Menopause and sarcopenia: A potential role for sex hormones

Meta analysis of the influencing factors of sarcopenia in patients with Crohn's disease

OBJECTIVE

To conduct a meta-analysis of the factors influencing sarcopenia in patients with Crohn's disease and provide evidence-based findings for early clinical detection and prevention.

METHODS

The study was registered on PROSPERO(CRD42023470300). A systematic review was performed on literature pertaining to sarcopenia in patients with Crohn's disease utilizing eight Chinese and English databases, which consist of CNKI, Wanfang, VIP, CBM, PubMed, Web of Science, Embase, and The Cochrane Library. The search was carried out from the inception of each database until October 8, 2023. Data analysis was carried out using the Stata 14.0 software.

RESULTS

A total of 603 Chinese and English literature sources were reviewed, and following the application of the inclusion and exclusion criteria, 9 articles were selected. These 9 articles take into account a total of 22 factors that may influence the occurrence of sarcopenia in Crohn's disease patients. The results of the meta-analysis demonstrate that gender (OR=5.49, 95 % CI [2.08,14.51]), BMI (OR=0.77, 95 % CI [0.62,0.95]), age (OR=1.03, 95 % CI [1.01,1.05]), and low albumin levels (OR=1.08, 95 % CI [1.01,1.15]) have significant impacts on the emergence of sarcopenia in patients with Crohn's disease.

CONCLUSIONS

The occurrence of sarcopenia in Crohn's disease patients is mainly influenced by gender, BMI, age, and low albumin levels. Additional factors that may influence the condition require further research to verify.

Weight Gain, Weight Loss, and Type 2 Diabetes Risk: Evidence From the Atherosclerosis Risk in Communities (ARIC) Study

INTRODUCTION

While type 2 diabetes (T2DM) has become a major health issue in the North American and Caribbean region, the effects of weight change on incident T2DM, conditional on either initial or attained weight, are poorly addressed. Therefore, we aimed to assess the impact of 3-year weight change on incident T2DM over 6 years among US individuals.

METHODS

A total of 8377 participants aged 45-64 years (4601 women), free of T2DM or cancer at baseline from the Atherosclerosis Risk in Communities (ARIC) study were included. Weight measurements were taken at baseline (visit 1, 1987-89) and approximately 3 years later (visit 2, 1990-92). Participants were categorised based on their weight change ratio into ≥ 5% weight loss, stable (±5%), and ≥ 5% weight gain. Cox proportional hazards models, adjusting for known diabetes risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident T2DM, with stable weight (±5%) as the reference category.

RESULTS

During a median follow-up period of 6 years, participants were classified into three categories: 361 persons remained stable (±5%), 47 with ≥ 5% loss, and 135 with ≥ 5% gain. In multivariable analysis, after adjustment with initial weight, ≥ 5% weight gain and loss were significantly associated with higher [HR (95% CI): 1.68 (1.36-2.06), p-value < 0.0001] and lower [0.73 (0.53-1.00), p-value = 0.05] risks of incident T2DM, respectively. When adjusted for attained weight, weight gain ≥ 5% remained a significant risk factor for T2DM [1.51 (1.21-1.88)]; however, weight loss ≥ 5% lost statistical significance [0.84 (0.60-1.17), p-value = 0.31].

CONCLUSIONS

We found a robust association between weight gain and incident T2DM; however, the beneficial impact of weight loss was significantly attenuated after considering the attained weight.

Relationship of Age and Running Biomechanics in Female Recreational Runners

Middle-age and older runners demonstrate differences in running biomechanics compared with younger runners. Female runners demonstrate differences in running biomechanics compared with males, and females experience hormonal changes during menopause that may also affect age-related changes in running biomechanics. The purpose of this study was to determine the relationship between age and running biomechanics in healthy female recreational runners. Fifty-two participants (ages 27-65 y) ran on an instrumented treadmill at 2 different self-selected speeds: easy pace and 5 km race pace. Lower-extremity kinematic and kinetic variables were calculated from 14 consecutive strides. Linear regression was used to determine the relationship between age and lower-extremity running biomechanics, controlling for self-selected running speed. There was a negative relationship between age and easy pace (R = -.49, P < .001) and age and 5 km race pace (R = -.43, P = .001). After controlling for self-selected running speed, there were no significant relationships between age and running biomechanics for either running speed. Several biomechanical variables were moderately to strongly correlated with running speed. Running speed should be considered when investigating age-related differences in running biomechanics.

Estradiol deficiency as a consequence of aging contributes to the depletion of the satellite cell pool in female mice

The effects of aging on the satellite cell pool have primarily been studied in male mice, where the role of cell-intrinsic versus environmental changes on satellite cell function remains contentious. Estradiol is necessary for maintenance of satellite cell pool size in adult female mice-here we investigate the hypothesis that in females, estradiol is a major environmental driver of age-associated effects on satellite cells. In 24-26 month-old ovarian senescent mice, we find the satellite cell pool size is severely diminished in certain muscles (TA and EDL) but only marginally affected in others (soleus and gastrocnemius). Supplementation with 17-beta estradiol significantly increases satellite cell pool size in the TA and EDL. To assess cell-intrinsic versus environmental regulation, we perform two transplantation experiments, Adult or Aged satellite cells transplanted into Adult recipients, and Adult satellite cells transplanted into Adult or Aged mice. These results demonstrate that the aged environment dominates over cell-autonomous age in terms of the specification of satellite cell pool size. Transcriptional profiling on satellite cells from Adult, Aged and ovariectomized mice revealed commonalities across the two estradiol-deficient conditions, Aged and ovariectomized, in GO terms from differentially expressed genes. Our findings support the hypothesis that the lack of estradiol contributes to reductions in satellite cell number in Aged female muscle, yet cells that remain are functional in terms of proliferative potential and self-renewal capacity. These findings have implications for sex hormone treatment of menopausal women and highlight the vital role of estradiol in the maintenance of the satellite cell pool.

Sex differences in sarcopenia prevalence and muscle-related outcomes among post-stroke inpatients

BACKGROUND

Sex differences in sarcopenia prevalence and recovery patterns among post-stroke patients remain poorly understood. This study aimed to investigate sex differences in sarcopenia prevalence, improvement rates, and changes in muscle-related indices among post-stroke patients in rehabilitation settings.

METHODS

A retrospective cohort study was conducted at a post-acute rehabilitation hospital. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. The primary outcomes were sarcopenia status and muscle-related indices (handgrip strength and skeletal muscle mass index) at discharge. Propensity score-adjusted logistic regression analysis was performed to examine the association between sex and non-sarcopenia at discharge.

RESULTS

A total of 598 patients (274 women) with a mean age of 71.6 years were analyzed. Women showed higher sarcopenia prevalence at admission compared to men (47.4% vs 34.2%, p = 0.001). After adjusting for confounders, male sex was positively associated with non-sarcopenia at discharge (OR 1.046, 95% CI 1.009-1.104, p < 0.001) and greater improvements in handgrip strength (B = 1.93, p = 0.031) and skeletal muscle mass index (B = 0.322, p = 0.019).

CONCLUSION

This study revealed significant sex differences in sarcopenia among post-stroke rehabilitation patients. While women showed higher sarcopenia prevalence at admission, men demonstrated better improvements in muscle-related outcomes.

The impact of ovarian aging on muscle strength and life quality in various reproductive aging stages

OBJECTIVE

Ovarian aging significantly impacts women's overall aging, affecting various systems including the musculoskeletal system. This study investigates the correlation between ovarian function and handgrip strength (HGS) across reproductive aging stages and their relation to health-related quality of life (HRQoL).

METHOD

A cross-sectional study was conducted with female participants spanning all stages of ovarian function. HGS was measured using a dynamometer, and ovarian function was assessed via hormone levels (estradiol [E2], follicle stimulating hormone [FSH], luteinizing hormone [LH], prolactin [PRL], progesterone [P4] and testosterone). HRQoL was evaluated using the Sarcopenia-specific Quality of Life questionnaire (SarQoL). Data analysis involved analysis of variance and Pearson's correlations, adjusted for confounding factors.

RESULTS

The prevalence of possible sarcopenia increased from 3.8% in premenopausal women to 10.3% in postmenopausal women. After adjusting for covariates (age, SarQoL, FSH, LH, FSH/LH ratio, PRL, E2, P4 and testosterone), the negative correlation between HGS and the Kupperman Menopausal Index (KMI) was no longer significant. However, the positive correlation between HGS and the SarQoL remained significant in both the overall population and the postmenopausal group. The negative correlation between HGS and FSH was no longer significant after controlling for age, KMI, LH and E2; however, it persisted after controlling for the SarQoL, FSH/LH ratio, PRL, P4 and testosterone.

CONCLUSION

HGS is positively correlated with the SarQoL and negatively correlated with age in the overall population. No significant association was found between HGS and testosterone, E2, LH or FSH/LH ratio. Further research is needed to clarify the relationship between HGS and the KMI or FSH.

Effects of aerobic and resistance training on bone, muscle hypertrophy and inflammation in OVX mice

OBJECTIVE

Bone loss is common with aging, particularly due to reduced sex hormones, as seen in menopause. While physical training is a known non-pharmacological therapy for osteopenia and sarcopenia, few studies compare resistance and aerobic protocols, especially with systemic inflammatory markers. This study evaluated the effects of aerobic and resistance training on physical performance, femoral trabecular bone quality (micro-computed tomography), serum inflammatory markers (IL-1β, IL-6, TNF-α, IL-10) and gastrocnemius muscle area in ovariectomized (OVX) female mice.

METHOD

Sixty-four c57bl/6 mice were divided into OVX and SHAM groups and subjected to sedentary, resistance (climbing) or aerobic (treadmill) protocols for 8 weeks.

RESULTS

Training reduced body mass (p < 0.001) in trained animals compared to sedentary. Bone quality was higher in trained groups versus sedentary. OVX increased TNF-α, but training did not alter it. IL-1β levels were higher in climbing than treadmill groups, and IL-6 increased with OVX and aerobic training (p < 0.001). IL-10 was elevated in the SHAM and climbing groups (p < 0.01). Gastrocnemius muscle area increased in both trained groups (p < 0.001) with no differences between modalities.

CONCLUSION

Aerobic and resistance training improved bone quality and muscle area in OVX mice, with climbing training uniquely linked to increased IL-10 levels.

The association between reproductive factors and frailty risk: a population-based analysis from the UK biobank

BACKGROUND

Previous studies have demonstrated that reproductive factors are associated with future frailty or frailty-related health issues in women. In view of the limited evidence, investigating the association between different reproductive factors and frailty in older women requires further exploration. The purpose of this study is to explore whether reproductive factors contribute to an increased risk of frailty in older women.

METHODS

This study included 238,555 female participants from the UK Biobank. Reproductive factors and several frailty-related indicators were obtained through self-reported data. A binomial logistic regression analysis was used to assess the association between reproductive factors and frailty in older women, while adjusting for age, race, smoking and drinking status, body mass index (BMI), Townsend deprivation index, education, occupation, income level, history of oral contraceptive use, and history of hormone replacement therapy (HRT) use. Finally, stratified analysis and sensitivity analysis were performed to verify the robustness of our results.

RESULTS

Compared with the menarche age of 12-13 years old, the risk of frailty was higher in those < 12 years old (OR: 1.118, 95%CI: 1.086-1.151). The age at menopause and reproductive lifespan is associated with frailty in a J-shaped dose-response manner. Women with the first live birth(AFB) younger than 21 years have an increased risk compared to those AFB aged 24-26 years (OR: 1.057, 95%CI: 1.011-1.106). Higher parity is associated with a reduced risk of frailty in older women (OR: 0.851, 95%CI: 0.807-0.898). In addition, no significant difference was observed between the risk of stillbirth and the risk of frailty.

CONCLUSIONS

According to our research results, age at menarche, age at menopause, AFB, reproductive lifespan, number of miscarriages and parity are associated with frailty in old women.

Association between sarcopenia and cardiovascular disease according to menopausal status: findings from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Little is known about the association between sarcopenia and cardiovascular disease (CVD) according to menopausal status, and we conducted cross-sectional as well as longitudinal analyses Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association between sarcopenia and CVD in Chinese women according to menopausal status.

METHOD

The study sample included 5365 (mean age 60.3 ± 9.3 years) female participants from CHARLS 2015 (wave 3). Additionally, 3,882 participants without cardiovascular disease (CVD) were recruited in CHARLS 2015 (Wave 3) and followed up in 2018 (Wave 4). CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. Menopausal status was determined based on self-reported information from questionnaires. Sarcopenia status was assessed using the diagnostic criteria established by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Binary logistic regression analyses were conducted to explore the association between sarcopenia and CVD in both premenopausal and postmenopausal women. Further analyses examined the interaction between sarcopenia and menopausal status to better understand its impact on CVD.

RESULTS

The prevalence of CVD in the total population is 22.5% (1209/5365). Among premenopausal women, the prevalence in no-sarcopenia, possible sarcopenia, and sarcopenia group are 11.3% (86/759), 16.2% (17/105), and 13.9% (5/36), respectively, for postmenopausal women, the prevalence are 19.2% (320/1668), 32.6% (520/1597), and 21.8% (261/1200). Both possible sarcopenia (OR = 1.58; 95% CI: 1.29-1.93) and sarcopenia (OR = 1.34; 95% CI: 1.05,1.72) are associated with CVD in the population of postmenopausal women. There was a significant positive interaction between menopause and sarcopenia on CVD, the RERI = 5.30 (95%CI: 4.63, 5.98), the SI = 2.44 (95%CI: 1.84, 3.63), and the multiplicative effect = 2.18 (95%CI: 1.70, 2.66). In the longitudinal analysis, 514 (13.2%) new cases of CVD were diagnosed. In premenopausal women, sarcopenia was significantly associated with the development of CVD (OR = 2.44, 95% CI: 1.3,4.59). In postmenopausal women, possible sarcopenia (OR = 1.45, 95% CI: 1.28, 1.65) and sarcopenia (OR = 1.42, 95% CI: 1.23, 1.65) were more likely to have new-onset CVD than the postmenopausal no-sarcopenia women.

CONCLUSIONS

Sarcopenia and cardiovascular disease (CVD) risk show significant variations in cross-sectional and longitudinal associations across different menopausal statuses, with higher risks in postmenopausal women. An interaction between menopausal status and sarcopenia on CVD risk was found.

Relationship of monocyte to high-density lipoprotein ratio (MHR) and other inflammatory biomarkers with sarcopenia: a population-based study

OBJECTIVES

In previous studies, several inflammatory biomarkers derived from complete blood cell counts (CBC), such as systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio (NHHR) have been identified as predictors of sarcopenia. However, whether Monocyte to High-Density Lipoprotein Cholesterol Ratio (MHR) can predict the development of sarcopenia has not yet been established. The research first attempts to investigate the association between MHR and low muscle mass and to compare the predictive abilities of MHR, SII, NLR, and NHHR for low muscle mass risk.

METHODS

The study comprised 10,321 participants aged 20 years and above from the United States. Multiple logistic regression was performed to explore the association between ln-transformed MHR, SII, NLR, NHHR and low muscle mass. Additionally, AUC values and ROC curves were used to assess the predictive effectiveness of ln MHR and other markers (ln SII, ln NLR, ln NHHR, ln MHR + ln SII, ln MHR + ln NHHR, and ln MHR + ln NLR). The bootstrap estimated 95% Cl was shown with the AUC.

RESULTS

In the fully adjusted model, ln SII, ln NLR, ln NHHR, ln MHR, ln MHR + ln SII, ln MHR + ln NHHR, and ln MHR + ln NLR were positively associated with low muscle mass (ln SII: OR = 1.59 [1.37-1.84]; ln NLR: OR = 1.35 [1.13-1.60]; ln NHHR: OR = 1.49[1.27-1.75]; ln MHR: OR = 1.98 [1.68-2.33]; ln MHR + ln SII: OR = 1.61 [1.46-1.79]; ln MHR + ln NHHR: OR = 1.42 [1.29-1.56]; ln MHR + ln NLR: OR = 1.58 [1.41-1.78]). Compared to the lowest quartile of ln MHR, higher quartiles were significantly associated with increased odds of low muscle mass (P for trend < 0.0001). In ROC analysis, ln MHR + ln SII had a higher AUC value than other indicators (AUC = 0.608).

CONCLUSION

Ln-transformed MHR, SII, NLR, and NHHR were positively associated with low muscle mass. MHR outperforms SII, NLR, and NHHR in predicting sarcopenia.

Strength training for osteoporosis prevention during early menopause (STOP-EM): a pilot study protocol for a single centre randomised waitlisted control trial in Canada

INTRODUCTION

Women lose up to 10% of their bone mass around menopause and the decade following. There is a need for proactive approaches to preserve bone mass and quality around menopause. Existing work has found that high-intensity resistance and impact training (HiRIT) can improve bone and muscle measures in late postmenopausal women. However, this has not been investigated in perimenopausal and early postmenopausal women who are in the midst of the menopausal transition.

METHODS AND ANALYSIS

This study is a 9-month randomised controlled feasibility trial evaluating a HiRIT programme in perimenopausal and early postmenopausal women. The primary objective of this study is to determine the feasibility of HiRIT in 40 perimenopausal and early postmenopausal women (45-60 years). Participants will be randomised 1:1 into a supervised HiRIT exercise intervention and waitlisted control. The primary outcomes are recruitment, retention and adherence to the exercise intervention. Secondary outcomes include bone (bone mineral density, microarchitecture and strength), muscle (mass, strength and power), physical function (balance and aerobic fitness) and quality of life measures. Feasibility will be assessed based on a priori criterion for success and secondary outcomes will be assessed via multiple linear regressions. The study will be considered feasible if>50% of interested and eligible participants are recruited, if there is>60% adherence to the two times per week, 9-month exercise intervention and if at least 65% of the sample complete the final study visit. Feasibility outcomes will be used to inform a larger, future trial aimed at identifying the efficacy of the exercise intervention for improving various health outcomes, including bone density and muscle mass. Secondary exploratory outcomes will provide insight into the effect of exercise on muscle and bone in perimenopausal and early postmenopausal women.

ETHICS AND DISSEMINATION

This study has been approved by the Conjoint Health Research Ethics Board of the University of Calgary REB22-1632. The results of this study will be disseminated at national and international conferences and published in academic journals.

TRAIL REGISTRATION NUMBER

ClinicalTrials.gov: NCT05961371. (Protocol V.1.2, 28 September 2023).

Possible sarcopenia, sarcopenic obesity phenotypes and their association with diabetes: Evidence from LASI wave-1 (2017-18)

AIMS

To assess the prevalence of possible sarcopenia and sarcopenic obesity phenotypes and investigate their association with self-reported diabetes among community-dwelling individuals aged 45 or above.

METHODS

Utilizing data from 62,899 individuals in LASI wave-1 (2017-18), the assessment of possible sarcopenia was done on two critical parameters: muscle (handgrip) strength and physical performance (gait speed), following the 2019 guidelines from the Asian working group on sarcopenia (AWGS). BMI, WC, WHR, and WHtR defined sarcopenic obesity phenotypes. Binary logistic regression analysis explored the association of possible sarcopenia and sarcopenic obesity phenotypes with self-reported diabetes.

RESULTS

The prevalence of possible sarcopenia and sarcopenic obesity defined by BMI was found to be 44.4 % and 10.6 %, respectively. Individuals with possible sarcopenia exhibited a 1.18 times higher likelihood of developing self-reported diabetes (p < 0.001), while those with sarcopenic obesity by BMI had significantly elevated odds (1.94, 95 % CI 1.81-2, p < 0.001) for self-reported diabetes.

CONCLUSIONS

Sarcopenia and sarcopenic obesity phenotypes may increase the risk of developing diabetes as we age. Therefore, it is imperative to formulate targeted preventive and therapeutic strategies to combat sarcopenia and diabetes among the aging population.

Effects of denosumab and zoledronic acid on postmenopausal osteoporosis, bone density, and fat-free mass

This study compared denosumab and zoledronic acid for treating osteoporosis in drug-naïve postmenopausal Korean women. Over 3 years, both drugs significantly increased bone mineral density. However, denosumab also improved fat-free mass, suggesting it may be a better initial treatment for osteoporosis with low muscle mass, assuming all other conditions remain constant.

BACKGROUND

Denosumab (DMAB) and zoledronic acid (ZOL), which are strong antiresorptive agents, are used to treat osteoporosis in postmenopause. Nonetheless, the data on their comparative efficacy in drug-naïve patients remain limited. Our research compared the therapeutic efficacy of DMAB and ZOL in drug-naïve postmenopausal Korean women with osteoporosis.

METHODS

In total, 120 women were enrolled and equally divided to the DMAB and ZOL groups. The bone density and biochemical parameters of the patients were monitored over 3 years. Furthermore, the changes in fat-free mass (FFM), which comprises muscle mass, were assessed by bioelectric impedance analysis. Baseline characteristics, including age, BMI, and the prevalence of fractures, were similar between the groups at the onset of the study. Serum 25(OH), calcium and, phosphorus levels and baseline bone mineral density (BMD) were also comparable between the groups.

RESULTS

Following 3 years of treatment, both groups exhibited a significant increase in BMD versus the baseline value. In particular, BMD increased by 9.7% and 5.1% at the lumber spine and total hip, respectively, in the DMAB group, versus increases of 7.1% and 4.4%, respectively, in the ZOL group. The increase in FFM was greater in the DMAB group. BMI-adjusted FFM decreased by 1.3% in the ZOL group, versus an increase of 3.6% in the DMAB group.

CONCLUSIONS

Conclusively, both DMAB and ZOL are effective antiresorptive agents that improved BMD over 3 years in drug-naïve individuals. Moreover, DMAB might represent a more reliable initial option for patients with osteoporosis accompanied by low muscle mass.

Sarcopenia is not associated with hypertension, but sarcopenic obesity increases risk of hypertension: a 7-year cohort study

Background

Sarcopenia, sarcopenic obesity, and hypertension are all widespread public health problems in middle-aged and older populations, and their association is controversial. The purpose of this study is to analyze the relationship between obesity, sarcopenia, and sarcopenic obesity with hypertension in a middle-aged and older community population in China through a large-scale longitudinal design.

Methods

In this cohort study with 7 years of follow-up, the study population was drawn from participants in the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and followed up in 2013, 2015, and 2018. The diagnostic criteria for sarcopenia were based on the consensus recommendations issued by the Asian Working Group for Sarcopenia (AWGS) in 2019. The diagnosis of obesity is based on body mass index and waist circumference. Sarcopenic obesity is defined as the coexistence of sarcopenia and obesity. Cox proportional risk regression models were used to analyze the association of obesity, sarcopenia, and sarcopenic obesity with hypertension.

Results

A total of 7,301 participants with a mean age of 58 ± 8.8 were enrolled in the study, and 51.9% females. A total of 1,957 participants had a new onset of hypertension after 7 years of follow-up. In a multifactorial analysis, obesity and sarcopenic obesity were associated with hypertension; hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.67 (1.43 ~ 1.96), p < 0.001, and 1.61 (1.09 ~ 2.37), p = 0.017. Sarcopenia and hypertension were not significantly associated; the HR and 95% CI were 1.17 (0.9 ~ 1.52), p = 0.23.

Conclusion

There is no significant correlation between sarcopenia and hypertension, but obesity and sarcopenic obesity increase the risk of hypertension. Targeted management of middle-aged and older people with sarcopenic obesity is needed in public health efforts.

Association between serum uric acid, hyperuricemia and low muscle mass in middle-aged and elderly adults: A national health and nutrition examination study

BACKGROUNDS

Recent research suggests that uric acid, as a metabolite with antioxidant properties, may affect muscle function and health. However, the association between serum uric acid (SUA) and low muscle mass remains relatively obscure. This study focuses on the association between SUA and low muscle mass in a middle-aged and elderly population in the United States.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES), a total of 12,106 patients aged ≥45 years, possessing complete analytical data, were incorporated. Low muscle mass in our study is defined as indices below 0.789 for males and 0.512 for females, according to the FNIH Biomarkers Consortium. Gender stratified analyses were conducted employing a multivariate weighted logistic regression model. When examining serum uric acid (SUA) levels, the SUA dataset was stratified into deciles, and odds ratios (ORs) were calculated across distinct subgroups of males and females. A restricted cubic spline (RCS) method was employed to investigate the potential nonlinear association between SUA levels and low muscle mass. A series of subgroup analyses stratified by demographic variables and clinical experience were conducted.

RESULTS

A total of 2,185 participants (18.05%) were identified with low muscle mass, comprising 1,121 males and 1,064 females. Females with low muscle mass had higher SUA levels and an increased incidence of hyperuricemia compared to those without low muscle mass. In females, a fully adjusted multivariable weighted regression model revealed a positive association between hyperuricemia and low muscle mass (OR, 1.43; 95% CI, 1.06 to 1.92; P = 0.021). No significant association was observed in males. Additionally, RCS curves indicated a J-shaped relationship between increasing SUA levels and the risk of low muscle mass in females, and an inverse J-shaped relationship in males.

CONCLUSIONS

This study reveals a significant positive correlation between hyperuricemia and the risk of low muscle mass in middle-aged and older women in the United States, whereas the relationship between SUA levels and low muscle mass did not attain statistical significance. In the male cohort, neither SUA levels nor hyperuricemia demonstrated a significant association with low muscle mass.

Weight-Adjusted Waist Index: an anthropometric measure for frailty in older adults

PURPOSE

Current measures of frailty often rely on subjective assessments or complex scoring systems. This study aims to investigate the utility of a novel anthropometric measure, the Weight-Adjusted Waist Index (WWI), as a simple and objective predictive marker for frailty in older adults.

METHODS

This cross-sectional study included 847 patients aged 65 years and older. Comprehensive geriatric assessments and anthropometric measurements were conducted. Frailty was diagnosed using the Clinical Frailty Scale (CFS). The association between WWI and frailty was analyzed using multivariate logistic regression analysis.

RESULTS

The mean age of the participants was 74.9 ± 6 years, with 56.3% (n = 477) being women and 14.8% (n = 125) classified as frail. The frail group had a significantly higher WWI than the non-frail group (p < 0.001). In multivariate logistic regression analysis, WWI remained significantly associated with frailty, even after adjusting for other potential confounding factors (OR = 2.51, 95% CI 1.77-3.57, p < 0.001). The predictive ability of WWI for frailty was measured by the area under the receiver operating characteristic (ROC) curve, which was 0.705 (95% CI 0.67-0.73; p < 0.001). The optimal WWI threshold for predicting frailty was identified as > 12.

CONCLUSION

The Weight-Adjusted Waist Index shows significant potential as a simple and objective predictive marker for frailty in older adults.

Association between sarcopenia and osteoporosis: the cross-sectional study from NHANES 1999-2020 and a bi-directions Mendelian randomization study

Background

Osteoporosis (OP) and sarcopenia are prevalent musculoskeletal conditions among the elderly. Nevertheless, the causal relationship between sarcopenia and OP remains a subject of controversy and uncertainty. In this study, we employed cross-sectional analysis and Mendelian randomization (MR) to investigate the intricate relationship between sarcopenia and OP.

Methods

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2020, which involved in 116,876 participants. It assessed the correlation between sarcopenia, osteoporosis (OP), and bone mineral density (BMD) using Chi-square tests, T-tests, and a multiple logistic regression model. Additionally, we conducted Mendelian randomization (MR) analysis to investigate the causal effects of sarcopenia-related characteristics (ALM) on OP. We employed IVW, sensitivity analysis, heterogeneity testing, and other methods for MR. The ALM data was sourced from the UK Biobank (n=450,243), while the aggregated data on OP was obtained from GWAS statistics (n=53,236).

Results

In this cross-sectional analysis, we observed that in the multivariate logistic regression model, without adjusting for any variables, OP emerged as a risk factor for sarcopenia [OR 95% CI = 1.90 (1.13-3.18), P = 0.02]. Following adjustments for gender, age, BMI, and biochemical variables, OP retained its status as a risk factor for sarcopenia [OR 95% CI = 3.54 (1.91-6.54), P < 0.001]. Moreover, after accounting for all variables, OP emerged as an independent risk factor for sarcopenia [OR 95% CI = 4.57 (1.47-14.22), P = 0.01].In the MR analysis, we uncovered that femoral neck BMD (FN BMD), lumbar spine BMD (LS BMD), and forearm bone mineral density (FA BMD) exerted a direct causal influence on ALM [FA BMD: OR 95% CI = 1.028 (1.008, 1.049), p = 0.006; FN BMD: OR (95% CI) = 1.131 (1.092, 1.170), p = 3.18E-12; LS BMD: OR (95% CI) = 1.080 (1.062, 1.098), p = 2.86E-19].

Conclusion

Our study has revealed a positive correlation between OP and the prevalence of sarcopenia. It suggests a potentially robust causal relationship between OP and sarcopenia. Notably, OP appears to be associated with a higher likelihood of losing ALM, and a significant loss of ALM may contribute to a decline in LS BMD.

Gene co-expression networks reveal sex-biased differences in musculoskeletal ageing

Aging is a universal and progressive process involving the deterioration of physiological functions and the accumulation of cellular damage. Gene regulation programs influence how phenotypes respond to environmental and intrinsic changes during aging. Although several factors, including sex, are known to impact this process, the underlying mechanisms remain incompletely understood. Here, we investigate the functional organization patterns of skeletal muscle genes across different sexes and ages using gene co-expression networks (GCNs) to explore their influence on aging. We constructed GCNs for three different age groups for male and female samples, analyzed topological similarities and differences, inferred significant associated processes for each network, and constructed null models to provide statistically robust results. We found that each network is topologically and functionally distinct, with young women having the most associated processes, likely due to reproductive tasks. The functional organization and modularity of genes decline with age, starting from middle age, potentially leading to age-related deterioration. Women maintain better gene functional organization throughout life compared to men, especially in processes like macroautophagy and sarcomere organization. The study suggests that the loss of gene co-expression could be a universal aging marker. This research offers insights into how gene organization changes with age and sex, providing a complementary method to analyze aging.

Tracking the Plasma C-Terminal Agrin Fragment as a Biomarker of Neuromuscular Decline in 18- to 87-Year-Old Men

OBJECTIVES

Plasma C-terminal agrin-fragment-22 (CAF22), a breakdown product of neuromuscular junction, is a potential biomarker of muscle loss. However, its levels from adolescence to octogenarians are unknown.

METHODS

We evaluated young (18-34 years, n = 203), middle-aged (35-59 years, n = 163), and old men (60-87 years, n = 143) for CAF22, handgrip strength (HGS), appendicular skeletal-mass index (ASMI), and gait speed.

RESULTS

We found an age-associated increase in CAF22 from young (100.9 ± 29 pmol) to middle-aged (128.3 ± 38.7 pmol) and older men (171.5 ± 35.5 pmol) (all p<0.05). This was accompanied by a gradual reduction in HGS (37.7 ± 6.1 kg, 30.2 ± 5.2 kg, and 26.6 ± 4.7 kg, for young, middle-aged, and old men, respectively), ASMI (8.02 ± 1.02 kg/m2, 7.65 ± 0.92 kg/m2, 6.87 ± 0.93 kg/m2, for young, middle-aged, and old men, respectively), and gait speed (1.29 ± 0.24 m/s, 1.05 ± 0.16 m/s, and 0.81 ± 0.13 m/s, for young, middle-aged, and old men, respectively). After adjustment for age, we found negative regressions of CAF22 with HGS (- 0.0574, p < 0.001) and gait speed (- 0.0162, p < 0.001) in the cumulative cohort. The receiver operating characteristics analysis revealed significant efficacy of plasma CAF22 in diagnosing muscle weakness (HGS < 27 kg) (middle-aged men; AUC = 0.731, 95% CI = 0.629-0.831, p < 0.001, Older men; AUC = 0.816, 95% CI = 0.761-0.833, p < 0.001), and low gait speed (0.8 m/s) (middle-aged men; AUC = 0.737, 95% CI = 0.602-0.871, p < 0.001, older men; AUC = 0.829, 95% CI = 0.772-0.886, p < 0.001), and a modest efficacy in diagnosing sarcopenia (middle-aged men; AUC = 0.701, 95% CI = 0.536-0.865, p = 0.032, older men; AUC = 0.822, 95% CI = 0.759-0.884, p < 0.001) in middle-aged and older men.

CONCLUSION

Altogether, CAF22 increases with advancing age and may be a reliable marker of muscle weakness and low gait speed.

Sexual dimorphisms in skeletal muscle: current concepts and research horizons

The complex compositional and functional nature of skeletal muscle makes this organ an essential topic of study for biomedical researchers and clinicians. An additional layer of complexity is added with the consideration of sex as a biological variable. Recent research advances have revealed sexual dimorphisms in developmental biology, muscle homeostasis, adaptive responses, and disorders relating to skeletal muscle. Many of the observed sex differences have hormonal and molecular mechanistic underpinnings, whereas others have yet to be elucidated. Future research is needed to investigate the mechanisms dictating sex-based differences in the various aspects of skeletal muscle. As such, it is necessary that skeletal muscle biologists ensure that both female and male subjects are represented in biomedical and clinical studies to facilitate the successful testing and development of therapeutics for all patients.

The optimal time restricted eating interventions for blood pressure, weight, fat mass, glucose, and lipids: A meta-analysis and systematic review

BACKGROUND

No previous systematic review or meta-analysis has evaluated the effect of optimal time-restricted eating (TRE) interventions on cardiovascular (CVD) risk factors. This meta-analysis aimed to illustrate the effect of a suitable TRE on CVD risk factors.

METHODS

A systematic review was performed to identify trials reporting the effects of TRE, relative to non-diet controls, on CVD risk factors in humans. A random-effects model was used to evaluate the effect sizes, and the results are expressed as the mean difference (MD) and 95% confidence intervals (CIs). Subgroup analyses were performed to examine the influence of the study population, age, duration of intervention, and baseline mean BMI on the CVD indexes.

RESULTS

TRE intervention significantly reduced systolic pressure (SBP) (MD: -3.45 mmHg; 95%CI:(-6.20,-0.71) mmHg; P = 0.01), body weight (MD: -1.63 Kg; 95%CI:(-2.09,-1.17) Kg; P<0.001), body mass index (BMI) (MD: -0.47 Kg/m2; 95% CI: (-0.72, -0.22) Kg/m2; P<0.001), and fat mass (MD: -0.98 Kg; 95% CI: (-1.51,-0.44) Kg; P<0.001), and reduced blood glucose levels. Based on the results of subgroup analysis, this meta-analysis identified the optimal TRE for BP (with a 6 h feeding window, last eating time point at 6-8 PM, and male participants with obesity and aged ≥ 45 years), obesity (with a 6 h feeding window, last eating time point at 6-8 PM, and female participants aged ≥ 45 years), lipids (with an 8 h feeding window, last eating time point at 6-8 PM, and male participants aged < 45 years), and glucose (with a 10-12 h feeding window, last eating time point before 6 PM, and female participants aged < 45years).

CONCLUSIONS

Relative to a non-diet control, TRE is effective for the improvement of CVD risks. Moreover, individual TRE interventions should be developed for different populations to achieve the most effective health improvement for CVD risk factors.

Associations between tinnitus and body composition: a cross-sectional study

The relationship between tinnitus and body composition in specific regions has not been extensively investigated. This study aimed to identify associations between tinnitus and body composition. Individuals with data on physical and otological examination findings, and bioelectrical impedance analysis were included from the ninth Korea National Health and Nutritional Examination Survey. They were divided into a tinnitus group and a non-tinnitus group. Participants with tinnitus were further classified into acute or chronic tinnitus group. The tinnitus group showed significantly higher body fat percentages in each region (arms: P = 0.014; legs: P = 0.029; trunk: P = 0.008; whole body: P = 0.010) and waist circumference (P = 0.007) than the non-tinnitus group, and exhibited lower leg muscle percentage (P = 0.038), total body fluid percentage (P = 0.010), and intracellular fluid percentage (P = 0.009) than the non-tinnitus group in men. Furthermore, men with chronic tinnitus showed a significantly higher trunk fat percentage (P = 0.015) and waist circumference (P = 0.043), and lower intracellular fluid percentage (P = 0.042) than their counterparts without tinnitus. No significant differences in body composition were observed among the groups in the female population. In men, body composition may be associated with tinnitus.

Bidirectional Relationships between Sarcopenia and Pelvic Floor Disorders

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.

Effects of weight-bearing dance aerobics on lower limb muscle morphology, strength and functional fitness in older women

Objective

To investigate the effects of 12-week weight-bearing dance aerobics (WBDA) on muscle morphology, strength and functional fitness in older women.

Methods

This controlled study recruited 37 female participants (66.31y ± 3.83) and divided them into intervention and control groups according to willingness. The intervention group received 90-min WBDA thrice a week for 12 weeks, while the control group maintained normal activities. The groups were then compared by measuring muscle thickness, fiber length and pennation angle by ultrasound, muscle strength using an isokinetic multi-joint module and functional fitness, such as 2-min step test, 30-s chair stand, chair sit-and-reach, TUG and single-legged closed-eyed standing test. The morphology, strength, and functional fitness were compared using ANCOVA or Mann-Whitney U test to study the effects of 12 weeks WBDA.

Results

Among all recruited participants, 33 completed all tests. After 12 weeks, the thickness of the vastus intermedius (F = 17.85, P < 0.01) and quadriceps (F = 15.62, P < 0.01) was significantly increased in the intervention group compared to the control group, along with a significant increase in the torque/weight of the knee flexor muscles (F = 4.47, P = 0.04). Similarly, the intervention group revealed a significant improvement in the single-legged closed-eyed standing test (z = -2.16, P = 0.03) compared to the control group.

Conclusion

The study concluded that compared to the non-exercising control group, 12-week WBDA was shown to thicken vastus intermedius, increase muscle strength, and improve physical function in older women. In addition, this study provides a reference exercise program for older women.

Reproductive factors and their association with physical and comprehensive frailty in middle-aged and older women: a large-scale population-based study

STUDY QUESTION

Are women's reproductive factors associated with physical frailty and comprehensive frailty in middle-age and later life?

SUMMARY ANSWER

Early menarche at <13 years, age at menopause <45 years, surgical menopause, experiencing miscarriage and a shorter reproductive period of <35 years were associated with increased odds of frailty, while having two or three children was related to decreased likelihood of frailty.

WHAT IS KNOWN ALREADY

Evidence has shown that women are frailer than men in all age groups and across different populations, although women have longer lifespans. Female-specific reproductive factors may be related to risk of frailty in women.

STUDY DESIGN SIZE DURATION

A population-based cross-sectional study involved 189 898 women from the UK Biobank.

PARTICIPANTS/MATERIALS SETTING METHODS

Frailty phenotype and frailty index were used to assess physical frailty and comprehensive frailty (assessed using 38 health indicators for physical and mental wellbeing), respectively. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CI between reproductive factors and likelihood of physical frailty and comprehensive frailty. Restricted cubic spline models were used to test the non-linear associations between them. In addition, we examined the combined effect of categorized age at menopause and menopause hormone therapy (MHT) on frailty.

MAIN RESULTS AND THE ROLE OF CHANCE

There was a J-shape relationship between age at menarche, reproductive period, and frailty; age at menarche <13 years and >16 years, and reproductive period <35 years or >40 years were all associated with increased odds of frailty. There was a negative linear relationship between menopausal age (either natural or surgical) and odds of frailty. Surgical menopause was associated with 30% higher odds of physical frailty (1.34, 1.27-1.43) and 30% higher odds of comprehensive frailty (1.30, 1.25-1.35). Having two or three children was linked to the lowest likelihood of physical frailty (0.48, 0.38-0.59) and comprehensive frailty (0.72, 0.64-0.81). Experiencing a miscarriage increased the odds of frailty. MHT use was linked to increased odds of physical frailty in women with normal age at natural menopause (after 45 years), while no elevated likelihood was observed in women with early natural menopause taking MHT.

LIMITATIONS REASONS FOR CAUTION

The reproductive factors were self-reported and the data might be subject to recall bias. We lacked information on the types and initiation time of MHT, could not identify infertile women who later became pregnant, and the number of infertile women may be underestimated. Individuals participating in the UK Biobank are not representative of the general UK population, limiting the generalization of our findings.

WIDER IMPLICATION OF THE FINDINGS

The reproductive factors experienced by women throughout their life course can potentially predict frailty in middle and old age. Identifying these reproductive factors as potential predictors of frailty can inform healthcare providers and policymakers about the importance of considering a woman's reproductive history when assessing their risk for frailty.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the National Key Research and Development Program of China (2022YFC2703800), National Natural Science Foundation of China (82273702), Science Fund Program for Excellent Young Scholars of Shandong Province (Overseas) (2022HWYQ-030), Taishan Scholars Project Special Fund (No. tsqnz20221103), and the Qilu Young Scholar (Tier-1) Program (202099000066). All authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Effect of resistance training and chicken meat on muscle strength and mass and the gut microbiome of older women: A randomized controlled trial

This study investigated the effects of white meat, such as chicken, intake combined with resistance training on muscle mass and strength in the elderly women, and whether the underlying mechanism involves changes in the gut microbiota. Ninety-three volunteers (age 59-79 years) were randomly allocated to sedentary control with placebo (Sed + PL) or chicken meat (Sed + HP) and resistance training with placebo (RT + PL) or chicken meat (RT + HP). Resistance training sessions were performed 3 d/week for 12 weeks using leg extensions and curls. Boiled chicken meat (110 g, containing 22.5 g protein) was ingested 3 d/week for 12 weeks. Maximal muscle strength and whole-body lean mass increased significantly in the RT + PL group compared to the Sed + HP group, and the RT + HP group showed a significantly greater increase than the Sed + HP and RT + PL groups. Additionally, the gut microbiota composition did not change before or after the interventions in any of the four groups. Moreover, the individual comparison of gut bacteria using false discovery rate-based statistical analysis showed no alterations before or after the interventions in the four groups. Resistance training combined with chicken meat intake may effective have increased muscle mass and strength without drastically modifying the gut microbiota composition in elderly women.

Impact of menopause-associated frailty on traumatic brain injury

Navigating menopause involves traversing a complex terrain of hormonal changes that extend far beyond reproductive consequences. Menopausal transition is characterized by a decrease in estradiol-17β (E2), and the impact of menopause resonates not only in the reproductive system but also through the central nervous system, musculoskeletal, and gastrointestinal domains. As women undergo menopausal transition, they become more susceptible to frailty, amplifying the risk and severity of injuries, including traumatic brain injury (TBI). Menopause triggers a cascade of changes leading to a decline in muscle mass, accompanied by diminished tone and excitability, thereby restricting the availability of irisin, a crucial hormone derived from muscles. Concurrently, bone mass undergoes reduction, culminating in the onset of osteoporosis and altering the dynamics of osteocalcin, a hormone originating from bones. The diminishing levels of E2 during menopause extend their influence on the gut microbiota, resulting in a reduction in the availability of tyrosine, tryptophan, and serotonin metabolites, affecting neurotransmitter synthesis and function. Understanding the interplay between menopause, frailty, E2 decline, and the intricate metabolisms of bone, gut, and muscle is imperative when unraveling the nuances of TBI after menopause. The current review underscores the significance of accounting for menopause-associated frailty in the incidence and consequences of TBI. The review also explores potential mechanisms to enhance gut, bone, and muscle health in menopausal women, aiming to mitigate frailty and improve TBI outcomes.

The different association between fat mass distribution and intake of three major nutrients in pre- and postmenopausal women

BACKGROUND

Obesity, characterized by excessive body fat accumulation, is associated with various chronic health conditions. Body fat plays a crucial role in health outcomes, and nutrient intake is a contributing factor. Menopause further influences body fat, but the precise relationships between nutrients and fat mass distribution in pre- and post-menopausal women are unclear.

METHODS

Data from 4751 adult women aged ≥18 years old (3855 pre-menopausal, 896 post-menopausal) with completed information were obtained from the National Health and Examination Survey (NHANES) from 2011 to 2018. Multivariate linear regression models were used to examine the associations between protein, carbohydrate, fat intake and total percent fat (TPF), android percent fat (APF), gynoid percent fat (GPF), android to gynoid ratio (A/G), subcutaneous adipose tissue mass (SAT), visceral adipose tissue mass (VAT). Subgroup analyses, stratified by menopausal status, were also conducted. Additionally, we employed smoothing curve fitting techniques to investigate potential non-linear relationships between fat mass distribution and nutrient intake.

RESULTS

Compared with pre-menopausal women, post-menopausal women had higher body fat, BMI, and metabolic indicators but lower nutrient intake (All p<0.05). In the overall analysis, we found significant correlations between nutrient intake and fat mass. Specifically, protein intake was negatively correlated with TPF (β = -0.017, 95% CI: -0.030, -0.005), APF (β = -0.028, 95% CI: -0.044, -0.012), GPF (β = -0.019, 95% CI: -0.030, -0.008), while fat intake showed positive correlations with these measures (SAT: β = 2.769, 95% CI: 0.860, 4.678). Carbohydrate intake exhibited mixed associations. Notably, body fat mass-nutrient intake correlations differed by menopausal status. Generally speaking, protein intake showed negative correlations with body fat distribution in pre-menopausal women but positive correlations in post-menopausal women. Carbohydrate intake revealed significant negative associations with abdominal and visceral fat in post-menopausal women, while fat intake was consistently positive across all fat distribution indices, especially impacting visceral fat in post-menopausal women.

CONCLUSION

Dietary intake plays a crucial role in body fat distribution, with menopausal status significantly influencing the impact of nutrients on specific fat distribution metrics. The study emphasizes the need for dietary guidelines to consider the nutritional needs and health challenges unique to women at different life stages, particularly concerning menopausal status, to effectively manage obesity.

Association of Handgrip Strength and Cardiovascular Disease Risk Among Middle-Aged Postmenopausal Women: An Analysis of the Korea National Health and Nutrition Examination Survey 2014-2019

Purpose

Handgrip strength is an indicator of overall muscle strength and has been associated with an increased risk of cardiovascular disease. Evidence suggests that menopause is a risk factor for cardiovascular disease in women, and muscle strength decreases progressively after menopause. Despite the prognostic importance of the decline in muscle strength and increased cardiovascular disease risk among postmenopausal women, evidence of their association is limited. This study aimed to investigate the relationship between handgrip strength and cardiovascular disease risk among postmenopausal, middle-aged Korean women.

Patients and Methods

Using pooled cohort equations, we calculated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among postmenopausal women (N = 2019) aged 50-64 years without cardiovascular disease history from the 2014-2019 Korea National Health and Nutrition Examination Survey. Relative grip strength was defined as measured grip strength divided by body mass index. Logistic regression analysis of a complex sampling design was performed to evaluate the association between relative grip strength and a predicted 10-year ASCVD risk ≥7.5%.

Results

The average handgrip strength was 24.8 kg, and 5.2% of women were considered for sarcopenia (<18 kg). The quartile-stratified relative grip strength was negatively associated with 10-year ASCVD risk (p < 0.001). In the multiple logistic regression analysis, the adjusted odds ratio for the highest relative grip strength quartile was 0.53 (95% confidence interval [CI]: 0.36-0.78), and that of the group who breastfed for more than 12 months was 1.75 (95% CI: 1.36-2.25) for 10-year ASCVD risk.

Conclusion

Increased handgrip strength may be associated with lower cardiovascular disease risk among middle-aged postmenopausal women in Korea. Our findings provide critical evidence regarding the importance of increasing handgrip strength among postmenopausal, middle-aged women to reduce cardiovascular disease risk. Handgrip strength measurement might be a valuable screening tool for cardiovascular disease prevention.

Reliability, costs, and radiation dose of dual-energy X-ray absorptiometry in diagnosis of radiologic sarcopenia in surgically menopausal women

OBJECTIVE

The aim of this study was to evaluate and compare reliability, costs, and radiation dose of dual-energy X-ray absorptiometry (DXA) to MRI and CT in measuring muscle mass for the diagnosis of sarcopenia.

METHODS

Thirty-four consecutive DXA scans performed in surgically menopausal women from November 2019 until March 2020 were analyzed by two observers. Observers analyzed muscle mass of the lower limbs in every scan twice. Reliability was assessed by calculating inter- and intra-observer variability. Reliability from CT and MRI as well as radiation dose from CT and DXA were collected from literature. Costs for each type of scan were calculated according to the guidelines for economic evaluation of the Dutch National Health Care Institute.

RESULTS

The 34 participants had a median age of 58 years (IQR 53-65) and a median body mass index of 24.6 (IQR 21.7-29.7). Inter-observer variability had an intraclass correlation coefficient (ICC) of 0.997 (95% CI 0.994-0.998) with a relative variability of 0.037 ± 0.022%. Regarding intra-observer variability, observer 1 had an ICC of 0.998 (95% CI 0.996-0.999) with a relative variability of 0.019 ± 0.016% and observer 2 had an ICC of 0.997 (95% CI 0.993-0.998) with a relative variability of 0.016 ± 0.011%. DXA costs were €62, CT €77, and MRI €195. The estimated radiation dose of CT was 2.5-3.0 mSv, for DXA this was 2-4 µSv.

CONCLUSIONS

DXA has lower costs and a lower radiation dose, with low inter- and intra-observer variability, compared to CT and MRI for assessing lower limb muscle mass.

TRIAL REGISTRATION

Netherlands Trial Register; NL8068.

CRITICAL RELEVANCE STATEMENT

DXA is a good alternative for CT and MRI in assessing lower limb muscle mass, with lower costs and lower radiation dose, while inter-observer and intra-observer variability are low.

KEY POINTS

• Screening for sarcopenia should be optimized as the population ages. • DXA outperformed CT and MRI in the measured metrics. • DXA validity should be further evaluated as an alternative to CT and MRI for sarcopenia evaluation.

Exploring the causal relationship between female reproductive traits and frailty: a two-sample mendelian randomization study

Background: The impact of female reproductive factors, including age at menarche (AAM), age at first birth (AFB), age at first sexual intercourse (AFS), age at natural menopause (ANM), and pregnancy abortion (PA), on the risk of developing frailty remains uncertain. Our objective is to examine the potential causal relationship between female reproductive traits and frailty through the utilization of two-sample univariable Mendelian Randomization (UVMR) and multivariable Mendelian Randomization (MVMR) analyses. Methods: Leveraging large-scale Genome-Wide Association Study (GWAS) data from individuals of European ancestry, we performed two-sample UVMR and MVMR analyses to examine the causal relationship between female reproductive traits and frailty. The primary analysis employed inverse-variance-weighted (IVW) estimation, and sensitivity analyses were conducted to assess the robustness of the findings. Results: The UVMR analysis revealed a significant causal relationship between female reproductive traits (AFS, AFB, AAM) and frailty [IVW: OR = 0.74, 95%CI(0.70-0.79), p = 0.000; OR = 0.93, 95%CI(0.92-0.95), p = 0.000; OR = 0.96, 95%CI(0.95-0.98), p = 0.000]. However, there was no significant effect of ANM and PA on frailty (p > 0.05). The sensitivity analysis results were robust, supporting the findings. Furthermore, this association remained significant even after adjusting for body mass index (BMI) and educational attainment (EA) in the MVMR analysis [IVW: OR = 0.94, 95%Cl (0.91-0.97), p = 0.000; OR = 0.77, 95%Cl (0.70-0.86), p = 0.000; OR = 0.95, 95%Cl (0.94-0.97), p = 0.000]. BMI and EA serve as mediators in this process. Conclusion: Our research has established a significant causal relationship between female reproductive traits (AFS, AFB, AAM) and frailty, with BMI and EA acting as mediating factors in this process. However, further research is warranted to validate our findings and elucidate the underlying biological mechanisms.

Effectiveness of an intermittent fasting diet versus regular diet on fat loss in overweight and obese middle-aged and elderly people without metabolic disease: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

As the number of adults aged over 40 with obesity increases dramatically, intermittent fasting interventions (IF) may help them to lose fat and weight. This systematic review investigated the most recent research on the effects of intermittent fasting and a regular diet on body composition and lipids in adults aged over 40 with obesity without the metabolic disease.

DATA SOURCES

Randomized controlled trials (RCTs) on IF on adults aged over 40 with obesity were retrieved from PubMed, Web of Science, EBSCO, China Knowledge Network (CNKI), VIP database, Wanfang database with the experimental group using IF and the control group using a regular diet. Revman was used for meta-analysis. Effect sizes are expressed as weighted mean differences (WMD) and 95% confidence intervals (CI).

STUDY SELECTION

A total of 9 articles of randomised controlled trials that met the requirements were screened for inclusion. Studies typically lasted 2-6 weeks. The experimental population was aged 42-66 years, with a BMI range of 25.7-35 kg/m2.

SYNTHESIS

A total of 9 RCTs were included. meta-analysis showed that body weight (MD: -2.05 kg; 95% CI (-3.84, -0.27); p = 0.02), BMI (MD: -0.73 kg/m2; 95% CI (-1.05, -0.41); p < 0.001), fat mass (MD: -2.14 kg; 95% CI (-3.81, 0.47); p = 0.01), and TG (MD = -0.32 mmol/L, 95% CI (-0.50, -0.15, p < 0.001) were significantly lower in the experimental group than in the control group. No significant reduction in lean body mass (MD: -0.31 kg; 95% CI (-0.96, 0.34); p = 0.35).

CONCLUSION

IF had a reduction in body weight, BMI, fat mass, and TG in adults aged over 40 with obesity without metabolic disease compared to RD, and IF did not cause a significant decrease in lean body mass, which suggests healthy and effective fat loss. However, more long-term and high-quality trials are needed to reach definitive conclusions.

Associations of micronutrient dietary patterns with sarcopenia among US adults: a population-based study

Background

Current epidemiological evidence points to an association between micronutrient (MN) intake and sarcopenia, but studies have focused on single MN, and no combined effects on MNs have been reported. The aim of this study was to investigate the relationship between different MN intake patterns and sarcopenia and skeletal muscle mass.

Methods

We performed a population-based cross-sectional study, with a total of 5,256 U.S. adults aged 20-59 years, and we collected total daily MN intake and appendicular skeletal muscle mass measured by Dual-Energy X-ray Absorptiometry (DXA). Principal component analysis (PCA) was used to obtain nutrient patterns and principal component scores based on the intake of 14 MNs, and logistic regression analysis was used to assess the effects of single MN and MN intake patterns on sarcopenia and muscle mass.

Results

We defined three MN intake patterns by PCA: (1) adherence to VitB-mineral, high intake of vitamin B and minerals; (2) adherence to VitAD-Ca-VB12, high intake of vitamin A, vitamin D, calcium and vitamin B12; and (3) adherence to Antioxidant Vit, high intake of antioxidant vitamins A, C, E, and K. These three nutrient patterns explained 73.26% of the variance of the population. A negative association was observed between most single MN intakes and sarcopenia, and after adjusting for confounders, adherence to the highest tertile of the three nutrient patterns was associated with a lower risk of sarcopenia and relatively higher skeletal muscle mass compared to the lowest adherence. In subgroup analysis, MN intake patterns were significantly correlated with sarcopenia in middle-aged females.

Conclusion

Nutritional patterns based on MN intake were significantly related to sarcopenia, indicating that MNs interact with each other while exerting their individual functions, and that MN dietary patterns may provide promising strategies for preventing the loss of muscle mass, with further prospective studies warranted in the future.

The effects of 12 weeks resistance training and vitamin D administration on neuromuscular joint, muscle strength and power in postmenopausal women

BACKGROUND

This study aimed to examine the effects of 12 weeks of resistance training (RT) and vitamin D (VitD) supplementation on muscle strength and C-terminal agrin fragment (CAF) and Neurotrophin-3 (NT-3) concentrations as potential biomarkers in postmenopausal women.

METHODS

This was a randomized double-blind placebo-controlled study. Forty-four healthy postmenopausal women (55.84 ± 4.70 years and 29.61 ± 4.26 kg/m2) were randomly assigned into four groups: (1) Resistance training + placebo (RT + PLA), (2) Vitamin D supplementation (VitD), (3) Resistance training + vitamin D (RT + VitD), and (4) Placebo (PLA). VitD was supplemented as an oral capsule containing 50000 IU of cholecalciferol every two weeks. RT involved leg press, chest press, leg extension, leg curl, and shoulder press exercises, performed with 3-4 sets at 70-85 % of 1RM, three times a week.

RESULTS

Circulating levels of CAF and NT-3 did not significantly change following the intervention period in the study groups (p > 0.05). There were significant increases in upper and lower body muscle strength and power for RT + VitD and RT + PLA ( < 0.05), but not for VitD or PLA (p > 0.05). The muscle function gains for RT + VitD and RT + PLA were higher than those for VitD and PLA but did not differ between them.

CONCLUSION

12-week of RT interventions resulted in significant increases in muscle strength and power in postmenopausal women. However, VitD supplementation did not result in any additional benefits. The positive changes in muscle function promoted by RT do not seem to be associated with changes in the neuromuscular joint via the CAF or NT-3 as potential biomarkers.

Decreased Neuromuscular Function and Muscle Quality along with Increased Systemic Inflammation and Muscle Proteolysis Occurring in the Presence of Decreased Estradiol and Protein Intake in Early to Intermediate Post-Menopausal Women

Menopause causes a reduction in estradiol (E2) and may be associated with neuromuscular degeneration. Compared to pre-menopausal (PRE-M) women, this study sought to determine dietary protein intake and whether lower levels of circulating E2 in post-menopausal women (POST-M) were occurring alongside increased levels of biomarkers of axonal and neuromuscular junction degeneration (NMJ), inflammation, muscle protein degradation, and reduced indices of muscle quality and performance. Employing a cross-sectional design, PRE-M (n = 6) and POST-M (n = 6) dietary analysis data were collected and participants then donated a blood and urine sample followed by assessments for body composition, motor unit activation, and muscle performance. Independent group t-tests were performed to determine differences between groups (p ≤ 0.05). In POST-M women, E2, motor unit activity, muscle quality, and muscle performance were significantly less than those for PRE-M women; however, the levels of c-terminal fragment of agrin, tumor necrosis factor-α, and urinary titin were significantly greater (p < 0.05). POST-M women were also shown to be ingesting fewer total calories and less protein than PRE-M (p < 0.05). Reduced E2 and dietary protein intake in POST-M women occurs in conjunction with increased levels of biomarkers of NMJ degradation, inflammation, and muscle proteolysis, which may be associated with reduced motor unit activation and muscle quality.

The contribution of mitochondria to age-related skeletal muscle wasting: A sex-specific perspective

As people age, their skeletal muscle (SkM) experiences a decline in mitochondrial functionality and density, which leads to decreased energy production and increased generation of reactive oxygen species. This cascade of events, in turn, might determine the loss of SkM mass, strength and quality. Even though the mitochondrial processes dysregulated by aging, such as oxidative phosphorylation, mitophagy, antioxidant defenses and mtDNA transcription, are the same in both sexes, mitochondria age differently in the SkM of men and women. Indeed, the onset and magnitude of the impairment of these processes seem to be influenced by sex-specific factors. Sexual hormones play a pivotal role in the regulation of SkM mass through both genomic and non-genomic mechanisms. However, the precise mechanisms by which these hormones regulate mitochondrial plasticity in SkM are not fully understood. Although the presence of estrogen receptors in mitochondria is recognized, it remains unclear whether androgen receptors affect mitochondrial function. This comprehensive review critically dissects the current knowledge on the interplay of sex in the aging of SkM, focusing on the role of sex hormones and the corresponding signaling pathways in shaping mitochondrial plasticity. Improved knowledge on the sex dimorphism of mitochondrial aging may lead to sex-tailored interventions that target mitochondrial health, which could be effective in slowing or preventing age-related muscle loss.

Cardiometabolic health across menopausal years is linked to white matter hyperintensities up to a decade later

Introduction

The menopause transition is associated with several cardiometabolic risk factors. Poor cardiometabolic health is further linked to microvascular brain lesions, which can be detected as white matter hyperintensities (WMHs) using T2-FLAIR magnetic resonance imaging (MRI) scans. Females show higher risk for WMHs post-menopause, but it remains unclear whether changes in cardiometabolic risk factors underlie menopause-related increase in brain pathology.

Methods

In this study, we assessed whether cross-sectional measures of cardiometabolic health, including body mass index (BMI) and waist-to-hip ratio (WHR), blood lipids, blood pressure, and long-term blood glucose (HbA1c), as well as longitudinal changes in BMI and WHR, differed according to menopausal status at baseline in 9,882 UK Biobank females (age range 40-70 years, n premenopausal = 3,529, n postmenopausal = 6,353). Furthermore, we examined whether these cardiometabolic factors were associated with WMH outcomes at the follow-up assessment, on average 8.78 years after baseline.

Results

Postmenopausal females showed higher levels of baseline blood lipids (HDL β  = 0.14, p < 0.001, LDL β  = 0.20, p < 0.001, triglycerides β  = 0.12, p < 0.001) and HbA1c (β  = 0.24, p < 0.001) compared to premenopausal women, beyond the effects of age. Over time, BMI increased more in the premenopausal compared to the postmenopausal group (β  = -0.08, p < 0.001), while WHR increased to a similar extent in both groups (β  = -0.03, p = 0.102). The change in WHR was however driven by increased waist circumference only in the premenopausal group. While the group level changes in BMI and WHR were in general small, these findings point to distinct anthropometric changes in pre- and postmenopausal females over time. Higher baseline measures of BMI, WHR, triglycerides, blood pressure, and HbA1c, as well as longitudinal increases in BMI and WHR, were associated with larger WMH volumes (β range = 0.03-0.13, p ≤ 0.002). HDL showed a significant inverse relationship with WMH volume (β  = -0.27, p < 0.001).

Discussion

Our findings emphasise the importance of monitoring cardiometabolic risk factors in females from midlife through the menopause transition and into the postmenopausal phase, to ensure improved cerebrovascular outcomes in later years.

Long-term exposure to air pollution and risk of Sarcopenia in adult residents of Taiwan: a nationwide retrospective cohort study

BACKGROUND

Sarcopenia is an age-related, multifactorial syndrome. Previous studies have shown that air pollutants are associated with inflammation and oxidative stress. However, the association between long-term exposure to air pollution and sarcopenia is not completely understood.

METHODS

The Taiwan National Health Research Database (NHIRD) contains medical records of almost all Taiwanese residents. Daily air pollution data collected by the Taiwan Environmental Protection Agency was used to analyze concentrations of sulfur oxide (SO2), carbon monoxide (CO), nitrogen monoxide (NO), nitrogen dioxide (NO2), and particulate matter (PM2.5, PM10). The databases were merged according to the insurants' living area and the location of the air quality monitoring station. We categorized the pollutants into quartiles (Q1, Q2, Q3, and Q4).

RESULTS

Our study population consisted of 286,044 patients, among whom 54.9% were female and 45.1% were male. Compared to Q1 levels of pollutants, Q4 levels of SO2 (adjusted hazard ratio [aHR] = 8.43; 95% confidence interval [CI] = 7.84, 9.07); CO (aHR = 3.03; 95%CI = 2.83, 3.25); NO (aHR = 3.47; 95%CI = 3.23, 3.73); NO2 (aHR = 3.72; 95%CI = 3.48, 3.98); PM2.5 (aHR = 21.9; 95% CI = 19.7, 24.5) and PM10 (aHR = 15.6; 95%CI = 14.1, 17.4) increased risk of sarcopenia.

CONCLUSIONS

Our findings indicated a significantly increased risk of sarcopenia in both male and female residents exposed to high levels of air pollutants.

Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis

IMPORTANCE

Postmenopausal women affected by overweight and obesity are susceptible to a variety of diseases due to inflammation. Exercise may reduce the risk of disease by attenuating low-grade chronic inflammation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the effects of exercise on inflammatory markers in postmenopausal women struggling with overweight and obesity.

METHOD

Literature as of May 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO and English-language randomized controlled trials (RCTs) that meet the inclusion criteria were selected. Studies were included based on the following criteria: (A) Written in English; (B) RCTs; (C) Postmenopausal women impacted by overweight and obesity as research objects; (D) Outcome measurements include CRP, TNF-α, IL-6, and adiponectin; (E) Duration of the exercise intervention is eight weeks.

RESULTS

A total of 34 articles and 2229 participants were included. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.59, 95 % CI: -0.87 to -0.31, p < 0.00001), tumor necrosis factor-α (TNF-α) (MD: -0.65, 95 % CI: -0.94 to -0.35, p < 0.00001), interleukin-6 (IL-6) (MD: -0.48, 95 % CI: -0.75 to -0.21, p < 0.00001), and exercise can significantly increase the level of adiponectin (MD: 0.33, 95 % CI: 0.02 to 0.65, p = 0.04) in women impacted by overweight and obesity.

CONCLUSION

These results suggest that exercise may be an effective intervention for reducing pro-inflammatory markers and increasing adiponectin in postmenopausal women impacted by overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for postmenopausal women living with overweight and obesity.

Fish Oil Supplementation with Resistance Exercise Training Enhances Physical Function and Cardiometabolic Health in Postmenopausal Women

Menopause is a condition associated with an increased risk of dysregulation in cardiovascular and metabolic health among older women. While fish oil (FO) has garnered great attention for its health-enhancing properties, its potential for enhancing cardiometabolic health in this demographic remains to be established. The purpose of this study was to determine the clinical efficacy of an 8 wk administration of FO combined with programmed resistance exercise training (RET) on physical function and risk factors associated with cardiometabolic health in healthy older women. Twenty, healthy, older women were randomly assigned to one of the two experimental groups: resistance training with placebo (RET-PL) or RET with fish oil (RET-FO). Physical function, blood pressure (BP), triglyceride (TG), and systemic inflammation and oxidative stress biomarkers were assessed before and after the intervention. Statistical significance was set at p ≤ 0.05. Physical function was greatly enhanced in both RET and RET-FO. Handgrip strength substantially increased only in RET-FO. RET-FO exhibited significant decreases in BP, TG, inflammatory cytokines (TNF-α and IL-6), and oxidative stress (MDA and 8-OHdG) levels, while no detectable changes were found in RET-PL. Our findings indicate that FO administration during 8 wks of RET appears to enhance muscle function and lower risk factors linked to cardiometabolic disorders in postmenopausal women.

Resistance training alters body composition in middle-aged women depending on menopause - A 20-week control trial

BACKGROUND

Resistance training (RT) is effective in counteracting the age- and menopause-related loss of muscle mass (MM) and strength in middle-aged women (40-60 years). Research on RT with free weights is limited in pre- and post-menopausal women. Based on this, a 20-week training intervention was conducted with this population to investigate the effects of systematic RT with free weights on strength capacity and body composition.

METHOD

Forty-one healthy women (52.0 ± 3.6 years) participated in this study. After 10-week control phase (no RT, T0-T1) followed by a 10-week intervention phase (T1-T2) with RT twice a week and 6-8 sets of each muscle per week. Subjects were randomly assigned to a low-intensity (50% 1-RM) or moderate-intensity (75% 1-RM) RT group and divided into pre-menopausal and post-menopausal according to their hormone profile. Fat-free mass (FFM), MM, fat mass (FM), muscle thickness (Vastus lateralis (VL), Rectus femoris (RF), Triceps brachii (TB)), grip strength, 1-RM squat and bench press were assessed before and after each phase. Statistical analysis was performed using a linear mixed model to account for fixed (time and group) and random (individual) effects.

RESULTS

A total of 31 women successfully completed the study. No injuries occurred during the intervention. Significant increases in 1-RM squat and bench press were observed in all groups. No interaction effect was observed for the strength parameters. In pre-menopausal women, FFM, MM and RF muscle thickness increased significantly, while VL showed a trend. These effects were not present in post-menopausal women regardless of RT intensity.

CONCLUSION

RT with free weight is safe and effective for middle-aged women to increase 1-RM. Hypertrophy effects were found exclusively in pre-menopausal women. To achieve hypertrophy and/or body composition changes in post-menopausal women, larger training volumes (> 6-8 sets/muscle per week) are likely required.

Comparison of Muscle, Bone and Fat Indices between Stages of Sarcopenia in Postmenopausal Malaysian Women

Background

The cumulative health impact of sarcopenia when it overlaps with obesity and osteoporosis is poorly understood. This cross-sectional study compared the muscle, bone and fat indices between stages of sarcopenia and determined the association of sarcopenia stages with adiposity and bone density in Malaysian postmenopausal women.

Methods

One hundred and thirty-six postmenopausal Malaysian women from Semenyih and Kuala Lumpur, Malaysia participated in the study. Muscle mass and body fat percentages (BFP) were assessed using a bioelectrical impedance analyser. Bone density was assessed using quantitative calcaneal ultrasonography. Handgrip strength (HGS) was assessed using a handgrip dynamometer. Gait speed was assessed using the 6-m walk test. The sarcopenia stage was classified into pre-sarcopenia, sarcopenia and severe sarcopenia.

Results

The overall prevalence of participants with various stages of 'sarcopenia' was 29.4%. The rates of low bone density were 13.7%, 12.5%, 17.4% and 85.7% in the non-sarcopenic, pre-sarcopenic, sarcopenic and severe sarcopenic groups, respectively (P < 0.000). Age, adiposity, muscle mass, gait speed and bone density differed significantly between the reference (non-sarcopenic) and 'severe sarcopenic' groups. The 'sarcopenic' and 'severe sarcopenic' groups had common impairments whereby no significant differences were found in HGS and gait speed between them.

Conclusion

The results showed significant correlations between sarcopenia stages and age, body weight, adiposity and bone density. Individuals with 'sarcopenia' had the same level of HGS and gait speed as those with severe forms of the disorder, implying that individuals with sarcopenia and severe sarcopenia were at the same level in terms of strength and endurance.

Multidisciplinary approach to sarcopenia: a narrative review

Sarcopenia is a condition in which muscle mass and strength are decreased and muscle function is impaired. It is an indicator of frailty and loss of independence in older adults. It is also associated with increased physical disability, which increases the risk of falls. As a multifactorial disease, sarcopenia is caused by a combination of factors including aging, hormonal changes, nutritional deficiencies, and physical inactivity. Understanding the underlying pathophysiology of sarcopenia and identifying its different causes is critical to developing effective prevention and treatment strategies. This review summarizes the pathophysiology, consequences, diagnostic methods, and multidisciplinary approaches to sarcopenia.

Sarcopenia, sarcopenic obesity and nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD), sarcopenia and sarcopenic obesity (SO) are highly prevalent conditions that may coexist, especially in the aging population, without any approved pharmacologic treatment for all of them. There are multiple pathophysiologic mechanisms suggested to explain an association between NAFLD and sarcopenia or SO, including alterations in the adipokines, cytokines, hepatokines and myokines, which may interplay with other factors, such as aging, diet and physical inactivity. In clinical terms, most observational studies support an association between NAFLD and sarcopenia or SO; importantly, there are few cohort studies indicating higher mortality in patients with NAFLD and sarcopenia. Their association also bears some treatment considerations: for example, pioglitazone or vitamin E, suggested as off label treatment for selected patients with nonalcoholic steatohepatitis, may be recommended in the coexistence of sarcopenia or SO, since limited evidence did not show adverse effects of them on sarcopenia and abdominal obesity. In this review, evidence linking sarcopenia and SO with NAFLD is summarized, with a special focus on clinical data. A synopsis of the major pathophysiological links between NAFLD and sarcopenia/SO is initially presented, followed by selected clinical studies and, finally, treatment considerations in patients with NAFLD and sarcopenia or SO are discussed.

Interaction of estradiol and vitamin D with low skeletal muscle mass among middle-aged and elderly women

BACKGROUND

Since the connection between muscle atrophy and vitamin D and estradiol status ambiguous, this study was thus conducted to determine whether low skeletal muscle mass (SMM) in middle-aged and elderly women was affected by estradiol and vitamin D levels together.

METHODS

Baseline data from a sub-cohort of the China Northwest Natural Population Cohort: Ningxia Project (CNC-NX) were analyzed. Serum 25-hydroxyvitamin D (25(OH) D) and estradiol were measured by chemiluminescence immunoassay analyzer. Bivariate logistic regression and multiplicative interaction analyses were used to assess the impact of estradiol level and vitamin D status on low SMM, as well as the combined impact of estradiol and low vitamin D status on low SMM.

RESULTS

A total of 287 (9.49%) participants had low SMM, which had lower levels of estradiol and vitamin D concentration than normal SMM group. While, after adjusting the confounding variables, these correlations were maintained in estradiol Q1, Q2, Q3 and vitamin D Q1. Furthermore, the significant combined effect of the highest quartile of estradiol concentrations and non-vitamin D deficiency, and interactions between vitamin D Q1 and estradiol Q2, vitamin D Q1 and estradiol Q3, vitamin D Q2 and estradiol Q1, vitamin D Q3 and estradiol Q3 on low SMM were stably reflected (P for interaction < 0.05).

CONCLUSIONS

Estradiol and vitamin D were interrelated with low SMM in middle-aged and elderly women. Combination of estradiol and vitamin D supplements should be encouraged for middle-aged and elderly women who are at risk of muscle atrophy or experiencing muscle atrophy.

Menopausal hormone therapy and change in physical activity in the Women's Health Initiative hormone therapy clinical trials

OBJECTIVE

The menopausal transition results in a progressive decrease in circulating estrogen levels. Experimental evidence in rodents has indicated that estrogen depletion leads to a reduction of energy expenditure and physical activity. It is unclear whether treatment with estrogen therapy increases physical activity level in postmenopausal women.

METHODS

A total of 27,327 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative randomized double-blind trials of menopausal hormone therapy. Self-reported leisure-time physical activity at baseline, and years 1, 3, and 6 was quantified as metabolic equivalents (MET)-h/wk. In each trial, comparison between intervention and placebo groups of changes in physical activity levels from baseline to follow-up assessment was examined using linear regression models.

RESULTS

In the CEE-alone trial, the increase in MET-h/wk was greater in the placebo group compared with the intervention group at years 3 ( P = 0.002) and 6 ( P < 0.001). Similar results were observed when analyses were restricted to women who maintained an adherence rate ≥80% during the trial or who were physically active at baseline. In the CEE + MPA trial, the primary analyses did not show significant differences between groups, but the increase of MET-h/wk was greater in the placebo group compared with the intervention group at year 3 ( P = 0.004) among women with an adherence rate ≥80%.

CONCLUSIONS

The results from this clinical trial do not support the hypothesis that estrogen treatment increases physical activity among postmenopausal women.

Longitudinal Association between Uric Acid and Incident Sarcopenia

BACKGROUND

Sarcopenia has emerged as a significant public health concern. Uric acid (UA), as a metabolite with excellent antioxidant capacity, has been found to be associated with sarcopenia. However, the casual effects of UA on incident sarcopenia still remain unclear. Our study aimed to explore the longitudinal association between UA and incident sarcopenia among middle-aged and older adults.

METHOD

A total of 5086 participants aged ≥45 years old without sarcopenia at baseline were included from the China Health and Retirement Longitudinal Study (CHARLS). Due to the sex differences, the UA levels were analyzed by categorizing into sex-specific quartiles or by using UA levels as a continuous variable (per 1 mg/dL). The longitudinal association between UA and incident sarcopenia was evaluated using Cox proportional hazards regression models.

RESULTS

During the 4-year follow-up period, 552 (10.85%) participants with incident sarcopenia were identified, of which 370 cases were males and 182 cases were females. Compared to the first quartile (Q1) UA levels, the Q3 and Q4 UA levels were significantly associated with lower risk of incident sarcopenia in males (Q3: adjusted hazard ratio (HR), 0.72; 95% CI (confidence interval), 0.54-0.97; Q4: HR, 0.57; 95% CI, 0.41-0.80). When UA was as a continuous variable (per 1 mg/dL), the association in males remained significant (HR: 0.87; 95% CI: 0.79-0.97). No significant association was observed in females.

CONCLUSION

Our findings indicated that UA was negatively associated with incident sarcopenia in males but not in females among middle-aged and older Chinese.

Low-intensity pulsed ultrasound and parathyroid hormone improve muscle atrophy in estrogen deficiency mice

Due to aging and long-term estrogen deficiency, postmenopausal women suffer muscle atrophy (MA), which is characterized by decreased muscle mass and muscle quality. Low-intensity pulsed ultrasound (LIPUS) is an acoustic wave inducing biological effects mainly by the mechanical stimulation and used as a non-invasive physical therapy for muscle repair. Parathyroid hormone (PTH) is an 84-amino-acid polypeptide, and its bioactive fragment [PTH (1-34)] has potential application in the treatment of MA. We speculate that the combination of physical therapy (i.e., the LIPUS) and regulatory hormone (i.e., the PTH) would be more effective in the treatment of MA. The objective of this study was to evaluate the individual and combined effects of LIPUS and PTH therapy on MA in estrogen deficiency mice. Seventy 8-week-old female C57BL/6J mice were used in this study and the MA model was induced by an intraperitoneal injection of 4-vinylcyclohexene diepoxide (VCD) for 20 consecutive days. The VCD-induced MA mice were randomly divided into MA, LIPUS, PTH and LIPUS + PTH (Combined) groups (n = 10/group). In the LIPUS group, the mice were treated by LIPUS in bilateral quadriceps muscles for 20 min, five times a week for 6 weeks. In the PTH group, the mice received subcutaneous injection of PTH (1-34) (80 ug/kg/d) five times a week, for 6 weeks. In the Combined group, the PTH was administrated 30 min before each LIPUS session. Hematoxylin-eosin (H&E) staining, serum biochemical analysis and quantitative real-time polymerase chain reaction (qRT-PCR) were applied to evaluate the therapeutic effects of related treatments. The results showed that the MA mice had a disordered estrus cycle, significantly decreased muscle mass and myofibers cross-sectional area (CSA). After treatments, LIPUS, PTH and Combined groups had a significantly increased CSA, compared with the MA mice without treatment. In addition, Combined group had a significantly increased mRNA expression of Pax7, MyoD and MyoG, compared with LIPUS and PTH monotherapy groups. Our findings indicated that the combination of LIPUS and PTH treatment improves muscle regeneration ability, which might have potential for treating MA in postmenopausal women.

The comparative effect of exercise interventions on balance in perimenopausal and early postmenopausal women: A systematic review and network meta-analysis of randomised, controlled trials

In addition to a range of physiological and psychological symptoms, menopause causes a decrement to balance performance and risk of falls. This review aimed to determine the effects of exercise interventions on balance in perimenopausal and early postmenopausal women. Web of Science, PubMed, CINAHL, SPORTDiscus and Cochrane Central Register of Controlled Trials databases were searched. Randomised, controlled trials of exercise interventions in perimenopausal or early postmenopausal populations with an average age of 65 years or younger reporting balance measures were included. Risk of bias was assessed using Cochrane RoB 2. A random effects model network meta-analysis was performed to assess the effect of exercise on balance. Standardised mean differences with 95 % confidence intervals were used as the measure of effect. Twenty-six studies were included after screening. Network meta-analyses were conducted for 5 balance variables. Whole-body vibration (standardised mean difference: 2.25, confidence interval: 0.08; 4.43), balance (standardised mean difference: 1.84, confidence interval: 0.15; 3.53), balance + nutrition (standardised mean difference: 3.81, confidence interval: 1.57; 6.05) and resistance (standardised mean difference: 1.43, confidence interval: 0.41; 2.46) exercise improved Berg balance scale performance. Resistance + aerobic + balance exercise improved one-leg stance (standardised mean difference: 0.80, confidence interval: 0.39; 1.22) and whole-body vibration improved anterior-posterior (standardised mean difference: -0.89, confidence interval: -1.48; -0.31), medio-lateral (standardised mean difference: -0.58, confidence interval: -1.15; -0.01) postural sway and falls indices (standardised mean difference: -0.75, confidence interval: -1.45; -0.04). Exercise improved all balance measures and should be considered as an adjunct therapy in perimenopausal and postmenopausal women. Whole-body vibration was most frequently the highest ranked intervention; resistance and balance training also improved balance.

The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis

INTRODUCTION

We conducted a systematic review and meta-analysis to investigate the effect of exercise training on body composition outcomes in postmenopausal women.

METHODS

PubMed, Web of Science, CINAHL, and Medline were searched to identify the randomized controlled trials which evaluated effect of exercise training versus control in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were calculated using random effects model.

RESULTS

One hundred and one studies involving 5,697 postmenopausal women were included in the meta-analysis. Results indicated that exercise training effectively increased muscle mass/ volume, muscle and fiber cross-sectional area and fat-free mass, and decreased fat mass, body fat percentage, waist circumference and visceral fat. Furthermore, subgroup analyses results revealed that aerobic and combined training had greater beneficial effects on fat mass outcomes, whereas resistance and combined training had greater beneficial effects on muscle mass outcomes.

DISCUSSION

Overall, our results revealed that exercise training is effective for improving body composition in postmenopausal women. To be specific, aerobic training is effective on fat loss, whereas resistance training is effective on muscle gain. However, combination of aerobic and resistance trainings may be considered a viable strategy to improve body composition in postmenopausal women.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42021283425.