fat and muscle mass ratio might impact exacerbation of chronic obstructive pulmonary disease (COPD). We investigated the association of visceral fat-to-muscle ratio (VMR) with severe COPD exacerbation requiring hospitalisation.

METHODS

This prospective cohort study in COPD patients was performed along with the Xinjiang Multi-Ethnic Cohort study between May 2018 and December 2023. Baseline VMR was calculated from visceral fat area and muscle mass measured by bioelectrical impedance analysis. Numbers of COPD exacerbation hospitalizations were monitored. Associations between various variables and exacerbation were assessed by logistics regression and Zero-inflated Poisson regression analyses.

RESULTS

A total of 631 COPD patients were included, with 186 (29.48%) and 304 (48.18%) severe COPD exacerbation within 1 and 5 years, respectively. Compared with body mass index and other obesity indicators, VMR had stronger associations with severe exacerbation. A higher VMR was associated with increased risks of 1-year and 5-year exacerbation (odds ratio [OR] = 1.34 and 1.44, respectively). The subgroup female and overweight individuals showed a strong association (female OR = 1.89 and 1.99, overweight OR = 1.80 and 1.88, for 1 and 5-year exacerbation, respectively). The number of COPD exacerbation increased by 46% for each one-point VMR increase. These results remained unchanged in the sensitivity analyses after removing underweight patients or smoke influence, as well as in the competing risk analysis when considering other causes for death.

CONCLUSION

VMR was a risk factors of severe COPD exacerbation. Proactive assessment of VMR might be helpful to guide management of COPD patients.

Intelligent predictive risk assessment and management of sarcopenia in chronic disease patients using machine learning and a web-based tool

BACKGROUND

Individuals with chronic diseases are at higher risk of sarcopenia, and precise prediction is essential for its prevention. This study aims to develop a risk scoring model using longitudinal data to predict the probability of sarcopenia in this population over next 3-5 years, thereby enabling early warning and intervention.

METHODS

Using data from a nationwide survey initiated in 2011, we selected patient data records from wave 1 (2011-2012) and follow-up data from wave 3 (2015-2016) as the study cohort. Retrospective data collection included demographic information, health conditions, and biochemical markers. After excluding records with missing values, a total of 2891 adults with chronic conditions were enrolled. Sarcopenia was assessed based on the Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. A generalized linear mixed model (GLMM) with random effects and diverse machine learning models were utilized to explore feature contributions to sarcopenia risk. The Recursive Feature Elimination (RFE) algorithm was employed to optimize the full Multilayer Perceptron (MLP) model and develop an online application tool.

RESULTS

Among total population, 580 (20.1%) individuals were diagnosed with sarcopenia in wave 1 (2011-2012), and 638 (22.1%) were diagnosed in wave 3 (2015-2016), while 2165 (74.9%) individuals were not diagnosed with sarcopenia across the study period. MLP model, performed better than other three classic machine learning models, demonstrated a ROC AUC of 0.912, a PR AUC of 0.401, a sensitivity of 0.875, a specificity of 0.844, a Kappa value of 0.376, and an F1 score of 0.44. According to MLP model-based SHapley Additive exPlanations (SHAP) scoring, weight, age, BMI, height, total cholesterol, PEF, and gender were identified as the most important features of chronic disease individuals for sarcopenia. Using the RFE algorithm, we selected six key variables-weight, age, BMI, height, total cholesterol, and gender-achieving an ROC AUC of about 0.9 for the online application tool.

CONCLUSION

We developed an MLP machine learning model that incorporates only six easily accessible variables, enabling the prediction of sarcopenia risk in individuals with chronic diseases. Additionally, we created a practical online application tool to assist in decision-making and streamline clinical assessments.

Regulation of the Nrf2/HO-1 pathway in chronic obstructive pulmonary disease-induced muscle atrophy using Jinshui Liujian decoction and Bajitian pills: insights from network pharmacology and animal models

OBJECTIVE

This study aimed to investigate the therapeutic effects of the combination of modified Jinshui Liujian decoction and Bajitian pills (TCM) on chronic obstructive pulmonary disease (COPD)-induced muscle atrophy using network pharmacology and animal model experiments.

METHODS

Network pharmacology technique has been employed to analyze the potential targets of TCM on treating COPD. In vivo, COPD mice model was induced by lipopolysaccharide (LPS) combined with smoke treatment. To comparing the protective effects of TCM on this disease, these parameters including general condition, serum inflammatory factors, protein expression levels, gene copies, and histopathological changes in the lungs and gastrocnemius muscle mass have been further assessed in mouse in different groups.

RESULTS

Network pharmacology analysis identified 203 intersecting targets, primarily associated with apoptosis, phosphorylation, and inflammatory response. Animal experimental demonstrated that TCM could significantly improve the decreased skeletal muscle mass (p < 0.001), abnormal histopathologic morphology, decreased superoxide dismutase (SOD, p < 0.05), increased levels of serum malondialdehyde (MDA, p < 0.001) and tumor necrosis factor-α (TNF-α, p < 0.001) as compared to model group. Further mechanism exploration showed that a significant increase on the gene and proteins levels of nuclear factor erythroid 2-related factor 2 (NRF2, p < 0.05) and heme oxygenase-1 (HO-1, p < 0.05) have been observed in TCM-treated animals compared with that of in model animals. Interestingly, some indicators (serum MDA/SOD/TNF-α, RNA and protein levels of NRF2 and HO-1) showed more positive changes in TCM combined with western medicine (TCM-WN) - treated animals compared with that of TCM-treated animals.

CONCLUSION

Modified Jinshui Liujian decoction and Bajitian pills effectively mitigate muscle atrophy associated with COPD by modulating the Nrf2/HO-1 pathway through multi-target mechanisms. The combined TCM and WM therapy demonstrates enhanced therapeutic efficacy compared to monotherapy.

The association between skeletal muscle mass and all-cause mortality in acute exacerbation of chronic obstructive pulmonary disease

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) significantly impacts patient quality of life and prognosis. Skeletal muscle mass loss, a systemic manifestation of COPD, has garnered increasing attention, but its association with all-cause mortality in AECOPD remains unclear. This study aimed to quantitatively assess skeletal muscle mass in AECOPD patients using computed tomography and explore the association between muscle mass-related indices and all-cause mortality risk.

Methods

A total of 319 patients were enrolled in this single-center retrospective cohort study. Muscle mass-related indices, including skeletal muscle area, mean muscle density, intermuscular fat density, intermuscular fat area, and skeletal muscle index (SMI), were considered as independent variables. All-cause mortality was considered as the dependent variable. Univariate and multivariate Cox regression, subgroup and sensitivity analyses, receiver operating characteristic curve (ROC), restricted cubic spline plot (RCS), and Kaplan-Meier survival curves were used to examine the association between these indices and all-cause mortality in AECOPD patients.

Results

During a median follow-up of 14.63 (6.33, 21.13) months, the all-cause mortality was 113 (35.4%). Multivariate Cox regression revealed that, regardless of whether SMI was grouped based on the median of 26.08 or the cut-off point of 24.01, the low SMI group had a higher risk of all-cause mortality (HR: 0.495, 95% CI: 0.330-0.743, p = 0.001; HR: 0.400, 95% CI: 0.270-0.592, p < 0.001). Moreover, as a continuous variable, lower levels of SMI were independently associated with a higher risk of all-cause mortality (SMI, HR = 0.964, 95% CI: 0.934-0.996, p = 0.027; Standardized SMI, HR = 0.748, 95% CI: 0.578-0.967, p = 0.027). Subgroup and sensitivity analyses confirmed the significant association between SMI and all-cause mortality (p < 0.05). ROC analysis showed good predictive value for SMI (area under the curve = 0.663, 95% CI: 0.559-0.728, p < 0.001), and RCS analysis revealed a non-linear relationship between SMI and mortality (p nonlinear = 0.019). The Kaplan-Meier survival curves analysis indicated that regardless of whether SMI was grouped by median or by cut-off point, there were significant differences in the survival probability of all-cause mortality among different SMI groups, with the low SMI group having a poorer prognosis (p < 0.001).

Conclusion

Among patients with AECOPD, higher levels of SMI are significantly associated with a lower risk of all-cause mortality, suggesting that SMI may have important prognostic value in the assessment of mortality risk in AECOPD patients.

Oxidative balance score is independently associated with reduced prevalence of sarcopenia among US adults with metabolic syndrome

Background

This research seeks to explore the link between the oxidative balance score (OBS) and sarcopenia in American adults with Metabolic Syndrome (MetS) using data from a national, population-based survey.

Methods

The study included 3,625 participants diagnosed with Metabolic Syndrome, all aged 20 years and above, derived from NHANES datasets spanning 1999-2006 and 2011-2018. OBS evaluation was based on 16 dietary and 4 lifestyle elements. MetS diagnosis followed the NCEP-ATP III guidelines, while sarcopenia identification was based on FNIH standards. We employed multivariate logistic regression analyses to delve into the connections between OBS and sarcopenia within the MetS cohort.

Results

Sarcopenia was found in 17.46% of the participants. In models adjusted for all variables, OBS, dietary OBS, and lifestyle OBS each showed a significant inverse relationship with sarcopenia among MetS individuals [OBS: OR = 0.959, 95%CI: (0.948, 0.982), P trend = 0.0005; dietary OBS: OR = 0.963, 95%CI: (0.939, 0.989), P trend = 0.0055; lifestyle OBS: OR = 0.860, 95%CI: (0.787, 0.939), P trend = 0.0011]. Higher scores in OBS were consistently linked with a decreased incidence of sarcopenia (all P for trend < 0.05). Restricted cubic spline analysis confirmed that these relationships were linear. The impact of age was significant, with OBS benefits only observed in those aged 40 and older.

Conclusions

Maintaining a diet and lifestyle rich in antioxidants is both independently and collectively linked with a lower occurrence of sarcopenia in individuals with MetS. These results bolster the proposition of developing OBS-centered preventive strategies for sarcopenia in MetS patients, particularly those aged 40 years and older.

Prognostic impact of low muscle mass on clinical outcomes in patients who undergo lung transplant

BACKGROUND

Low muscle mass (LMM) is recognized as a poor prognostic factor in various chronic lung diseases. However, its prognostic impact on recipients of lung transplants remains inconclusive.

METHODS

We retrospectively analyzed patients who underwent lung transplantation at a tertiary referral center in South Korea. Pretransplant skeletal muscle mass was quantified at the L1 vertebral level by computed tomography scans of the chest using a commercially available body composition analysis software. Patients were classified into LMM and non-LMM group using a threshold for LMM that had been previously validated in the South Korean population. We then evaluated the prognostic impact of preoperative LMM on clinical outcomes after lung transplantation.

RESULTS

A total of 107 patients were included in this analysis, of whom 44 (41.1%) were classified into the LMM group. The median follow-up duration was 958 days posttransplantation. A preoperative LMM was identified as an independent factor associated with a greater risk of overall mortality (adjusted hazard ratio, 2.15; 95% confidence interval, 1.07-4.34). In addition, patients with LMM had a greater risk of developing primary graft dysfunction (adjusted odds ratio, 3.56; 95% confidence interval, 1.25-10.18). At the 1-year follow-up, 37.5% of the patients with baseline LMM had recovered and were reclassified into the non-LMM group, and this improvement was found to mitigate the negative impact of preoperative LMM.

CONCLUSIONS

Pretransplant LMM was significantly associated with poor clinical outcomes in recipients of lung transplants. These findings highlight the importance of maintaining adequate muscle mass during the waiting period for lung transplantation.

Association of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with COPD prevalence and all-cause mortality: a population-based study based on NHANES 2007-2016

Background

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in metabolic and cardiovascular diseases. However, its association with chronic obstructive pulmonary disease (COPD) is not well-defined. Here, we aim to investigate the potential association of NHHR with both the prevalence of COPD and all-cause mortality among individuals with COPD.

Methods

This population-based NHANES (2007-2016) study utilized weighted statistical analyses. Multivariable logistic regression assessed the NHHR-COPD prevalence association, with restricted cubic spline (RCS) testing for non-linearity. The association between NHHR and all-cause mortality in COPD was evaluated using Cox proportional hazards models and Kaplan-Meier, with RCS testing for non-linearity. Subgroup and sensitivity analyses confirmed the findings' reliability.

Results

This study included 6349 participants, of whom 1271 were diagnosed with COPD. Participants in the highest NHHR tertile demonstrated 62% higher odds of COPD prevalence compared to those in the lowest tertile (OR = 1.62, 95% CI:1.11-2.39, P = 0.017). Results from RCS analysis indicated a nonlinear relationship between NHHR and the prevalence of COPD (P for nonlinear = 0.007), with the curve demonstrating an inverted L-shape. Over an average follow-up period of 93 months, 320 participants with COPD died. In the weighted Kaplan-Meier survival analysis, participants with COPD in the lower NHHR tertile demonstrated greater cumulative probability of all-cause mortality compared to higher tertiles (P < 0.001). Weighted multivariable Cox regression models revealed an inverse association between NHHR levels and COPD all-cause mortality, with the highest NHHR tertile showing 11% lower likelihood of COPD all-cause mortality relative to the lowest tertile (HR = 0.89, 95% CI:0.80-0.99, P = 0.027). In addition, RCS analysis demonstrated a significant negative linear association between NHHR levels and all-cause mortality in COPD patients (P for nonlinear = 0.081). Subgroup and sensitivity analyses further confirmed the associations of NHHR on both morbidity and all-cause mortality.

Conclusion

Higher NHHR levels were associated with increased COPD prevalence yet inversely correlated with all-cause mortality in COPD patients. These paradoxical associations underscore the need for COPD-specific lipid management strategies that balance disease progression and mortality risks.

The Association Between Severity of Constipation and Oral Frailty Index-8 in the JUSTICE-TOKYO Study: A Cross-Sectional Study

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = -0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT.

An Indian Consensus on Sarcopenia: Epidemiology, Etiology, Clinical Impact, Screening, and Therapeutic Approaches

The burden of sarcopenia in India continues to be of significant concern. Its diagnosis is challenging due to the lack of standardized cutoffs for assessing muscle strength, quantity, and function among Indians. This consensus aims to identify features of sarcopenia in Indians and provide culturally relevant recommendations for its management. An expert panel from diverse medical specialties across India arrived at a consensus using the modified Delphi method. The panel recommended that a baseline handgrip strength (HGS) cutoff value of <27.5 kg in males and 18.0 kg in females be defined as low muscle strength for the Indian population. All patients with comorbidities should be screened for sarcopenia. In people with sarcopenia, resistance exercise and nutrition with specialized nutrients such as protein, beta-hydroxy-beta-methylbutyrate (HMB), and micronutrients for at least 3 months were recommended as key interventions.

YAP/TAZ-mediated nuclear membrane rupture in promoting senescence of skeletal muscle associated with COPD

Patients with chronic obstructive pulmonary disease (COPD) often develop complications associated with sarcopenia; however, the underlying mechanisms remain unclear. Through a combination of in vitro and in vivo experiments, as well as bioinformatics analysis, our study identified YAP/TAZ as a key regulator of the aging phenotype in the skeletal muscle of COPD patients. In skeletal muscle affected by cigarette smoke-induced COPD, we observed significant reductions in YAP/TAZ levels, alongside markers indicative of skeletal muscle aging and dysfunction. Notably, overexpression of YAP/TAZ significantly improved these conditions. Our results suggest a novel mechanism whereby the maintenance of YAP/TAZ activity interacts with ACTR2 to preserve nuclear membrane integrity and reduce cytoplasmic dsDNA levels, thereby attenuating STING activation and cellular senescence. Additionally, we found that YAP is involved in the transcriptional regulation of the ACTR2 promoter region. Overall, preserving YAP/TAZ activity may help prevent skeletal muscle aging associated with COPD, representing a new strategy for intervening in COPD-related sarcopenia.

Insights into associations between Life's essential 8 and lung function from NHANES data

The Life's Essential 8 (LE8) is a novel indicator of cardiovascular health proposed by the American Heart Association. While numerous studies have demonstrated its guiding value in chronic diseases, research on its role in lung function remains limited. This study utilized data from the National Health and Nutrition Examination Surveys (NHANES 2007-2012), which included comprehensive measurements of lung function, diet, physical activity, nicotine exposure, sleep patterns, body mass index (BMI), blood glucose, blood pressure, blood lipids, and relevant covariates. We calculated lung function Z-score and LE8 scores, employing multiple linear regression, multivariable logistic regression, and restricted cubic spline models to evaluate their correlations. In this study of 10,400 participants (mean age 44 years; 48.75% male), participants were classified into threeforcedexpiratory volume in one second (FEV1) Z-score groups: Z1 (normal lung function, n = 9,600), Z2 (mild impairment, n = 618), and Z3 (moderate to severe impairment, n = 182). Significant differences in demographic characteristics and health parameters were observed among the groups. Notably, variations in the Healthy Eating Index 2015 (HEI-2015), physical activity, nicotine exposure, and sleep patterns were identified within the LE8 health behavior domain. Higher LE8 scores were found to be positively associated with lung function, even after adjusting for demographic and health factors. Further analysis revealed positive correlations between lung function and favorable dietary habits, higher physical activity levels, reduced nicotine exposure, and improved sleep quality. Conversely, BMI, blood lipids, blood glucose, and blood pressure exhibited variable effects. Subgroup and sensitivity analyses consistently supported findings, confirming a positive correlation between LE8 and lung function. Our study highlights significant associations between LE8 scores and lung function, demonstrating that higher LE8 scores, which reflect better cardiovascular health behaviors, are positively correlated with improved lung function.

Myostatin/Smad2/Smad3 pathway define a differential clinical phenotype in COPD-associated sarcopenia

Background

Sarcopenia, defined as the loss of muscle mass and function, represents one of the most relevant comorbidities in patients with COPD even at early stages. We hypothesised that sarcopenia defines a specific clinical phenotype in COPD irrespective of respiratory disease severity. Markers of myostatin/Smad2/Smad3 and IGF-1/PI3K/Akt may be differentially expressed in the vastus lateralis (VL) of patients with COPD-associated sarcopenia.

Methods

In muscle specimens from VL, markers of the myostatin/Smad2/Smad3, Smad4 and IGF-1/PI3K/Akt pathways were evaluated (real-time PCR and immunoblotting) and correlations between clinical and biological variables of patients with sarcopenia (n=23), without sarcopenia (n=18) and healthy controls (n=13) were examined.

Results

In the VL of sarcopenic COPD patients, expression levels of myostatin, Smad2/Smad3 and Smad4 increased compared with those in nonsarcopenic patients and healthy controls. In sarcopenic limb muscles of patients with COPD, the myostatin Smad2/Smad3 pathway was differentially activated from patients without sarcopenia and healthy controls. Among sarcopenic patients, myostatin and p-Smad3/Smad3 levels negatively correlated with fat-free mass index (r=-0.727, p=0.026 and r=-0.703, p=0.035, respectively), myostatin and Smad4 levels correlated with quadriceps strength (r=-0.886, p=0.003 and r=-0.431, p=0.040, respectively) and myostatin correlated with diffusion capacity (r=-0.781, p=0.022). Remarkable negative correlations were observed between clinical parameters related to body composition and quadriceps muscle strength and levels of the myostatin Smad2/Smad3 pathway, suggesting its implication in the process of muscle atrophy in COPD. IGF1 gene expression was also upregulated in the VL of sarcopenic patients.

Conclusion

Collectively, these findings offer a potential therapeutic target in COPD-associated sarcopenia.

Multilabel segmentation and analysis of skeletal muscle and adipose tissue in routine abdominal CT scans

PURPOSE

This paper presents a deep learning-based multi-label segmentation network that extracts a total of three separate adipose tissues and five different muscle tissues in CT slices of the third lumbar vertebra and additionally improves the segmentation of the intermuscular fat.

METHOD

Based on a self-created data set of 130 patients, an extended Unet structure was trained and evaluated with the help of Dice score, IoU and Pixel Accuracy. In addition, the interobserver variability for the decision between ground truth and post-processed segmentation was calculated to illustrate the relevance in everyday clinical practice.

RESULTS

On average, the presented approach achieved 91.0±0.065% DSC for the muscle tissues and 88.9±0.062% DSC for the adipose tissues. It was shown that by post-processing the intermuscular fat tissue, physicians prefer the result of the algorithm presented in the paper to their segmentation by 91.51%.

CONCLUSION

The algorithm provided more precise segmentations of muscles and adipose tissue, demonstrating high-quality performance in segmenting muscle tissue. In qualitative evaluations, physicians preferred the algorithm's segmentation over expert segmentations, with the preference quantified as 91.51%. This indicates that, based on their assessment, the algorithm's results were significantly favored. This qualitative feedback supports the algorithm's use in subsequent analyses of patient fitness, leveraging the detailed information it provides.

Comparing the Effectiveness of Single Exercises on Improving Exercise Capacity in Chronic Obstructive Pulmonary Disease Patients: Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease that significantly impairs the quality of life of patients. Single exercises can help COPD patients focus on enhancing specific physical abilities, and enable a more precise analysis of the specific effects of single exercises on improving exercise capacity in COPD patients.

OBJECTIVES

To evaluate the effectiveness of single exercises in improving the exercise capacity of COPD patients and to conduct an indirect comparison to identify the most efficacious intervention.

METHODS

We conducted a comprehensive search for randomized controlled trials in the following databases: PubMed, Web of Science, Scopus, Cochrane Library, Embase, and Chinese National Knowledge Infrastructure, from their inception to July 1, 2024. A network meta-analysis was used. We calculated mean differences and their corresponding 95% confidence intervals to quantify the effect sizes and assess the precision of the estimates.

RESULTS

65 studies that met the inclusion criteria, encompassing a total sample size of 5,034 participants. The meta-analysis demonstrated that single exercises significantly enhanced the exercise capacity in COPD patients. Upon direct comparison, several exercises showed significant improvements in exercise capacity compare to conventional therapy. Core muscle Elastic band exercise appeared to provide the most substantial benefit in enhancing exercise capacity in COPD patients.

CONCLUSION

Healthcare providers are encouraged to consider incorporating Core muscle Elastic band exercise into their intervention plans, given its demonstrated efficacy. However, the presence of substantial heterogeneity among the included studies highlights the need for caution in interpreting these results.

Goals of chronic obstructive pulmonary disease management: a focused review for clinicians

PURPOSE OF REVIEW

The diagnosis of chronic obstructive pulmonary disease (COPD) encompasses heterogeneous pathophysiological mechanisms which can shape an individual patient's experience. This paper reviews available therapeutic options for the clinician intending to individualize care toward patient goals.

RECENT FINDINGS

The contemporary targeted interventions for COPD include the novel phosphodiesterase inhibitor ensifentrine, the interleukin-4 receptor (IL4R alpha subunit) antibody dupilumab, augmentation therapy for alpha-1 antitrypsin deficiency. Other interventions promoting physical and mental well being include re-envisioned pulmonary rehabilitation, self-management, targeting of comorbidities such as sarcopenia, and virtual health coaching interventions to expand patient access. Opioids did not relieve dyspnea and did not change total step count.

SUMMARY

Advances in precision therapy are complemented by the discovery of novel pathophysiology pathways and behavioral and rehabilitation interventions as a holistic view of COPD management emerges. The management of COPD continues to evolve with new tools including precision medicine and individualized care. Comorbidities remain important determinants of health, yet their prevalence and impact are underestimated.

The impact of chronic diseases and lifestyle on sarcopenia risk in older adults: a population-based longitudinal study

Background

Sarcopenia, characterized by the gradual decline of muscle mass and strength, seriously affects the health and mobility of older adults. The purpose of this study is to investigate the risk factors for sarcopenia, particularly the relationship between chronic diseases and lifestyle factors in individuals aged 60 and over.

Methods

This study used data from the Longitudinal Study on Health and Retirement in China (CHARLS) collected in 2011 and 2015. All eligible participants were classified according to the standards established by the Asian Sarcopenia Working Group in 2019. The evaluation of sarcopenia was based on a comprehensive score across five dimensions: strength, assistance in walking, rise from a chair, climb stairs, and falls. A multivariate logistic regression model was employed to explore the risk factors for sarcopenia.

Results

The risk of sarcopenia is significantly influenced by multiple factors. Key findings include the association between past drinking and an increased risk of sarcopenia (HR = 2.198, 95% CI: 1.072-4.560, p < 0.05), indicating that individuals with a history of drinking have more than twice the risk of sarcopenia compared to non-drinkers. Chronic diseases such as stroke were also associated with a significantly elevated risk (HR = 3.137, 95% CI: 1.128-8.721, p < 0.05). Conversely, participation in social activities significantly reduced the risk of sarcopenia (HR = 0.482, 95% CI: 0.265-0.876, p < 0.05). A three-piece spline regression model revealed a nonlinear relationship between physical activity and the risk of sarcopenia, characterized by an initial decline in risk followed by an increase as physical activity levels rose. Moderate-intensity physical activity reduced the risk of sarcopenia by approximately 35% (HR ≈ 0.65). However, high-intensity physical activity led to a rebound in risk, increasing the likelihood of sarcopenia relative to moderate activity. Similarly, adequate sleep duration was associated with a reduced risk of sarcopenia, whereas excessive sleep counteracted this benefit.

Conclusion

The findings underscore the critical role of lifestyle modifications and balanced physical activity in mitigating the risk of sarcopenia among older adults. Implementing targeted interventions for high-risk groups is essential to reduce the incidence of sarcopenia.

Personalised screening tool for early detection of sarcopenia in stroke patients: a machine learning-based comparative study

BACKGROUND

Sarcopenia is a common complication in patients with stroke, adversely affecting recovery and increasing mortality risk. However, no standardised tool exists for its screening in this population. This study aims to identify factors influencing sarcopenia in patients with stroke, develop a risk prediction model and evaluate its predictive performance.

METHODS

Data from 794 patients with stroke were analysed to assess demographic and clinical characteristics. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate regression analysis. Logistic regression (LR), random forest (RF) and XGBoost algorithms were used to construct prediction models, with the optimal model subjected to external validation. Internal validation was conducted via bootstrap resampling, and external validation involved an additional cohort of 159 patients with stroke. Model performance was assessed using the area under the curve (AUC), calibration curves and decision curve analysis (DCA).

RESULTS

Seven variables were identified through LASSO and multivariate regression analysis. The LR model achieved the highest AUC (0.805), outperforming the RF (0.796) and XGBoost (0.780) models. Additionally, the LR model exhibited superior accuracy, precision, recall, specificity and F1-score. External validation confirmed the LR model's robustness, with an AUC of 0.816. Calibration and DCA curves demonstrated their accuracy and clinical applicability.

CONCLUSIONS

A predictive model, presented as a nomogram and an online risk calculator, was developed to assess sarcopenia risk in patients with stroke. Early screening using this model may facilitate timely interventions and improve patient outcomes.

Cigarette Smoking Induces Skeletal Muscle Atrophy in Mice by Activated Macrophage-Mediated Pyroptosis

Objective

Skeletal muscle atrophy is a major comorbidity associated with chronic obstructive pulmonary disease caused by exposure to cigarette smoke (CS). CS-activated macrophages and pyroptosis play an important role in skeletal muscle atrophy, but its specific molecular mechanism remains unclear. This study investigated the role and mechanisms of pyroptosis and activated macrophages in CS-induced skeletal muscle atrophy.

Methods

In the in vivo model, mice were exposed to either CS or air for 24 weeks, and in the in vitro model, C2C12 murine skeletal muscle cells were co-cultured with macrophages in Transwell chambers. Western blotting, real-time PCR, ELISA, and other methods were used to detect pyroptosis-related markers to investigate the mechanism of CSE-activated macrophages on skeletal muscle atrophy and pyroptosis.

Results

In vivo, CS-induced atrophy of the mouse gastrocnemius muscle was accompanied by increased expression of pyroptosis-related markers, including NLRP3 inflammasome, cleaved Caspase-1, the GSDMD N-terminal domain, and interleukin (IL)-18. In vitro, CS extract (CSE)-activated macrophages mediates pyroptosis of skeletal muscle cells and induces myotube atrophy. Further studies demonstrated that macrophage-derived TNF-α is the initiating factor of skeletal muscle pyroptosis, and this process appears to be mediated through TNF-α activating the TNFR1/NLRP3/caspase-1/GSDMD signaling pathway.

Conclusion

TNF-α released by CSE-activated macrophages can promote skeletal muscle pyroptosis by activating the TNFR1/NLRP3/Caspase-1/GSDMD signaling pathway, which likely contributes to skeletal muscle atrophy. These findings provide more insight into the mechanisms underlying skeletal muscle atrophy in COPD.

Are There Differences in Postural Control and Muscular Activity in Individuals with COPD and with and Without Sarcopenia?

AIM

The aim of this study was to compare balance performance and electromyographic activity in individuals with COPD, with and without sarcopenia.

METHOD

Thirty-five patients with COPD were classified with and without sarcopenia according to EWGSOP criteria. Balance was assessed using a force platform under four conditions: standing with feet apart and eyes opened (FHEO), eyes closed (FHEC), on an unstable surface (US), and on one leg (OLS). The surface electromyography activity of lower limb muscles and trunks was recorded. Additionally, the timed up and go test (TUG) and the Brief Balance Evaluation Systems Test (Brief-BESTest) were also utilized.

RESULTS

Under the FHEO, FHEC, and US conditions, individuals with sarcopenia demonstrated increased velocities, larger oscillation amplitudes, and greater center of pressure displacements under the US condition (p ≤ 0.02). They also showed a higher activation of the scalene, sternocleidomastoid, and abdominal muscles during OLS, along with a reduced activation of the tibialis anterior during OLS and US, and a decreased activation of the vastus medialis during FHEC and US (p ≤ 0.04). Furthermore, sarcopenic COPD patients exhibited poorer performance on the TUG and Brief-BESTest compared to their non-sarcopenic counterparts (p ≤ 0.02).

CONCLUSIONS

Individuals with COPD and sarcopenia demonstrated greater instability in both bipedal stances and on unstable surfaces, as well as poorer performance in both dynamic and static balance assessments. Furthermore, these individuals exhibited reduced muscular activation in the lower limbs compared to those without sarcopenia.

ADAMTS4 Reduction Contributes to Extracellular Matrix Deposition and Impaired Myogenesis in the Skeletal Muscle of Cigarette Smoke-Exposed Mice

Background: The extracellular matrix (ECM) plays a critical role in the proper regeneration of skeletal muscle. ECM remodeling has been reported in the skeletal muscle of chronic obstructive pulmonary disease (COPD), while the mechanisms remain poorly understood. Methods: In this study, we examined the dynamic interplay between ECM components and ECM enzymes in COPD skeletal muscle and cigarette smoke (CS) extract-treated C2C12 cells. C2C12 cells were further used to evaluate the role of a disintegrin and metalloproteinase with thrombospondin motif 4 (ADAMTS4) in ECM remodeling and myogenesis. Results: Chronic CS exposure induced the development of COPD and comorbid sarcopenia in C57BL/6J mice. Muscle fibrosis was observed in the gastrocnemius muscle of CS-exposed mice, accompanied by an upregulation of protein expression but a downregulation of mRNA levels of fibronectin and versican. We found that the discrepancy of mRNA and protein expression was attributed to the aberrant secretion of some ECM enzymes belonging to matrix metalloproteinases and ADAMTS proteases, especially ADAMTS4. CS exposure reduced ADAMTS4 expression in gastrocnemius muscles and C2C12 cells, and Adamts4 knockdown induced fibronectin and versican accumulation and impeded myogenic process. Conclusions: Considering that recent studies have indicated an impaired skeletal muscle regeneration in COPD, we suggested that the restrained production of ADAMTS4 in response to CS could be involved in the damaged muscle regeneration through regulating skeletal muscle ECM in COPD. Targeting ECM enzymes may benefit the rehabilitation of COPD-related sarcopenia.

Joint association of systemic inflammatory response index and sarcopenia with mortality among individuals with self-reported cancer

PURPOSE

The aim of this study was to investigate the joint association of systemic inflammatory response index (SIRI) and sarcopenia with cancer-specific and all-cause mortality in individuals with self-reported cancer.

METHODS

The study cohort comprised individuals with a self-reported cancer diagnosis from the NHANES database, with data collected between 1999 and 2006 and 2011-2018. The researchers tracked deaths up to 31 December 2019 by linking the relevant records to those held by the (NDI). A weighted sampling design was employed, with participants stratified according to the median value of the SIRI. Cox regression models were employed to assess the association between SIRI, sarcopenia, all-cause mortality, and cancer-specific mortality.

RESULTS

The study cohort comprised 1316 individuals with self-reported cancer. Over a median follow-up period of 9.21 years, 523 all-cause deaths were recorded, including 163 cancer-specific and 360 non-cancer deaths. Adjusting for multiple confounders, elevated SIRI levels were significantly associated with increased risks of all-cause (HR = 1.90 [1.58-2.28]), cancer (HR = 1.88 [1.26-2.78]), and non-cancer mortality (HR = 1.93 [1.54-2.41]). Sarcopenia also emerged as a significant predictor of mortality. Individuals with sarcopenia faced a 50% higher risk of all-cause mortality (HR = 1.50 [1.18-1.91]) and a 54% higher risk of non-cancer mortality (HR = 1.54 [1.11-2.12]). However, the association with cancer mortality was not significant in the fully adjusted model. When both sarcopenia and elevated SIRI were present, the risk was the highest for all-cause (HR = 2.54 [1.92-3.37]), cancer (HR = 2.29 [1.19-4.40]), and non-cancer mortality (HR = 2.63 [1.78-3.89]). Elevated SIRI alone was linked to significant risks for all-cause (HR = 1.91 [1.51-2.42]), cancer (HR = 1.95 [1.28-2.97]), and non-cancer mortality (HR = 1.92 [1.46-2.53]). Sarcopenia alone significantly increased the risk of all-cause mortality (HR = 1.63 [1.01-2.56]) but not cancer mortality.

CONCLUSION

Our study is the first to demonstrate the joint association between the SIRI and sarcopenia with mortality among individuals with self-reported cancer. These findings underscore the importance of assessing and managing these two factors in individuals with self-reported cancer to reduce the risk of death and improve survival outcomes.

Additive impact of metabolic syndrome and sarcopenia on all-cause and cause-specific mortality: an analysis of NHANES

Background

Metabolic syndrome (MetS) and sarcopenia (SP) are increasingly significant public health issues in aging societies, sharing common pathophysiological mechanisms and being associated with severe health consequences. This study investigates the impact of MetS and SP on all-cause and cause-specific mortality using a longitudinal, nationally representative population-based cohort.

Methods

The study analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. Mortality data were obtained from the National Death Index up to December 2019.

Results

Among the 21,962 participants, 13,517 (61.5%) had neither MetS nor SP(MetS-/SP-), 5,407 (24.6%) had MetS only(MetS+/SP-), 2,698 (12.2%) had SP only(MetS-/SP+), and 340 (1.5%) had both MetS and SP(MetS+/SP+). Compared to the group without MetS and SP, the groups with MetS only, SP only, and both MetS and SP showed increased all-cause mortality, with adjusted hazard ratios (HR) of 1.23 (95% CI: 1.11-1.37), 1.63 (95% CI: 1.41-1.89), and 1.61 (95% CI: 1.33-1.95), respectively. The MetS+/SP+ group had the highest overall mortality risk (trend test p<0.0001). For cause-specific mortality, the MetS+/SP+ group exhibited increased cardiovascular mortality (HR: 1.89, 95% CI: 1.27-2.81), cardiac mortality (HR: 1.89, 95% CI: 1.25-2.86), respiratory mortality (HR: 2.63, 95% CI: 1.29-5.35), and diabetes mortality (HR: 8.79, 95% CI: 2.62-29.45) compared to the group without MetS and SP.

Conclusion

The coexistence of MetS and SP significantly increases the risk of all-cause and cause-specific mortality. Individuals with either condition may require more vigilant management to prevent the onset of the other condition, thereby reducing mortality rates. These findings highlight the importance of integrated healthcare strategies targeting both MetS and SP to improve patient outcomes and longevity.

Lipid peroxidation and sarcopenia: molecular mechanisms and potential therapeutic approaches

Sarcopenia is an age-related condition characterized by the progressive loss of skeletal muscle mass and strength. With the global aging population, its incidence is rapidly increasing. Lipid peroxidation is a critical biochemical process that generates reactive oxygen species (ROS), leading to the destruction of muscle cell structure and function. It plays a pivotal role in the onset and progression of sarcopenia. This review summarizes the mechanisms by which lipid peroxidation contributes to sarcopenia, with a focus on its regulatory effects on cell membrane damage, mitochondrial dysfunction, and cell death. In addition, we discuss the protective role of antioxidant factors such as GPX4 (glutathione peroxidase 4) and antioxidant peptides like SS peptides in mitigating lipid peroxidation and delaying the progression of sarcopenia. Finally, the potential of various strategies, including natural compounds, supplements, natural extracts, and lifestyle interventions, in inhibiting lipid peroxidation and promoting muscle health is explored.

Associations of Muscle-Related Metrics With Respiratory Disease in Chinese Adults: A Prospective Cohort Study

BACKGROUND

There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance.

METHODS

We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex-specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease.

RESULTS

In total, 17 510 participants aged 38-88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013-2014 and followed up until 31 December 2018. During a median follow-up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14-1.51) for low grip strength and 1.25 (1.09-1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%-34%) and 14% (95% CI: 7%-22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index.

CONCLUSION

Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle-related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials.

Associations between sedentary behaviour and sarcopenia among patients aged 40 and older with chronic obstructive pulmonary disease: a cross-sectional study

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) and sarcopenia experience poorer clinical prognosis. Although sedentary behaviour (SB) is common risk factor for COPD, its relationship with sarcopenia in this specific population remains unclear.

METHODS

This is a cross-sectional survey of participants aged 40 and above with COPD, involving 27 communities and 2 hospitals' outpatient departments. The definition of sarcopenia was in accordance with the Asian Expert Consensus Criteria for sarcopenia. SB and physical activity (PA) were evaluated using the short form of the international physical activity questionnaires (IPAQ-SF). SB was categorized into 4 categories: less than 4 h/day, 4 to 6 h/day, 6 to 8 h/day, and 8 h or more per day. PA was classified into light-intensity and moderate-to-vigorous intensity physical activity (LPA and MVPA). Multiple logistic regression and restricted cubic spline (RCS) were performed to investigate the rates of association between sarcopenia and SB. Subgroups was analysed by gender.

RESULTS

A total of 414 COPD patients with complete information were included in this trial. The overall prevalence of sarcopenia was 22.9%. Participants with sarcopenia had longer of SB (P = 0.008) and less MVPA (P < 0.001) compared to those without sarcopenia. After adjustment for confounders, SB showed a significant association with sarcopenia (adjusted β = 1.47, 95% CI = 1.28-1.68). The participants who spent 6 or more hours on SB had a greater odds ratio for sarcopenia (= 6-8 h: adjusted OR = 2.97, 95% CI = 1.14-7.70; > 8 h: OR = 9.14, 95% CI = 3.59-23.22) than the participants who spent less than 4 h. The results of RCS indicated that when SB exceeded 5.7 h/day, a trend towards a significant increasing prevalence of sarcopenia was observed with increased SB. This trend was also observed across genders, differing only in the threshold values (male: SB = 5.7 h; female: SB = 8.0 h).

CONCLUSION

SB was an independent determinant of sarcopenia, independent of MVPA, and the prevalence of sarcopenia increases as SB increases within a certain range. This study advocated for the integration of SB in the self-management strategies for patients with COPD. Regardless of their engagement in MVPA, it was crucial to regulate SB.

Reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction patients over 80 years old in China

AIMS

This study aims to explore the efficacy of reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction (STEMI) patients over 80 years old in China.

METHODS AND RESULTS

A retrospective cohort study was performed on STEMI patients over 80 years old who underwent reperfusion strategies and no reperfusion between January 2014 and December 2021, based on the Chinese Cardiovascular Association (CCA) Database-Chest Pain Center. This study included a total of 42,699 patients (mean age 84.1 ± 3.6 years, 52.2% male), among whom 19,280 (45.2%) underwent no reperfusion, 20,924 (49.0%) underwent primary percutaneous coronary intervention (PCI), and 2495 (5.8%) underwent thrombolytic therapy. After adjusting for potential confounders, multivariable logistic regression analysis revealed that patients who underwent primary PCI strategy showed a significantly lower risk of in-hospital mortality [odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.57-0.67, P < 0.001] and the composite outcome (OR = 0.83, 95% CI: 0.79-0.87, P < 0.001) compared to those who received no reperfusion. In contrast, patients with thrombolytic therapy exhibited a non-significantly higher risk of in-hospital mortality (OR = 0.99, 95% CI: 0.86-1.14, P = 0.890) and a significantly elevated risk of the composite outcome (OR = 1.15, 95% CI: 1.05-1.27, P = 0.004). During a median follow-up of 6.7 months post-hospital admission, there was a percentage 31.4% of patients died, and patients in the primary PCI group consistently demonstrated a reduced incidence of all-cause mortality (hazard ratio (HR) = 0.58, 95% CI: 0.56-0.61, P < 0.001).

CONCLUSION

STEMI patients over 80 years old who underwent the primary PCI strategy are more likely to have favourable clinical outcomes compared to those who received no reperfusion, whereas thrombolytic therapy warrants careful assessment and monitoring.

Association of Lung Function With Visceral Adiposity and Skeletal Muscle Mass Considering Myosteatosis

BACKGROUND

Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function.

RESEARCH QUESTION

What is the relationship between lung function, visceral adiposity, and skeletal muscle mass, considering myosteatosis measured using CT scans in middle-aged Korean adults?

STUDY DESIGN AND METHODS

We reviewed 15,827 participants (9,237 men and 6,590 women) with a mean (SD) age of 52.5 (8.3) years who underwent comprehensive health examinations, including abdominal CT imaging and spirometry. Selected CT scans were segmented automatically to quantify total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area. Muscle quality was assessed by categorizing TAMA into 3 regions based on CT scan density: good-quality muscle (normal attenuation muscle area [NAMA]), fatty muscle (low attenuation muscle area), and intermuscular and intramuscular fat areas. Low lung function was defined as FVC % predicted and FEV1 < 80% predicted. Standardized residuals for CT scan-derived measurements, adjusted for age and BMI using linear regression, were calculated and stratified into quartiles for lung function comparison. Multivariate logistic regression was used to analyze associations between low lung function and variables.

RESULTS

NAMA was positively correlated with FVC and FEV1, whereas VFA was negatively correlated with both. In men, low FVC and FEV1 were significantly associated with lower NAMA and higher VFA. Among women with obesity (BMI ≥ 25 kg/m2), low FVC and FEV1 were associated significantly with higher VFA and lower NAMA (FVC only); among women without obesity, low FVC and FEV1 were negatively associated with NAMA.

INTERPRETATION

Lung function was significantly associated with visceral adiposity and skeletal muscle quality, which differed according to sex and BMI. Improving lung function may require tailored management, including reducing visceral fat, enhancing skeletal muscle quality, or both, based on CT scan-body composition analysis.

SARC-CalF using calf circumference adjusted for BMI predicts 6-mo readmission and mortality in hospitalized patients: a secondary analysis of a cohort study

BACKGROUND

Sarcopenia is a prevalent condition associated with worse clinical outcomes in hospitalized patients. The SARC-CalF is an accurate instrument for its screening; however, it includes the calf circumference (CC) measure as a criterion, which is influenced by adiposity. An adjustment for CC based on body mass index (BMI) has been proposed, but the literature lacks studies evaluating the SARC-CalF using adjusted CC.

OBJECTIVES

This study aimed to evaluate the prognostic value of the SARC-CalF with BMI-adjusted CC and compare it between adult and older hospitalized patients.

METHODS

This is a secondary analysis of a cohort with prospective data collection, including individuals aged ≥18 y who were lucid and able to communicate. SARC-CalF was applied using BMI-adjusted CC, obtained by subtracting 3, 7, and 12 cm from CC values when BMI was 25 to 29.99, 30 to 39.99, and ≥40 kg/m2, respectively. Outcomes of interest included prolonged hospital stay, in-hospital death, hospital readmission, and mortality 6 mo after discharge. Logistic and Cox regression analyses, adjusted for Charlson Comorbidity Index and sex, were performed.

RESULTS

We analyzed data from 554 patients (mean age 55.2 ± 14.9 y, 52.9% male). Suggestive signs of sarcopenia by SARC-CalF with BMI-adjusted CC were identified in 40.4% of patients (38.6% of adults and 42.7% of older patients, P = 0.380). Suggestive signs of sarcopenia were associated with hospital readmission in adults (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.1, 2.9), and 6-mo death in both adult (OR: 4.0; 95% CI: 1.3, 12.1) and older patients (OR: 2.8; 95% CI: 1.2, 6.6). It was not independently associated with in-hospital outcomes.

CONCLUSIONS

SARC-CalF with BMI-adjusted CC identifies a high frequency of patients with suggestive signs of sarcopenia, regardless of age, and it is independently associated with worse outcomes 6 mo after discharge.

The Role of Diaphragmatic Ultrasound in Identifying Sarcopenia in COPD Patients: A Cross-Sectional Study

Background/Aim

Chronic obstructive pulmonary disease (COPD) is often complicated by sarcopenia, a condition of reduced muscle mass and function that adversely affects quality of life, lung function, and exacerbation rates. Ultrasonography could be an effective tool for detecting sarcopenia, notably by assessing diaphragmatic function, which may indicate muscle health in COPD patients. This study aims to evaluate the effectiveness of diaphragmatic ultrasound in detecting sarcopenia among COPD patients.

Materials and Methods

Thirty-five patients with COPD, with a forced expiratory volume in one second (FEV1) between 30% and 80%, were consecutively enrolled in this cross-sectional and double-blind study. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was assessed with bioelectrical impedance analysis (BIA), muscle strength was assessed using the handgrip test and physical performance was assessed using a 4-meter gait speed test. Pulmonary function tests (PFT) (including maximum inspiratory pressure-MIP and maximum expiratory pressure-MEP) were performed. Diaphragm excursion and thickness at residual volume, functional residual capacity, and total lung capacity were measured using ultrasound. The diaphragm thickening fraction was calculated during normal (TF) and deep breathing (TLC-TF).

Results

Seventeen of 35 patients (48.6%) were found to be sarcopenic. Diaphragm thickness did not show significant variation between the groups. Both TF (27.43%) and TLC-TF (39.7%) were found to be lower in the sarcopenic group (p<0.05). The diaphragmatic excursion in the sarcopenic group was found to be 1.38 cm (p=0.078). There was no difference in median MIP and MEP values between the groups.

Conclusion

Diaphragmatic TF may be a valuable tool for detecting sarcopenia in COPD patients, which may vary independently of PFTs. This study highlights TF as a potential auxiliary measure, but further research with larger sample sizes and additional parameters is needed to confirm its clinical utility.

Current perspectives on the rehabilitation of COPD patients with comorbidities

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by a variety of comorbidities, complicating management and rehabilitation efforts. Understanding this interplay is crucial for optimizing patient outcomes.

AREAS COVERED

This review, based on the MEDLINE, Embase and Cochrane Library databases, summarizes the main research on the rehabilitation of patients with COPD, with an emphasis on relevant comorbidities, such as cardiovascular diseases, pulmonary hypertension, lung cancer, metabolic, musculoskeletal, and gastrointestinal disorders. anxiety/depression and cognitive disorders. The study highlights the importance of pre-participation assessments, ongoing monitoring and personalized rehabilitation programs. A review includes a comprehensive literature search to assess the scientific evidence on these interventions and their impact.

EXPERT OPINION

The integration of cardiorespiratory rehabilitation program is essential for improving physical capacity and quality of life in COPD patients with comorbidities. While existing studies highlight positive outcomes, challenges such as interdisciplinary collaboration and access to rehabilitation services remain. Future strategies must prioritize personalized and integrated approaches programs combining pharmacological optimization and a close monitoring during cardiopulmonary rehabilitation to significantly reduce hospital readmissions and mortality, even in patients with complex multimorbidities. Continued research is necessary to refine rehabilitation protocols and better understand the complexities of managing COPD alongside cardiac conditions.

Relationship among depressive symptoms, dyspnea-related fear and sarcopenia in patients with chronic obstructive pulmonary disease: The mediating effect of physical activity

Objectives: Sarcopenia is influenced by multiple factors, including psychological aspects. This study aimed to explore the relationships among depressive symptoms, dyspnea-related fear, and sarcopenia, with a focus on the mediating role of physical activity. Methods: A cross-sectional study was conducted among 348 COPD patients at a tertiary hospital in Western China from July 2023 to July 2024. Sarcopenia was assessed according to the 2019 AWGS criteria, including hand bioelectrical impedance analysis (BIA), and grip strength testing. Depressive symptoms, dyspnea-related fear, and physical activity were evaluated through self-reported measures using the depression subscale of the Hospital Anxiety and Depression Scale (HADS), the Breathlessness Beliefs Questionnaire (BBQ), and the International Physical Activity Questionnaire Short Form (IPAQ-SF), respectively. Logistic regressions analyses explored associations among depressive symptoms, dyspnea-related fear, and sarcopenia. Maximum Likelihood (ML) estimation was employed using Mplus software to evaluate the mediating effect of physical activity on the relationships. Results: The prevalence of sarcopenia among COPD patients was 60.3%. In the logistic regression analysis with sarcopenia as the dependent variable, physical activity levels (OR = 0.508, p = 0.019) and depressive symptoms (OR = 1.079, p = 0.029) were statistically significant, while BBQ scores were not (OR = 1.031, p = 0.070). Mediating analyses revealed that depressive symptoms directly increased the risk of sarcopenia (β = 0.076, p = 0.042) but did not do so indirectly via physical activity (β = 0.056, p = 0.146). Conversely, dyspnea-related fear had an indirect effect on sarcopenia through physical activity, with a borderline statistical significance (β = 0.053, p = 0.049). Conclusions: This study highlights the critical role of psychological factors in sarcopenia development among COPD patients, with physical activity serving as a significant mediator. These findings underscore the need for integrated rehabilitation strategies addressing both psychological and physical activity barriers to improve outcomes for COPD patients.

Changes in sarcopenia and incident cardiovascular disease in prospective cohorts

BACKGROUND

Previous studies have identified sarcopenia as a significant risk factor for cardiovascular disease (CVD). However, these studies primarily focused on sarcopenia status at baseline, without considering changes in sarcopenia status during follow-up. The aim of this study is to investigate the association between changes in sarcopenia status and the incidence of new-onset cardiovascular disease.

METHODS

This study utilized prospective cohort data from the China Health and Retirement Longitudinal Study (CHARLS). Sarcopenia status was assessed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm and categorized as non-sarcopenia, possible sarcopenia, or sarcopenia. Changes in sarcopenia status were evaluated based on assessments at baseline and at the second follow-up survey 2 years later. CVD was identified through self-reported physician diagnoses of heart disease, including angina, myocardial infarction, congestive heart failure, and other heart problems, or stroke. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounding factors.

RESULTS

Based on the inclusion and exclusion criteria, a total of 7499 CHARLS participants were included in the analysis, with 50.8% being female and an average age of 58.5 years. Compared to participants with stable non-sarcopenia status, those who progressed from non-sarcopenia to possible sarcopenia or sarcopenia exhibited a significantly increased risk of new-onset CVD (HR 1.30, 95% CI 1.06-1.59). Conversely, participants who recovered from sarcopenia to non-sarcopenia or possible sarcopenia had a significantly reduced risk of new-onset CVD compared to those with stable sarcopenia status (HR 0.61, 95% CI 0.37-0.99). Among participants with baseline possible sarcopenia, those who recovered to non-sarcopenia had a significantly lower risk of new-onset CVD compared to those with stable possible sarcopenia status (HR 0.67, 95% CI 0.52-0.86).

CONCLUSIONS

Changes in sarcopenia status are associated with varying risks of new-onset CVD. Progression in sarcopenia status increases the risk, while recovery from sarcopenia reduces the risk of developing cardiovascular disease.

Urinary titin as an early biomarker of skeletal muscle proteolysis and atrophy in various catabolic conditions

Skeletal muscle atrophy impairs quality of life and increases the risk of disease, but current methods for assessment of muscle mass have several limitations. We here investigated the urinary concentration of a fragment of the muscle protein titin as a potential biomarker for the early detection of skeletal muscle atrophy. Four mouse models with different atrophy pathways were studied: those of cardiotoxin-induced acute muscle injury, cast-induced muscle immobilization, lipopolysaccharide-induced sepsis, and streptozotocin-induced diabetes. In all four models, urinary titin levels increased early, concurrent with or preceding upregulation of the atrophy-related genes for atrogin-1 and MuRF-1. The increase in the urinary titin concentration was thus associated with initial muscle damage and the onset of proteolysis, rather than with late-stage muscle wasting. Our findings suggest that urinary titin is a promising biomarker for detection of the onset of skeletal muscle catabolism and prediction of the subsequent development of atrophy in different catabolic states. Noninvasive measurement of urinary titin may therefore allow the earlier detection of skeletal muscle proteolysis compared with conventional techniques.

DKK3 as a diagnostic marker and potential therapeutic target for sarcopenia in chronic obstructive pulmonary disease

Sarcopenia, characterized by the progressive loss of muscle mass and function, significantly affects patients with chronic obstructive pulmonary disease (COPD) and worsens their morbidity and mortality. The pathogenesis of muscle atrophy in patients with COPD involves complex mechanisms, including protein imbalance and mitochondrial dysfunction, which have been identified in the muscle tissues of patients with COPD. DKK3 (Dickkopf-3) is a secreted glycoprotein involved in the process of myogenesis. However, the role of DKK3 in the regulation of muscle mass is largely unknown. This study investigated the role of DKK3 in COPD-related sarcopenia. DKK3 was found to be overexpressed in cigarette smoking-induced muscle atrophy and in patients with COPD. Importantly, plasma DKK3 levels in COPD patients with sarcopenia were significantly higher than those without sarcopenia, and plasma DKK3 levels could effectively predict sarcopenia in patients with COPD based on two independent cohorts. Mechanistically, DKK3 is secreted by skeletal muscle cells that acts in autocrine and paracrine manners and interacts with the cell surface-activated receptor cytoskeleton-associated protein 4 (CKAP4) to induce mitochondrial dysfunction and myotube atrophy. The inhibition of DKK3 by genetic ablation prevented cigarette smoking-induced skeletal muscle dysfunction. These results suggest that DKK3 is a potential target for the diagnosis and treatment of sarcopenia in patients with COPD.

Sarcopenia and sleep in individuals with chronic obstructive pulmonary disease

OBJECTIVE

To verify the relationship between sarcopenia and sleep in individuals with chronic obstructive pulmonary disease (COPD).

METHODS

Individuals with COPD were cross-sectionally assessed for lung function (spirometry), sleep (both subjectively [Pittsburgh Sleep Quality Index, PSQI] and objectively [Actiwatch sleep monitor]) and the presence of sarcopenia (handgrip strength by dynamometry). All tests were carried out in accordance with international standards.

RESULTS

Twenty-nine individuals with COPD were analyzed (16 women; 69 ± 7 years; BMI 27 ± 5 kg/m2; FEV1 59 ± 19% predicted). Upon division in groups according to the presence or absence of sarcopenia, individuals with sarcopenia (in comparison to those without sarcopenia) had shorter sleep time (81 [75-85] vs. 86 [81-90] %; p = 0.043), lower sleep efficiency (77 [69-83] vs. 85 [75-87] %; p = 0.038), longer time awake after sleep onset (92 [71-120] vs. 58 [47-83] minutes; p = 0.0012) and more marked sleep fragmentation, represented by a higher number of sleep blocks/night (46 [41-49] vs. 34 [26-48]; p = 0.018), higher number of awake blocks/night (45 [40-49] vs. 34 [26-48]; p = 0.018) and shorter duration of sleep blocks/night (9 [8-10] vs. 14 [8-58] minutes; p = 0.043). There was no statistical difference when comparing the PSQI variables between the groups. However, handgrip strength was negatively associated with PSQI components 2 [R= -0.51, p = 0.005] and 5 [R= -0.39, p = 0.037].

CONCLUSION

Individuals with COPD and sarcopenia (as measured by handgrip strength) have worse objectively measured sleep outcomes. This was not the case regarding a self-reported perception of worse sleep quality, although there was weak-to-moderate association between handgrip strength and subjective sleep.

Association of grip strength, sleep duration, and comorbidities with depressive symptoms in middle-aged and older patients with chronic lung diseases: a cross-sectional network analysis based on CHARLS data

Background

Depressive symptoms are prevalent among patients with chronic lung diseases (CLDs) and adversely impact their quality of life. This study aims to explore the association of grip strength (GS), sleep duration, and comorbidities with depressive symptoms in patients with CLDs, with an in-depth analysis of the underlying mechanisms.

Methods

Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this study included participants aged 45 and above with diagnosed CLDs. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Binary logistic regression, subgroup analysis, and network analysis were conducted to examine the intricate relationships between GS, sleep duration, comorbidities, and specific depressive symptoms.

Results

Among the 1,427 participants, 39.8% exhibited depressive symptoms. Adjusted analyses revealed that GS (OR = 0.964, p < 0.001) and sleep duration (OR = 0.808, p < 0.001) were negatively associated with depressive symptoms, whereas the number of comorbid chronic diseases (OR = 1.189, p < 0.001) showed a significant positive correlation with depressive symptoms. Subgroup analyses demonstrated variations in these relationships across different demographic characteristics and lifestyle factors. Network analysis pinpointed "depressed" as the core symptom, with "annoyed," "exhausted," and "lonely" as secondary core symptoms. The robust associations between specific factors and depressive symptoms (GS with "annoyed," sleep and comorbid chronic diseases with "depressed") suggested potential targets for interventions.

Conclusion

This study underscores the complex interplay of GS, sleep duration, and comorbidities with depressive symptoms in patients with CLDs. These findings offer new perspectives for improving the mental health of this vulnerable population.

Skeletal muscle atrophy induces memory dysfunction via hemopexin action in healthy young mice

Age-related morbidity has become an increasingly significant issue worldwide. Sarcopenia, the decline in skeletal muscle mass and strength with age, has been reported to be a risk factor for cognitive impairment. Our previous study revealed that skeletal muscle atrophy shifts the onset of memory dysfunction earlier in young Alzheimer's disease mice and found that hemopexin is a myokine responsible for memory loss. This study aimed to elucidate the occurrence of memory impairment due to skeletal muscle atrophy in non-genetically engineered healthy young mice and the involvement of hemopexin. Closed-colony ddY mice at 12-13 weeks of age were used. Both hind limbs were immobilized by cast attachment for 14 d. Casting for 2 weeks induced a loss of skeletal muscle weight. The memory function of the mice was evaluated using a novel object recognition test. The cast-attached mice exhibited memory impairment. Hemopexin levels in the conditioned medium of the skeletal muscle, plasma, and hippocampus were increased in cast-attached mice. Continuous intracerebroventricular hemopexin infusion induced memory deficits in non-cast mice. To investigate whether hemopexin is the main causative factor of cognitive impairment, cast-attached mice were intracerebroventricularly infused with an anti-hemopexin antibody. Cast-induced memory impairment was reversed by the infusion of an anti-hemopexin antibody. These findings provide new evidence that skeletal muscle atrophy causes memory impairment in healthy young mice through the action of hemopexin in the brain.

Lessons learned from a combined, personalized lifestyle intervention in hospitalized patients at risk for sarcopenia: a feasibility study

PURPOSE

To examine the feasibility of a combined, personalized exercise and nutrition intervention in hospitalized patients at risk of sarcopenia.

METHODS

The study is part of the FITFOOD randomized controlled trial. Eligible patients were randomized into two groups: receiving a personalized nutrition and exercise intervention, or receiving usual care. The intervention entailed a high-protein diet with daily protein supplementation combined with functional training with strength and aerobic exercises. Feasibility was assessed using quantitative data, such as recruitment rate, and qualitative data retrieved from focus group and individual semi-structured interviews.

RESULTS

In total, 14 out of 115 eligible patients participated. The recruitment rate was 12%, and the dropout rate was 50% (7 out of 14 participants). Patients at risk for sarcopenia found it difficult to be involved in a lifestyle intervention, because they were often preoccupied with their recovery, had little interest in changing their diet or level of exercise, and were often unable to participate fully due to health issues and mobility difficulty.

CONCLUSIONS

The evaluated combined, personalized lifestyle intervention had limited feasibility in hospitalized patients at risk for sarcopenia, with low recruitment and high dropout rates. The current lifestyle intervention might be too challenging for this vulnerable population.

TRIAL REGISTRATION

The trial associated with this feasibility study was pre-registered on ClinicalTrials.gov under the registration number NCT05413616 on 07 June 2022.

The impact of appendicular skeletal muscle index and trunk muscle index on stress urinary incontinence risk in female adults: a retrospective study

Objective

This study sought to examine the effect of the appendicular skeletal muscle index (ASMI) and trunk muscle index (TMI) on the likelihood of stress urinary incontinence (SUI) among female adults.

Methods

This investigation utilized data from the National Health and Nutrition Examination Survey from 2001 to 2006 and 2011-2018. To evaluate the impact of ASMI and TMI on the likelihood of SUI, the study utilized restricted cubic splines (RCS) and weighted multivariable logistic regression models. Subgroup and interaction analyses were conducted to investigate how other covariates influenced their relationship.

Results

In total, 11,168 female adults participated in the analysis. Multivariable logistic regression analysis revealed that high TMI was associated with a decreased likelihood of SUI (OR = 0.34; 95% CI: 0.16-0.75; p = 0.013). ASMI was not correlated with the likelihood of SUI. RCS analysis demonstrated a linear correlation between TMI and SUI risk, showing a decreasing trend in SUI risk as TMI increases (p for overall <0.001, p for nonlinearity = 0.73).

Conclusion

Our study results showed that there was no association between ASMI and the risk of SUI, while a high TMI reduced the risk of SUI. This suggested that the ratio of muscle mass and BMI in different body regions has varying effects on SUI.

Association of computed tomography-derived pectoralis muscle area and density with disease severity and respiratory symptoms in patients with chronic obstructive pulmonary disease: A case-control study

RATIONALE AND OBJECTIVES

Computed tomography (CT) is commonly used and offers an additional viewpoint for evaluating extrapulmonary symptoms, disease severity, and muscle atrophy. This study assessed whether the pectoralis muscle area (PMA) and pectoralis muscle density (PMD) are lower in patients with chronic obstructive pulmonary disease (COPD) than in healthy controls and elucidated their relationships with these variables.

MATERIALS AND METHODS

The participants were enrolled in the hospital outpatient clinic between October 2023 and May 2024. Information was obtained from questionnaires, lung function, and CT imaging findings. On full-inspiratory CT, the PMA and PMD were measured at the aortic arch level using predetermined attenuation ranges of -29 and 150 Hounsfield units. We observed lower PMA and PMD and evaluated their associations with lung function, respiratory symptoms, and CT imaging findings in patients with COPD.

RESULTS

Overall, 120 participants were enrolled at baseline (60 healthy controls and 60 patients with COPD). PMA and PMD were lower with progressive airflow limitation severity in those with COPD. The degree of emphysema and air trapping, as well as lung function, were correlated with PMA and PMD (P < 0.05), although not with the COPD Assessment Test or modified Medical Research Council scores (P > 0.05).

CONCLUSION

Participants with COPD had smaller PMA and PMD. These measurements were correlated with the severity of airflow limitation, lung function, emphysema, and air trapping, suggesting that these features of the pectoralis muscle obtained from CT are helpful in assessments of patients with COPD.

Determinant factors of sedentary time in individuals with COPD

BACKGROUND

The factors influencing sedentary time (ST) of individuals with chronic obstructive pulmonary disease (COPD) have not been thoroughly explored.

AIM

To identify determinant factors of ST in individuals with stable COPD.

METHODS

Individuals with COPD had their ST and variables of physical activity (PA) cross-sectionally assessed during seven days with an activity monitor. Main variables were ST/day (<1.5 METs), steps/day, time/day in light PA (light PA/day, 1.5-2.9 METs) and in moderate-to-vigorous PA (MVPA/day, ≥3 METs). Additional assessments included 6-min walking test (6MWT), Medical Research Council (MRC) scale, lung function and body composition. Multiple linear regression models were built with variables correlating significantly with ST/day.

RESULTS

50 individuals were analyzed (44 % males; 66 ± 8 years; FEV1 50 ± 19%pred). ST/day was 488 ± 160 min (61 ± 15 % of the day). 6MWT, MRC scale, MVPA/day, steps/day and light PA/day correlated significantly with ST expressed as minutes/day or as % of the day. In the multiple regression analyses, variables explaining the variance of ST in minutes/day were MRC scale (1 %) and light PA/day (53 %) (model R2 = .541, p < 0.001) and of ST in % of the day were steps/day (53 %) and light PA/day (46 %) (model R2 = .994, p < 0.001).

CONCLUSION

In individuals with COPD, the variance in sedentary time can be explained by dyspnea in daily life, step count and specially time/day in light PA, which reinforces the increase in light PA (rather than necessarily MVPA) as a strategy to reduce sedentary time.

Gas exchange efficiency slopes to assess exercise tolerance in chronic obstructive pulmonary disease

BACKGROUND

In patients with chronic obstructive pulmonary disease (COPD), the clinical use of the minute ventilation-carbon dioxide production ([Formula: see text]E-[Formula: see text]CO2) slope has been reported as a measure of exercise efficiency, but the oxygen uptake efficiency slope (OUES), i.e., the slope of oxygen uptake ([Formula: see text]O2) versus the logarithmically transformed [Formula: see text]E, has rarely been reported.

METHODS

We hypothesized that the [Formula: see text]E-[Formula: see text]CO2 slope is more useful than OUES in clinical use for the pathophysiological evaluation of COPD. Then, we investigated the cardiopulmonary exercise testing parameters affecting each of these slopes in 122 patients with all Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD grades selected from our database.

RESULTS

Compared with the GOLD I-II group (n = 51), peak [Formula: see text]O2 (p < 0.0001), OUES (p = 0.0161), [Formula: see text]E at peak exercise (p < 0.0001), and percutaneous oxygen saturation (SpO2) at peak exercise (p = 0.0004) were significantly lower in the GOLD III-IV group (n = 71). The GOLD III-IV group was divided into two groups by the exertional decrease in SpO2 from rest to peak exercise: 3% or less (the non-desaturation group: n = 23), or greater than 3% (the desaturation group: n = 48). OUES correlated only weakly with peak [Formula: see text]O2, [Formula: see text]E at peak exercise, and the difference between inspired and expired mean O2 concentrations (ΔFO2) at peak exercise, i.e., an indicator of oxygen consumption ability throughout the body, in the GOLD III-IV group with exertional hypoxemia. In contrast, the [Formula: see text]E-[Formula: see text]CO2 slope was significantly correlated with ΔFO2 at peak exercise, regardless of the COPD grade and exertional desaturation. Across all COPD stages, there was no correlation between the [Formula: see text]E-[Formula: see text]CO2 slope and [Formula: see text]E at peak exercise, and stepwise analysis identified peak [Formula: see text]O2 (p = 0.0345) and ΔFO2 (p < 0.0001) as variables with a greater effect on the [Formula: see text]E-[Formula: see text]CO2 slope.

CONCLUSIONS

The OUES may be less useful in advanced COPD with exertional hypoxemia. The [Formula: see text]E-[Formula: see text]CO2 slope, which is independent of [Formula: see text]E, focuses on oxygen consumption ability and exercise tolerance in COPD, regardless of the exertional hypoxemia level and COPD grade. Therefore, the [Formula: see text]E-[Formula: see text]CO2 slope might be useful in establishing or evaluating tailor-made therapies for individual patient's pathologies in COPD as an indicator focusing on oxygen consumption ability.

Exploring the relationship between sarcopenia and 11 respiratory diseases: a comprehensive mendelian randomization analysis

BACKGROUND

Sarcopenia (SP) is an aging-related loss of muscle mass and function, affecting the respiratory system. However, the causality of the association between sarcopenia on lung diseases remains elusive.

METHODS

The bidirectional univariate Mendelian randomization (UVMR), multivariate MR (MVMR) analysis, and mediation MR were utilized to systematically investigate the genetic causal relationship of SP and 11 respiratory diseases. Independent genomic variants related to sarcopenia or respiratory diseases were identified as instrumental variables (IVs), and the summary level data of genome-wide associated studies (GWAS) were obtained from the UK biobank and FinnGen. MVMR analysis was conducted to explore the mediation effects of body mass index (BMI), Alcohol Use Disorders Identification Test (AUDIT), smoking, education attainment (EA), physical activity, and Type 2 Diabetes Mellitus (T2DM).

RESULTS

Forward UVMR analysis based on the primary method revealed that pneumoconiosis was associated with a higher risk of appendicular lean mass (ALM) (OR = 1.01, p = 0.03), and BMI (10.65%), smoking (10.65%), and physical activity (17.70%) had a mediating role in the effect of pneumoconiosis on ALM. In reverse MR analysis, we found that genetically predicted ALM was significantly associated with an increased risk of pulmonary embolism (PE) (OR = 1.24, p = 7.21E-05). Chronic obstructive pulmonary disease (COPD) (OR = 0.98, p = 0.002) and sarcoidosis (OR = 1.01, p = 0.004) were identified to increase the loss of left-hand grip strength (HGS). Conversely, the increase in left- HGS presented a protective effect on chronic bronchitis (CB) (OR = 0.35, p = 0.03), (OR = 0.80, p = 0.02), and asthma (OR = 0.78, p = 0.04). Similarly, the loss of the right-HGS elevated the risk of low respiratory tract infection (LRTI) (OR = 0.97, p = 0.02) and bronchiectasis (OR = 1.01, p = 0.03), which is also an independent protective factor for LRTI and asthma. In the aspects of low HGS, the risk of LRTI was increased after MVMR analysis, and the risk of sarcoidosis and pneumoconiosis was elevated in the reverse analysis. Lastly, asthma was found to be related to the loss of the usual walking pace, and the reverse MR analysis suggested a causal relationship between the usual walking pace and LRTI (OR = 0.32, p = 2.79 × 10-5), asthma (OR = 0.24, p = 2.09 × 10-6), COPD (OR = 0.22, p = 6.64 × 10-4), and PE(OR = 0.35, p = 0.03).

CONCLUSIONS

This data-driven MR analysis revealed SP was bidirectional causally associated with lung diseases, providing genetic evidence for further mechanistic and clinical studies to understand the crosstalk between SP and lung diseases.

Body compositions phenotypes of older adults with COPD

Purpose

Changes in nutritional status are important extrapulmonary manifestations of the chronic obstructive pulmonary disease (COPD). The study aimed to assess the prevalence of different body composition phenotypes in older patients with COPD and to investigate the relationship between these phenotypes and the severity of the disease, as well as physical performance of the subjects.

Patients and methods

The study included 124 subjects aged ≥60 with COPD. In all of them body composition analysis and muscle strength measurement were performed. Additionally, data from patients' medical records were analyzed. Study sample was divided into four groups based on the phenotypic body composition: normal phenotype (N), sarcopenia, obesity and sarcopenic obesity (SO).

Results

Incidence of sarcopenia was significantly higher in patients with severe or very severe COPD based on GOLD in comparison with subjects with mild or moderate obstruction (p = 0.043). Participants with sarcopenia, obesity and SO had lower results of the 6-min walk test than subjects with N (225.77 m, 275.33 m, 350.67 m, 403.56 m, respectively). Moreover, sarcopenia and SO had lower results than obesity (p = 0.001, p = 0.041, respectively).

Conclusion

Sarcopenia is common in patients with advanced COPD. Sarcopenia and SO are associated with poorer physical performance. All older people with COPD should routinely have their body composition assessed, instead of simply measuring of body weight or body mass index (BMI).

Sarcopenia as a predictor of mortality in kidney transplant recipients: A 5-year prospective cohort study with propensity score matching

BACKGROUND

Sarcopenia is known to bring about adverse outcomes in elderly populations and dialysis patients. However, whether it is a risk factor in kidney transplant recipients (KTRs) has not yet been established. In the present study, the association of sarcopenia with mortality was investigated in KTRs.

METHODS

We conducted a single-center prospective cohort study and recruited KTRs who were more than 1-year posttransplant from August 2017 to January 2018. The participants were followed for 5 years, and the Kaplan-Meier method and Cox proportional hazards model were used to assess patient survival.

RESULTS

A total of 212 KTRs with a median age of 54 years and median transplant vintage of 79 months were enrolled in this study. Among them, 33 (16%) had sarcopenia according to the Asia Working Group for Sarcopenia 2019 at baseline. During the 5-year follow-up period, 20 (9.4%) died, 5 returned to dialysis after graft loss, and 4 were lost to follow-up. The 5-year overall survival rate was 90%. After 1:1 propensity score matching, a matched cohort with 60 KTRs was generated. The overall survival rate was significantly lower in the sarcopenia group compared to the non-sarcopenia group (p = 0.025, log-rank test). Furthermore, mortality risk was significantly higher in the sarcopenia group compared to the non-sarcopenia group (hazard ratio = 7.57, 95% confidence interval = 0.94-62).

CONCLUSION

Sarcopenia was a predictor of mortality in KTRs. KTRs with suboptimal muscle status who were at risk for poor survival could have a clinical benefit by interventions for sarcopenia.

Reducing the risk of death - a possible outcome in COPD patients

INTRODUCTION

COPD is a leading cause of global mortality, particularly under-recognized and under-diagnosed. In 2020, it was the sixth leading cause of death in the US and has contributed to 4.72% of all-cause mortality (ACM) according to the Global Burden of Disease Study 2017. Factors influencing COPD-related mortality include smoking, aging populations, comorbidities, sarcopenia, physical capacity, and lack of effective treatments.

AREAS COVERED

This review discusses various factors influencing COPD-related mortality and analyzes observational studies and pivotal RCTs evaluating the impact of different therapies on ACM.

EXPERT OPINION

COPD significantly impacts ACM, necessitating effective management strategies. Smoking cessation is crucial in reducing mortality risk. Exacerbation management and comorbidity treatment are essential to improve patient outcomes. Various therapeutic interventions, such as smoking cessation, vaccination, long-term oxygen therapy, and lung volume reduction surgery, have shown benefits in reducing mortality. Pharmacotherapies might reduce the risk of mortality, although the current scientific evidences remain inconclusive. Advances in pharmacological interventions, tailored treatment plans, and physical activity programs are vital. More robust and long-term studies, focusing on real-world data and addressing biases in treatment allocation, are needed to conclusively determine the efficacy of different therapies in reducing ACM in COPD patients.

Dual-Task Performance in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis

Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS-I). The meta-analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06-1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD.

Low serum creatinine levels are associated with major post-operative complications in patients undergoing surgery with gynecologic oncologists

OBJECTIVE

Serum creatinine is a byproduct of muscle metabolism, and low creatinine is postulated to be associated with diminished muscle mass. This study examined the association between low pre-operative serum creatinine and post-operative outcomes.

METHODS

This retrospective cohort study utilized the 2014-2021 National Surgical Quality Improvement Program to identify patients undergoing surgery with gynecologic oncologists. Patients with missing pre-operative creatinine, end-stage renal disease, sepsis, septic shock, dialysis, or pregnancy were excluded. Pre-operative creatinine was categorized into markedly low (≤0.44 mg/dL), mildly low (0.45-0.64 mg/dL), normal (0.65-0.84 mg/dL), and four categories of elevated levels (0.85-1.04, 1.05-1.24, 1.25-1.44, and ≥1.45 mg/dL). Outcomes included major (≥Grade 3) 30-day complications, categorized into any complications, wound, cardiovascular and pulmonary, renal, infectious, and thromboembolic complications. Also examined were 30-day readmissions, reoperations, and mortality. Logistic regressions assessed the association between creatinine and complications, with stratification by albumin and sensitivity analysis with propensity score matching.

RESULTS

Among 84 786 patients, 0.8% had markedly low, 19.6% mildly low, and 50.2% normal creatinine; the remainder had elevated creatinine. As creatinine decreased, the risks of major complications increased in a dose-dependent manner on univariable and multivariable analyses. A total of 9.6% (n=63) markedly low patients experienced major complications, second to creatinine ≥1.45 mg/dL (9.9%, n=141). On multivariable models, both markedly and mildly low creatinine were associated with higher odds of major complications (OR 1.715, 95% CI 1.299 to 2.264 and OR 1.093, 95% CI 1.001 to 1.193) and infections (OR 1.575, 95% CI 1.118 to 2.218 and OR 1.165, 95% CI 1.048 to 1.296) versus normal. Markedly low creatinine had similar ORs to creatinine ≥1.45 mg/dL and was further associated with higher odds of cardiovascular and pulmonary complications (OR 2.301, 95% CI 1.300 to 4.071), readmissions (OR 1.403, 95% CI 1.045 to 1.884), and mortality (OR 2.718, 95% CI 1.050 to 7.031). After albumin stratification, associations persisted for markedly low creatinine. Propensity-weighted analyses demonstrated congruent findings.

CONCLUSIONS

Low creatinine levels are associated with major post-operative complications in gynecologic oncology in a dose-dependent manner. Low creatinine can offer useful information for pre-operative risk stratification, surgical counseling, and peri-operative management.