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Yang H, Wan XX, Ma H, Li Z, Weng L, Xia Y, Zhang XM. Prevalence and mortality risk of low skeletal muscle mass in critically ill patients: an updated systematic review and meta-analysis. Front Nutr 2023; 10:1117558. [PMID: 37252244 PMCID: PMC10213681 DOI: 10.3389/fnut.2023.1117558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Patients with critical illness often develop low skeletal muscle mass (LSMM) for multiple reasons. Numerous studies have explored the association between LSMM and mortality. The prevalence of LSMM and its association with mortality are unclear. This systematic review and meta-analysis was performed to examine the prevalence and mortality risk of LSMM among critically ill patients. Methods Three internet databases (Embase, PubMed, and Web of Science) were searched by two independent investigators to identify relevant studies. A random-effects model was used to pool the prevalence of LSMM and its association with mortality. The GRADE assessment tool was used to assess the overall quality of evidence. Results In total, 1,582 records were initially identified in our search, and 38 studies involving 6,891 patients were included in the final quantitative analysis. The pooled prevalence of LSMM was 51.0% [95% confidence interval (CI), 44.5-57.5%]. The subgroup analysis showed that the prevalence of LSMM in patients with and without mechanical ventilation was 53.4% (95% CI, 43.2-63.6%) and 48.9% (95% CI, 39.7-58.1%), respectively (P-value for difference = 0.44). The pooled results showed that critically ill patients with LSMM had a higher risk of mortality than those without LSMM, with a pooled odds ratio of 2.35 (95% CI, 1.91-2.89). The subgroup analysis based on the muscle mass assessment tool showed that critically ill patients with LSMM had a higher risk of mortality than those with normal skeletal muscle mass regardless of the different assessment tools used. In addition, the association between LSMM and mortality was statistically significant, independent of the different types of mortality. Conclusion Our study revealed that critically ill patients had a high prevalence of LSMM and that critically ill patients with LSMM had a higher risk of mortality than those without LSMM. However, large-scale and high-quality prospective cohort studies, especially those based on muscle ultrasound, are required to validate these findings. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022379200.
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Affiliation(s)
- Hui Yang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xi-Xi Wan
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Hui Ma
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Urology, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Li Weng
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Ying Xia
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
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Edmundson PM, Balogh R, Shelley JK, Shirvani A, Shah AH, Caero J, Thomas E, Reynolds M, McShan EE, Bennett MM, Warren AM, Foreman ML. Utilizing psoas muscle cross-sectional area to predict functional outcome. Proc AMIA Symp 2023; 36:468-472. [PMID: 37334081 PMCID: PMC10269380 DOI: 10.1080/08998280.2023.2207724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background This study evaluated psoas muscle area (PMA) as a predictor of frailty and functional outcome in trauma patients. Methods The cohort included 211 trauma patients admitted to an urban level I trauma center from March 2012 to May 2014 who consented to participate in a longitudinal study and underwent abdominal-pelvic computed tomography scans during their initial evaluation. Physical component scores (PCS) of the Veterans RAND 12-Item Health Survey were administered to assess physical functionality at baseline and at 3, 6, and 12 months after injury. PMA in mm2 and Hounsfield units was calculated using the Centricity PACS system. Statistical models were stratified by injury severity score (ISS), <15 or ≥15, and adjusted for age, sex, and baseline PCS. Follow-up PCS were analyzed using general linear regression models. Results For participants with an ISS <15, increased PMA was significantly associated with higher PCS at 3 (P = 0.008), 6 (P = 0.02), and 12 months (P = 0.002), although this relationship was not statistically significant for ISS ≥15 (P = 0.85, 0.66, 0.61). Conclusion For mild to moderately injured (but not seriously injured) patients, those with larger psoas muscles experience better functional outcomes after injury.
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Affiliation(s)
| | - Ryan Balogh
- Baylor University Medical Center, Dallas, Texas
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Darden N, Sharma S, Wu X, Mancini B, Karamchandani K, Bonavia AS. Long-Term Clinical Outcomes in Critically Ill Patients with Sepsis and Pre-existing Sarcopenia: A Retrospective Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.12.23288490. [PMID: 37131776 PMCID: PMC10153350 DOI: 10.1101/2023.04.12.23288490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Sarcopenia has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear. Methods Retrospective cohort analysis of patients treated at a tertiary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with sarcopenia defined by skeletal muscle index at the L3 lumbar area on abdominal Computed-Tomography scan. The prevalence of sarcopenia and its association with clinical outcomes was analyzed. Results Sarcopenia was present in 34 (23%) of 150 patients, with median skeletal muscle indices of 28.1 cm 2 /m 2 and 37.3 cm 2 /m 2 in sarcopenic females and males, respectively. In-hospital mortality was not associated with sarcopenia when adjusted for age and illness severity. One year mortality was increased in sarcopenic patients, after adjustment for illness severity (HR 1.9, p = 0.02) and age (HR 2.4, p = 0.001). However, it was not associated with increased likelihood for discharge to long-term rehabilitation or hospice care in adjusted analyses. Conclusion Sarcopenia independently predicts one year mortality but is not associated with unfavorable hospital discharge disposition in critically ill patients with sepsis.
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Espinosa-Moreno MF, Torres-Restrepo JM, Sanjuan-Marín JF, Medina-Rojas R. Medidas antropométricas versus grosor de masa muscular como predictores de mortalidad en la unidad de cuidado intensivo. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. En Colombia, la tasa de mortalidad en la Unidad de Cuidados Intensivos es cercana al 32 %, por lo anterior, se han estudiado múltiples predictores de mortalidad que identifiquen de manera precoz una evolución inadecuada. La masa muscular corresponde a cerca del 50 % del peso corporal y cumple importantes funciones metabólicas, como la generación de energía y la homeostasis de la glucosa. Se ha informado la disminución de hasta el 1,6 % de la masa muscular por día en pacientes críticos, factor relacionado con la mortalidad.
Métodos. Se realizó un estudio de cohorte prospectiva entre enero de 2020 y diciembre de 2021, con una muestra no probabilística a conveniencia, incluyendo a los pacientes que ingresaron a las diferentes Unidad de Cuidados Intensivos del Hospital Universitario Hernando Moncaleano Perdomo, en quienes se realizó un registro periódico de las medidas antropométricas y del grosor del musculo cuádriceps.
Resultados. Se incluyeron 82 pacientes, encontrando como variables asociadas a la mortalidad la edad, el número de días de hospitalización, el índice de masa corporal y el delta del musculo cuádriceps. Una medida del grosor del musculo cuádriceps al ingreso menor de 2,5 cm, se asoció con alto riesgo de muerte y una disminución de más de 1,72 cm durante el control ecográfico se relacionó con mal pronóstico.
Conclusiones. Aunque estas variables se eligieron en función de su asociación con mortalidad, nuestros resultados emplean importantes características, como la medición del grosor muscular y su delta durante la estancia en la unidad de cuidados intensivos, lo que indica un mayor consumo de las reservas fisiológicas, asociándose a mayor riesgo de complicaciones y mortalidad.
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Oh HJ, Kim JH, Kim HR, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom JS, Song YG. The impact of sarcopenia on short-term and long-term mortality in patients with septic shock. J Cachexia Sarcopenia Muscle 2022; 13:2054-2063. [PMID: 35478354 PMCID: PMC9397556 DOI: 10.1002/jcsm.12995] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite medical advances, septic shock remains one of the main causes of high mortality in critically ill patients. Although sarcopenia is considered a predictor of mortality in septic shock patients, most studies have only investigated short-term mortality, and those on long-term prognosis are limited. We investigated the impact of sarcopenia on long-term mortality in a large patient population with septic shock. METHODS A retrospective cohort study comprising 905 patients with septic shock was conducted from 2008 to 2019. Sarcopenia was defined based on the measurement of the total abdominal muscle area, assessed using abdominal computed tomography scans. Thereafter, we stratified the patients into two groups-sarcopenia and non-sarcopenia groups-and compared the impact of sarcopenia on short-term (28 days) and long-term (1 year and overall) mortality using multivariable Cox proportional analysis. RESULTS A total of 905 patients were included, and the mean age was 65.7 ± 15.1 years. Among them, 430 (47.5%) patients were male and 407 (45.0%) had sarcopenia. We found that the 28 day, 1 year, and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (13.8% vs. 6.4%, P < 0.001; 41.8% vs. 21.7%, P < 0.001; 62.2% vs. 35.7%, P < 0.001, respectively). Univariable Cox analysis showed that the sarcopenia group had a significant association with the increase in each mortalities compared with the non-sarcopenia group (28 day mortality, hazard ratio (HR) = 2.230, 95% confidence interval (CI) [1.444-3.442], P < 0.001; 1 year mortality, HR = 2.189, 95% CI [1.720, 2.787], P < 0.001; overall mortality, HR = 2.254, 95% CI [1.859, 2.734], P < 0.001). Multivariable Cox analysis showed that both the short-term and long-term mortality rates remained significantly higher in the sarcopenia group than in the non-sarcopenia group, even after adjusting for confounding variables (28 day mortality, HR = 2.116, 95% CI [1.312, 3.412], P = 0.002; 1 year mortality, HR = 1.679, 95% CI [1.291, 2.182], P < 0.001; overall mortality, HR = 1.704, 95% CI [1.381, 2.102], P < 0.001). CONCLUSIONS Sarcopenia was associated with both short-term and long-term mortality in patients with septic shock. In clinical settings, close attention should be paid to these patients for both short-term and long-term outcomes.
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Affiliation(s)
- Hyung Jung Oh
- Department of Nephrology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Hye Rim Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,AIDS Research Institute, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea
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Low skeletal muscle index and myosteatosis as predictors of mortality in critically ill surgical patients. Nutrition 2022; 101:111687. [DOI: 10.1016/j.nut.2022.111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
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The predictive value of phase angle on long-term outcome after ICU admission. Clin Nutr 2022; 41:1256-1259. [DOI: 10.1016/j.clnu.2022.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022]
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Ren C, Su H, Tao J, Xie Y, Zhang X, Guo Q. Sarcopenia Index Based on Serum Creatinine and Cystatin C is Associated with Mortality, Nutritional Risk/Malnutrition and Sarcopenia in Older Patients. Clin Interv Aging 2022; 17:211-221. [PMID: 35256845 PMCID: PMC8898017 DOI: 10.2147/cia.s351068] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose To investigate the association of sarcopenia index (SI) [(serum creatinine/serum cystatin C) × 100] with mortality, nutritional risk/malnutrition and sarcopenia among hospitalized older adults. Subjects and Methods A prospective analysis was performed in 758 hospitalized older adults. Anthropometric measures and biochemical parameters were carried out for each patient. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) 2019 algorithm. Nutritional risk/malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. The logistic regression analysis was employed for the analysis of correlation between the SI and other variables. Cox regression analysis was employed to analyze correlation between the SI and mortality. Results A total of 758 participants agreed to participate in this study (589 men and 169 women; mean age: 85.6±6.1 years). The median of the follow-up period was 212 days. A total of 112 patients died. A high SI (per 1-SD was 22.1) was independently associated with all-cause mortality (HR per 1-SD = 0.61, 95% CI: 0.47–0.79), nutritional risk/malnutrition (OR per 1-SD = 0.38, 95% CI: 0.29–0.49) and sarcopenia (OR per 1-SD = 0.58, 95% CI: 0.45–0.74). High SI was positively correlated with albumin (r = 0.32, P < 0.001), hemoglobin (r = 0.24, P < 0.001), body mass index (BMI) (r = 0.12, P = 0.001), waist circumference (WC) (r = 0.08, P = 0.046), calf circumference (CC) (r = 0.45, P < 0.001), hand grip strength (HGS) (r = 0.52, P < 0.001) and negatively correlated with triglyceride glucose (TyG) (r = −0.11, P = 0.007). Conclusion The SI based on serum cystatin C and creatinine is associated with long-term mortality, nutritional risk/malnutrition and sarcopenia in hospitalized older Chinese patients.
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Affiliation(s)
- Chenxi Ren
- Department of gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
| | - Hang Su
- Department of gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Jun Tao
- Department of gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Ying Xie
- Department of Endocrinology, the Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China
| | - Xiaoyan Zhang
- Department of gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
| | - Qihao Guo
- Department of gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China
- Correspondence: Qihao Guo, Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, No. 600, Yi Shan Road, Shanghai, 200233, People’s Republic of China, Email
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Abstract
The Exercise Boom of the 1970's resulted in the adoption of habitual exercise in a significant portion of the population. Many of these individuals are defying the cultural norms by remaining physically active and competing at a high level in their later years. The juxtaposition between masters athletes and non-exercisers demonstrate the importance of remaining physically active throughout the lifespan on physiological systems related to healthspan (years of healthy living). This includes ~50% improved maximal aerobic capacity (VO2max) and enhanced skeletal muscle health (size, function, as well as metabolic and communicative properties) compared to non-exercisers at a similar age. By taking a reductionist approach to VO2max and skeletal muscle health, we can gain insight into how aging and habitual exercise affects the aging process. Collectively, this review provides a physiological basis for the elite performances seen in masters athletes, as well as the health implications of lifelong exercise with a focus on VO2max, skeletal muscle metabolic fitness, whole muscle size and function, single muscle fiber physiology, and communicative properties of skeletal muscle. This review has significant public health implications due to the potent health benefits of habitual exercise across the lifespan.
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Affiliation(s)
- Kevin J Gries
- Exercise and Sports Science, Marian University, Indianapolis, United States
| | - S W Trappe
- Human Performance Laboratory, Ball State University, Muncie, United States
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Tolonen A, Pakarinen T, Sassi A, Kyttä J, Cancino W, Rinta-Kiikka I, Pertuz S, Arponen O. Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review. Eur J Radiol 2021; 145:109943. [PMID: 34839215 DOI: 10.1016/j.ejrad.2021.109943] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW We aim to review the methods, current research evidence, and future directions in body composition analysis (BCA) with CT imaging. RECENT FINDINGS CT images can be used to evaluate muscle tissue, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) compartments. Manual and semiautomatic segmentation methods are still the gold standards. The segmentation of skeletal muscle tissue and VAT and SAT compartments is most often performed at the level of the 3rd lumbar vertebra. A decreased amount of CT-determined skeletal muscle mass is a marker of impaired survival in many patient populations, including patients with most types of cancer, some surgical patients, and those admitted to the intensive care unit (ICU). Patients with increased VAT are more susceptible to impaired survival / worse outcomes; however, those patients who are critically ill or admitted to the ICU or who will undergo surgery appear to be exceptions. The independent significance of SAT is less well established. Recently, the roles of the CT-determined decrease of muscle mass and increased VAT area and epicardial adipose tissue (EAT) volume have been shown to predict a more debilitating course of illness in patients suffering from severe acute respiratory syndrome coronavirus 2 (COVID-19) infection. SUMMARY The field of CT-based body composition analysis is rapidly evolving and shows great potential for clinical implementation.
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Affiliation(s)
- Antti Tolonen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Tomppa Pakarinen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Antti Sassi
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Jere Kyttä
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland
| | - William Cancino
- Connectivity and Signal Processing Group, Universidad Industrial de Santander, Cl. 9 #Cra 27, Bucaramanga, Colombia
| | - Irina Rinta-Kiikka
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
| | - Said Pertuz
- Connectivity and Signal Processing Group, Universidad Industrial de Santander, Cl. 9 #Cra 27, Bucaramanga, Colombia
| | - Otso Arponen
- Faculty of Medicine and Health Sciences, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Radiology, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520 Tampere, Finland
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Assessing calorie and protein recommendations for survivors of critical illness weaning from prolonged mechanical ventilation - can we find a proper balance? Clin Nutr ESPEN 2021; 45:449-453. [PMID: 34620353 PMCID: PMC8925994 DOI: 10.1016/j.clnesp.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/07/2022]
Abstract
Background & aims: Survivors of critical illness requiring prolonged mechanical ventilation (PMV) are predisposed to malnutrition, muscle wasting, and weakness. There is a lack of data regarding nutrition adequacy among these patients, and although nitrogen balance has been studied as a marker of adequate protein intake in healthy individuals and acutely critically ill patients, it has not been well studied in critically ill patients with PMV. The purpose of this study was to determine if patients requiring PMV admitted to a long-term acute care hospital (LTACH) achieved registered dietitian (RD) recommended goals for energy and protein intake and if the recommendations were adequate to avoid negative nitrogen balance. Methods: Using a retrospective, cohort study design, patients requiring PMV who had orders for 24-h urine collections for urea nitrogen (24hrUUN) were included. Energy and protein intake was calculated from chart documentation of dietary intake for the 24-h period during which patients underwent a 24hrUUN. Nitrogen intake was estimated from protein intake. Dietary intake was compared to RD-recommendations to determine the percentage of RD-recommendations achieved. Nitrogen balance was calculated as nitrogen intake minus nitrogen loss, with negative balance categorized as less than −1. Results: Subjects (n = 16) were 38% male and 75% African American (mean age 61.5 ± 3.2 years; mean BMI 27.5 ± 2.5 kg/m2). Duration of LTACH hospitalization was 26.5 (6–221) days. Mean energy and protein intake was 21.7 ± 2.9 kcal/kg/d and 1.1 ± 0.1 g/kg/d, respectively, which corresponded to 86% of both RD energy and protein recommendations. Ten patients achieved a positive nitrogen balance (mean 0.9 ± 1.1 g). In addition, there was a positive linear relationship between protein intake and nitrogen balance (r = 0.59, p = 0.016). Conclusion: Survivors of critical illness requiring PMV achieved a high percentage of RD-recommended protein and calories, and prevented a negative nitrogen balance in a majority of patients. Increasing protein intake can prevent a negative nitrogen balance. Future studies should evaluate whether these patients are able to maintain a steady state of nitrogen intake and excretion over time and how this affects time to and/or success of weaning.
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Zhang XM, Chen D, Xie XH, Zhang JE, Zeng Y, Cheng AS. Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis. BMC Geriatr 2021; 21:339. [PMID: 34078275 PMCID: PMC8173733 DOI: 10.1186/s12877-021-02276-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. METHODS We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. RESULTS Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83-2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71-5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60-2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37-3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15-3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45-2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36-3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). CONCLUSIONS Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), 100730, Beijing, China
| | - Denghong Chen
- The Third Affiliated Hospital of Guangdong Medical University (LongJiang hospital of Shunde District, Foshan, Guangdong, China
| | - Xiao-Hua Xie
- Department of Nursing, The Second People's Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Yingchun Zeng
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Silverio R, Gonçalves DC, Andrade MF, Seelaender M. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link? Adv Nutr 2021; 12:682-692. [PMID: 32975565 PMCID: PMC7543263 DOI: 10.1093/advances/nmaa125] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging disease that has reached pandemic status by rapidly spreading worldwide. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension show a higher risk of hospitalization, severe disease, and mortality by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These patients frequently show exacerbated secretion of proinflammatory cytokines associated with an overreaction of the immune system, the so-called cytokine storm. Host nutritional status plays a pivotal role in the outcome of a variety of different infectious diseases. It is known that the immune system is highly affected by malnutrition, leading to decreased immune responses with consequent augmented risk of infection and disease severity. Body composition, especially low lean mass and high adiposity, has consistently been linked to worsened prognosis in many different diseases. In this review, evidence concerning the impact of nutritional status on viral infection outcomes is discussed.
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Affiliation(s)
- Renata Silverio
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Multicenter Graduate Program in Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Daniela Caetano Gonçalves
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Biosciences Department, Universidade Federal de São Paulo (UNIFESP), Campus Baixada Santista, Santos, Brazil
| | - Márcia Fábia Andrade
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Clinical Surgery, LIM 26-HC, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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14
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Chapple LAS, Dirks ML, Kouw IW. Stable isotope approaches to study muscle mass outcomes in clinical populations. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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15
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Ultrasonographic Size of the Thenar Muscles of the Nondominant Hand Correlates with Total Body Lean Mass in Healthy Subjects. Acad Radiol 2021; 28:517-523. [PMID: 32739076 DOI: 10.1016/j.acra.2020.02.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Sarcopenia is associated with adverse outcomes in clinical situations such as elderly population, in-hospital setting and oncologic patients. However, no direct measurement of muscular mass is routinely available for clinicians. The aim of this study was to assess the correlation between thenar musculature of the nondominant hand evaluated by ultrasound and body fat-free mass. MATERIALS AND METHODS In this one-center, cross-sectional, observational study, the width and depth of thenar muscles of both hands was assessed by ultrasonography. Nondominant hand musculature was taken as reference as a better estimator of total body muscular mass. These data were compared to body composition by bioimpedance analysis and dual-energy X-ray absorptiometry (DXA), hand grip strength, arm muscular area and physical activity (with International Physical Activity Questionnaire ). Statistical correlation was determined for each parameter. RESULTS We obtained ultrasonographic measurements, International Physical Activity Questionnaire and hand grip strength from 83 subjects, whereas bioimpedance was performed in 64 subjects and DXA in 29 subjects. The strongest correlations were found between longitudinal thenar depth vs fat-free mass index (fat-free mass in DXA [kg]/height2 [m]) (r = 0.63, p < 0.001, 95%CI 0.34-0.81), longitudinal depth and hand dynamometry (r = 0.72, p < 0.001, 95%CI 0.59-0.81), longitudinal depth and DXA fat-free total mass (r = 0.76, p < 0.001, 95%CI 0.54-0.88), transversal thenar depth vs fat-free mass index (r = 0.67, p < 0.001, 95%CI 0.41-0.83), transversal width and DXA fat-free total mass (r = 0.62, p < 0.001, 95%CI 0.33-0.8), transversal depth and DXA nonfat total mass (r = 0.81, p < 0.001, 95%CI 0.63-0.91). CONCLUSION Ultrasonographic examination of the nondominant thenar musculature is a fast and simple way of assessing total body fat-free mass, showing a good correlation with body composition measured by bioimpedance analysis and DXA, hand grip strength and arm muscular area.
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16
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Akan B. Influence of sarcopenia focused on critically ill patients. Acute Crit Care 2021; 36:15-21. [PMID: 33524252 PMCID: PMC7940098 DOI: 10.4266/acc.2020.00745] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
Abstract
A systemic review was performed to evaluate the epidemiological, pathophysiological, and
clinical features of sarcopenia, the relationship of sarcopenia with critical illness and its impact on mortality, and diagnostic methods and treatment modalities. Generally, in the presence of critical illness, sarcopenia is not included in the treatment approach strategies. An intensivist should be aware that sarcopenia may be present in critically ill patients. Although the main modalities against sarcopenia are early mobilization and nutritional support, they can only prevent its development and may have positive effects on prognosis rather than treating the existing sarcopenia.
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Affiliation(s)
- Belgin Akan
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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17
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Ueshima J, Maeda K, Ishida Y, Shimizu A, Inoue T, Nonogaki T, Matsuyama R, Yamanaka Y, Mori N. SARC-F Predicts Mortality Risk of Older Adults during Hospitalization. J Nutr Health Aging 2021; 25:914-920. [PMID: 34409971 DOI: 10.1007/s12603-021-1647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN Single-center retrospective study. SETTING A university hospital. PARTICIPANTS All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.
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Affiliation(s)
- J Ueshima
- Keisuke Maeda, M.D., Ph.D. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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18
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De Waele E, Jakubowski JR, Stocker R, Wischmeyer PE. Review of evolution and current status of protein requirements and provision in acute illness and critical care. Clin Nutr 2020; 40:2958-2973. [PMID: 33451860 DOI: 10.1016/j.clnu.2020.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in increased risk of infection, morbidity, and mortality. This has led to the practice of "permissive underfeeding" of calories; however, this can often lead to inadequate provision of guideline-recommended protein intakes. Acutely ill patients requiring nutritional therapy have high protein requirements, and studies demonstrate that provision of adequate protein can result in reduced mortality and improvement in quality of life. However, a significant challenge to adequate protein delivery is the current lack of concentrated protein solutions. Patients often have fluid administration restrictions and existing protein solutions are frequently not sufficiently concentrated to deliver a patient's protein requirements. This has led to the development of new enteral and parenteral nutrition solutions incorporating higher levels of protein in smaller volumes. This review article summarizes current evidence supporting the role of higher protein intakes, especially during the early phases of nutrition therapy in acute illness, methods for assessing protein requirements, as well as, the currently available high-protein enteral and parenteral nutrition solutions. There is sufficient evidence (albeit limited from true randomized, controlled studies) to indicate that earlier provision of guideline-recommended protein intakes may be key to improving patient outcomes and that nutritional therapy that tailors caloric and protein intake to the patients' needs should be considered a desired standard of care.
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Affiliation(s)
- Elisabeth De Waele
- Department of Intensive Care Medicine and Department of Nutrition, UZ Brussel, Vrije Unversiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Julie Roth Jakubowski
- Medical Affairs, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA.
| | - Reto Stocker
- Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, 8032, Zurich, Switzerland.
| | - Paul E Wischmeyer
- Department of Anesthesiology and Surgery Duke University School of Medicine, 200 Morris Street, #7600-H, P.O. Box 17969, Durham, NC 27701, USA.
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19
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Nutritional Assessment: A Primary Component of the Multidimensional Geriatric Assessment in the Intensive Care Unit. Crit Care Clin 2020; 37:205-219. [PMID: 33190771 DOI: 10.1016/j.ccc.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The importance of evaluating and adjusting the nutritional state of critically ill patients has become a core principle of care. This article focuses on tools for the nutritional assessment of geriatric intensive care unit patients, including a review of imaging and other standardized techniques for evaluation of muscle mass, an indicator of malnutrition and sarcopenia. It concludes with a discussion of the interplay of malnutrition, reduced muscle mass/sarcopenia, and frailty. The goal of this multidimensional assessment is to identify those at risk and thereby initiate interventions to improve outcomes.
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20
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Ligthart-Melis GC, Luiking YC, Kakourou A, Cederholm T, Maier AB, de van der Schueren MA. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 21:1216-1228. [DOI: 10.1016/j.jamda.2020.03.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
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21
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Troesch B, Eggersdorfer M, Laviano A, Rolland Y, Smith AD, Warnke I, Weimann A, Calder PC. Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition. Nutrients 2020; 12:E2555. [PMID: 32846900 PMCID: PMC7551800 DOI: 10.3390/nu12092555] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Life expectancy is increasing and so is the prevalence of age-related non-communicable diseases (NCDs). Consequently, older people and patients present with multi-morbidities and more complex needs, putting significant pressure on healthcare systems. Effective nutrition interventions could be an important tool to address patient needs, improve clinical outcomes and reduce healthcare costs. Inflammation plays a central role in NCDs, so targeting it is relevant to disease prevention and treatment. The long-chain omega-3 polyunsaturated fatty acids (omega-3 LCPUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are known to reduce inflammation and promote its resolution, suggesting a beneficial role in various therapeutic areas. An expert group reviewed the data on omega-3 LCPUFAs in specific patient populations and medical conditions. Evidence for benefits in cognitive health, age- and disease-related decline in muscle mass, cancer treatment, surgical patients and critical illness was identified. Use of DHA and EPA in some conditions is already included in some relevant guidelines. However, it is important to note that data on the effects of omega-3 LCPUFAs are still inconsistent in many areas (e.g., cognitive decline) due to a range of factors that vary amongst the trials performed to date; these factors include dose, timing and duration; baseline omega-3 LCPUFA status; and intake of other nutrients. Well-designed intervention studies are required to optimize the effects of DHA and EPA in specific patient populations and to develop more personalized strategies for their use.
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Affiliation(s)
- Barbara Troesch
- Nutrition Science and Advocacy, DSM Nutritional Products, 4303 Kaiseraugst, Switzerland; (B.T.); (I.W.)
| | - Manfred Eggersdorfer
- Department of Internal Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy;
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, INSERM 1027, Centre Hospitalo-Universitaire de Toulouse, 31300 Toulouse, France;
| | - A. David Smith
- Department of Pharmacology, University of Oxford, Oxford OX1 2JD, UK;
| | - Ines Warnke
- Nutrition Science and Advocacy, DSM Nutritional Products, 4303 Kaiseraugst, Switzerland; (B.T.); (I.W.)
| | - Arved Weimann
- Clinic for General, Visceral and Oncological Surgery, St. Georg gGmbH Clinic, 04129 Leipzig, Germany;
| | - Philip C. Calder
- Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK
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22
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Flaatten H, Beil M, Guidet B. Elderly Patients in the Intensive Care Unit. Semin Respir Crit Care Med 2020; 42:10-19. [PMID: 32772353 DOI: 10.1055/s-0040-1710571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a "rarity," they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors.
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Affiliation(s)
- Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen Norway
| | - Michael Beil
- Institute of Health Sciences, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Paris, France
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23
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De Biasio JC, Mittel AM, Mueller AL, Ferrante LE, Kim DH, Shaefi S. Frailty in Critical Care Medicine: A Review. Anesth Analg 2020; 130:1462-1473. [PMID: 32384336 DOI: 10.1213/ane.0000000000004665] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traditional approaches to clinical risk assessment utilize age as a marker of increased vulnerability to stress. Relatively recent advancements in the study of aging have led to the concept of the frailty syndrome, which represents a multidimensional state of depleted physiologic and psychosocial reserve and clinical vulnerability that is related to but variably present with advancing age. The frailty syndrome is now a well-established clinical entity that serves as both a guide for clinical intervention and a predictor of poor outcomes in the primary and acute care settings. The biological aspects of the syndrome broadly represent a network of interrelated perturbations involving the age-related accumulation of molecular, cellular, and tissue damage that leads to multisystem dysregulation, functional decline, and disproportionately poor response to physiologic stress. Given the complexity of the underlying biologic processes, several well-validated approaches to define frailty clinically have been developed, each with distinct and reasonable considerations. Stemming from this background, the past several years have seen a number of observational studies conducted in intensive care units that have established that the determination of frailty is both feasible and prognostically useful in the critical care setting. Specifically, frailty as determined by several different frailty measurement tools appears associated with mortality, increased health care utilization, and disability, and has the potential to improve risk stratification of intensive care patients. While substantial variability in the implementation of frailty measurement likely limits the generalizability of specific findings, the overall prognostic trends may offer some assistance in guiding management decisions with patients and their families. Although no trials have assessed interventions to improve the outcomes of critically ill older people living with frailty, the particular vulnerability of this population offers a promising target for intervention in the future.
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Affiliation(s)
- Justin C De Biasio
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aaron M Mittel
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ariel L Mueller
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Shahzad Shaefi
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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24
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Tao J, Ke YY, Zhang Z, Zhang Y, Wang YY, Ren CX, Xu J, Zhu YX, Zhang XL, Zhang XY. Comparison of the value of malnutrition and sarcopenia for predicting mortality in hospitalized old adults over 80 years. Exp Gerontol 2020; 138:111007. [PMID: 32590128 DOI: 10.1016/j.exger.2020.111007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to compare the prognostic value of malnutrition and sarcopenia for mortality in old adults over 80 years. METHODS A prospective analysis was performed in 427 hospitalized old adults. Anthropometric measures and biochemical parameters were carried out for each patient. Sarcopenia was defined according to the revised consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. Mortality data were available for up to 32 months of follow-up. RESULTS The overall prevalence of sarcopenia and malnutrition was 35.1% and 19.4%, respectively. The percentage of coexistence of sarcopenia and malnutrition was 12.2%. Of the 427 participants, 83 deaths were reported during the mean follow-up periods of 24.9 months. Compared with non-sarcopenic subjects with well-nutrition, sarcopenic subjects with well-nutrition and non-sarcopenic subjects with well-nutrition had higher mortality risk (Hazard Ratio (HR), 2.36; 95% confidence interval (CI), 1.31-4.24, P < 0.001; HR, 4.33; 95% CI, 2.12-8.85, P = 0.004; respectively). The patients who coexisted with sarcopenia and malnutrition had the highest risk of mortality (HR, 7.31; 95% CI, 4.21-12.69, P < 0.001). Both sarcopenia and malnutrition could predict mortality separately. Still, from the components of the Cox regression multivariate models, the malnutrition was one of the independent factors influencing the death, sarcopenia was not. CONCLUSION When malnutrition and sarcopenia were compared together in a longitude cohort, malnutrition was an independent risk factor for mortality, while sarcopenia was not. The coexistence of malnutrition and sarcopenia showed a synergistically accumulated risk for death.
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Affiliation(s)
- Jun Tao
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Ying-Ying Ke
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Zhen Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Yue Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Yan-Yan Wang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Chen-Xi Ren
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Jun Xu
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Yun-Xia Zhu
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Xing-Liang Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China
| | - Xiao-Yan Zhang
- Department of Geriatrics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, No. 600, Yi Shan road, Shanghai 200233, China.
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25
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Joyce PR, O'Dempsey R, Kirby G, Anstey C. A retrospective observational study of sarcopenia and outcomes in critically ill patients. Anaesth Intensive Care 2020; 48:229-235. [PMID: 32486830 DOI: 10.1177/0310057x20922234] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Frailty assessment in patients admitted to intensive care is often limited using traditional clinical frailty assessment tools. Opportunistic use of contemporary computed tomography (CT) can provide an objective estimate of low skeletal muscle mass (sarcopenia) as a proxy for frailty. The aim of this study was to establish the prevalence of sarcopenia in an Australian intensive care unit (ICU) population and to examine the relationship between sarcopenia and clinical outcomes. We undertook a single centre retrospective study of 1085 adult patients admitted to a single ICU over 12 months. Patients with a contemporary CT scan including the L3 vertebral body were included. Patients were categorised as sarcopenic or non-sarcopenic using previously published data. A total of 279 patients with a mean age of 67 years had an eligible CT scan; 163 (58%) were male. Higher 30-day mortality was associated with the use of CRRT (continuous renal replacement therapy) during the ICU admission (OR 6.84, P < 0.001) and also associated with lower cross-sectional muscle area (odds ratio (OR) 0.98, P = 0.004). Sarcopenia was found to be highly prevalent in this particular Australian ICU population (68%) and associated with older age (68 versus 55 years, P < 0.001), lower body mass index (27 versus 32 kg m-2, P < 0.001), more comorbidities (3 versus 2, P = 0.009), and longer stays in hospital (279 versus 223 h, P = 0.043). As a continuous predictor, lumbar muscle mass was associated with 30-day mortality with and without adjusting for other covariates.
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Affiliation(s)
- Patrick R Joyce
- Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Ryan O'Dempsey
- Department of Medical Imaging, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Giles Kirby
- Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Christopher Anstey
- Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Australia
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26
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Zhang XM, Zhang WW, Yu XZ, Dou QL, Cheng AS. Comparing the performance of SOFA, TPA combined with SOFA and APACHE-II for predicting ICU mortality in critically ill surgical patients: A secondary analysis. Clin Nutr 2020; 39:2902-2909. [PMID: 32008873 DOI: 10.1016/j.clnu.2019.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Total psoas muscle area (TPA) can indicate the status of the entire human body's skeletal muscle mass. It has been reported that lower TPA can increase the risk of mortality in critically ill patients. The aim of our study was to evaluate the relationship between TPA and ICU mortality and to compare the performance of Sequential Organ Failure Assessment (SOFA), TPA combined with SOFA and Acute Physiology, Chronic Health Evaluation (APACHE-II) for predicting ICU mortality in critically ill surgical patients. METHODS This study was a retrospective observational cohort study with a total of 96 critically ill surgical patients, ages 21-96 years old. Main outcome measures included difficult-to-wean (DTW), operation methods, ICU mortality, ICU stay, APACHE II, sepsis and SOFA. CT-scan assessed the TPA. It is acknowledged that the entire study was completed by Hao-Wei Kou et al. and the data were uploaded from plosone.com. The authors used this data only for secondary analysis. RESULTS The results showed that TPA is a protective factor for ICU mortality (OR: 0.99 95% [0.99, 1.00], P = 0.0269). In addition, when we defined sarcopenia-based TPA, our study showed that sarcopenia increased the risk of ICU mortality (OR:3.73 (1.27, 10.98) P = 0.0167. Furthermore, discrimination of ICU mortality was significantly higher using SOFA (AUROC, 0.7810 [99% CI, 0.6658-0.8962]) than either TPA (AUROC, 0.7023 [99% CI, 0.5552-0.8494]) or APACHE II score (AUROC, 0.7447 [99% CI, 0.6289-0.8604]). Additionally, when we combined TPA with SOFA score, the ROC of TPA + SOFA (AUROC, 0.8647 [99% CI, 0.7881-0.9412]) was the highest when compared to the other three models. CONCLUSION The relationship between TPA and ICU mortality is negative in critically ill surgical patients. In addition, the combination of TPA and SOFA was the best tool among the three scoring systems in providing significant discriminative ability when predicting ICU mortality in critically ill surgical patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Wen-Wu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Xue-Zhong Yu
- Peking Union Medical College Hospital, Beijing, China.
| | - Qing-Li Dou
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, The People's Hospital of Baoan Shenzhen, Shenzhen, China.
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Lopes ACP, Coltro PH, Lopes VJ, Fiori SMP, Knapik JS, Boumer TC. Muscle weakness assessment in older intensive care unit patients. GERIATRICS, GERONTOLOGY AND AGING 2020. [DOI: 10.5327/z2447-212320202000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: After long periods of hospitalization, older adults may develop muscle weakness that can affect their functional independence after discharge. OBJECTIVE: To assess muscle weakness in older patients admitted to an ICU. METHOD: This cross-sectional, descriptive study with a quantitative approach assessed functional independence with the Katz Index and post-ICU muscle strength with a handgrip strength (HS) test and the Medical Research Council (MRC) sum-score. The sample consisted of 60 patients with an average age of 76 (60–99) years, 36 (60%) of whom were female. RESULTS: Post-ICU, 86.7% of the patients were functionally dependent. Female patients had significantly lower HS than males: 7 (0–24) vs. 17 (1–37) (p < 0.001). Female patients who received mechanical ventilation (MV) or sedation had significantly lower HS and MRC scores than those who did not (p < 0.001): HS MV 1 (0–13) vs. 11 (0–24) p < 0.001; MRC MV 35 (14–48) vs. 43 (27–57) p < 0.001; HS sedation 0 (0–12) vs. 9 (0–24) p < 0.001; MRC sedation 34 (14–36) vs. 42 (22–57) p < 0.001, respectively. Finally, there was an inversely proportional correlation between HS, MRC scores, and ICU length of stay, Spearman’s rho = -0.267 (p = 0.0039) and Spearman’s rho = -0.347 (p = 0.007), respectively. CONCLUSION: Older women who received mechanical ventilation and sedation have lower muscle strength than those who did not. As the ICU length of stay increases, muscle strength decreases.
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Chambers TL, Burnett TR, Raue U, Lee GA, Finch WH, Graham BM, Trappe TA, Trappe S. Skeletal muscle size, function, and adiposity with lifelong aerobic exercise. J Appl Physiol (1985) 2019; 128:368-378. [PMID: 31829806 DOI: 10.1152/japplphysiol.00426.2019] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We examined the influence of lifelong aerobic exercise on skeletal muscle size, function, and adiposity. Young exercisers [YE; n = 20, 10 women (W), 25 ± 1 yr], lifelong exercisers (LLE; n = 28, 7 W, 74 ± 2 yr), and old healthy nonexercisers (OH; n = 20, 10 W, 75 ± 1 yr) were studied. On average, LLE exercised 5 days/wk for 7 h/wk over the past 52 ± 1 yr. The LLE men were subdivided by exercise intensity [Performance (LLE-P), n = 14; Fitness (LLE-F), n = 7]. Upper and lower leg muscle size and adiposity [intermuscular adipose tissue (IMAT)] were determined via MRI, and quadriceps isotonic and isometric function was assessed. For the quadriceps, aging decreased muscle size, isotonic and isometric strength, contraction velocity (men only), and power (P < 0.05). In women, LLE did not influence muscle size or function. In men, LLE attenuated the decline in muscle size and isometric strength by ~50% (P < 0.05). LLE did not influence other aspects of muscle function, nor did training intensity influence muscle size or function. For the triceps surae, aging decreased muscle size only in the women, whereas LLE (both sexes) and training intensity (LLE men) did not influence muscle size. In both sexes, aging increased thigh and calf IMAT by ~130% (P < 0.05), whereas LLE attenuated the thigh increase by ~50% (P < 0.05). In the LLE men, higher training intensity decreased thigh and calf IMAT by ~30% (P < 0.05). In summary, aging and lifelong aerobic exercise influenced muscle size, function, and adipose tissue infiltration in a sex- and muscle-specific fashion. Higher training intensity throughout the life span provided greater protection against adipose tissue infiltration into muscle.NEW & NOTEWORTHY This is the first study to examine skeletal muscle size, function, and adiposity in women and men in their eighth decade of life that have engaged in lifelong aerobic exercise. The findings reveal sex and upper and lower leg muscle group-specific benefits related to skeletal muscle size, function, and adiposity and that exercise intensity influences intermuscular adiposity. This emerging cohort will further our understanding of the health implications of maintaining exercise throughout the life span.
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Affiliation(s)
- Toby L Chambers
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Timothy R Burnett
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Ulrika Raue
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Gary A Lee
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - W Holmes Finch
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Bruce M Graham
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana
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Lee K, Shin Y, Huh J, Sung YS, Lee IS, Yoon KH, Kim KW. Recent Issues on Body Composition Imaging for Sarcopenia Evaluation. Korean J Radiol 2019; 20:205-217. [PMID: 30672160 PMCID: PMC6342757 DOI: 10.3348/kjr.2018.0479] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/15/2018] [Indexed: 02/07/2023] Open
Abstract
Recently, sarcopenia has garnered renewed interest. Sarcopenia is a disease characterized by decreased skeletal muscle mass and strength/function, which can impair the quality of life and increase physical disability, adverse metabolic effects, and mortality. Imaging tools for evaluating and diagnosing sarcopenia have developed rapidly. Radiologists should be aware of sarcopenia and its clinical implications. We review current knowledge about sarcopenia, its pathophysiological impact, and advantages and disadvantages of methods for evaluation of sarcopenia focusing on body composition imaging modalities such as whole-body dual-energy X-ray absorptiometry, CT, and MRI. Controversial issues are discussed, including the lack of consensus and standardization of the disease definition, imaging modality, measurement methods, and diagnostic cutoff points.
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Affiliation(s)
- Koeun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yongbin Shin
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jimi Huh
- Department of Radiology, Ajou University School of Medicine & Graduate School of Medicine, Ajou University Medical Center, Suwon, Korea.
| | - Yu Sub Sung
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Seob Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwon Ha Yoon
- Department of Radiology, Wonkwang University College of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW To help guide metabolic support in critical care, an understanding of patients' nutritional status and risk is important. Several methods to monitor lean body mass are increasingly used in the ICU and knowledge about their advantages and limitations is essential. RECENT FINDINGS Computed tomography scan analysis, musculoskeletal ultrasound, and bioelectrical impedance analysis are emerging as powerful clinical tools to monitor lean body mass during ICU stay. Accuracy, expertise, ease of use at the bedside, and costs are important factors which play a role in determining which method is most suitable. Exciting new research provides an insight into not only quantitative measurements, but also qualitative measurements of lean body mass, such as infiltration of adipose tissue and intramuscular glycogen storage. SUMMARY Methods to monitor lean body mass in the ICU are under constant development, improving upon bedside usability and offering new modalities to measure. This provides clinicians with valuable markers with which to identify patients at high nutritional risk and to evaluate metabolic support during critical illness.
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Looijaard WGPM, Weijs PJM, Oudemans-van Straaten HM. Letter to the Editor: Functional Compromise Cohort Study (FCCS): Sarcopenia is a Strong Predictor of Mortality in the Intensive Care Unit. World J Surg 2018; 42:3819-3820. [PMID: 29426970 DOI: 10.1007/s00268-018-4541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Peter J M Weijs
- Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
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