Sarcopenia, frailty and their prevention by exercise

Reliability and Diagnostic Accuracy of EOS Full-Body Upright Imaging for Sarcopenia: A Retrospective Study Comparing Thigh Muscle to CT-Derived Psoas Muscle Measurements

BACKGROUND

Sarcopenia increases postoperative complication and mortality rates in elderly patients. Although measurement of the psoas muscle area on computed tomography (CT) scans is traditionally used to diagnose sarcopenia, CT is not routine in orthopaedic practice and causes unnecessary radiation exposure. EOS, a low-dose full-body imaging modality, captures musculoskeletal structures in an upright position, offering an alternative for sarcopenia diagnosis.

METHODS

Patients ≥18 years of age were included in this retrospective study if they had undergone non-contrast CT spine and EOS imaging between May 2022 and May 2024. Psoas muscle measurements at L3 and L4 were made using non-contrast CT scans, while thigh muscle measurements were obtained with EOS imaging. Inter- and intra-rater reliabilities were assessed using intraclass correlation coefficients (ICCs). Predicted probabilities for L4-psoas sarcopenia were determined through logistic regression, controlling for demographic covariates and validated with an 80% to 20% train-validate split. Sarcopenia cutoffs for anteroposterior (AP) thigh thickness and lateral (LAT) quadriceps thickness were determined with use of the Youden index.

RESULTS

Sarcopenia was identified in 23.1% of 134 patients (85 female and 49 male; 121 White, 7 Black, and 6 Hispanic) on the basis of L4-psoas muscle index thresholds. EOS and CT measurements showed excellent ICCs (≥0.90). Multivariable regressions identified AP thigh thickness and LAT quadriceps thickness as significant predictors of psoas area and L4-psoas sarcopenia. The area under the receiver operating characteristic curve for identifying L4-psoas sarcopenia was 0.85 for AP thigh thickness and 0.77 for LAT quadriceps thickness. Cutoffs were 12.47 cm (males) and 10.68 cm (females) for AP thigh thickness, and 3.23 cm (males) and 2.20 cm (females) for LAT quadriceps thickness. In the validation cohort of 27 patients, the AP thigh thickness model showed 0.94 sensitivity and 0.89 specificity, while the LAT quadriceps thickness model showed 0.70 sensitivity and 1.00 specificity. Applying these cutoffs to the entire data set showed that 66.7% of males and 75.0% of females with measurements below both cutoffs had sarcopenia.

CONCLUSIONS

EOS is a reliable alternative to CT for muscle mass assessment and sarcopenia diagnosis. EOS may be a valuable tool for assessing sarcopenia without a CT scan, as thigh muscle measurements via EOS correlate well with CT-derived psoas measurements. This imaging modality aids in early sarcopenia diagnosis, potentially enhancing preoperative planning and reducing radiation exposure, unnecessary costs, and resource utilization.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

Possible sarcopenia and depression among middle-aged and older adults in China: A 9-year longitudinal survey

Possible sarcopenia (PS) and depression are prevalent among middle-aged and older adults. However, few studies have evaluated the causal association between depression and PS, as well as its components. This study conducted both cross-sectional and longitudinal analyses to explore the relationship between PS and depression in a population aged 45 and oledr. We evaluated the association between PS and its components with depression using data from the China Health and Retirement Longitudinal Study (CHARLS). PS was assessed according to the Asian Working Group for sarcopenia gudielines established in 2019 (AWGS 2019). Depression was measured by the validated 10-item Center for Epidemiological Studies Depression Scale (CES-D.10), with a cut-off score of 12 or higher indicating the presence of depression. 10,058 participants included in cross-sectional study and 5,726 participants without depression from the same cohort in 2011 were followed through 2020. Logistic regression and Cox proportional hazards models were employed to assess the association between PS and its components with depression. Restricted cubic spline (RCS) model was utilized to evaluate dose-response relationshipbetween muscle strength and physical performance with depression, and subgroup analyses were performed to validate the robustness of the findings. Cross-sectional analysis revealed that the prevalence of PS among middle-aged and older adults was 32.84% (3,303/10,058). Both PS (OR:1.47,95%CI:1.34-1.63), low muscle strength (LMS) (OR:1.46,95%CI:1.24-1.71) and low physical performance (LPP) (OR:1.45,95%CI:1.31-1.61) exhibited higher odds of depression after adjusting covariates. 1515 cases (26.46%) of incident depression were identified during the 9-years follow-up. Subjects with PS (HR:1.10,95%CI:1.01-1.19), LMS (HR:1.16,95%CI:1.01-1.34) and LPP (HR:1.08,95%CI:1.01-1.18) were at an elevated risk of new-onset depression compared to those without these conditions. The RCS analysis demonstrated a non-linear relationship between muscle strength and physical performance with depression (p > 0.05). Participants aged 50-59, married, with education below middle school, living in rural areas, non-smokers or non-drinkers, sleeping less than 8 hours, and classified as obese exhibited an increased risk in subgroup analysis. (all p <  0.05). PS, LMS and LPP were indentified as independent risk factors for new-onset depression. It is essential to assess muscle strength and physical performance in community-dwelling middle-aged and older adults using simple and feasible objective measures to enhance depression screening.

Development and validation of a risk prediction model for frailty in older nappers

BACKGROUND

Frailty among older adults has received widespread attention from society, especially among nappers. The objective of this study was to develop a frailty prediction model for nappers.

METHODS

The data source was the China Health and Retirement Longitudinal Study, with a cohort of 1830 older nappers. We used the least absolute shrinkage and selection operator to screen the best predictors from multiple factors, logistic regression analysis to explore the best predictors of frailty in older nappers, and nomogram to establish a prediction model. A calibration curve was used to evaluate the precision of the model, and the predictive performance was assessed by analyzing the area under the characteristic and decision curves.

RESULTS

The prevalence of frailty among older nappers was 28.9 % (528/1830). Chronic diseases, physical activity, sleep quality, pain, fatigue, depression, nap duration, and nighttime sleep duration were the best predictive factors for frailty in older nappers. The area under the curve (AUC) in the training set was 0.751 (95 % confidence interval [CI] = 0.724-0.779) with a specificity of 0.662 and sensitivity of 0.711. The AUC in the validation set was 0.781 (95 % CI = 0.749-0.812) with a specificity of 0.730 and sensitivity of 0.714. The Hosmer-Lemeshow test values were both p > 0.05. The nomogram model showed good concordance and accuracy.

CONCLUSION

We constructed a nomogram that serves as a valuable and convenient instrument for assessing the prevalence of frailty among older nappers.

Physical exercise for primary sarcopenia: an expert opinion

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

Nonleisure-time physical activity as a protective factor against sarcopenia in hemodialysis patients: a prospective cohort study

Objectives

Sarcopenia is prevalent among individuals undergoing maintenance hemodialysis (MHD) and is influenced by sedentary lifestyles. Although leisure-time physical activities have been shown to prevent sarcopenia in patients undergoing MHD, the impact of nonleisure-time physical activities on sarcopenia has not yet been examined in prospective studies.

Methods

This prospective cohort study, conducted in 2020 with a 12-month follow-up, included stable MHD patients without baseline sarcopenia. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia criteria. Physical activity was assessed using the International Physical Activity Questionnaire. Additionally, demographic, dietary, nutritional, and laboratory data were collected. Modified Poisson regression analysis was employed to evaluate the impact of physical activity on the risk of developing sarcopenia.

Results

Among the 196 MHD patients who completed the 1-year follow-up, 29 (14.8%) developed sarcopenia. The average total physical activity was 1,268 METs/week, with leisure-time activity averaging 300 METs/week and nonleisure-time activity averaging 724 METs/week. Adjusted analyses indicate that leisure-time physical activities do not significantly affect the risk of sarcopenia (RR = 0.920, 95% CI = 0.477-1.951; P > 0.05), whereas nonleisure-time physical activities are significantly associated with a reduced risk of sarcopenia (RR = 0.449, 95% CI = 0.248-0.814).

Conclusion

Actively participating in physical activities (nonleisure-time physical activities) can reduce the incidence of sarcopenia in patients undergoing MHD. Promoting such activities may be an effective strategy to enhance physical fitness and mitigate sarcopenia risk among this population.

Determinants and risk prediction models for frailty among community-living older adults in eastern China

Objective

The purpose of this study is to develop predictive models for frailty risk among community-dwelling older adults in eastern China using machine learning techniques. This approach aims to facilitate early detection of high-risk individuals and inform the design of tailored interventions, with the ultimate goals of enhancing quality of life and mitigating frailty progression in the older adult population.

Methods

This study involved 1,263 participants aged 60 years or older, who were selected through stratified cluster sampling. Frailty was assessed using the Tilburg Frailty Indicator (TFI), which encompasses physical, psychological, and social dimensions. Predictive models were constructed using decision trees, random forests, and XGBoost algorithms, implemented in R software (version 4.4.2). The performance of these models was evaluated using metrics such as the area under the receiver operating characteristic curve (AUC), ROC curves, and confusion matrices.

Results

The results showed that 64.77% of the older adult were physically weak. Body mass index (BMI), living arrangements, frequency of visits and smoking status are the main factors contributing to frailty. When comparing predictive model metrics, random forest and extreme Gradient Lift (XGBoost) outperform decision tree models in terms of accuracy and applicability.

Conclusion

Older adults living in communities in eastern China showed slight frailty, and many factors influenced their frailty scores. Random forest and XGBoost models outperform decision tree models in predicting frailty in older adults, so identifying high-risk individuals early and developing personalized interventions can help slow the development of frailty and improve quality of life in older adults.

Causal associations between Sarcopenia-related traits and obstructive sleep apnea: a mendelian randomization study

BACKGROUND

Evidence for a causal relationship between sarcopenia and obstructive sleep apnea (OSA) is scarce. This study aimed to investigate the causal association between sarcopenia-related traits and OSA utilizing Mendelian randomization (MR) analyses.

METHODS

MR analyses were conducted using genetic instruments for sarcopenia-related traits, including hand grip strength, muscle mass, fat mass, water mass, and physical performance. Data from large-scale genome-wide association studies (GWAS) were utilized to identify genetic variants associated with these traits. Causal associations with OSA were assessed using various MR methods, including the inverse variance-weighted (IVW) method, MR-Egger, and weighted median approaches. Pleiotropy and heterogeneity were evaluated through MR-PRESSO and other sensitivity analyses.

RESULTS

Low hand grip strength in individuals aged 60 years and older exhibited a positive correlation with the risk of OSA (IVW, OR = 1.190, 95% CI = 1.003-1.413, p = 0.047), while no significant causal effects were observed for grip strength in the left and right hands. Muscle mass, fat mass, and water mass were significantly associated with OSA, even after adjusting for multiple testing. Notably, higher levels of body fat percentage, trunk fat percentage, and limb fat percentage were strongly correlated with increased risk of OSA. Physical performance indicators such as walking pace demonstrated an inverse association with OSA, while a higher risk of OSA was observed with increased log odds of falling risk and greater frequency of falls in the last year. Additionally, a causal effect was found between long-standing illness, disability, or infirmity and OSA.

CONCLUSIONS

This comprehensive MR analysis provides evidence of a significant causal relationship between characteristics associated with sarcopenia, including low hand grip strength, muscle mass, fat mass, and physical performance, and the risk of OSA. These findings underscore the importance of addressing sarcopenia-related factors in the management and prevention of OSA.

Prevalence and Factors Associated With Frailty Among Middle-Aged Adults

PURPOSE

To examine the prevalence and factors related to frailty in 200 community-dwelling middle-aged adults (aged 50 to 64 years).

METHOD

Frailty was assessed using the Fried Frailty Phenotype scale. The following parameters were recorded: demographic characteristics, lifestyle characteristics, nutritional supplements, sleep quality, and mood status.

RESULTS

Prevalences of frailty and pre-frailty in the population were 1% and 36.5%, respectively. Low physical activity was the predominant symptom experienced by middle-aged adults with pre-frailty. Moreover, males, those with low educational levels, and those with poor mood status had a higher risk of frailty (p < 0.05). In addition, those who consumed milk more than three times per week had a lower risk of frailty compared to their counterparts (p < 0.05).

CONCLUSION

Health care programs that focus on increasing physical activity, milk consumption, and psychological support could be suitable strategies for preventing and managing pre-frailty in this population. [Research in Gerontological Nursing, 18(2), 81-89.].

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

AIM

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Low-Magnitude High-Frequency Vibration Attenuates Sarcopenia by Modulating Mitochondrial Quality Control via Inhibiting miR-378

BACKGROUND

Sarcopenia, the age-related decline in muscle mass and muscle strength, significantly contributes to falls, diminished quality of life, and mortality. Although mitochondrial dysfunction is increasingly implicated in sarcopenia, the underlying mechanisms are not fully discovered. Low-magnitude high-frequency vibration (LMHFV), a recommended treatment by the Centers for Disease Control and Prevention (CDC) to reduce fall risk, remains poorly understood of the mechanism on improving skeletal muscle quality. This study aims to investigate whether mitochondrial dysfunction contributes to sarcopenia and evaluate whether LMHFV mitigates sarcopenia by improving mitochondrial homeostasis.

METHODS

The relationship between mitochondria dysfunction and sarcopenia using senescence accelerated mice prone 8 (SAMP8) model was investigated, assessing muscle and mitochondria. The effects of LMHFV on muscle and mitochondria were evaluated in SAMP8 mice during sarcopenia progression. The role of miR-378 in muscle and mitochondrial homeostasis were evaluated in SAMP8 mice and transgenic over-expressing miR-378 mice (TG mice). The target gene of miR-378 was investigated by dual-luciferase reporter assay in C2C12 cells. Subsequently, we evaluated the effect of LMHFV on miR-378 using both mouse models.

RESULTS

Reduction in muscle strength was observed from the ages of month 8 to 10 in SAMP8 mice (grip strength decreased 27.1%, p = 0.0263; twitch force decreased 29.1%, p = 0.0178; tetanic force decreased 29.9%, p = 0.011), as well as muscle atrophy (cross-section area: 38.3%, p = 0.0121). Mitochondrial morphological deterioration was noticed from month 6 to 10. Mitochondrial homeostasis, including biogenesis, fusion, fission, mitophagy, and ATP production declined from month 6 to 10. Compared to control group at month 10, knocking down miR-378 in SAMP8 mice mitigated sarcopenia (twitch force increased 44.3%, p = 0.0023; tetanic force increased 51.9%, p = 0.0005), improved mitochondrial morphologies (mitochondrial number increased 1.65-fold, p = 0.0023; mitochondrial density increased 1.65-fold, p = 0.0023; mitochondrial relative area increased 9.05-fold, p = 0.0019) along with improved mitochondrial homeostasis. Over-expressing miR-378 in transgenic mice exacerbated muscle atrophy and mitochondrial deterioration significantly. The dual-luciferase reporter assay in C2C12 cells revealed that miR-378 inhibited PGC-1α directivity. LMHFV was found to mitigate sarcopenia by modulating mitochondrial homeostasis, such as attenuating mitochondrial morphological deterioration and improving mitochondrial biogenesis through increasing PGC-1α via inhibiting miR-378 in skeletal muscle.

CONCLUSIONS

Our findings indicate that mitochondrial biogenesis, fusion, fission, and mitophagy were compromised during progression of sarcopenia, with mitochondrial deterioration preceding the onset of sarcopenia symptoms. The study also demonstrated that LMHFV could attenuate sarcopenia by modulating mitochondrial quality control through inhibiting miR-378, highlighting its therapeutic potential in the management of age-related muscular degeneration.

Effects of digital-based interventions on the outcomes of the eligibility criteria for sarcopenia in healthy older adults: A systematic review and meta-analysis

BACKGROUND

While the digital-based interventions targeting older adults to prevent age-related health problems such as sarcopenia have grown rapidly in recent years, there are no meta-analyses indicating synthesized pooled estimates.

OBJECTIVE

To examine the effects of digital-based interventions on sarcopenia-related measures, including physical performance and muscle mass, in healthy community-dwelling older adults.

METHODS

Systematic searches were performed on MEDLINE, Web of Science, and Cochrane Library for eligible studies published up to 31 March 2023. The mean difference with a 95 % confidence interval was calculated. Methodological quality was assessed using Cochrane RoB 2.0. The GRADE criteria were used to assess evidence certainty.

RESULTS

Thirteen randomized controlled trials with 742 participants were included in the meta-analysis. Handgrip strength, usual walking speed, five times sit-to-stand performance, and 30-second chair stand test showed significant enhancements with the digital-based interventions. However, there were no significant effects of digital-based interventions in appendicular muscle mass. The overall evidence certainty was low.

CONCLUSIONS

Although digital-based interventions for healthy older adults are effective in improving physical functions, evidence certainty is low. Additional randomized controlled trials are thus required to further validate the findings.

The Relationship Between a Mediterranean Diet and Frailty in Older Adults: NHANES 2007-2017

BACKGROUND

Frailty is a geriatric syndrome of significant public health concern that causes vulnerability to physiologic stressors and an increased risk of mortality and hospitalizations. Dietary intake and quality are contributing factors to the development of frailty. The Mediterranean diet is known to be one of the healthiest eating patterns with promising health impacts for prevention. We evaluated the association between Mediterranean diet patterns and frailty status.

METHODS

We conducted a cross-sectional study using National Health and Nutrition Examination Survey data from 2007 to 2017. We included 7300 participants aged > 60 years who completed the first day of a 24 h diet recall and had full covariate data. We constructed an alternate Mediterranean diet (aMED) score based on the quantity of specific food-group intake and categorized participants to low-, moderate-, and high-adherence groups (aMED adherence scores of 0-2, 3-4, and 5-9, respectively). Using a modified Fried Frailty phenotype (weakness, low physical activity, exhaustion, slow walking speed, and weight loss), participants were categorized as robust (met no criteria), pre-frail (met one or two criteria), and frail (met three or more criteria). Logistic regression evaluated the association of frailty (prefrail/robust as referent) and aMED adherence.

RESULTS

Included participants were mainly female (54.5%) and non-Hispanic White (80.0%). The mean (SD) aMED score was 3.6 (1.6) with 45% of participants falling into moderate aMED adherence (26% low adherence, 30% high adherence). Frailty prevalence among participants was 7.1%, with most participants classified as robust (51.0%) or pre-frail (41.9%). Fully adjusted models showed significantly reduced odds of frailty with moderate-adherence and high-adherence groups (odds ratio (95%CI) of 0.71 (0.55, 0.92) and 0.52 (0.36, 0.75), respectively).

CONCLUSIONS

Mediterranean diet adherence is associated with decreased odds of frailty in older adults. These findings suggest that adherence to a Mediterranean diet may play a critical role in mitigating frailty and its associated conditions. Future research should include longitudinal and interventional studies that can definitively determine the effect of a Mediterranean diet on frailty and what food components provide the greatest benefit.

Sarcopenia and cachexia: molecular mechanisms and therapeutic interventions

Sarcopenia is defined as a muscle-wasting syndrome that occurs with accelerated aging, while cachexia is a severe wasting syndrome associated with conditions such as cancer and immunodeficiency disorders, which cannot be fully addressed through conventional nutritional supplementation. Sarcopenia can be considered a component of cachexia, with the bidirectional interplay between adipose tissue and skeletal muscle potentially serving as a molecular mechanism for both conditions. However, the underlying mechanisms differ. Recognizing the interplay and distinctions between these disorders is essential for advancing both basic and translational research in this area, enhancing diagnostic accuracy and ultimately achieving effective therapeutic solutions for affected patients. This review discusses the muscle microenvironment's changes contributing to these conditions, recent therapeutic approaches like lifestyle modifications, small molecules, and nutritional interventions, and emerging strategies such as gene editing, stem cell therapy, and gut microbiome modulation. We also address the challenges and opportunities of multimodal interventions, aiming to provide insights into the pathogenesis and molecular mechanisms of sarcopenia and cachexia, ultimately aiding in innovative strategy development and improved treatments.

Pilot study of the sequential square mat "Fisior® program": A strategy for improving mobility in older adults

OBJECTIVE

The present study aims to analyze the effectiveness of a gait re-education program using a sequential square mat (Tapiz Fisior®, in advance SSM Fisior®) in aspects related to mobility, balance, muscle strength, and gait of elderly people.

METHODS

The intervention lasted eight weeks through progressive resistance training designed specifically for older people, with an approximate duration of 30-40 min, and was carried out three times a week on non-consecutive days using the SSM Fisior®.

RESULT

The intervention improved gait, balance, physical performance, lower limb strength, and walking speed. The women improved in balance, gait, physical performance, and lower limb strength, while the men improved only in balance and gait. Better outcomes were seen in participants who were not functionally dependent at baseline. Older people who did not have functional dependence before the intervention improved in balance, gait, physical performance, and strength of the lower limbs.

CONCLUSION

In conclusion, our findings underscore that the SSM Fisior® program stands out as an effective strategy for enhancing the mobility domain of intrinsic capacity in older individuals. These results advocate for the implementation of the SSM Fisior® program as a promising approach to improve the overall well-being and functional abilities of older adults.

Identification and Management of Medical Comorbidities in Patients With HR+/HER2- Metastatic Breast Cancer Treated With CDK4/6 Inhibitors: Literature Review and Recommendations From Experts in Spain Opinion

Approximately one-third of patients with breast cancer have comorbidities at the time of their diagnosis. Recommendations for managing metastatic breast cancer are usually based on the results of clinical trials, which often limit patients with comorbidities. However, comorbidities greatly influence the quality of life, patient survival rate and treatment choice, particularly in older patients. The objective of this review was to identify clinically relevant comorbidities in patients with metastatic breast cancer, analyze the clinical approach to the treatment of these comorbidities, and propose recommendations from experts. An expert panel of eight medical oncologists identified seven therapeutic areas associated with the most relevant comorbidities in metastatic breast cancer: cardiovascular, gastrointestinal, endocrine/metabolic, renal, geriatric, psychological, and pain related. A clinical specialist from each therapeutic area specific to the relevant comorbidities (n = 8) joined the panel of experts (n = 8) to provide guidance on the appropriate management of these comorbidities. The specific comorbidities analyzed were hypertension, atrial fibrillation, venous thromboembolism, obesity, diabetes mellitus, cancer cachexia, chronic kidney disease, age-related disorders, arthritis, and fibromyalgia. In most cases, patients with metastatic breast cancer and medical comorbidities are polymedicated and/or vulnerable to toxicity. The oncologists provided recommendations on initial assessment and monitoring, follow-up recommendations, and warning signs and symptoms for referral to corresponding specialists based on their experience. The panel of experts also explored clinical scenarios related to each comorbidity and recommended a preferred CDK4/6 inhibitor based on available evidence regarding drug-drug interactions and potential for toxicity.

Exploring the associations of plasma proteins with frailty based on Mendelian randomization

BACKGROUND

Frailty is an emerging global burden of disease, characterized as an age-related clinical syndrome. Recent studies have suggested a potential link of circulating protein levels with the onset of frailty. This study aims to analyze the potential causal relationships of plasma proteins with frailty using a Mendelian Randomization (MR) study design.

METHODS

Associations of plasma proteins with frailty were assessed using inverse variance weighted (IVW), MR-Egger regression, weighted median, maximum-likelihood method, and MR-PRESSO test. Protein-protein interaction network construction and gene ontology functional enrichment analysis were conducted based on MR-identified target proteins.

RESULTS

After false discovery rate (FDR) correction, MR analysis identified five plasma proteins, including BIRC2 [OR = 0.978, 95%CI (0.967-0.990)] and PSME1 [OR = 0.936, 95%CI (0.909-0.965)], as protective factors against frailty, and 49 proteins, including APOB [OR = 1.053, 95%CI (1.037-1.069)] and CYP3A4 [OR = 1.098, 95%CI (1.068-1.128)], as risk factors. Network analysis suggested BIRC2, PSME1, APOE, and CTNNB1 as key intervention targets.

CONCLUSION

This study employed MR design to investigate the association of circulating plasma proteins with frailty, identified five proteins negatively associated with frailty risk and 49 proteins positively associated with frailty.

Scale-based screening and assessment of age-related frailty

As the population ages, the prevalence of age-related frailty increases sharply, which increases the risk of poor health status of older adults, such as disability, falls, hospitalization, and death. Across the globe, frailty is moving toward the forefront of health and medical research. Currently, frailty is believed to be preventable and reversible, so the early identification of frailty is critical. However, there are neither precise biomarkers of frailty nor definitive laboratory tests and corresponding clinical testing techniques and equipment in clinical practice. As a result, the clinical identification of frailty is mainly achieved through the widely used frailty scale, which is an objective, simple, time-saving, effective, economical, and feasible measurement tool. In this narrative review, we summarized and analyzed the various existing frailty scales from different perspectives of screening and evaluation, aiming to provide a reference for clinical researchers and practitioners to judge and manage frail older people accurately.

Sarcopenia, Frailty and Diabetic Foot: A Mini Narrative Review

The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.

Feasibility and effectiveness of a 6-month, home-based, resistance exercise delivered by a remote technological solution in healthy older adults

BACKGROUND

Aging is characterized by a physiological decline in physical function, muscle mass, strength, and power. Home-based resistance training interventions have gained increasing attention from scientists and healthcare system operators, but their efficacy is yet to be fully determined.

AIMS

to verify the safety, feasibility, and efficacy of a home-based resistance training program delivered by innovative technological solution in healthy older adults.

METHODS

73 participants (36 females) were randomly allocated to either a control (C) or an intervention (I) group consisting of a 6-months home-based resistance training program delivered through an innovative technological solution, which included a wearable inertial sensor and a dedicated tablet. The safety and feasibility of the intervention were assessed by recording training-related adverse events and training adherence. Body composition, standing static balance, 10-meter walking, and loaded 5 sit-to-stand tests were monitored to quantify efficacy.

RESULTS

No adverse events were recorded. Adherence to the training program was relatively high (61 % of participants performed the target 3 sessions) in the first trimester, significantly dropping during the second one. The intervention positively affected walking parameters (p < 0.05) and maximal force (p = 0.009) while no effect was recorded on body composition, balance, and muscle power.

CONCLUSIONS

The home-based device-supported intervention was safe and feasible, positively affecting walking parameters and lower limbs' maximal force. This approach should be incentivized when barriers to participation in traditional resistance exercise programs are present.

Diet and exercise in frailty and sarcopenia. Molecular aspects

Function declines throughout life although phenotypical manifestations in terms of frailty or disability are only seen in the later periods of our life. The causes underlying lifelong function decline are the aging process "per se", chronic diseases, and lifestyle factors. These three etiological causes result in the deterioration of several organs and systems which act synergistically to finally produce frailty and disability. Regardless of the causes, the skeletal muscle is the main organ affected by developing sarcopenia. In the first section of the manuscript, as an introduction, we review the quantitative and qualitative age-associated skeletal muscle changes leading to frailty and sarcopenia and their impact in the quality of life and independence in the elderly. The reversibility of frailty and sarcopenia are discussed in the second and third sections of the manuscript. The most effective intervention to delay and even reverse frailty is exercise training. We review the role of different training programs (resistance exercise, cardiorespiratory exercise, multicomponent exercise, and real-life interventions) not only as a preventive but also as a therapeutical strategy to promote healthy aging. We also devote a section in the text to the sexual dimorphic effects of exercise training interventions in aging. How to optimize the skeletal muscle anabolic response to exercise training with nutrition is also discussed in our manuscript. The concept of anabolic resistance and the evidence of the role of high-quality protein, essential amino acids, creatine, vitamin D, β-hydroxy-β-methylbutyrate, and Omega-3 fatty acids, is reviewed. In the last section of the manuscript, the main genetic interventions to promote robustness in preclinical models are discussed. We aim to highlight the molecular pathways that are involved in frailty and sarcopenia. The possibility to effectively target these signaling pathways in clinical practice to delay muscle aging is also discussed.

Mechanism-Driven Strategies for Reducing Fall Risk in the Elderly: A Multidisciplinary Review of Exercise Interventions

Falls among older adults present a major public health challenge, causing significant physical, psychological, and economic consequences. Exercise interventions are a proven strategy to reduce fall risk by targeting biomechanical, physiological, and psychological factors. This review examines evidence from 155 studies published between 2004 and 2024, including systematic reviews, meta-analyses, randomized controlled trials, and cohort studies. Data were rigorously screened and extracted using predefined criteria, with studies sourced from PubMed, MEDLINE, EBSCO (EDS), and additional gray literature identified via Google Scholar. Key findings show that balance and strength training improves postural control, gait stability, and neuromuscular coordination, while resistance training mitigates sarcopenia and enhances joint mobility. Cognitive exercises enhance attention, spatial awareness, decision-making, and psychological benefits like reduced fear of falling and greater social engagement. Multidisciplinary approaches integrating physical, cognitive, and social components deliver the most significant impact. This review underscores the value of evidence-based exercise programs in promoting active aging and enhancing the quality of life for older adults.

Nomogram model for screening the risk of frailty in older adult atrial fibrillation patients: a cross-sectional study

Background

Frailty is common in atrial fibrillation (AF) patients, but the specific risk factors contributing to frailty need further investigation. There is an urgent need for a risk prediction model to identify individuals at high risk of frailty.

Aims and objectives

This cross-sectional study aims to explore the multiple risk factors of frailty in older adult patients with AF and then construct a nomogram model to predict frailty risk.

Methods

We recruited 337 hospitalized patients over the age of 60 (average age: 69, 53.1% male) with AF between November 2021 and August 2022. Data collected included patient demographics, disease characteristics, sleep patterns, mental health status, and frailty measures. We used LASSO and ordinal regression to identify independent risk factors. These factors were then incorporated into a nomogram model to predict frailty risk. The model's performance was assessed using the concordance index (C-index) and calibration curves.

Results

Among the AF patients, 23.1% were classified as frail and 52.2% as pre-frail. Six risk factors were identified: age, gender, history of coronary heart disease, number of chronic conditions, sleep disruption, and mental health status. The internal validation C-index was 0.821 (95% CI: 0.778-0.864; bias-corrected C-index: 0.795), and the external validation C-index was 0.819 (95% CI: 0.762-0.876; bias-corrected C-index: 0.819), demonstrating strong discriminative ability. Calibration charts for both internal and external validations closely matched the ideal curve, indicating robust predictive performance.

Conclusion

The nomogram developed in this study is a promising and practical tool for assessing frailty risk in AF patients, aiding clinicians in identifying those at high risk.

Relevance to clinical practice

This study demonstrates the utility of a comprehensive predictive model based on frailty risk factors in AF patients, offering clinicians a practical tool for personalized risk assessment and management strategies.

The Non-Linear Profile of Aging: U-Shaped Expression of Myostatin, Follistatin and Intermediate Signals in a Longitudinal In Vitro Murine Cell Sarcopenia Model

Sarcopenia is linked to the decline in muscle mass, strength and function during aging. It affects the quality and life expectancy and can lead to dependence. The biological process underlying sarcopenia is unclear, but the proteins myostatin and follistatin are involved in the balance between muscle breakdown and synthesis. While myostatin promotes muscle breakdown, follistatin promotes muscle growth, but several works have shown an inconsistent association of these proteins with aging-related parameters in serum of older people. We aimed to know the evolution of these putative sarcopenia biomarkers along muscle aging in an in vitro model. We created and phenotyped a longitudinal murine model (C2C12 cells). Then, we analyzed the protein and genetic expression of myostatin and follistatin as well as the signaling pathway regulators mTOR and RPS6KB1. Myostatin and RPS6KB1 showed a similar tendency in both protein and genetic expression with aging (basal-up-down). Follistatin, on the other hand, shows the opposite tendency (basal-down-up). Regarding mTOR, the tendencies differ when analyzing proteins (basal-up-down) or genes (basal-down-down). Our work demonstrates a U-shape tendency for myostatin and follistatin and for the signaling pathway regulators. These results could be of the utmost importance when designing further research on seeking molecular biomarkers and/or targets for sarcopenia.

Associations of frailty with RA-ILD and poor control of disease activity in patients with rheumatoid arthritis: A multi-center retrospective observational study

BACKGROUND

This study aimed to investigate factors associated with frailty in rheumatoid arthritis (RA) patients.

METHODS

A total of 656 RA patients were evaluated using data from an observational study in 2022. Among these patients, 152 with frailty were assigned to the frailty group, and 504 without frailty were assigned to the non-frailty group. Patient characteristics were compared between the two groups by univariate analysis, and factors associated with frailty were assessed by logistic regression analysis. Patient characteristics were also compared between patients with RA-associated interstitial lung disease (RA-ILD) (n = 102) and those without RA-ILD (n = 554).

RESULTS

The frailty group was older (mean: 73.6 vs. 66.8 years) and had a higher DAS28-ESR (3.67 vs. 2.66), a higher HAQ-DI (1.13 vs. 0.32), and a higher rate of RA-ILD (25.0 vs. 12.7 %) than the non-frailty group. Age (OR: 1.03, 95 % CI: 1.01-1.05), HAQ-DI (3.22, 2.28-4.56), DAS28-ESR (1.44, 1.19-1.75), and RA-ILD (2.21, 1.24-3.94) were associated with frailty. RA patients with RA-ILD were older (73.3 vs. 67.5 years) and had a higher DAS28-ESR (3.30 vs. 2.80), a higher HAQ-DI (1.19 vs. 0.32), a higher proportion of frail patients (37.3 vs. 20.6 %), lower MTX use (26.5 vs. 62.9 %), and higher steroid use (44.1 vs. 26.8 %) than those without RA-ILD.

CONCLUSIONS

Maintaining reasonable control of disease activity is necessary for RA patients, including those with RA-ILD, to recover from frailty.

Gender-specific capacity of insulin resistance proxies to predict functional decline in older adults

OBJECTIVES

Insulin resistance determined by Homeostasis Model of Insulin Resistance (HOMA-IR) has been associated with functional decline in non-diabetic older subjects. However, insulin is not routinely assessed. The study evaluated the predictive value of non-insulin-dependent IR surrogates on functional decline in non-diabetic older men and women.

DESIGN AND PARTICIPANTS

Prospective cohort study over 5 years. The study included 615 older participants from the Toledo Study of Healthy Aging.

METHODS

Frailty was assessed by the Frailty Trait Scale-5 (FTS-5) at baseline and after 5 years follow-up. 193 subjects experienced functional decline (2.5-point reduction in the FTS-5 score). Multivariate regression models analysed the effect of five described IR surrogates on functional decline considering potential confounders.

RESULTS

Among evaluated IR proxies, triglyceride glucose-body mass index (TyG-BMI) and HOMA-IR were significantly associated with an increased risk of functional decline (odd ratio (95% confidence interval) TyG-BMI: 1.16 (1.05, 1.28), p = 0.0035 and HOMA-IR: 1.59 (1.15, 2.21), p = 0.0056) among all participants. When stratified by gender, HOMA-IR was related to functional decline in men [2.02 (1.13, 3.59), p = 0.0173] and TyG-BMI in women [1.19 (1.05, 1.35), p = 0.0057].

CONCLUSIONS

Only TyG-BMI index mimics the predictive capacity of insulin-based IR marker. The predictive ability of IR indexes is gender-specific, being TyG-BMI the only index able to predict functional decline in women and HOMA-IR in men.

Assessing the Impact of Frailty on Infection Risk in Older Adults: Prospective Observational Cohort Study

Background

Infectious diseases are among the leading causes of death and disability and are recognized as a major cause of health loss globally. At the same time, frailty as a geriatric syndrome is a rapidly growing major public health problem. However, few studies have investigated the incidence and risk of infectious diseases in frail older people. Thus, research on frailty and infectious diseases is urgently needed.

Objective

The purpose of this study was to evaluate the association between frailty and infectious diseases among older adults aged 65 years and older.

Methods

In this prospective observational cohort study, we have analyzed the infectious disease prevalence outcomes of older adults aged 65 years and older who participated in frailty epidemiological surveys from March 1, 2018, to March 2023 in Dalang Town, Dongguan City, and from March 1, 2020, to March 2023 in Guancheng Street, Dongguan City. This study has an annual on-site follow-up. Incidence data for infectious diseases were collected through the Chinese Disease Control and Prevention Information System-Infectious Disease Monitoring and Public Health Emergency Monitoring System. A project-developed frailty assessment scale was used to assess the frailty status of study participants. We compared the incidence rate ratios (IRR) of each disease across frailty status, age, and gender to determine the associations among frailty, gender, age, and infectious diseases. Cox proportional hazards regression was conducted to identify the effect of frailty on the risk of demographic factors and frailty on the risk of infectious diseases, with estimations of the hazard ratio and 95% CI.

Results

A total of 235 cases of 12 infectious diseases were reported during the study period, with an incidence of 906.21/100,000 person-years in the frailty group. In the same age group, the risk of infection was higher in men than women. Frail older adults had a hazard ratio for infectious diseases of 1.50 (95% CI 1.14-1.97) compared with healthy older adults. We obtained the same result after sensitivity analyses. For respiratory tract-transmitted diseases (IRR 1.97, 95% CI 1.44-2.71) and gastrointestinal tract-transmitted diseases (IRR 3.67, 95% CI 1.39-10.74), frail older adults are at risk. Whereas no significant association was found for blood-borne, sexually transmitted, and contact-transmitted diseases (IRR 0.76, 95% CI 0.37-1.45).

Conclusions

Our study provides additional evidence that frailty components are significantly associated with infectious diseases. Health care professionals must pay more attention to frailty in infectious disease prevention and control.

Ingestion of β-nicotinamide mononucleotide increased blood NAD levels, maintained walking speed, and improved sleep quality in older adults in a double-blind randomized, placebo-controlled study

The study evaluated how ingestion of nicotinamide mononucleotide (NMN) for 12 weeks by older adults affected blood nicotinamide adenine dinucleotide (NAD +) levels and physical function, particularly walking function. Information concerning sleep, and stress was also collected as secondary endpoints. In this randomized, placebo-controlled, double-blind, parallel-group comparison study, 60 participants were randomly allocated into a placebo group or NMN group. Members of the NMN group consumed 250 mg/day NMN for 12 weeks. Motor function tests, blood NAD metabolite analysis, and questionnaires were conducted at the start of the study and 4 and 12 weeks after intake. This trial was registered at umin.ac.jp/ctr as UMIN000047871 on June 22nd, 2022.At primary outcome, at both 4 weeks and 12 weeks, the NMN and placebo groups had no significant differences in a stepping test. At secondary outcomes, after 12 weeks of NMN intake, the NMN group had a significantly shorter 4-m walking time than the placebo group as well as significantly higher blood levels of NAD + and its metabolites. A significant negative correlation was observed between the change in the 4-m walking time and the change in blood NAD + , N1-methyl-2-pridone-5-carboxamide (2-PY), and N1-methyl-4-pridone-3-carboxamide (4-PY) at 12 weeks. The NMN group had improved sleep quality at 12 weeks relative to the placebo group as evidenced by lower scores for "Daytime dysfunction" and "Global PSQI" on the Pittsburgh Sleep Questionnaire. No adverse effects related to test substance consumption were observed. Together, these results indicate that NMN intake could increase blood NAD + levels, maintain walking speed, and improve sleep quality in older adults. Interventions involving NMN aimed at maintaining walking speed could contribute to extended healthy life expectancy.

The prevalence of frailty among patients with metabolic syndrome: a systematic review and meta-analysis

BACKGROUND

Growing evidence shows that metabolic syndrome and frailty are significantly associated. Screening and assessing frailty in patients with metabolic syndrome is important to help improve their clinical outcomes and quality of life. Therefore, understanding the prevalence of frailty in patients with metabolic syndrome is the first critical step, however, the prevalence reported in the literature varies widely.

AIM

To pool the overall prevalence of frailty among patients with metabolic syndrome.

DESIGN

Systematic review and meta-analysis.

METHODS

The Cochrane Library, PubMed, Web of Science, Embase, APA PsycINFO, Scopus, CINAHL Complete, CNKI, Wan Fang, SinoMed, and VIP databases were searched from the inception to March 6, 2024. Statistical analysis was performed using STATA15 software. The prevalence was pooled using the random-effects model. The sources of heterogeneity were investigated by using meta-regression and subgroup analyses.

RESULTS

A total of 22 original studies published between 2007 and 2023 were included in this systematic review and meta-analysis, involving 19,921 metabolic syndrome patients. The prevalence of frailty and pre-frailty among patients with metabolic syndrome was 20% (95% CI: 16% to 25%, I2 = 99.44%) and 45% (95% CI: 36% to 53%, I2 = 99.20%). Subgroup analyses revealed differences in prevalence by frailty instruments, geographic regions, study settings, publication years, study quality, study design, and different components of metabolic syndrome.

CONCLUSIONS

This systematic review and meta-analysis showed the high prevalence of frailty and pre-frailty in patients with metabolic syndrome. In the future, more high-quality longitudinal studies and exploration of other potential demographic characteristics that may influence frailty are needed to understand more information on frailty in patients with metabolic syndrome.

Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit

BACKGROUND

Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.

METHOD

This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients' International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0-2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.

RESULT

Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24-2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts.

CONCLUSIONS

Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.

IMPLICATION FOR CLINICAL PRACTICE

The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.

Innovative Chair and System Designs to Enhance Resistance Training Outcomes for the Elderly

INTRODUCTION

This study aims to provide a safe, effective, and sustainable resistance training environment for the elderly by modifying chairs and movement systems used during training, particularly under unsupervised conditions.

MATERIALS AND METHODS

The research focused on investigating the effect of modified chair designs on enhancing physical stability during resistance training by involving 19 elderly participants (mean 72.1, SD 4.7). The study measured changes in the body's acceleration during movements to compare the effectiveness of the modified chairs with those commonly used in chair-based exercise (CBE) training in maintaining physical stability. A system was developed based on experimental video data, which leverages MediaPipe to analyze the videos and compute joint angles, identifying whether the actions are executed correctly.

RESULTS AND CONCLUSIONS

Comparisons revealed that modified chairs offered better stability during sitting (p < 0.001) and stand-up (p < 0.001) resistance training. According to the questionnaire survey results, compared to the regular chair without an armrest, the modified chair provided a greater sense of security and a better user experience for the elderly. Video observations indicated that the correct completion rate for most exercises, except stand-up resistance training, was only 59.75%, highlighting the insufficiency of modified chairs alone in ensuring accurate movement execution. Consequently, the introduction of an automatic system to verify proper exercise performance is essential. The model developed in this study for recognizing the correctness of movements achieved an accuracy rate of 97.68%. This study proposes a new chair design that enhances physical stability during resistance training and opens new avenues for utilizing advanced technology to assist the elderly in their training.

Effect of prehabilitation exercises on postoperative frailty in patients undergoing laparoscopic colorectal cancer surgery

Background

To improve perioperative frailty status in patients undergoing laparoscopic colorectal cancer surgery (LCCS), we explored a new intensive prehabilitation program that combines prehabilitation exercises with standard enhanced recovery after surgery (ERAS) and explored its impact.

Methods

We conducted a prospective randomized controlled trial. Between April 2021 to August 2021, patients undergoing elective LCCS were randomized into the standardized ERAS (S-ERAS) group or ERAS based on prehabilitation (group PR-ERAS). Patients in the PR-ERAS group undergoing prehabilitation exercises in the perioperative period in addition to standard enhanced recovery after surgery. We explored the effects of this prehabilitation protocol on frailty, short-term quality of recovery (QoR), psychological status, postoperative functional capacity, postoperative outcomes, and pain.

Results

In total, 125 patients were evaluated, and 95 eligible patients were enrolled and randomly allocated to the S-ERAS (n = 45) and PR-ERAS (n = 50) groups. The Fried score was higher in the PR-ERAS group on postoperative day (7 (2(2,3) vs. 3(2,4), P = 0.012). The QoR-9 was higher in the PR-ERAS group than in the S-ERAS group on the 1st, 2nd, 3rd, and 7th postoperative days. The PR-ERAS group had an earlier time to first ambulation (P < 0.050) and time to first flatus (P < 0.050).

Conclusion

Prehabilitation exercises can improve postoperative frailty and accelerate recovery in patients undergoing LCCS but may not improve surgical safety. Therefore, better and more targeted prehabilitation recovery protocols should be explored.

Clinical trial registration

www.clinicaltrials.org , identifier NCT04964856.

Association of metabolic syndrome and frailty with postoperative complications in older gastric cancer patients: A body composition perspective

OBJECTIVES

To compare the characteristics of body compositions between metabolic syndrome (MetS) and frailty, and determine the independent and overlapping of MetS and frailty with postoperative complications among older patients with gastric cancer.

DESIGN

A prospectively observational study.

SETTING AND PARTICIPANTS

Two hundred and eighty six older patients from 60 to 80 years undergoing radical gastrectomy for the first time.

MEASUREMENTS

MetS was diagnosed by the criteria from the 2020 edition of Chinese guideline for the prevention and treatment of type 2 diabetes mellitus, and frailty was defined by frailty phenotype. An InBody770 impedance analyzer was used to measure body compositions and with 10 fat- and muscle-related indicators being included in this study. Based on the presence of frailty and MetS, patients were divided into the frailty group, MetS group, frailty+MetS group, and normal group, and the body compositions indicators of these groups were compared. Clavien-Dindo classification was used to grade the severity of postoperative complications. Univariate and multivariate regression models were performed to explore the independent and joint association of MetS and frailty with postoperative complications.

RESULTS

The incidence rate of MetS, frailty, and frailty+MetS being 20.3%, 15.7%, and 4.2% respectively. Compared with the normal group, both fat and muscle compositions were decreased significantly in the frailty group (p < 0.05), while the statistically significant difference of fat-to-muscle mass ratio (FMR) and skeletal muscle mass to visceral fat area ratio (SVR) were not observed (p > 0.05). In contrast, except SVR, the other indicators of the MetS group were higher than the normal group (p < 0.05). As to the frailty+MetS group, there was a significant increase in fat compositions and FMR, as well as a significant decline in SVR (p < 0.05), while the difference of muscle compositions was not statistically significant (p > 0.05). There was an association of frailty with postoperative total (OR = 3.068, 95% CI: 1.402-6.713) and severe (OR = 9.423, 95% CI: 2.725-32.589) complications, but no association was found of MetS alone. MetS coexisting with frailty was associated with the highest risk of both total (OR = 3.852, 95% CI: 1.020-14.539) and severe (OR = 12.096, 95% CI: 2.183-67.024) complications.

CONCLUSIONS

Both frailty and MetS coexisting with frailty had adverse effects on postoperative complications, which appeared greatly different characteristics in body compositions and therefore reinforced the importance of targeted nutritional or metabolic intervention. Although MetS alone were not significantly associated with postoperative complications, it is essential to focus on the causal relationship and development trend between MetS and frailty to prevent MetS from shifting into frailty, considering the highest risk in their coexistence state.

Evaluating the efficacy of immunotherapy in gastric cancer: Insights from immune checkpoint inhibitors

The emergence of immunotherapy, particularly immune checkpoint inhibitors (ICIs), represents a groundbreaking approach to treating gastric cancer (GC). However, the prognosis of GC patients receiving ICI treatment is influenced by various factors. This manuscript identified sarcopenia and myosteatosis as inde-pendent prognostic factors impacting the outcomes of GC patients treated with ICIs. Additionally, this study introduced a visual predictive model to estimate the prognosis of GC patients. If confirmed by further studies, this observation could provide valuable insights to propel the advancement of personalized clinical medicine and the integration of precision medicine practices.

Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)-A Pilot Study

Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has been proposed as a useful point-of-care diagnostic tool to assess muscle quality, but no validated cut-offs for sarcopenia have been reported. Using novel automated artificial intelligence (AI) software to interpret ultrasound images may assist in mitigating the operator-dependent nature of the modality. Our study aims to evaluate the fidelity of AI-aided ultrasound as a reliable and reproducible modality to assess muscle quality and diagnose sarcopenia in surgical patients. Methods: Thirty-six adult participants from an outpatient clinic were recruited for this prospective cohort study. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Ultrasonography of the rectus femoris muscle was performed, and images were analyzed by an AI software (MuscleSound® (Version 5.69.0)) to derive muscle parameters including intramuscular adipose tissue (IMAT) as a proxy of muscle quality. A receiver operative characteristic (ROC) curve was used to assess the predictive capability of IMAT and its derivatives, with area under the curve (AUC) as a measure of overall diagnostic accuracy. To evaluate consistency between ultrasound users of different experience, intra- and inter-rater reliability of muscle ultrasound parameters was analyzed in a separate cohort using intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: The median age was 69.5 years (range: 26-87), and the prevalence of sarcopenia in the cohort was 30.6%. The ROC curve plotted with IMAT index (IMAT% divided by muscle area) yielded an AUC of 0.727 (95% CI: 0.551-0.904). An optimal cut-off point of 4.827%/cm2 for IMAT index was determined with a Youden's Index of 0.498. We also demonstrated that IMAT index has excellent intra-rater reliability (ICC = 0.938, CI: 0.905-0.961) and good inter-rater reliability (ICC = 0.776, CI: 0.627-0.866). In Bland-Altman plots, the limits of agreement were from -1.489 to 1.566 and -2.107 to 4.562, respectively. Discussion: IMAT index obtained via ultrasound has the potential to act as a point-of-care evaluation for sarcopenia screening and diagnosis, with good intra- and inter-rater reliability. The proposed IMAT index cut-off maximizes sensitivity for case finding, supporting its use as an easily implementable point-of-care test in the community for sarcopenia screening. Further research incorporating other ultrasound parameters of muscle quality may provide the basis for a more robust diagnostic tool to help predict surgical risk and outcomes.

The predictive capacity of adductor pollicis muscle thickness for physical frailty in older adults

PURPOSE

There is a need for an easily measurable and reliable surrogate marker for physical frailty. This study aims to investigate the predictive capacity of adductor pollicis muscle thickness (AMPT), which can be easily measured externally and minimally influenced by subcutaneous adipose tissue, for physical frailty.

METHODS

A total of 589 patients (16.3% physically frail, 54.7% pre-frail, 29% robust) were included. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. Physical frailty was diagnosed using the fried frailty phenotype. The predictive ability of APMT for the diagnosis of frailty was examined.

RESULTS

Of all the participants, 64.3% were women, and the average age was 74 ± 5.9 years. There was no significant difference in waist and hip circumference, or body mass index between the frail and non-frail groups. APMT, handgrip strength, gait speed, and calf circumference were significantly lower in frail patients than in non-frail ones (p < 0.01). The area under the curve (AUC) of APMT for physical frailty was determined to be 0.627 (95% confidence interval [CI] 0.58-0.66; p < 0.001). The best cut-off value for APMT was ≤ 18.5 mm for all individuals.

CONCLUSION

Adductor pollicis muscle thickness can be a useful anthropometric marker for evaluating the risk of physical frailty.

Genome-wide association study of exercise-induced skeletal muscle hypertrophy and the construction of predictive model

The aim of the current study was to investigate interindividual differences in muscle thickness of the rectus femoris (MTRF) following 12 wk of resistance training (RT) or high-intensity interval training (HIIT) to explore the genetic architecture underlying skeletal muscle hypertrophy and to construct predictive models. We conducted musculoskeletal ultrasound assessments of the MTRF response in 440 physically inactive adults after the 12-wk exercise period. A genome-wide association study was used to identify variants associated with the MTRF response, separately for RT and HIIT. Using the polygenic predictor score (PPS), we estimated the genetic contribution to exercise-induced hypertrophy. Predictive models for the MTRF response were constructed using random forest (RF), support vector mac (SVM), and generalized linear model (GLM) in 10 cross-validated approaches. MTRF increased significantly after both RT (8.8%, P < 0.05) and HIIT (5.3%, P < 0.05), but with considerable interindividual differences (RT: -13.5 to 38.4%, HIIT: -14.2 to 30.7%). Eleven lead single-nucleotide polymorphisms in RT and eight lead single-nucleotide polymorphisms in HIIT were identified at a significance level of P < 1 × 10-5. The PPS was associated with the MTRF response, explaining 47.2% of the variation in response to RT and 38.3% of the variation in response to HIIT. Notably, the GLM and SVM predictive models exhibited superior performance compared with RF models (P < 0.05), and the GLM demonstrated optimal performance with an area under curve of 0.809 (95% confidence interval: 0.669-0.949). Factors such as PPS, baseline MTRF, and exercise protocol exerted influence on the MTRF response to exercise, with PPS being the primary contributor. The GLM and SVM predictive model, incorporating both genetic and phenotypic factors, emerged as promising tools for predicting exercise-induced skeletal muscle hypertrophy.NEW & NOTEWORTHY The interindividual variability induced muscle hypertrophy by resistance training (RT) or high-intensity interval training (HIIT) and the associated genetic architecture remain uncertain. We identified genetic variants that underlie RT- or HIIT-induced muscle hypertrophy and established them as pivotal factors influencing the response regardless of the training type. The genetic-phenotype predictive model developed has the potential to identify nonresponders or individuals with low responsiveness before engaging in exercise training.

Physical activity to reduce the burden of frailty after menopause: effectiveness and adherence rate of a resource saving exercise plan

OBJECTIVE

Frailty may be increased by menopause. Physical activity has been proposed to reduce frailty, but poor adherence and cost limit effectiveness. We aimed to investigate both the effectiveness against the frailty burden and the adherence rate of a multicomponent physical activity scheme partially managed by the participating women themselves.

METHODS

Prospective controlled study consisting of a twice-weekly group physical activity scheme divided into two consecutive periods, one supervised by a health professional (12 wk) and the other supervised by the women themselves (36 wk). Group cohesion and mutual support during the patient-only period were aided by social networking via smartphones. Community-dwelling postmenopausal women were divided into a physical activity group (PAG = 126) and a usual activity control group (UAG = 126), both assessed at baseline and at the end of the study. Participants self-assigned to one of the two study arms.

RESULTS

Overall, women in the PAG were more likely to improve their frailty status (60.2% vs 42.6%, P < 0.05). The frailty reversal rate from prefrail to robust was significantly higher in the PAG than in the UAG (34.04 vs 8.00%, P < 0.05). Logistic regression confirmed that women in the PAG were more likely to improve their frailty phenotype (odds ratio [OR], 9.12; 95% confidence interval [CI], 3.45-31.52; P < 0.001). Adherence, defined by participants attending 75% of sessions, was attained by 56.35% of women at 48 wk.

CONCLUSION

A physical activity scheme implemented to improve frailty proved effective and attained acceptable adherence. Conditions in the peer-supervised 36-wk phase may increase sustainability.

Aging and putative frailty biomarkers are altered by spaceflight

Human space exploration poses inherent risks to astronauts' health, leading to molecular changes that can significantly impact their well-being. These alterations encompass genomic instability, mitochondrial dysfunction, increased inflammation, homeostatic dysregulation, and various epigenomic changes. Remarkably, these changes bear similarities to those observed during the aging process on Earth. However, our understanding of the connection between these molecular shifts and disease development in space remains limited. Frailty syndrome, a clinical syndrome associated with biological aging, has not been comprehensively investigated during spaceflight. To bridge this knowledge gap, we leveraged murine data obtained from NASA's GeneLab, along with astronaut data gathered from the JAXA and Inspiration4 missions. Our objective was to assess the presence of biological markers and pathways related to frailty, aging, and sarcopenia within the spaceflight context. Through our analysis, we identified notable changes in gene expression patterns that may be indicative of the development of a frailty-like condition during space missions. These findings suggest that the parallels between spaceflight and the aging process may extend to encompass frailty as well. Consequently, further investigations exploring the utility of a frailty index in monitoring astronaut health appear to be warranted.

Bidirectional Association between Sarcopenia and Depressive Symptoms among Chinese Middle- and Older-Aged Adults: Longitudinal Observational Study

BACKGROUND

The study aimed to examine the bidirectional relationship between sarcopenia and depressive symptoms in a national, community-based cohort study, despite the unclear temporal sequence demonstrated previously.

METHODS

Data were derived from four waves (2011 baseline and 2013, 2015, and 2018 follow-ups) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 17,708 participants aged 45 years or older who had baseline data on both sarcopenia status and depressive symptoms in 2011 were included in the study. For the two cohort analyses, a total of 8092 adults without depressive symptoms and 11,292 participants without sarcopenia in 2011 were included. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Depressive symptoms were defined as a score of 20 or higher on the 10-item Center for Epidemiologic Studies Depressive Scale (CES-D-10). Cox proportional hazard regression models were conducted to examine the risk of depressive symptoms and sarcopenia risk, while cross-lagged panel models were used to examine the temporal sequence between depressive symptoms and sarcopenia over time.

RESULTS

During a total of 48,305.1 person-years follow-up, 1262 cases of incident depressive symptoms were identified. Sarcopenia exhibited a dose-response relationship with a higher risk of depressive symptoms (HR = 1.7, 95%CI: 1.2-2.3 for sarcopenia, and HR = 1.5, 95%CI: 1.2-1.8 for possible sarcopenia, p trend < 0.001). In the second cohort analysis, 240 incident sarcopenia cases were identified over 39,621.1 person-years. Depressive symptoms (HR = 1.5, 95%CI: 1.2-2.0) are significantly associated with a higher risk of developing sarcopenia after multivariable adjustment (p < 0.001, Cross-lagged panel analyses demonstrated that depressive symptoms were associated with subsequent sarcopenia (β = 0.003, p < 0.001). Simultaneously, baseline sarcopenia was also associated with subsequent depressive symptoms (β = 0.428, p < 0.001).

CONCLUSION

This study identified a bidirectional relationship between depressive symptoms and sarcopenia. It seems more probable that baseline sarcopenia is associated with subsequent depressive symptoms in a stronger pattern than the reverse pathway. The interlinkage indicated that maintaining normal muscle mass and strength may serve as a crucial intervention strategy for alleviating mood disorders.

Biological basis and treatment of frailty and sarcopenia

In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.

A Genotype-Phenotype Model for Predicting Resistance Training Effects on Leg Press Performance

This study develops a comprehensive genotype-phenotype model for predicting the effects of resistance training on leg press performance. A cohort of physically inactive adults (N=193) underwent 12 weeks of resistance training, and measurements of maximum isokinetic leg press peak force, muscle mass, and thickness were taken before and after the intervention. Whole-genome genotyping was performed, and genome-wide association analysis identified 85 novel SNPs significantly associated with changes in leg press strength after training. A prediction model was constructed using stepwise linear regression, incorporating seven lead SNPs that explained 40.4% of the training effect variance. The polygenic score showed a significant positive correlation with changes in leg press strength. By integrating genomic markers and phenotypic indicators, the comprehensive prediction model explained 75.4% of the variance in the training effect. Additionally, five SNPs were found to potentially impact muscle contraction, metabolism, growth, and development through their association with REACTOME pathways. Individual responses to resistance training varied, with changes in leg press strength ranging from -55.83% to 151.20%. The study highlights the importance of genetic factors in predicting training outcomes and provides insights into the potential biological functions underlying resistance training effects. The comprehensive model offers valuable guidance for personalized fitness programs based on individual genetic profiles and phenotypic characteristics.

Predictive value of adductor pollicis muscle thickness for ultrasound-based sarcopenia in older adults

BACKGROUND

The adductor pollicis muscle thickness (APMT) is least affected by subcutaneous adipose tissue and can be measured externally. The aim of this study is to identify the predictive value of APMT for the diagnosis of ultrasonography-based sarcopenia.

METHODS

A total of 245 outpatients who were aged ≥65 years (49 with sarcopenia and 196 without sarcopenia) were included in this cross-sectional study. Patients with knee or hip replacement, advanced dementia, cerebrovascular disease, neurodegenerative disease, or decompensated heart failure and those using drugs that affect muscle functions, such as steroids, were excluded. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. The diagnosis of sarcopenia was based on a low Sonographic Thigh Adjustment Ratio (STAR) index (anterior thigh muscle thickness by ultrasonography/body mass index [BMI] ratio, cutoff points are <1.4 for men and <1.0 for women) and low handgrip strength. The predictive ability of APMT for ultrasound-based sarcopenia diagnosis was examined.

RESULTS

There was no significant difference in terms of arm and calf circumference and BMI between the sarcopenic and nonsarcopenic groups. APMT, handgrip strength, anterior thigh muscle thickness, and gait speed were significantly lower in the patients with sarcopenia. The best cutoff points of APMT for sarcopenia were ≤16.5 for women and ≤21.5 for men with areas under the curve of 0.70 and 0.66, respectively, and negative predictive values of 91.2 and 94.3, respectively (P < 0.001).

CONCLUSION

APMT can be a useful anthropometric marker for ultrasound-based sarcopenia diagnosis.

High serum klotho levels are inversely associated with the risk of low muscle mass in middle-aged adults: results from a cross-sectional study

Objective

Muscle mass gradually declines with advancing age, and as an anti-aging protein, klotho may be associated with muscle mass. This study aims to explore the relationship between klotho levels and muscle mass in the middle-aged population.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2018, we conducted a cross-sectional analysis on a cohort of individuals aged 40-59. Weighted multivariable analysis was employed to assess the correlation between klotho and low muscle mass, with stratified and Restricted Cubic Spline (RCS) analyses.

Results

The cross-sectional investigation revealed a significant negative correlation between klotho levels and the risk of low muscle mass (Model 3: OR = 0.807, 95% CI: 0.712-0.915). A notable interaction between klotho and sex was observed, with a significant interaction effect (P for interaction = 0.01). The risk association was notably higher in females. The risk association was notably higher in females. Additionally, RCS analysis unveiled a significant linear relationship between klotho and low muscle mass (P for nonlinear = 0.9495, P for overall<0.0001).

Conclusion

Our observational analysis revealed a noteworthy inverse relationship between klotho and low muscle mass, particularly prominent among female participants. This discovery provides crucial insights for the development of more effective intervention strategies and offers a new direction for enhancing muscle quality in the middle-aged population.

Associations of CBC-Derived inflammatory indicators with sarcopenia and mortality in adults: evidence from Nhanes 1999 ∼ 2006

BACKGROUND

It has been proposed that inflammation plays a role in the development of sarcopenia. This study aimed to investigate the links of complete blood cell count (CBC) parameters and CBC-derived inflammatory indicators with sarcopenia and mortality.

METHODS

Data pertaining to sarcopenia were extracted from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), and mortality events were ascertained through the National Death Index up to December 31, 2019. The CBC-derived inflammatory indicators assessed in this study included the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII). The prognostic significance of these CBC-derived inflammatory indicators was evaluated using the random survival forests (RSF) analysis.

RESULTS

The study encompassed a cohort of 12,689 individuals, among whom 1,725 were diagnosed with sarcopenia. Among individuals with sarcopenia, 782 experienced all-cause mortality, and 195 succumbed to cardiovascular causes. Following adjustment for confounding variables, it was observed that elevated levels of NLR, dNLR, NMLR, SIRI, and SII were associated with an increased prevalence of sarcopenia. Among participants with sarcopenia, those in the highest quartile of NLR (HR = 1.336 [1.095-1.631]), dNLR (HR = 1.274 [1.046-1.550]), MLR (HR = 1.619 [1.290-2.032]), NMLR (HR = 1.390 [1.132-1.707]), and SIRI (HR = 1.501 [1.210-1.862]) exhibited an elevated risk of all-cause mortality compared to those in the lowest quartile of these inflammation-derived indicators. These associations were similarly observed in cardiovascular mortality (HR = 1.874 [1.169-3.003] for MLR, HR = 1.838 [1.175-2.878] for SIRI). The RSF analysis indicated that MLR exhibited the highest predictive power for both all-cause and cardiovascular mortality among individuals with sarcopenia.

CONCLUSIONS

Our findings underscore the association between CBC-derived inflammatory indicators and mortality in adults with sarcopenia. Of note, MLR emerged as the most robust predictor of all-cause and cardiovascular mortality in this population.

Protein Intake and Physical Activity Levels as Determinants of Sarcopenia Risk in Community-Dwelling Older Adults

Community screening for sarcopenia is complex, with barriers including access to specialized equipment and trained staff to conduct body composition, strength and function assessment. In the current study, self-reported dietary protein intake and physical activity (PA) in adults ≥65 years was assessed relative to sarcopenia risk, as determined by body composition, strength and physical function assessments, consistent with the European Working Group on Sarcopenia in Older People (EWGSOP) definition. Of those screened (n = 632), 92 participants (77% female) were assessed as being at high risk of developing sarcopenia on the basis of dietary protein intake ≤1 g∙kg-1∙day-1 [0.9 (0.7-0.9) g∙kg-1∙day-1] and moderate intensity physical activity <150 min.week-1. A further 31 participants (65% female) were defined as being at low risk, with both protein intake [1.2 (1.1-1.5) g∙kg-1∙day-1] and PA greater than the cut-off values. High-risk participants had reduced % lean mass [53.5 (7.8)% versus 54.8 (6.1)%, p < 0.001] and impaired strength and physical function. Notably, high-risk females exhibited greater deficits in lean mass and strength, with minimal differences between groups for males. In community-dwelling older adults, self-reported low protein intake and low weekly PA is associated with heightened risk for sarcopenia, particularly in older women. Future research should determine whether early intervention in older adults with low protein intake and PA attenuates functional decline.

Diet and lifestyle behaviours simultaneously act on frailty: it is time to move the threshold of frailty prevention and control forward

BACKGROUND

To analyse the association among the simultaneous effects of dietary intake, daily life behavioural factors, and frailty outcomes in older Chinese women, we predicted the probability of maintaining physical robustness under a combination of different variables.

METHODS

The Fried frailty criterion was used to determine the three groups of "frailty", "pre-frailty", and "robust", and a national epidemiological survey was performed. The three-classification decision tree model was fitted, and the comprehensive performance of the model was evaluated to predict the probability of occurrence of different outcomes.

RESULTS

Among the 1,044 participants, 15.9% were frailty and 50.29% were pre-frailty; the overall prevalence first increased and then decreased with age, reaching a peak at 70-74 years of age. Through univariate analysis, filtering, and embedded screening, eight significant variables were identified: staple food, spices, exercise (frequency, intensity, and time), work frequency, self-feeling, and family emotions. In the three-classification decision tree, the values of each evaluation index of Model 3 were relatively average; the accuracy, recall, specificity, precision, and F1 score range were between 75% and 84%, and the AUC was also greater than 0.800, indicating excellent performance and the best interpretability of the results. Model 3 takes exercise time as the root node and contains 6 variables and 10 types, suggesting the impact of the comprehensive effect of these variables on robust and non-robust populations (the predicted probability range is 6.67-93.33%).

CONCLUSION

The combined effect of these factors (no exercise or less than 0.5 h of exercise per day, occasional exercise, exercise at low intensity, feeling more tired at work, and eating too many staple foods (> 450 g per day) are more detrimental to maintaining robustness.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.

A review on associated factors and management measures for sarcopenia in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by hyperglycemia, insulin resistance, and insufficient insulin secretion. Sarcopenia, as a new complication of diabetes, is characterized by the loss of muscle mass and the progressive decline of muscle strength and function in T2DM patients, which has a serious impact on the physical and mental health of patients. Insulin resistance, mitochondrial dysfunction, and chronic inflammation are common mechanisms of diabetes and sarcopenia. Reasonable exercise training, nutrition supplement, and drug intervention may improve the quality of life of patients with diabetes combined with sarcopenia. This article reviews the relevant factors and management measures of sarcopenia in T2DM patients, in order to achieve early detection, diagnosis, and intervention.