1
|
Shi J, Yin G, Shi Z, Zhang S, Wei J, Xue T, Su X. Evaluation of the Effectiveness of In-Hospital Exercise Rehabilitation in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus Combined with Sarcopenia Effect of Lifestyle Management on Disease Status in Patients with Type 2 Diabetes Mellitus. Endocr Res 2024:1-11. [PMID: 38762774 DOI: 10.1080/07435800.2024.2353121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE The aim of this study was to explore the effects of in-hospital exercise rehabilitation on glucose and lipid metabolism and healthy physical fitness in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) combined with sarcopenia, and to provide a reference for the effective implementation of exercise rehabilitation for middle-aged and elderly patients with T2DM combined with sarcopenia in healthcare institutions. METHODS This study retrospectively included 122 patients with T2DM combined with sarcopenia treated at the General Hospital of Ningxia Medical University from August 2017 to August 2020 and randomly divided into a control group and an experimental group. The control group was given conventional treatment and the experimental group was given exercise rehabilitation in the hospital for 12 weeks to compare the indexes related to glucose and lipid metabolism and healthy fitness in the two groups. RESULTS After the intervention, the experimental group showed significant decreases in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density cholesterol (LDL-C) and body fat percentage (p < 0.05), while high-density cholesterol (HDL-C), grip strength, lower limb extension, lower limb flexion, peak oxygen uptake were significantly higher (p < 0.05) and were more significant at 12 weeks compared to the 6-week intervention (p < 0.05). However, there were no significant changes in any of the glucose metabolism indicators in the control group before and after the intervention. A two-way repeated measures ANOVA showed that at control baseline levels, HbA1c decreased significantly in the experimental group after both 6 and 12 weeks of intervention compared to the control group (p < 0.05). After 6 weeks of intervention, the experimental group showed a significant decrease in body fat percentage and a significant increase in grip strength. After 12 weeks of intervention, the experimental group showed an increase in glycemic control from 33.3% to 73.3%, a significant decrease in body fat percentage and a significant increase in grip strength, lower limb extension and lower limb flexion strength and peak oxygen uptake. CONCLUSION In-hospital exercise rehabilitation can effectively improve the glycemic and lipid profiles of patients with T2DM combined with sarcopenia and enhance their health fitness, with good clinical rehabilitation effects.
Collapse
Affiliation(s)
- Jianhua Shi
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Gaojun Yin
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zhiyun Shi
- Inspection Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Shengjun Zhang
- Department of Nutrition, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jing Wei
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Tao Xue
- Department of Nutrition, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoqian Su
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
| |
Collapse
|
2
|
Baygi F, Buhl SF, Thilsing T, Søndergaard J, Nielsen JB. Sarcopenia and sarcopenic obesity among older adults in the nordic countries: a scoping review. BMC Geriatr 2024; 24:421. [PMID: 38741067 DOI: 10.1186/s12877-024-04970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Sarcopenia and sarcopenic obesity (SO) are age-related syndromes that may compromise physical and mental health among older adults. The Nordic countries differ from other regions on prevalence of disease, life-style behavior, and life expectancy, which may impact prevalence of sarcopenia and SO. Therefore, the aim of this study is to review the available evidence and gaps within this field in the Nordic countries. METHODS PubMed, Embase, and Web of science (WOS) were searched up to February 2023. In addition, grey literature and reference lists of included studies were searched. Two independent researcher assessed papers and extracted data. RESULTS Thirty-three studies out of 6,363 searched studies were included in this scoping review. Overall prevalence of sarcopenia varied from 0.9 to 58.5%. A wide prevalence range was still present for community-dwelling older adults when definition criteria and setting were considered. The prevalence of SO ranged from 4 to 11%, according to the only study on this field. Based on the included studies, potential risk factors for sarcopenia include malnutrition, low physical activity, specific diseases (e.g., diabetes), inflammation, polypharmacy, and aging, whereas increased levels of physical activity and improved dietary intake may reduce the risk of sarcopenia. The few available interventions for sarcopenia were mainly focused on resistance training with/without nutritional supplements (e.g., protein, vitamin D). CONCLUSION The findings of our study revealed inadequate research on SO but an increasing trend in the number of studies on sarcopenia. However, most of the included studies had descriptive cross-sectional design, small sample size, and applied different diagnostic criteria. Therefore, larger well-designed cohort studies that adhere to uniform recent guidelines are required to capture a full picture of these two age-related medical conditions in Nordic countries, and plan for prevention/treatment accordingly.
Collapse
Affiliation(s)
- Fereshteh Baygi
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Sussi Friis Buhl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Trine Thilsing
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Belfield AE, Wilkinson TJ, Henson J, Sargeant JA, Breen L, Hall AP, Davies MJ, Yates T. Sarcopenia prevalence using handgrip strength or chair stand performance in adults living with type 2 diabetes mellitus. Age Ageing 2024; 53:afae090. [PMID: 38706394 PMCID: PMC11070724 DOI: 10.1093/ageing/afae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND The updated European Working Group on Sarcopenia in Older People (EWGSOP2) recommends handgrip strength (HGS) and the chair stand test (CST) to assess muscle strength, with the CST being a convenient proxy for lower limb strength. However, adiposity may differentially influence these strength criteria and produce discrepant sarcopenia prevalence. OBJECTIVE To determine the prevalence of sarcopenia using HGS or the CST, and to investigate the associations between these strength criteria and adiposity in adults with type 2 diabetes mellitus. METHODS The EWGSOP2 definition was used to assess the prevalence of probable (low muscle strength), confirmed (plus low muscle mass) and severe (plus poor physical performance) sarcopenia. Linear regression models were used to study the association between different measures of muscle strength and adiposity. RESULTS We used data from 732 adults with type 2 diabetes mellitus (35.7% female, aged 64 ± 8 years, body mass index 30.7 ± 5.0 kg/m2). Using the CST compared with HGS produced a higher prevalence of probable (31.7% vs. 7.1%), confirmed (5.6% vs. 1.6%) and severe (1.0% vs. 0.3%) sarcopenia, with poor agreement between strength criteria to identify probable sarcopenia. CST performance, but not HGS, was significantly associated with all measures of adiposity in unadjusted and adjusted models. CONCLUSIONS Higher levels of adiposity may impact CST performance, but not HGS, resulting in a higher prevalence of sarcopenia in adults with type 2 diabetes mellitus. Consideration should be paid to the most appropriate measure of muscle function in this population.
Collapse
Affiliation(s)
- Archie E Belfield
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Thomas J Wilkinson
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Joseph Henson
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Birmingham, UK
| | - Andrew P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
4
|
Lapi F, Aprile PL, Cricelli I, Vetrano DL, Cricelli C. How to support general practitioners to better detect sarcopenia among older adults: a nested case-control analysis. Eur Geriatr Med 2024:10.1007/s41999-024-00967-2. [PMID: 38523191 DOI: 10.1007/s41999-024-00967-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE This study explores correlations of sarcopenia and its proxies, such as history of falls, asthenia, and ambulation issues, with frailty levels among older adults in primary care. METHODS In a cohort of 546,590 patients aged 60 years or older, "definite" sarcopenia cases were operationally defined through the use of non-specific diagnostic codes coupled with inspection of free-texts. Proxies of sarcopenia, such as falls history, asthenia, and ambulation issues were considered as well. Frailty was calculated using an Index intended to primary care. RESULTS Overall, 171 definite sarcopenia cases were found, rising to 51,520 cases when including proxies (9.4% prevalence). There was a significant association between severe frailty and increased odds of sarcopenia, consistently observed across different event definitions. CONCLUSIONS Sarcopenia was strongly associated with severe frailty in primary care. The history of falls, asthenia, and ambulation issues were reliable proxies to raise the suspect of sarcopenia. Improved strategies for sarcopenia detection, focusing on specific indicators within severely frail individuals, are warranted.
Collapse
Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Via del Sansovino 179, 50142, Florence, Italy.
| | | | | | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| |
Collapse
|
5
|
Lee J, Yoon Y, Kim J, Kim YH. Metaheuristic-Based Feature Selection Methods for Diagnosing Sarcopenia with Machine Learning Algorithms. Biomimetics (Basel) 2024; 9:179. [PMID: 38534863 DOI: 10.3390/biomimetics9030179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
This study explores the efficacy of metaheuristic-based feature selection in improving machine learning performance for diagnosing sarcopenia. Extraction and utilization of features significantly impacting diagnosis efficacy emerge as a critical facet when applying machine learning for sarcopenia diagnosis. Using data from the 8th Korean Longitudinal Study on Aging (KLoSA), this study examines harmony search (HS) and the genetic algorithm (GA) for feature selection. Evaluation of the resulting feature set involves a decision tree, a random forest, a support vector machine, and naïve bayes algorithms. As a result, the HS-derived feature set trained with a support vector machine yielded an accuracy of 0.785 and a weighted F1 score of 0.782, which outperformed traditional methods. These findings underscore the competitive edge of metaheuristic-based selection, demonstrating its potential in advancing sarcopenia diagnosis. This study advocates for further exploration of metaheuristic-based feature selection's pivotal role in future sarcopenia research.
Collapse
Affiliation(s)
- Jaehyeong Lee
- Department of IT Convergence, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| | - Yourim Yoon
- Department of Computer Engineering, Gachon University, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| | - Jiyoun Kim
- Department of Exercise Rehabilitation, Gachon University, 191 Hambakmoe-ro, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Yong-Hyuk Kim
- School of Software, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Republic of Korea
| |
Collapse
|
6
|
Ruiz-Cárdenas JD, Montemurro A, Martínez-García MDM, Rodríguez-Juan JJ. Sit-to-Stand Video Analysis-Based App for Diagnosing Sarcopenia and Its Relationship With Health-Related Risk Factors and Frailty in Community-Dwelling Older Adults: Diagnostic Accuracy Study. J Med Internet Res 2023; 25:e47873. [PMID: 38064268 PMCID: PMC10746979 DOI: 10.2196/47873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/29/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition. OBJECTIVE We aimed to create and validate a sit-to-stand video analysis-based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty. METHODS A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis-based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test. RESULTS Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2. CONCLUSIONS The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3390/s22166010.
Collapse
Affiliation(s)
- Juan D Ruiz-Cárdenas
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain
| | - Alessio Montemurro
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain
| | - María Del Mar Martínez-García
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain
- Cystic Fibrosis Association of Murcia, Murcia, Spain
| | - Juan J Rodríguez-Juan
- Physiotherapy Department, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| |
Collapse
|
7
|
Villain C, Lebaube S, Kremer C, Chavoix C, Fournel F, Briant AR, Beauplet B. Gripwise Versus Jamar: The Challenge of a New Dynamometer Assessing Handgrip Strength. J Gerontol A Biol Sci Med Sci 2023; 78:2458-2465. [PMID: 37578949 PMCID: PMC10692423 DOI: 10.1093/gerona/glad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Sarcopenia diagnosis is partly based on handgrip strength (HGS) assessment. The gold-standard dynamometer for this measurement is the Jamar. The electronic Gripwise is a smaller and lighter one, and its measurements are correlated with the Jamar's in laboratory tests. Our study aimed to confirm this correlation in aged patients. METHODS This monocenter cross-sectional study was performed in patients of 65 years and older admitted at the University Hospital. Participants were assessed either in a seated or bedridden position, randomly allocated to begin the measurements with the Jamar or the Gripwise. RESULTS Among 649 aged inpatients assessed for eligibility, 348 were included (mean age: 79 ± 9; 52% females). The intraclass correlation coefficient was 0.93 (95% confidence interval [CI] 0.92-0.94, p < .001) for the maximum value measured with both devices and 0.94 (95% CI 0.93-0.95, p < .001) for the mean values. However, there was a significant difference in detecting low values (<16 kg in women, <27 kg in men), found in 48% of patients with Jamar, and 71% with Gripwise (p < .001). Thus, we determined alternate cutoffs for diagnosing HGS low values with the Gripwise (<12 kg in women, <22 kg in men), further validated in a supplementary validation population (n = 70). The diagnostic performances of these alternative cutoffs were high (93% sensitivity and 87% specificity in women; 94% sensitivity and 96% specificity in men). CONCLUSIONS The correlation of the Gripwise with the Jamar was confirmed in aged inpatients. However, lower values recorded with the Gripwise require alternate cutoffs for a relevant low HGS diagnosis.
Collapse
Affiliation(s)
- Cédric Villain
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, Normandie Univ., UNICAEN, INSERM U1075, COMETE, Caen, France
| | - Soazig Lebaube
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Corinne Kremer
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Chantal Chavoix
- Normandie Univ., UNICAEN, INSERM U1075, COMETE, Caen, France
| | - François Fournel
- Clinical Research Department, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Anaïs R Briant
- Biostatistical Unit of Research Department, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Bérengère Beauplet
- Department of Geriatric Medicine, Centre Hospitalier Universitaire de Caen Normandie, Normandie Univ., UNICAEN, INSERM U1086, ANTICIPE, Caen, France
- Normandy Interregional Oncogeriatric Coordination Unit, Caen, France
| |
Collapse
|
8
|
Kamper RS, Nygaard H, Ekmann A, Schultz M, Hansen SK, Hansen P, Pressel E, Rasmussen J, Suetta C. Feasibility of Assessing Older Patients in the Acute Setting: Findings From the Copenhagen PROTECT Study. J Am Med Dir Assoc 2023; 24:1898-1903. [PMID: 37567243 DOI: 10.1016/j.jamda.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Older patients are typically underrepresented in clinical trials despite representing a major proportion of the patient population. We aim to describe the feasibility of performing body composition measures, physical function measures, and patient-reported questionnaires within the first 24 hours of admission in a large sample of older acutely admitted medical patients. In addition, we aim to characterize patients with missing measurements. DESIGN Secondary analyses of cross-sectional data from a cohort study. SETTING AND PARTICIPANTS A total of 1071 acutely admitted patients aged ≥65 years from the acute medical ward at Bispebjerg Hospital, were enrolled within the first 24 hours of hospitalization. METHODS Body composition was investigated using direct segmental multifrequency bioelectrical impedance analyses (DSM-BIA) and physical function was assessed using hand grip strength (HGS) and the 30-second sit-to-stand test (STS). The orientation-memory-concentration test (OMC) was used to evaluate the prevalence of cognitive impairments within 24 hours of hospitalization, and the OMC in conjunction with the Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F) was used to assess the feasibility of patient-reported outcomes (PROs). RESULTS Mean age was 78.8 ± 7.8 years (53.0% female). HGS was performed in 96.2% of the enrolled patients, whereas the PRO, 30-second STS, and DSM-BIA were performed in 91.2%, 69.2%, and 59.8% of patients, respectively. The main barrier for performing the 30-second STS and body composition measurements was an inability to mobilize the patient from the hospital bed. CONCLUSIONS AND IMPLICATIONS The assessment of HGS and PROs show excellent feasibility in clinical research including older patients, even when the patients are enrolled and tested within 24 hours of an acute admission. Assessments of DSM-BIA and the 30-second STS show good feasibility but are less feasible in immobile patients often presenting as more frail, weaker, and cognitively impaired.
Collapse
Affiliation(s)
- Rikke S Kamper
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Hanne Nygaard
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anette Ekmann
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Schultz
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Sofie Krarup Hansen
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Hansen
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eckart Pressel
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jens Rasmussen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Geriatric & Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark; CopenAge, Copenhagen Center for Clinical Age Research, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Johansson J, Grimsgaard S, Strand BH, Sayer AA, Cooper R. Comparing associations of handgrip strength and chair stand performance with all-cause mortality-implications for defining probable sarcopenia: the Tromsø Study 2015-2020. BMC Med 2023; 21:451. [PMID: 37981689 PMCID: PMC10659040 DOI: 10.1186/s12916-023-03172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Widely adopted criteria suggest using either low handgrip strength or poor chair stand performance to identify probable sarcopenia. However, there are limited direct comparisons of these measures in relation to important clinical endpoints. We aimed to compare associations between these two measures of probable sarcopenia and all-cause mortality. METHODS Analyses included 7838 community-dwelling participants (55% women) aged 40-84 years from the seventh survey of the Tromsø Study (2015-2016), with handgrip strength assessed using a Jamar + Digital Dynamometer and a five-repetition chair stand test (5-CST) also undertaken. We generated sex-specific T-scores and categorised these as "not low", "low", and "very low" handgrip strength or 5-CST performance. Cox Proportional Hazard regression models were used to investigate associations between these two categorised performance scores and time to death (up to November 2020 ascertained from the Norwegian Cause of Death registry), adjusted for potential confounders including lifestyle factors and specific diseases. RESULTS A total of 233 deaths occurred (median follow-up 4.7 years) with 1- and 5-year mortality rates at 3.1 (95% confidence interval [CI] 2.1, 4.6) and 6.3 (95% CI 5.5, 7.2) per 1000 person-years, respectively. There was poor agreement between the handgrip strength and 5-CST categories for men (Cohen's kappa [κ] = 0.19) or women (κ = 0.20). Fully adjusted models including handgrip strength and 5-CST performance mutually adjusted for each other, showed higher mortality rates among participants with low (hazard ratio [HR] 1.22, 95% CI 0.87, 1.71) and very low (HR 1.68, 95% CI 1.02, 2.75) handgrip strength compared with the not low category. Similar associations, although stronger, were seen for low (HR 1.88, 95% CI 1.38, 2.56) and very low (HR 2.64, 95% CI 1.73, 4.03) 5-CST performance compared with the not low category. CONCLUSIONS We found poor agreement between T-score categories for handgrip strength and 5-CST performance and independent associations with mortality. Our findings suggest that these tests identify different people at risk when case-finding probable sarcopenia. As discussions on an international consensus for sarcopenia definitions proceed, testing both handgrip strength and chair stand performance should be recommended rather than viewing these as interchangeable assessments.
Collapse
Affiliation(s)
- Jonas Johansson
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Heine Strand
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department for Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle Upon Tyne NHS Foundation Trust and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
10
|
Kwon HE, Ko N, Yuk D, Choi SW, Koh SE. Improved Muscle Mass and Function With Protein Supplementation in Older Adults With Sarcopenia: A Meta-Analysis. Ann Rehabil Med 2023; 47:358-366. [PMID: 37907227 PMCID: PMC10620490 DOI: 10.5535/arm.23076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To systematically review the effects of protein supplementation in older adults with sarcopenia. METHODS : A systematic literature search was conducted in PubMed, Cochrane Library, and Embase databases until May 2023. The inclusion criteria were as follows: (1) randomized controlled trials with a quantitative study design; (2) studies with a study group of older adults with sarcopenia; (3) studies comparing muscle mass, muscle strength, and performance of older adults with sarcopenia after protein supplementation; and (4) studies published up to May 2023. RESULTS : Six retrospective comparative studies, including 715 patients, met the inclusion criteria. The nutritional supplementation group exhibited significant improvement in appendicular skeletal muscle mass (standardized mean difference [SMD]=0.41; 95% confidence interval [CI], 0.24-0.58; p<0.001; I2=1%), while handgrip strength (SMD=0.37; 95% CI, -0.32-1.07; p=0.29; I2=94%) and Short Physical Performance Battery (SPPB) (SMD=0.35; 95% CI, -0.47-1.18; p=0.40; I2=94%) showed a tendency for improvement. CONCLUSION : Nutritional supplementation with protein increased appendicular muscle mass in older adults with sarcopenia and improved handgrip strength and SPPB scores.
Collapse
Affiliation(s)
- Hyo Eun Kwon
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Nayeon Ko
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Doyoung Yuk
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Seo Won Choi
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University Medical Center, and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| |
Collapse
|
11
|
Cacciatore S, Marzetti E. Sarcopenia and physical function: Proxies of overall health and predictors of mortality in older adults. Arch Gerontol Geriatr 2023; 112:105037. [PMID: 37086681 DOI: 10.1016/j.archger.2023.105037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Affiliation(s)
- Stefano Cacciatore
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
| |
Collapse
|
12
|
Bae JH, Seo JW, Kim DY. Deep-learning model for predicting physical fitness in possible sarcopenia: analysis of the Korean physical fitness award from 2010 to 2023. Front Public Health 2023; 11:1241388. [PMID: 37614451 PMCID: PMC10443707 DOI: 10.3389/fpubh.2023.1241388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Physical fitness is regarded as a significant indicator of sarcopenia. This study aimed to develop and evaluate a deep-learning model for predicting the decline in physical fitness due to sarcopenia in individuals with potential sarcopenia. Methods This study used the 2010-2023 Korean National Physical Fitness Award data. The data comprised exercise- and health-related measurements in Koreans aged >65 years and included body composition and physical fitness variables. Appendicular muscle mass (ASM) was calculated as ASM/height2 to define normal and possible sarcopenia. The deep-learning model was created with EarlyStopping and ModelCheckpoint to prevent overfitting and was evaluated using stratified k-fold cross-validation (k = 5). The model was trained and tested using training data and validation data from each fold. The model's performance was assessed using a confusion matrix, receiver operating characteristic curve, and area under the curve. The average performance metrics obtained from each cross-validation were determined. For the analysis of feature importance, SHAP, permutation feature importance, and LIME were employed as model-agnostic explanation methods. Results The deep-learning model proved effective in distinguishing from sarcopenia, with an accuracy of 87.55%, precision of 85.57%, recall of 90.34%, and F1 score of 87.89%. Waist circumference (WC, cm), absolute grip strength (kg), and body fat (BF, %) had an influence on the model output. SHAP, LIME, and permutation feature importance analyses revealed that WC and absolute grip strength were the most important variables. WC, figure-of-8 walk, BF, timed up-and-go, and sit-and-reach emerged as key factors for predicting possible sarcopenia. Conclusion The deep-learning model showed high accuracy and recall with respect to possible sarcopenia prediction. Considering the need for the development of a more detailed and accurate sarcopenia prediction model, the study findings hold promise for enhancing sarcopenia prediction using deep learning.
Collapse
Affiliation(s)
- Jun-Hyun Bae
- Able-Art Sport, Department of Theory, Hyupsung University, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Ji-won Seo
- Department of Physical Education, Seoul National University, Seoul, Republic of Korea
| | - Dae Young Kim
- Senior Exercise Rehabilitation Laboratory, Department of Gerokinesiology, Kyungil University, Gyeongsan, Gyeongsangbuk-do, Republic of Korea
| |
Collapse
|
13
|
Montemurro A, Ruiz-Cárdenas JD, Martínez-García MDM, Rodríguez-Juan JJ. Consequences of applying the different criteria of the EWGSOP2 guideline for sarcopenia case-finding in Spanish community-dwelling older adults. Arch Gerontol Geriatr 2023; 109:104964. [PMID: 36821872 DOI: 10.1016/j.archger.2023.104964] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Sarcopenia prevalence varies according to differences in diagnostic criteria used. In order to overcome this issue, the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) published a consensus to increase harmonization for sarcopenia diagnosis. This study aimed to determine the prevalence and risk factors across the different sarcopenia diagnosis criteria recommended by EWGSOP2 and to analyze its agreement. METHODS A total of 699 community-dwelling older adults (median-age: 72, 60% female) were recruited in this cross-sectional study. Sarcopenia prevalence was obtained by different combinations of muscle strength (handgrip strength or 5-times sit-to-stand) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the EWGSOP2. Cohen's Kappa coefficient was calculated to analyze agreement among the four sarcopenia diagnostic criteria and logistic regressions were performed to identify risks associated to health-related outcomes for each diagnostic criterion. RESULTS Sarcopenia prevalence varied from 2.1% to 11.6%, depending on the diagnostic criteria used. Weak-to-moderate agreements (κ-range: 0.13-0.66) were observed among the four sarcopenia diagnosis criteria. There was scarce overlap in sarcopenic people when different diagnostic criteria were used leading to up to 10.4% of underdiagnosis. Sarcopenia defined by 5-times sit-to-stand was more associated with health-related outcomes compared to handgrip strength. CONCLUSIONS Sarcopenia prevalence rates vary considerably depending on the diagnostic criteria used. These criteria should not be used in an interchangeable way due to their weak agreement. Sarcopenia diagnosis criteria defined by 5-times sit-to-stand could be more suitable in Spanish community-dwelling older adults due their associations with health-related outcomes.
Collapse
Affiliation(s)
- Alessio Montemurro
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain.
| | - Juan D Ruiz-Cárdenas
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain
| | - María Del Mar Martínez-García
- Physiotherapy Department, Faculty of Physiotherapy, Podiatry and Occupational Therapy, Universidad Católica de Murcia, Murcia, Spain; Cystic Fibrosis Association of Murcia, Av. de las Palmeras, 37, 30120 Murcia, Spain
| | - Juan J Rodríguez-Juan
- Physiotherapy Department, Facultad de Medicina, Universidad de Murcia, Campus de Ciencias de la Salud, 30120, Murcia, Spain
| |
Collapse
|