Impact of sarcopenia and phase angle on mortality of the very elderly

New research progress of sarcopenia in surgically resectable malignant tumor diseases

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

Optimal lumbar vertebral level for trunk muscle CT assessments in opportunistic sarcopenia screening: a cross-sectional study

OBJECTIVES

This study aims to identify the optimal lumbar vertebral level for CT-based assessments of trunk muscles in relation to physical function and muscle strength, and to establish a foundation for opportunistic CT screening for sarcopenia.

DESIGN

A cross-sectional study was conducted between April 2022 and December 2022. Pearson's correlation coefficients and multiple linear regression analyses were employed to estimate the correlation between CT parameters of trunk muscle with physical function and muscle strength.

SETTING AND PARTICIPANTS

The study included community residents aged 50 years and older from Kunming, Yunnan Province, China, who were part of the SOY (Sarcopenia and Osteoporosis Study of Yunnan) cohort. A total of 615 participants were enrolled, comprising 424 men and 191 women. Among these, 31 individuals (20 men and 11 women) were diagnosed with sarcopenia.

INTERVENTIONS

Each participant underwent lumbar CT scanning, the Short Physical Performance Battery (SPPB) and handgrip strength (HGS) assessment.

PRIMARY OUTCOME MEASURES

A correlation analysis was conducted for both the general and sarcopenia groups, after adjusting for age and body mass index. Additionally, a gender-stratified analysis was performed.

RESULTS

Muscle density and muscle area at all levels exhibited a moderate correlation with grip strength, with the correlation for muscle area being more pronounced (correlation β of muscle density =0.48-0.54, p value <0.001; correlation β of muscle area=0.66-0.68, p value <0.001). However, only muscle density demonstrated a weak correlation in the correlation analysis with SPPB (correlation β of muscle density =0.09-0.12, p value <0.01). When stratified by gender, trunk muscle attenuation at the L1 vertebral level in the male group showed a more pronounced correlation with physical performance (L1-βHGS =0.25, p value <0.001 vs L2-L5-βHGS =0.16-0.19, p value =0.01-0.04; L1-βSPPB =0.31, p value <0.001 vs L2-L5-βSPPB =0.23-0.29, p value <0.01). In the female cohort, both the muscle area and muscle density at all levels showed correlations with grip strength, and the muscle area at L3 vertebrae showed the best performance (L3-βHGS =0.23, p value <0.001). In the sarcopenia group, the L1 level correlates better with HGS and SPPB than other levels. (L1-βHGS =0.54, p value =0.03 and L1-βSPPB =-0.35, p value =0.04).

CONCLUSIONS

In this study, the area and density of lumbar muscles based on CT showed correlations of varying degrees with grip strength or SPPB. The L1 layer exhibited superior performance in those aged more than 50 years, especially in the male and sarcopenia groups. This study suggests that CT-based muscle assessment at the L1 vertebra may be a feasible option for opportunistic sarcopenia screening.

TRIAL REGISTRATION NUMBER

ChiCTR210005215; Pre-results.

Development and Validation of a Risk Predictive Model for Adverse Postoperative Health Status of Elderly Patients Undergoing Major Abdominal Surgery Using Lasso-Logistic Regression

Background

The postoperative health status of elderly patients has a substantial impact on both the individuals themselves and their families, and this impact became more pronounced with advancing age. The aim of this study was to identify risk factors that can predict the health status of patients aged 80 and over after major abdominal surgery and to establish a nomogram model.

Methods

We conducted a retrospective study of elderly patients (aged 80+) who underwent major abdominal surgery at the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Least absolute shrinkage and selection operator (lasso) regression analysis was employed to identify potential perioperative factors associated with the patients' health status one year post-surgery. Subsequently, logistic regression was then used to refine these factors for the model. The nomogram's performance was assessed through discriminative ability, calibration, and clinical utility in both training and validation datasets.

Results

In total, 576 and 145 individuals were allocated to the training and validation sets, respectively. Lasso regression first identified 10 variables as candidate risk factors. After further screening through univariate and multivariate logistic regression, it was confirmed that seven variables, including tumor, operative duration, left ventricular ejection fraction (LVEF), blood transfusion, direct bilirubin, erythrocyte, and self-care, were included in the final nomogram model. The Hosmer-Lemeshow test, with a P-value of 0.835, indicates that the model was well-fitted. The area under the Receiver Operating Characteristic curve (ROC-AUC) for the model on the training set was 0.81 (95% CI 0.764-0.855), and for the validation set, it was 0.83 (95% CI 0.751-0.91). Additionally, the calibration curves and decision curve analyses in both the training and validation sets demonstrated the accuracy and clinical applicability of the predictive model.

Conclusion

The nomogram has a good predictive ability for the health status of older patients aged 80 years and above after abdominal surgery for one year, which can help clinical doctors develop better treatment plans.

Association between phase angle and all-cause mortality in adults aged 18-49 years: NHANES 1999-2004

Phase angle (PhA) is an indicator of nutritional status. The association between PhA and all-cause mortality has been confirmed in older adults, but no relevant studies have been conducted in adults aged 18-49 years. This study aimed to investigate the relationship between PhA and all-cause mortality in adults aged 18-49 years. Our study included 6338 adults aged 18-49 from the National Health and Nutrition Examination Survey (1999-2004). Kaplan-Meier (KM) curve, multiple Cox regression and stratified analyses were performed. These adults were divided into two groups based on the median PhA value (the low PhA group: PhA < 6.96°; the high PhA group: PhA ≥ 6.96°). During a median follow-up of 214 months, 307 all-cause deaths were recorded. The all-cause mortality rate was 5.07% in the low PhA group and 3.98% in the high PhA group. After full adjustment, a higher PhA value was significantly associated with reduced risk of all-cause mortality (HR = 0.73,95CI%:0.59-0.91, P = 0.005). Similarly, compared with those in the low PhA group, individuals in the high PhA group had a lower risk of all-cause mortality (HR = 0.67, 95% CI 0.46-0.98, P = 0.041). There was an interaction between smoking status and PhA (P for interaction = 0.029), with a statistically significant negative association between PhA and all-cause mortality in the non-smokers (HR:0.62, 95%CI:0.53-0.88, P = 0.003). In conclusion, there was a significant negative association between PhA and all-cause mortality in adults aged 18-49 years. The negative association was stronger in non-smokers.

Limited predictive value of bioelectrical phase angle for the development of sarcopenia in older Europeans

BACKGROUND

Despite the emerging interest in phase angle (PhA), a non-invasive marker of cell hydration and nutritional status, no previous study has reported the prospective association between PhA and incident sarcopenia. Therefore, the aim of our study was to evaluate the association of baseline PhA in older subjects without sarcopenia with the development of new sarcopenia as outcome.

METHODS

Six-hundred ninety-six subjects without sarcopenia aged ≥75 years enrolled in an international multicenter observational study were included. Sarcopenia was assessed according to the revised EWGSOP2 criteria at baseline and in follow-up visits at 12 and 24 months. Muscle strength was assessed through the handgrip strength test using a hydraulic grip strength dynamometer, muscle mass was assessed by bioimpedance analysis (BIA) and appendicular skeletal muscle mass (ASMM) was estimated. Physical performance was assessed by Short Physical Performance Battery (SPPB).

RESULTS

Participants who developed sarcopenia were older, less educated, had higher prevalence of osteoporosis, and lower baseline cognitive function, SPPB, handgrip strength and ASMM than those without sarcopenia. Baseline PhA was significantly lower in subjects developing sarcopenia. Nevertheless, after adjusting for all potential covariates including baseline components of sarcopenia in multiple logistic regression, neither PhA as continuous variable nor different levels of PhA were any more significant predictors of sarcopenia.

CONCLUSIONS

As an indicator of cells function, PhA could be a potential useful early marker in identifying older people at risk of developing sarcopenia but its practical applicability remains uncertain with the present data.

Quality of Life and non-motor symptoms Improvement in Parkinson's Disease through Nutritional Intervention: a Case Study

Non-motor symptomatology in Parkinson's disease (PD) is related to patients' quality of life (QoL). The Non-Motor Symptoms Scale (NNMS) assesses QoL by investigating numerous domains including nutritional status, which is represented by domain 6. Patients with PD commonly suffer from dysphagia, and consequently malnutrition, leading to sarcopenia and increasing motor deficits in relation to loss of muscle mass and energy deficit. The impact of dysphagia on PD patients' health status, makes it necessary to study the effectiveness of specific nutritional programs in addressing feeding needs, with the goal to improve clinical outcomes and the patient's perception of their QoL. The 'Weancare' Program was trialed on an 84-year-old PD patient suffering from dysphagia and the Tower of Pisa Syndrome. The first assessment of the patient showed an early overall deteriorating condition, particularly under a nutritional point of view. The patient was assessed before and after the intervention considering serological tests, and the QoL through the New Non-Motor Symptoms Scale (NNMS). We found a beneficial impact of the 'Weancare' program on the patient significantly improving the non-motor symptomatology and QoL and the investigated outcomes, enhancing a better subjective experience of mealtime lived by the patient.

Establishment and validation of a risk prediction model for sarcopenia in gastrointestinal cancer patients: A systematic review and meta-analysis-based approach

OBJECTIVE

The study aimed to develop a model to predict the risk of sarcopenia in gastrointestinal cancer patients. The goal was to identify these patients early and classify them into different risk categories based on their likelihood of developing sarcopenia.

METHODS

This study evaluated risk factors for sarcopenia in patients with gastrointestinal cancers through a systematic review and meta-analysis. The natural logarithm of the combined risk estimate for each factor was used as a coefficient to assign scores within the model for risk prediction. Data from 270 patients with gastrointestinal cancers, collected between October 2023 and April 2024, was used to assess the predictive performance of the scoring model.

RESULTS

The analysis included 17 studies that included 9405 patients with gastrointestinal cancers, out of which 4361 had sarcopenia. The model identified several significant predictors of sarcopenia, including age (OR = 2.45), sex (OR = 1.15), combined diabetes (OR = 2.02), neutrophil-to-lymphocyte ratio (NLR) category (OR = 1.61), TNM stage (OR = 1.61), and weight change (OR = 1.60). Model validation was performed using an external cohort through logistic regression, resulting in an area under the curve (AUC) of 0.773. This model attained a sensitivity of 0.714 and a specificity of 0.688 and ultimately selected 16.5 as the ideal critical risk score. Furthermore, an AUC of 0.770 was obtained from Bayesian model validation; the optimal critical risk score was determined to be 19.0, which corresponds to a sensitivity of 0.658 and a specificity of 0.847.

CONCLUSIONS

The model of risk prediction developed through systematic review and meta-analysis demonstrates substantial for sarcopenia in patients with gastrointestinal cancers. Its clinical usability facilitates the screening of patients at high risk for sarcopenia.

Association between phase angle and sarcopenia in patients with connective tissue diseases

BACKGROUND AND AIMS

Early detection and management of sarcopenia in patients with connective tissue diseases (CTDs) are essential. However, the relationship between the phase angle and sarcopenia in patients with CTDs is unknown. This study investigated the association between the phase angle and sarcopenia in patients with (CTDs) and determined the optimal phase angle cutoff values for the early detection of sarcopenia.

METHODS

A retrospective cross-sectional study was conducted in 279 hospitalized patients with CTDs undergoing rehabilitation (median age 73.3 years; 80 men and 199 women). Bioimpedance analysis was used to measure the phase angle, and sarcopenia was assessed according to the Asian Working Group for Sarcopenia criteria.

RESULTS

Sarcopenia was identified in 134 patients (36 men and 98 women). Patients with sarcopenia had a significantly smaller phase angle than those without sarcopenia. Multivariate analysis revealed that phase angle was significantly associated with sarcopenia after adjusting for confounding factors in each sex. The optimal phase angle cutoff value for identifying sarcopenia was 4.6° for men and 4.3° for women, with area under the curve values of 0.795 and 0.754, respectively.

CONCLUSION

Phase angle is a valuable marker for identifying sarcopenia in patients with CTDs. The established phase angle cutoff values of 4.6° in men and 4.3° in women can facilitate the early detection and management of sarcopenia.

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients

BACKGROUND AND AIMS

Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.

METHODS

A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.

RESULTS

The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.

CONCLUSION

The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

Impact of CFTR modulator therapy on body composition as assessed by thoracic computed tomography: A follow-up study

OBJECTIVE

Treatment with cystic fibrosis transmembrane conductance regulator (CFTR) modulators in individuals with cystic fibrosis (CF) has brought a significant change in forced expiratory volume in 1 second (FEV1) and clinical parameters. However, it also results in weight gain. The aim of our study is to evaluate the effect of CFTR modulator treatment on body composition, measured by computed tomography (CT).

METHODS

Adult subjects with CF under follow-up at La Princesa University Hospital were recruited. All of them were on elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) treatment. Body composition analysis was conducted using CT scans and an open-source software. The results were then compared with bioimpedance estimations, as well as other clinical and spirometry data.

RESULTS

Our sample consisted of 26 adult subjects. The fat mass compartments on CT scans correlated with similar compartments on bioimpedance, and normal-density muscle mass exhibited a strong correlation with phase angle. Higher levels of very low-density muscle prior to treatment were associated with lower final FEV1 and less improvement in FEV1 after therapy. We observed an increase in total body area (P < 0.001), driven by increases in total fat mass (P < 0.001), subcutaneous fat (P < 0.001), visceral fat (P = 0.002), and intermuscular fat (P = 0.022). The only muscle compartment that showed an increase after treatment was very low-density muscle (P = 0.032).

CONCLUSIONS

CT scans represent an opportunity to assess body composition on CF. Combination treatment with CFTR modulators, leads to an improvement in FEV1 and to an increase in body mass in all compartments primarily at the expense of fat mass.

The association between the change in severity score from baseline and the outcomes of critically ill patients was enhanced by integration of bioimpedance analysis parameters

The study of the outcomes of critically ill patients has been a hard stuff in the field of intensive care. To explore the relationship between changes of severity scores, bioelectrical impedance analysis (BIA) and outcomes of critically ill patients, we enrolled patients (n = 206) admitted to intensive care unit (ICU) in Jinling Hospital from 2018 to 2021 with records of BIA on the days 1- and 3- ICU. Collected BIA and clinical data including simplified acute physiology score II (SAPS II) and sequential organ failure assessment. According to the baseline and change of severity scores or phase angle (PA) values, the patients were divided into: G-G, baseline good status, 3rd day unchanged; G-B, baseline good status, 3rd day deteriorated; B-G, baseline bad status, 3rd day improved; and B-B, baseline bad status, 3rd day unchanged. According to PA, the mortality of group G-G was 8.6%, and it was greater than 50% in group B-B for severity scores. The new score combining PA and severity scores established. Multivariate logistic regression analysis revealed that PA-SAPS II score was the only independent factor for 90-day mortality (P < 0.05). A linear correlation was found between mortality and PA-SAPS II score (prediction equation: Y ( % ) = 16.97 × X - 9.67 , R2 = 0.96, P < 0.05).

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care

AIM

Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care.

METHODS

The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs.

RESULTS

Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001).

CONCLUSIONS

Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

Glucagon-like peptide-1 receptor agonist, semaglutide attenuates chronic liver disease-induced skeletal muscle atrophy in diabetic mice

A glucagon-like peptide-1 receptor agonist (GLP-1RA) has recently been established as a pharmacological option for the treatment of type 2 diabetes. Recent studies have demonstrated the molecular role of GLP-1R in skeletal muscle homeostasis; however, the therapeutic efficacy of semaglutide, a GLP-1RA, on skeletal muscle atrophy in chronic liver disease (CLD) under diabetic conditions remains unclear. In the present study, semaglutide effectively inhibited psoas muscle atrophy and suppressed declines in grip strength in a diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet-fed diabetic KK-Ay mouse model. Moreover, semaglutide inhibited ubiquitin-proteosome-mediated skeletal muscle proteolysis and promoted myogenesis in palmitic acid (PA)-stimulated C2C12 murine myocytes. Mechanistically, this effect of semaglutide on skeletal muscle atrophy was mediated by multiple functional pathways. First, semaglutide protected against hepatic injury in mice accompanied by increased production of insulin-like growth factor 1 and reduced accumulation of reactive oxygen species (ROS). These effects were associated with decreased proinflammatory cytokines and ROS accumulation, leading to the suppression of ubiquitin-proteosome muscle degradation. Moreover, semaglutide inhibited the amino acid starvation-related stress signaling that was activated under chronic liver injury, resulting in the recovery of the mammalian target of rapamycin activity in the skeletal muscle of DDC-diet fed KK-Ay mice. Second, semaglutide improved skeletal muscle atrophy by directly stimulating GLP-1R in myocytes. Semaglutide induced cAMP-mediated activation of PKA and AKT, enhanced mitochondrial biogenesis, and reduced ROS accumulation, thereby resulting in inhibition of NF-κB/myostatin-mediated ubiquitin-proteosome degradation and the augmentation of heat-shock factor-1-mediated myogenesis. Collectively, semaglutide may have potential as a new therapeutic strategy for CLD-related skeletal muscle wasting.

PCDH7 as the key gene related to the co-occurrence of sarcopenia and osteoporosis

Sarcopenia and osteoporosis, two degenerative diseases in older patients, have become severe health problems in aging societies. Muscles and bones, the most important components of the motor system, are derived from mesodermal and ectodermal mesenchymal stem cells. The adjacent anatomical relationship between them provides the basic conditions for mechanical and chemical signals, which may contribute to the co-occurrence of sarcopenia and osteoporosis. Identifying the potential common crosstalk genes between them may provide new insights for preventing and treating their development. In this study, DEG analysis, WGCNA, and machine learning algorithms were used to identify the key crosstalk genes of sarcopenia and osteoporosis; this was then validated using independent datasets and clinical samples. Finally, four crosstalk genes (ARHGEF10, PCDH7, CST6, and ROBO3) were identified, and mRNA expression and protein levels of PCDH7 in clinical samples from patients with sarcopenia, with osteoporosis, and with both sarcopenia and osteoporosis were found to be significantly higher than those from patients without sarcopenia or osteoporosis. PCDH7 seems to be a key gene related to the development of both sarcopenia and osteoporosis.

Association between phase angle and the nutritional status in pediatric populations: a systematic review

Background and aims

Malnutrition is prevalent in pediatric populations with any disease, and it is also related to changes in body composition. In addition, recent studies have documented relationships between these changes and phase angle (PhA), an important parameter of functional nutritional assessment. PhA could be a new marker of nutritional status. Many studies have generated information about the association between PhA and malnutrition in various pathologies, although the vast majority of this information is from adult populations. In this systematic review, we answered the following question: What is the association between PhA and the nutritional status in pediatric populations?

Methods

We performed a systematic search of the Medline/PubMed and Latin American and Caribbean Health Sciences Literature databases (LILACS) databases for studies published up to October 2022. The inclusion criteria were pediatric subjects, which reported the relationship between PhA and the nutritional status with any objective nutritional indicator, and PhA was measured by electric impedance and reported at 50 kHz. We synthesized data from the studies that reported cutoff analysis of PhA with receiver operating characteristic (ROC) curves, mean PhA values presented by nutritional status strata, and correlations between PhA and nutritional status indicators. We assessed the risk of bias by using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment for Diagnostic Accuracy Studies.

Results

Of the 126 studies we identified, 15 met the inclusion criteria. The included studies reported the association between PhA and objective indicators of nutritional status, including weight-for-age z-score (WAZ) <-1 standard deviation (SD) for malnutrition, height-for-age z-score (HAZ) for malnutrition-stunting, body mass index (BMI) for the starvation state, body mass index z-score (BMIz) and BMI for malnutrition, mid-upper arm circumference (MUAC) <11 cm for severe acute malnutrition (SAM), and fat-free mass index z-score (FFMIz) <-2 z-score for moderate malnutrition, among others. The report of these associations between PhA and nutritional status was based on cutoff points generated with ROC curve analysis or comparison of mean PhA values, which were reported stratified by the presence or absence of malnutrition, and correlations between PhA and anthropometric indicators for the evaluation of the nutritional status in the pediatric population. It was difficult to compare the studies due to the heterogeneity of the bioelectrical impedance analysis models used, how PhA was reported (standardized, percentiles, or degrees), and the anthropometric indicators used to diagnose malnutrition.

Conclusion

The early identification of malnutrition is relevant to establish the correct nutritional treatment; PhA appears to be a sensitive indicator of nutritional status and is easy to obtain. Although the results of this review are inadequate to establish PhA cutoff points associated with malnutrition in pediatric populations, in most of the studies, there was an association between PhA and objective indicators of nutritional status.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022362413, identifier: PROSPERO 2022 CRD42022362413.

Phase Angle as a Prognostic Indicator of Survival in Institutionalized Psychogeriatric Patients

Phase angle (PhA) has been evidenced to be a useful survival indicator and predictor of morbi-mortality in different pathologies, but not in psychogeriatric patients. The aim of this study was to evaluate the clinical utility of PhA as a prognostic indicator of survival in a group of institutionalized psychogeriatric patients. A survival study was conducted on 157 patients (46.5% dementia, 43.9% schizophrenia). Functional impairment stage, frailty, dependence, malnutrition (MNA), comorbidity, polypharmacy, BMI, and waist circumference were registered. Body composition was analyzed using a 50-kHz whole-body BIA; PhA was recorded. The association between mortality and standardized-PhA was evaluated through univariate and multivariate Cox regression models and ROC-curve. The risk of death decreased when Z-PhA, BMI, and MNA were higher. Mortality increases with age, frailty, and dependence. The risk of death was statistically significantly lower (56.5%) in patients with schizophrenia vs. dementia (89%). The Z-PhA cut-off point was -0.81 (Sensitivity:0.75; Specificity:0.60). Mortality risk was multiplied by 1.09 in subjects with a Z-PhA < -0.81, regardless of age, presence of dementia, and BMI. PhA presented a remarkable clinical utility as an independent indicator of survival in psychogeriatric patients. Moreover, it could be useful to detect disease-related malnutrition and to identify subjects eligible for an early clinical approach.

Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study

BACKGROUND

Social isolation is a pervasive and debilitating condition that has adverse prognostic impacts. This condition often co-occurs with other geriatric syndromes, further exacerbating negative health outcomes. Given these considerations, the present study aims to elucidate the roles of social isolation in older adults with anorexia of aging and/or sarcopenia with respect to long-term mortality using a nationally representative cohort study.

METHODS

Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with a sample size of 3,762 study participants aged 50 years and older. Data from 1999 (wave 4) to 2015 (wave 9) were analyzed. The TLSA questionnaire was used to define social isolation, anorexia, and sarcopenia. Logistic regressions were employed to explore the associations between social isolation, anorexia, and sarcopenia. The Cox proportional hazard model was utilized to examine the synergistic effects of social isolation and anorexia or sarcopenia on 16-year all-cause mortality.

RESULTS

After controlling for demographic information and comorbidities, older adults with social isolation were significantly associated with anorexia (adjusted odds ratio [aOR] 1.46 [95% confidence interval: 1.00-2.12, p=0.0475]) and sarcopenia (aOR 1.35 [95% CI: 1.12-1.64, p=0.0021]). Furthermore, the synergistic effects of social isolation with anorexia (aOR 1.65 [95% CI: 1.25-2.18, p=0.0004]) or sarcopenia (aOR 1.65 [95% CI: 1.42-1.92, p<0.0001]) were both significantly associated with higher risks of all-cause mortality, while social isolation alone revealed borderline statistical significance.

CONCLUSIONS

Our findings indicate that social isolation is closely linked to anorexia and sarcopenia among middle-aged and older adults. Additionally, social isolation significantly exacerbates the long-term mortality risk associated with anorexia of aging and sarcopenia. However, social isolation alone appears to have borderline long-term mortality risk in this cohort. These findings underscore the importance of addressing social isolation in older adults with anorexia and/or sarcopenia to optimize their health outcomes and mitigate long-term mortality risk.