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Yin Yang X, Hu Q. Comment on:"Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial". Clin Nutr 2024; 43:1658. [PMID: 38302382 DOI: 10.1016/j.clnu.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Xi Yin Yang
- Department of Traditional Chinese Medicine, Community Health Service Center of Guali Town of Xiaoshan, 180 Guayu RD, Hangzhou, 311241, China
| | - Qiang Hu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui RD, Hangzhou, 310012, China.
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Akgul YSS, Akin S, Cengiz BE, Kocaslan D, Ozer NT. Body composition assessment for sarcopenic obesity and 3-year mortality in older adults: A comparison study. JPEN J Parenter Enteral Nutr 2024; 48:460-468. [PMID: 38400558 DOI: 10.1002/jpen.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND There is no universally accepted definition of sarcopenic obesity (SO), and its prevalence is ambiguous. This study aimed to investigate the prevalence of SO in older adults based on different definitions and determine which predicts all-cause mortality. METHODS This prospective longitudinal follow-up study included outpatients aged ≥60 years. SO was defined by sarcopenia definition based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria plus obesity. Three different methods were used to define obesity. Body mass index (BMI) ≥ 30 kg/m2, waist circumference (WC) ≥ 102 cm for men and ≥88.0 cm for women, and body fat percentage (BF%) ≥ 37.3% for men and ≥51.1% for women. Different definitions of SO and their mortality predictions were compared. RESULTS The median age of the 584 patients in the study was 70.0 (interquartile range, 66.0-76.0) years. The prevalence of sarcopenia was 38.5% (47.5% in men and 35.7% in women). The prevalence of SO based on BMI, WC, and BF% was 15.3%, 16.4%, and 10.5%, respectively. The mortality rate was 6.7%. SO based on BMI (odds ratio [OR], 2.73; 95% CI, 1.12-17.9; P = 0.024) and BF% (OR, 1.43; 95% CI, 1.19-3.02; P = 0.007) were significantly associated with 3-year mortality after adjusting for the confounding variables of age, sex, and number of comorbidities. SO based on WC was not associated with mortality (OR, 0.78; 95% CI, 0.07-1.27; P = 0.104). CONCLUSION The use of BF% and BMI for defining SO is appropriate in outpatient older adults.
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Affiliation(s)
- Yavuz Sultan Selim Akgul
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Sibel Akin
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Burcu Eren Cengiz
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Derya Kocaslan
- Division of Geriatrics, Department of Internal Medicine, Erciyes School of Medicine, Erciyes University, Kayseri, Türkiye
| | - Nurhayat Tugra Ozer
- Department of Nutrition and Dietetic, Faculty of Health Science, Agri Ibrahim Cecen University, Agri, Türkiye
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Maruyama M, Kagaya Y, Kajiwara S, Oikawa T, Horikawa M, Fujimoto M, Sasaki M. The relationship between sarcopenic obesity and changes in quadriceps muscle thickness and echo intensity in patients with stroke. Top Stroke Rehabil 2024:1-10. [PMID: 38590086 DOI: 10.1080/10749357.2024.2340369] [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: 01/10/2024] [Accepted: 03/31/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Research findings on skeletal muscle degeneration in post-stroke sarcopenic obesity are limited. Thus, this study aimed to investigate the association between post-stroke sarcopenic obesity and quantitative and qualitative changes in skeletal muscles. METHODS This was a cross-sectional study conducted on patients with stroke admitted to the convalescent rehabilitation ward. For skeletal muscle assessment, an ultrasound system was used to measure quadriceps muscle thickness and echo intensity (QMT and QEI) on the paretic and non-paretic sides. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Multiple regression analysis was performed to determine the relationships between sarcopenic obesity and QMT and QEI. RESULTS A total of 130 patients with stroke were included in this study (mean age: 69.4 ± 12.7 years). The prevalence of sarcopenic obesity was 23.1%. The multiple regression analysis showed that sarcopenic obesity was significantly negatively associated with QMT on both the paretic and non-paretic sides (paretic side: β = -0.28, p < 0.001; non-paretic side: β = -0.37, p < 0.001) and significantly positively associated with QEI (paretic side β = 0.21, p = 0.034; non-paretic side: β = 0.20, p = 0.029). CONCLUSIONS Post-stroke sarcopenic obesity was independently associated with quantitative and qualitative changes in skeletal muscles on both the paretic and non-paretic sides.
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Affiliation(s)
- Motoki Maruyama
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
- Department of Rehabilitation Medicine, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Yuki Kagaya
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Sota Kajiwara
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Takuto Oikawa
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Manabu Horikawa
- Department of Rehabilitation, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Mika Fujimoto
- Department of Nutrition, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Masahiro Sasaki
- Department of Rehabilitation Medicine, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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Bahat G, Ozkok S. The Current Landscape of Pharmacotherapies for Sarcopenia. Drugs Aging 2024; 41:83-112. [PMID: 38315328 DOI: 10.1007/s40266-023-01093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
Sarcopenia is a skeletal muscle disorder characterized by progressive and generalized decline in muscle mass and function. Although it is mostly known as an age-related disorder, it can also occur secondary to systemic diseases such as malignancy or organ failure. It has demonstrated a significant relationship with adverse outcomes, e.g., falls, disabilities, and even mortality. Several breakthroughs have been made to find a pharmaceutical therapy for sarcopenia over the years, and some have come up with promising findings. Yet still no drug has been approved for its treatment. The key factor that makes finding an effective pharmacotherapy so challenging is the general paradigm of standalone/single diseases, traditionally adopted in medicine. Today, it is well known that sarcopenia is a complex disorder caused by multiple factors, e.g., imbalance in protein turnover, satellite cell and mitochondrial dysfunction, hormonal changes, low-grade inflammation, senescence, anorexia of aging, and behavioral factors such as low physical activity. Therefore, pharmaceuticals, either alone or combined, that exhibit multiple actions on these factors simultaneously will likely be the drug of choice to manage sarcopenia. Among various drug options explored throughout the years, testosterone still has the most cumulated evidence regarding its effects on muscle health and its safety. A mas receptor agonist, BIO101, stands out as a recent promising pharmaceutical. In addition to the conventional strategies (i.e., nutritional support and physical exercise), therapeutics with multiple targets of action or combination of multiple therapeutics with different targets/modes of action appear to promise greater benefit for the prevention and treatment of sarcopenia.
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Affiliation(s)
- Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Hatay Training and Research Hospital, Hatay, 31040, Turkey
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5
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Heng MWY, Chan AWD, Man REK, Fenwick EK, Chew STH, Tay L, Sien NY, Ng D, Koh FH, Yong EL, Gupta P, Lamoureux EL. Individual and combined associations of sarcopenia, osteoporosis and obesity with frailty in a multi-ethnic asian older adult population. BMC Geriatr 2023; 23:802. [PMID: 38053025 PMCID: PMC10696759 DOI: 10.1186/s12877-023-04500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND We explored the relationships between sarcopenia (SP), osteoporosis (OP), obesity (OB), (alone and in combination) with physical frailty (PF) in a multi-ethnic, population-based study of Asians aged ≥ 60 years. METHODS Participants were enrolled from the PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study (PIONEER) study. PF was defined using the modified Fried phenotype; SP using the Asian Working Group for Sarcopenia 2019; OP using bone mineral density scores; and OB using the fat mass index. Modified Poisson regression models investigated the associations between exposures and PF, and the relative excess rates of PF due to interactions (RERI) to determine synergistic or antagonistic interactions. RESULTS Of the 2643 participants, 54.8% was female; and 49.8%, 25.1%, 25.0% were Chinese, Indians, and Malays, respectively. 25%, 19.0% and 6.7% participants had OB only, SP only, and OP only, respectively. A total of 356 (17.5%), 151 (7.4%) and 97 (4.8%) had osteosarcopenia (OSP), sarcopenic obesity (SOB) and osteo-obesity (OOB), respectively; while 70 (3.5%) had all 3 morbid conditions (osteosarcopenic obesity, OSO). Both SP only and OB only were strongly associated with increased rates of PF (RR: 2.53, 95% CI: 1.95, 3.29; RR: 2.05, 95% CI: 1.58, 2.66 respectively); but not OP. Those with OSP, OOB and SOB were also associated with high risks of PF (RR: 2.82, 95% CI: 2.16, 3.68; RR: 2.34, 95% CI: 1.69, 3.23; and RR: 2.58, 95% CI: 1.95, 3.41, respectively) compared to robust individuals. Critically, individuals with OSO had the highest relative risk of having PF (RR: 3.06, CI: 2.28, 4.11). Only the sarcopenia-obesity interaction was significant, demonstrating negative synergism (antagonism). The concurrent presence of SP and OB was associated with a 100% lower rate of PF compared to the sum of the relatively rates of SP only and OB only. CONCLUSION The prevalence of SP, OB and OP, alone and combined, is substantial in older Asians and their early identification is needed to mitigate the risk of frailty. OB may interact with SP in an antagonistic manner to moderate rates of frailty. Further longitudinal studies are needed to address causality and mechanistic underpinnings our findings.
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Affiliation(s)
- Matthew Wong Yu Heng
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- University of Cambridge, Cambridge, England
| | - Aurora W D Chan
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Samuel T H Chew
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Laura Tay
- Department of Geriatric Medicine, Sengkang General Hospital, Sengkang, Singapore
| | - Ng Yee Sien
- Rehabilitation Medicine, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - David Ng
- Department of Nuclear Medicine, Singapore General Hospital, Singapore, Singapore
| | - Frederick H Koh
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Eu-Leong Yong
- Department of Obstetrics & Gynecology, National University of Singapore, Singapore, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
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Altinkaynak M, Gurel E, Oren MM, Kilic C, Karan MA, Bahat G. Associations of EWGSOP1 and EWGSOP2 probable sarcopenia definitions with mortality: A comparative study. Clin Nutr 2023; 42:2151-2158. [PMID: 37774651 DOI: 10.1016/j.clnu.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND & AIMS Sarcopenia is a well-defined geriatric syndrome and a major cause of disability and mortality. We investigate the associations of alternative sarcopenia definitions with mortality in community-dwelling older adults. METHODS Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 probable sarcopenia criteria, with standard handgrip strength (HGS) cut-offs of 30/20 kg for an EWGSOP1 definition and 27/16 kg for an EWGSOP2 definition, or alternatively, population-specific cut-offs of 35/20 kg for a EWGSOP2 definition. The 5-year mortality rate was assessed in the accessible cases. RESULTS The prevalence of sarcopenia among 204 older adults [53.9% female; aged 74.5 ± 7.0] was 4.9% based on the EWGSOP1 criterion, 23.5% according to the EWGSOP2-suggested standard (British) HGS cut-offs and 50.0% based on the EWGSOP2 population-specific cut-offs. In the 103 accessible patients, the mortality rate was 30.1%. Cox-regression analyses adjusted for parameters determined through univariate analyses [age and sarcopenia definitions (in 3 different models)], showed that the EWGSOP1 definition (HR = 4.26, 95% CI = 1.45-12.42, p = 0.008) and EWGSOP2 probable sarcopenia definition with population-specific cut-offs (HR = 2.58, 95% CI = 1.12-5.93, p = 0.03) were associated with a greater mortality risk, while the EWGSOP2 probable sarcopenia definition with standard-cut offs was not (p = 0.09). CONCLUSIONS This is the first study to investigate the associations of EWGSOP2-defined probable sarcopenia with mortality based on standard vs. population-specific HGS cut-offs. The results suggest that population-specific cut-offs should be used when available. We suggest that conducted in community-dwelling older adults, our results have implications for most of older adults.
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Affiliation(s)
- Mustafa Altinkaynak
- Department of Internal Medicine, Division of General Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
| | - Erdem Gurel
- Department of Internal Medicine, Division of General Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
| | - Meryem Merve Oren
- Department of Public Health, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
| | - Cihan Kilic
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Fatih, 34390, Istanbul, Turkey.
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Bahat G, Ozkok S, Petrovic M. Management of Type 2 Diabetes in Frail Older Adults. Drugs Aging 2023; 40:751-761. [PMID: 37434085 DOI: 10.1007/s40266-023-01049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
Aging is one of the most important factors associated with the dramatic increase in the prevalence of type 2 diabetes mellitus (T2DM) globally. In addition to traditional micro- and macrovascular complications, diabetes mellitus (DM) in older adults is of great importance due to its independent relationship with frailty, which is defined as a decline in functional reserves and vulnerability to stressors. Frailty assessment enables the determination of biological age, thus predicting potential complications in older adults and identifying tailored treatment strategies. Although the latest guidelines have acknowledged the frailty concept and provided recommendations specific to this subgroup of older adults, frail older adults are particularly considered only as anorexic, malnourished people for whom relaxed treatment targets should be set. However, this approach bypasses other metabolic phenotypes in the context of diabetes and frailty. Recently, a spectrum of metabolic phenotypes in the context of frailty in DM was suggested, and the two edges of this spectrum were defined as "anorexic malnourished (AM)" and "sarcopenic obese (SO)." These two edges were suggested to require different strategies: Opposite to the AM phenotype requiring less stringent targets and de-intensification of treatments, tight blood glucose control with agents promoting weight loss was recommended in the SO group. Our suggestion is that, regardless of their phenotype, weight loss should not be the primary goal in DM management in older adults who are overweight or obese, because of the increased malnutrition prevalence in older adults suffering from DM compared with standard older adults. Furthermore, overweight older adults have been reported to have the lowest risk of mortality compared with other groups. On the other hand, obese older individuals may benefit from intensive lifestyle interventions including caloric restriction and regular exercise with the assurance of at least 1 g/kg/day high-quality protein intake. Besides metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) should be considered in appropriate SO cases, due to high evidence of cardiorenal benefits. MF should be avoided in the AM phenotype due to their weight loss property. Although weight loss is not desired in AM phenotype, SGLT-2i may still be preferred with close follow-up in certain individuals demonstrating high cardiovascular disease (CVD) risk. Of note, SGLT-2i should be considered earlier in the diabetes treatment in both groups due to their multiple benefits, i.e., organ protective effects, the potential to reduce polypharmacy, and improve frailty status. The concept of different metabolic phenotypes in frail older adults with diabetes once again shows "one size fits all" cannot be applied in geriatric medicine, and a tailored, individualized approach should be adopted to get the highest benefit from treatments.
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Affiliation(s)
- Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Türkiye.
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Hatay Training and Research Hospital, 31040, Hatay, Türkiye
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Curtis M, Swan L, Fox R, Warters A, O'Sullivan M. Associations between Body Mass Index and Probable Sarcopenia in Community-Dwelling Older Adults. Nutrients 2023; 15:nu15061505. [PMID: 36986233 PMCID: PMC10059806 DOI: 10.3390/nu15061505] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background/Objectives: The relationship between body mass index (BMI) and probable sarcopenia, a precursor to sarcopenia diagnosis, is unclear. While low BMI has been associated with sarcopenia risk, some evidence suggests that obesity may confer protection. We aimed to investigate the association between probable sarcopenia and BMI and, furthermore, to explore associations with waist circumference (WC). (2) Methods: This cross-sectional study included 5783 community-dwelling adults (mean age 70.4 ± 7.5 years) from Wave 6 of the English Longitudinal Study of Ageing (ELSA). Probable sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for low hand grip strength and/or slow chair rise. Associations between BMI and probable sarcopenia were examined using multivariable regression analysis and were similarly performed for WC. (3) Results: Our overall findings show that an underweight BMI was significantly associated with an increased likelihood of probable sarcopenia [OR (CI) 2.25 (1.17, 4.33), p = 0.015]. For higher BMI categories, the findings were conflicting. Overweight and obesity were associated with an increased likelihood of probable sarcopenia when defined by lower limb strength alone, [OR (CI), 2.32 (1.15, 4.70), p = 0.019; 1.23 (1.02, 1.49), p = 0.35, and 1.49 (1.21, 1.83), p < 0.001, respectively]. In contrast, overweight and obesity appeared protective when probable sarcopenia was assessed by low hand grip strength alone [OR (CI) 0.72 (0.60, 0.88), p = 0.001, and 0.64 (0.52, 0.79), p < 0.001, respectively]. WC was not significantly associated with probable sarcopenia on multivariable regression analysis. (4) Conclusion: This study supports the evidence that low BMI is associated with an increased likelihood of probable sarcopenia, highlighting an important at-risk group. The findings for overweight and obesity were inconsistent and may be measurement dependent. It seems prudent that all older adults at risk of probable sarcopenia, including those with overweight/obesity, are assessed to prevent underdetection of probable sarcopenia alone or with the double burden of obesity.
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Affiliation(s)
- Molly Curtis
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, St. James's Healthcare Campus, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Lauren Swan
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, St. James's Healthcare Campus, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Rebecca Fox
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, St. James's Healthcare Campus, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Austin Warters
- Older Person Services, Dublin North City and County Community Health Organisation, The Health Service Executive, D09 C8P5 Dublin, Ireland
| | - Maria O'Sullivan
- Department of Clinical Medicine, School of Medicine, Trinity Centre for Health Sciences, St. James's Healthcare Campus, Trinity College Dublin, D08 W9RT Dublin, Ireland
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Cao X, Yang B, Zhou J. Waist-to-calf circumstance ratio and cognitive function among Chinese older adults: Mediating roles of physical performance and social activity. Front Aging Neurosci 2023; 15:1166341. [PMID: 37139093 PMCID: PMC10150408 DOI: 10.3389/fnagi.2023.1166341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 05/05/2023] Open
Abstract
Background In light of the potentially detrimental effects of central fat and decreased muscle mass on cognitive function, it would be beneficial to learn more about the mediating mechanisms underpinning the association between the two. The purpose of this study is to determine the association between waist-to-calf circumstance ratio (WCR) and cognitive function, as well as to investigate whether physical performance and social activity mediate the relationship between WCR and cognitive function among older Chinese adults. Methods An analysis of 9,652 older Chinese adults was conducted during the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). The Mini-Mental State Examination (MMSE) and a self-reported scale were used to measure cognitive function, physical performance, and social activity, respectively. Multiple linear regression and mediation analyses were conducted. Results The findings suggest that a high WCR had a significant negative association with cognitive function (B = -0.535, 95% CI: -0.754, -0.317). Mediation analysis revealed that a high WCR influenced old adults' cognitive function in three ways: first, through the partial mediating effect of physical performance (B = -0.270; 95% CI: -0.340, -0.203); second, through the partial mediating effect of social activity (B = -0.035; 95% CI: -0.055, -0.017); and third, through the serial mediating effects of physical performance and social activity (B = -0.021, 95% CI: -0.029, -0.015). Conclusion The study results suggest the adverse impact of a high WCR on older adults' cognitive function, and the possible mechanisms of physical performance and social activity by which the association takes place. Multidimensional health and social interventions aimed at improving physical, social, and cognitive functioning among older adults with sarcopenic obesity are recommended.
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Affiliation(s)
- Xia Cao
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Chronic Disease Health Management Medical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Binfang Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Chronic Disease Health Management Medical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Mental and Mental Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jiansong Zhou
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10
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de Souza Moreira B, de Souza Andrade AC, Lustosa Torres J, de Souza Braga L, de Carvalho Bastone A, de Melo Mambrini JV, Lima-Costa MF. Nationwide handgrip strength values and factors associated with muscle weakness in older adults: findings from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). BMC Geriatr 2022; 22:1005. [PMID: 36585620 PMCID: PMC9805021 DOI: 10.1186/s12877-022-03721-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Handgrip strength (HGS) is a simple, quick, inexpensive, and highly reliable method for the assessment of muscle strength in clinical practice and epidemiological studies. This study aimed at describing the HGS values by age group and sex in Brazilians aged 50 years and over, determining age group- and sex-specific cutoff points for muscle weakness, and investigating sociodemographic and anthropometric variables associated with muscle weakness for each sex. METHODS Data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. HGS was measured in the dominant hand using a hydraulic hand dynamometer. Fractional polynomial regression models were fitted to estimate the percentiles (P5, P10, P20, P25, P50, P75, P90, and P95) of HGS by age group and sex. The P20 of the maximum HGS by age group and sex was used to define muscle weakness. Associations between sociodemographic (racial self-classification, place of residence, schooling, and monthly household income per capita in tertiles) and anthropometric variables (body mass index and waist circumference) and muscle weakness, by sex, were evaluated using logistic regression. RESULTS The analytical sample included 7905 participants (63.1 ± 9.1 years; 60% women). HGS reduced with increasing age in both sexes. Men presented higher HGS than women in all age groups. The cutoff points for muscle weakness ranged from 28 to 15 kg for men and from 17 to 9 kg for women. In the adjusted analyses, low schooling (0-4 years) was positively associated with muscle weakness in both sexes (in men, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.46-4.12; in women, OR 1.90, 95%CI 1.18-3.06). Low and middle monthly household income per capita also had a positive association with muscle weakness among women (OR 1.78, 95%CI 1.37-2.32; OR 1.32, 95%CI 1.01-1.73, respectively). Overweight had a negative association with muscle weakness among men (OR 0.66, 95%CI 0.52-0.83), and obesity was inversely associated with muscle weakness in both sexes (in men, OR 0.49, 95%CI 0.31-0.78; in women, OR 0.69, 95%CI 0.52-0.92). CONCLUSIONS This study provides HGS values and cutoff points for muscle weakness by age group and sex from a nationally representative sample of older Brazilian adults. The variables associated with muscle weakness slightly differed between men and women. HGS values and cutoff points generated can be used as benchmarks in clinical settings and foster future epidemiological research.
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Affiliation(s)
- Bruno de Souza Moreira
- grid.8430.f0000 0001 2181 4888Núcleo de Estudos Em Saúde Pública E Envelhecimento, Universidade Federal de Minas Gerais E Fundação Oswaldo Cruz - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanda Cristina de Souza Andrade
- grid.411206.00000 0001 2322 4953Programa de Pós-Graduação Em Saúde Coletiva, Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso Brazil
| | - Juliana Lustosa Torres
- grid.8430.f0000 0001 2181 4888Núcleo de Estudos Em Saúde Pública E Envelhecimento, Universidade Federal de Minas Gerais E Fundação Oswaldo Cruz - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil ,grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Programa de Pós-Graduação Em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana de Souza Braga
- grid.8430.f0000 0001 2181 4888Núcleo de Estudos Em Saúde Pública E Envelhecimento, Universidade Federal de Minas Gerais E Fundação Oswaldo Cruz - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil ,grid.8430.f0000 0001 2181 4888Faculdade de Medicina, Programa de Pós-Graduação Em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra de Carvalho Bastone
- grid.411287.90000 0004 0643 9823Programa de Pós-Graduação Em Reabilitação E Desempenho Funcional, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri, Diamantina, Minas Gerais Brazil
| | - Juliana Vaz de Melo Mambrini
- grid.418068.30000 0001 0723 0931Programa de Pós-Graduação Em Saúde Coletiva, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Fernanda Lima-Costa
- grid.8430.f0000 0001 2181 4888Núcleo de Estudos Em Saúde Pública E Envelhecimento, Universidade Federal de Minas Gerais E Fundação Oswaldo Cruz - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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