Role of dietary protein in the sarcopenia of aging

Georg Schmorl Prize of the German Spine Society (DWG) 2023: the influence of sarcopenia and paraspinal muscle composition on patient-reported outcomes: a prospective investigation of lumbar spinal fusion patients with 12-month follow-up

PURPOSE

This study aimed to investigate the impact of sarcopenia and lumbar paraspinal muscle composition (PMC) on patient-reported outcomes (PROs) after lumbar fusion surgery with 12-month follow-up (12 M-FU).

METHODS

A prospective investigation of patients undergoing elective lumbar fusion was conducted. Preoperative MRI-based evaluation of the cross-sectional area (CSA), the functional CSA (fCSA), and the fat infiltration(FI) of the posterior paraspinal muscles (PPM) and the psoas muscle at level L3 was performed. Sarcopenia was defined by the psoas muscle index (PMI) at L3 (CSAPsoas [cm2]/(patients' height [m])2). PROs included Oswestry Disability Index (ODI), 12-item Short Form Healthy Survey with Physical (PCS-12) and Mental Component Scores (MCS-12) and Numerical Rating Scale back and leg (NRS-L) pain before surgery and 12 months postoperatively. Univariate and multivariable regression determined associations among sarcopenia, PMC and PROs.

RESULTS

135 patients (52.6% female, 62.1 years, BMI 29.1 kg/m2) were analyzed. The univariate analysis demonstrated that a higher FI (PPM) was associated with worse ODI outcomes at 12 M-FU in males. Sarcopenia (PMI) and higher FI (PPM) were associated with worse ODI and MCS-12 at 12 M-FU in females. Sarcopenia and higher FI of the PPM are associated with worse PCS-12 and more leg pain in females. In the multivariable analysis, a higher preoperative FI of the PPM (β = 0.442; p = 0.012) and lower FI of the psoas (β = -0.439; p = 0.029) were associated with a worse ODI at 12 M-FU after adjusting for covariates.

CONCLUSIONS

Preoperative FI of the psoas and the PPM are associated with worse ODI outcomes one year after lumbar fusion. Sarcopenia is associated with worse ODI, PCS-12 and NRS-L in females, but not males. Considering sex differences, PMI and FI of the PPM might be used to counsel patients on their expectations for health-related quality of life after lumbar fusion.

Factors associated with the maintenance in food texture for dependent older people with dysphagia living in nursing home - A retrospective cohort study

OBJECTIVES

Maintaining the texture of the food that nursing home residents eat is critical for maintaining quality of life and preventing malnutrition. The aim of the present study was to identify the conditions necessary for maintaining food texture for this population.

MATERIALS AND METHODS

The study included 143 people for whom reevaluation 1-year post-baseline was possible from among 256 dependent older people who consumed solid food on admission to a nursing home (baseline). The age, sex, primary disease, activities of daily living, nutritional status, oral status, swallowing ability, primitive reflexes, and food texture of the participants were determined. The participants who ate pureed or jelly after 1 year were identified and evaluated to determine factors related to maintenance of a solid diet.

RESULTS

A total of 21 participants (14.7%) changed to a pureed or jelly diet after 1 year. Multivariate analysis showed good activities of daily living (p < .05), good swallowing ability (p < .05), and maintained nutritional status (p < .05) to be correlated with solid food maintenance.

CONCLUSIONS

Maintaining activities of daily living, feeding and swallowing ability, and nutritional status appear to be important factors for the maintenance of a solid diet.

Reevaluation of the protein requirement in Chinese elderly adults without sarcopenia with the indicator amino acid oxidation technique

It is now generally believed that elderly may have slightly higher dietary protein requirements than those of the young-middle-aged adults. We have previously conducted related studies by the indicator amino acid oxidation (IAAO) technique, but more research data are needed to revise the protein requirements of the elderly. The main objective was to reevaluate the dietary protein requirements of healthy Chinese adults (65-80 years) without sarcopenia by using the IAAO technique. Nine healthy adult men and seven healthy adult women participated in the study, with protein intakes ranging from 0·1 to 1·8 g/(kg·d). Diets that delivered energy at a 1·5 resting energy expenditure were isocaloric. The amounts of phenylalanine and tyrosine needed to remain constant for each protein dosage. By applying a nonlinear mixed-effects model analysis on the F13CO2 data, which revealed a breakpoint in F13CO2 in response to graded protein intakes, the mean protein requirement was calculated. The mean estimated average requirement (EAR) for healthy elderly Chinese adults without sarcopenia was determined to be 0·94 g/(kg·d). The protein recommended nutrient intake (RNI) determined using various derivation approaches ranged from 1·13 to 1·36 g/(kg·d). The EAR for Chinese adults without sarcopenia aged 65-80 years in this study is 6·8 % higher than the current recommended EAR (0·88 g/(kg·d)). The RNI derived using various derivation approaches are all greater than the current RNI (0·98 g/(kg·d)). This trial was registered with the Chinese clinical trial registry as ChiCTR2200061382.

Eating Behaviors and Physical Activity versus the Big Five Personality Traits in Women with a Hereditary Predisposition to Breast or Ovarian Cancer

The Big Five personality traits-neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness-represent continuous, individual features that affect a number of vital health aspects, including morbidity, self-reported health status, or lifestyle. The aim of this study was to analyze the relationship between the eating behaviors and engagement in physical activity of women with a hereditary predisposition to breast or ovarian cancer and the Big Five personality traits. A total of 357 women, participants of 'The National Program for Families With Genetic/Familial High Risk for Cancer', were included in the study. In the healthy group, the following statistically significant predictors were found in variables: agreeableness-meal frequency (β = 0.151; p = 0.030); neuroticism-consumption of fruits and vegetables (β = -0.177; p = 0.016) and cereal products (β = -0.223; p = 0.002); openness to experience-consumption of plant-based fats (β = 0.141; p = 0.034) and physical activity (β = 0.153; p = 0.021). In the cancer group, the frequency of dairy consumption (β = 0.286; p = 0.003) and physical activity (β = 0.370; p = 0.000) were found to be statistically significant predictors for the openness to experience variable. Neuroticism is associated with less frequent consumption of fresh fruits and vegetables as well as cereal products. Openness to experience was more often linked with a higher frequency of dairy consumption, plant-based fats, and physical activity. Women with breast or ovarian cancer and a higher openness to experience consumed dairy and engaged in physical activity more often than their peers with the remaining personality traits.

Association between nut consumption and low muscle strength among Korean adults

Nuts are an important component of a healthy diet, but little has been known about their effects on muscle health. Therefore, this study examined the association between nut consumption and low muscle strength among Korean adults. This cross-sectional analysis was conducted using single 24-h recall and handgrip strength data from 3962 younger adults 19-39 years, 6921 middle-aged adults 40-64 years and 3961 older adults ≥65 years participated in the seventh cycle (2016-2018) of the Korea National Health and Nutrition Examination Survey. Low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Sex-specific OR were obtained for younger, middle-aged and older adults using multivariable logistic regression analyses. About one in four Korean adults were consuming nuts (using a culinary definition) with peanut being the most frequently consumed type. After adjustment for age, BMI, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical history and dietary protein intake, nut consumption was associated with the lower risk of low muscle strength among older adults ≥65 years (men: OR 0·55, 95 % CI (0·38, 0·79); women: OR 0·69, 95 % CI (0·51, 0·93)); however, this association was not observed among younger adults 19-39 years or middle-aged adults 40-64 years. Our results suggest that consuming nuts might be beneficial in lowering the risk of low muscle strength among Korean older adults.

Evaluation of protein requirements using the indicator amino acid oxidation method: a scoping review

BACKGROUND

The indicator amino acid oxidation (IAAO) method has been accepted as an approach to evaluate habitual protein requirements under free-living conditions.

OBJECTIVES

This scoping review reports on literature that evaluated protein requirements in humans using the IAAO methods.

METHODS

Three databases (PubMed/Medline, Web of Science, and ProQuest) were systematically searched to identify studies that evaluated protein requirements using the IAAO method published in English until 5 June, 2023. We evaluated the study quality using previously developed criteria. We extracted the characteristics of the study design and the results of protein requirements. Two reviewers conducted both reviews and quality assessments independently; any differences among them were resolved by consensus or agreement of all team members.

RESULTS

We extracted 16 articles targeting children, young adults (including pregnant women, resistance training athletes, endurance-training athletes, and team sports), and older adults. In quality assessment, 14 studies were evaluated "strong," but the remaining 2 were "moderate." These studies were conducted in only 3 countries and did not include all sexes or life stages. The range of the estimated average protein requirements of each life stage was 1.30 g/kg body weight/d for children, 0.87 to 2.10 (0.87-0.93 for general young adults, 1.22-1.52 for pregnant women, 1.49-2.00 for resistance-trained athletes, 1.65-2.10 for endurance athletes, and 1.20-1.41 for team sports athletes) g/kg body weight/d for young adults, and 0.85 to 0.96 g/kg body weight/d for older adults.

CONCLUSIONS

Protein requirements in 14 studies were higher than the current reference for each sex, life stage, and physical activity that are related to protein requirements. In the future, protein requirements of various populations including sex and life stage could be assessed using the IAAO methods worldwide.

Effects of resistance training and protein supplementation interventions on muscle volume and muscle function: sex differences in humans

PURPOSE

This review aimed to identify differences in the effects of co-intervention with resistance training (RT) and protein supplementation according to sex and provide meaningful information for future research on the development of exercise programs to improve muscle volume and muscle function.

METHODS

PubMed, Science Direct, and Google Scholar were searched to identify clinical and nonclinical studies that assessed the effects of RT in older adults with sarcopenia; these studies were published between 1990 and 2023. Cross-sectional and double-blind studies (randomized controlled trials, RCTs) were examined in this review.

RESULTS

The effects of parallel intervention with RT and protein supplementation on muscle volume and physical function were found to differ according to sex. Both males and females had improvements in muscle strength, muscle mass, and physical function after RT and protein supplementation; however, many studies found a greater increase in muscle volume and function in males than in females. Such difference may be due to differences in physiological characteristics between males and females.

CONCLUSION

Based on the findings of this review, the effects of combined intervention with RT and protein supplementation on muscle strength, muscle mass, and physical function to differ according to sex. Owing to these sex differences in the response and physiological characteristics caused by the parallel intervention of RT and protein supplementation, such differences must be considered to maximize the effects of RT and protein supplementation.

Can sarcopenia predict poor prognosis of sepsis due to acute cholecystitis?

AIM OF THE STUDY

As sepsis is a life-threatening disease, it is important to predict the prognosis in the early stages to establish treatment plans. This study aimed to investigate the association between sarcopenia, determined by the psoas muscle area, and the prognosis of sepsis due to acute cholecystitis.

METHODS

This retrospective single-center observational study included adult patients with sepsis due to acute cholecystitis who visited the emergency department between January 2016 and December 2021. The area of both sides of the psoas muscle at the L3 level was measured, and the psoas muscle index (PMI) corrected by the patient's height was calculated. Sarcopenia was determined based on PMI. The primary outcome was in-hospital mortality, and secondary outcomes were intensive care unit (ICU) admission, length of hospital stay (LOS), and 14-day mortality.

RESULTS

A total of 374 patients were included in this study. In this cohort, the lower quartile of PMI according to gender was set as the cut-off value to define sarcopenia. Sarcopenia was defined as PMI < 423 mm2/m2 for males and < 269 mm2/m2 for females. There were 94 patients in the sarcopenic group and 280 in the non-sarcopenic group. There was a significant association between sarcopenia and ICU admission (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.05-3.76), and there was also a significant association between sarcopenia and in-hospital mortality (OR, 6.40; 95%CI, 1.13-36.09). Additionally, the median LOS in the sarcopenic group (11.5 (Cruz-Jentoft et al., 2010; Kawaguchi et al., 2019; Kim et al., 2017; Ritz et al., 2021; Cox et al., 2021; Lee et al., 2018; Okada et al., 2021; Prashanthi et al., n.d.; Amini et al., 2015; Fearon et al., 2011) days) was significantly longer than the median (8 (Rosenberg, 1989, 1997; Cruz-Jentoft et al., 2010; Kawaguchi et al., 2019; Kim et al., 2017; Ritz et al., 2021) days) in the non-sarcopenic group.

CONCLUSIONS

In patients with sepsis due to acute cholecystitis, sarcopenia was significantly associated with ICU admission, LOS, and in-hospital mortality.

Are sit-to-stand and isometric handgrip tests comparable assessment tools to identify dynapenia in sarcopenic people?

Sarcopenia is a neuromuscular disease characterized by the simultaneous existence of reduced muscle strength and muscle atrophy. The current recommendations for the diagnosis of sarcopenia suggest dynapenia be operationalized using either isometric handgrip strength (IHG) or sit-to-stand (STS) tests. However, specific associations between each of these assessment tools and sarcopenia-related parameters have been observed. In addition, important neuromuscular and biomechanical aspects differ between IHG and STS. This scenario has important clinical implications and calls for detailed studies to refine the current recommendations for sarcopenia identification. The present communication presents evidence to foster a constructive debate on the matter.

When a calorie is not just a calorie: Diet quality and timing as mediators of metabolism and healthy aging

An epidemic of obesity has affected large portions of the world, increasing the risk of developing many different age-associated diseases, including cancer, cardiovascular disease, and diabetes. In contrast with the prevailing notion that "a calorie is just a calorie," there are clear differences, within and between individuals, in the metabolic response to different macronutrient sources. Recent findings challenge this oversimplification; calories from different macronutrient sources or consumed at different times of day have metabolic effects beyond their value as fuel. Here, we summarize discussions conducted at a recent NIH workshop that brought together experts in calorie restriction, macronutrient composition, and time-restricted feeding to discuss how dietary composition and feeding schedule impact whole-body metabolism, longevity, and healthspan. These discussions may provide insights into the long-sought molecular mechanisms engaged by calorie restriction to extend lifespan, lead to novel therapies, and potentially inform the development of a personalized food-as-medicine approach to healthy aging.

Effectiveness of Home-Based Exercise and Nutrition Programs for Senior Adults on Muscle Outcomes: A Scoping Review

This scoping review investigates the volume of evidence for home-based exercise and nutrition programs and their effect on muscle quality among senior adults to inform implementation and future research. It aims to answer the research question: What are the evidence, challenges, and needs for research regarding a home-based exercise and nutrition intervention program to improve muscle outcomes in senior adults? This scoping review was conducted following the PRISMA extension for Scoping Review. The following databases were searched: PubMed, Scopus, MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Applied filters were used to help condense the research articles. A total of 13 studies met the inclusion criteria for this scoping review. Most exercise interventions were either resistance or multi-component exercise programs. The nature of the nutrition intervention varied between different supplements, foods, education, or counseling. Muscle outcomes included muscle mass in nine studies, muscle function in all the studies, muscle strength in ten studies, and biochemical analyses in two studies. Two studies found improvements in muscle mass; two studies revealed improvements in all their muscle function tests; and three studies revealed improvements in muscle strength. Muscle biopsy in a study revealed enhanced muscle fibers, but both studies did not reveal any biomarker improvements. The scoping review findings revealed mixed results on the effectiveness of a home-based exercise and nutrition program. However, the current evidence does have many gaps to address before recommending this form of intervention for senior adults as an effective way to prevent and manage sarcopenia. Since this review identified multiple knowledge gaps, strengths, and limitations in this growing field, it can be a starting point to help build future study designs and interventions in this population.

"Diet for the prevention and management of sarcopenia"

Sarcopenia is a geriatric condition characterized by a progressive loss of skeletal muscle mass and strength, with an increased risk of adverse health outcomes (e.g., falls, disability, institutionalization, reduced quality of life, mortality). Pharmacological remedies are currently unavailable for preventing the development of sarcopenia, halting its progression, or impeding its negative health outcomes. The most effective strategies to contrast sarcopenia rely on the adoption of healthier lifestyle behaviors, including adherence to high-quality diets and regular physical activity. In this review, the role of nutrition in the prevention and management of sarcopenia is summarized. Special attention is given to current "blockbuster" dietary regimes and agents used to counteract age-related muscle wasting, together with their putative mechanisms of action. Issues related to the design and implementation of effective nutritional strategies are discussed, with a focus on unanswered questions on the most appropriate timing of nutritional interventions to preserve muscle health and function into old age. A brief description is also provided on new technologies that can facilitate the development and implementation of personalized nutrition plans to contrast sarcopenia.

Physical Therapy Assessment Tool Threshold Values to Identify Sarcopenia and Locomotive Syndrome in the Elderly

This study aimed to evaluate sarcopenia and locomotive syndrome in Korean elderly patients, analyze the closely related factors, and determine the threshold for distinguishing participants with sarcopenia, locomotive syndrome, and non-disease. To this end, we enrolled 210 subjects aged 65 years or more and classified them into the sarcopenia (n = 36) and locomotive syndrome (n = 164) groups; a control group was also included (n = 10). We evaluated the characteristics of these patients using the Timed Up and Go (TUG) test and Berg Balance Scale (BBS) and performed statistical analysis. Our findings showed statistically significant differences between the groups, leading to the derivation of a significant threshold value. The threshold value of the TUG test between the control and locomotive syndrome groups was 9.47 s; the threshold value of the BBS was 54 points, respectively. The threshold value of the TUG test between the locomotive syndrome and sarcopenia groups was 10.27 s, and the threshold value of the BBS was 50 points, respectively. These findings suggest that sarcopenia is closely related to locomotive syndrome, and that sarcopenia and locomotive syndrome can be identified using a physical therapy diagnostic evaluation tool.

Exercise therapy for sarcopenia and diabetes

Aging is characterized by the gradual deterioration of function at the molecular, cellular, tissue, and organism levels in humans. The typical diseases caused by changes in body composition, as well as functional decline in the human body’s organs due to aging include sarcopenia and metabolic disorders. The accumulation of dysfunctional aging β cells with age can cause decreased glucose tolerance and diabetes. Muscle decline has a multifactorial origin, involving lifestyle habits, disease triggers, and age-dependent biological changes. The reduced function of β cells in elderly people lowers insulin sensitivity, which affects protein synthesis and interferes with muscle synthesis. The functional decrease and aggravation of disease in elderly people with less regular exercise or physical activity causes imbalances in food intake and a continuous, vicious cycle. In contrast, resistance exercise increases the function of β cells and protein synthesis in elderly people. In this review, we discuss regular physical activities or exercises to prevent and improve health, which is sarcopenia as decreased muscle mass and metabolic disorders as diabetes in the elderly.

Epicatechin Inhibited Lipid Oxidation and Protein Lipoxidation in a Fish Oil-Fortified Dairy Mimicking System

In this study, a typical tea polyphenol epicatechin (EC) was investigated for its impact on the oxidative stability of whey protein isolate (WPI) in a fish oil-fortified emulsion. The oil-in-water emulsion system consisted of fish oil (1%, w/w), WPI (6 mg/mL), and EC (0.1, 1, and 2 mM), and the oxidation reaction was catalyzed by Fenton's reagent at 25 °C for 24 h. The results showed EC exhibited a dose-dependent activity in the reduction of lipid oxidation (TBARS) and protein carbonylation. A Western blot analysis demonstrated that protein lipoxidation was inhibited by EC via interrupting the covalent binding of lipid secondary oxidation products, MDA, onto proteins. In addition, protein lipoxidation induced a loss of tryptophan fluorescence, and protein hydrolysis was partially recovered by EC. The findings of this study provide an in-depth understanding of the performance of phenolic antioxidants in relieving lipid oxidation and subsequent protein lipoxidation in oil-containing dairy products.

Essential Amino Acid and Tea Catechin Supplementation after Resistance Exercise Improves Skeletal Muscle Mass in Older Adults with Sarcopenia: An Open-Label, Pilot, Randomized Controlled Trial

Tea catechins (TCCs) have gained significant attention owing to their health effects. However, evidence is limited regarding the benefit of TCC and essential amino acids (EAAs) ingestion plus that of TCC ingestion after resistance exercise (RE) among older individuals with sarcopenia. We aimed to evaluate whether a 24-week nutritional program involving EAA and TCC supplementation after RE improved skeletal muscle mass (SMM) among older adults with sarcopenia.

METHODS

We conducted an open-label, pilot, randomized controlled trial among older adults with sarcopenia at the Harima Care Center or community in Hyogo, Japan. Participants were allocated to RE (n = 18), RE with EAA supplementation (RE + EAA, n = 18), or RE with EAA and TCC supplementation (RE + EAA + TCC, n = 18) groups. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria. A 24-week resistance exercise program was carried out twice weekly, with an intake of 3,000 mg and 540 mg of EAA and TCC supplements, respectively. SMM was the primary outcome parameter.

The mean adherence rate to exercise and supplementation intake over the 24-week intervention period was 86.8% in the RE + EAA + TCC group, 86.4% in the RE + EAA group, and 85.4% in the RE group. A significant group-by-time interaction was identified for SMM (p = 0.010). The pre- to post-intervention increase in SMM was significantly higher in the RE + EAA + TCC group than in the RE group (p = 0.010).

These results suggest that supplementation with EAA and TCC after RE, compared to RE only, improves SMM in older people with sarcopenia. To the best of our knowledge, our study is the first pilot randomized controlled trial to evaluate the effect of TCC supplementation on SMM in older people with sarcopenia.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/07315724.2022.2025546.

Impact of sarcopenia on postoperative pulmonary complications after gastric cancer surgery: A retrospective cohort study

Background

Few studies have investigated the relationship between sarcopenia and postoperative pulmonary complications (PPCs) after gastric cancer surgery. This study aimed to explore the impact of sarcopenia on PPCs in patients who had undergone gastric cancer surgery.

Methods

We included patients who underwent a transabdominal radical gastrectomy between June 2016 and October 2020. Patients were divided into two groups according to the median prevalence rate of lumbar triplane skeletal muscle index (L3 SMI): sarcopenia group (≤37.5% percentile in male and female group) and non-sarcopenia group (>37.5% percentile in male and female group). Baseline characteristics, intraoperative and postoperative conditions, pulmonary complications, and overall complications were compared between the two groups. The primary outcome was the incidence of PPCs. The secondary outcomes were overall postoperative complications and length of stay (LOS).

Results

Among the 143 patients included, 50 had sarcopenia and 93 had not. Compared to the non-sarcopenia group, the sarcopenia group had a higher the incidence of PPCs (22.0% vs. 8.6%, P = 0.024). The incidence of overall postoperative complications in the sarcopenia group was higher than that in the non-sarcopenia group (36.00% vs. 20.43%, P = 0.043). There was no significant difference in the LOS between the two groups.

Conclusions

Our research indicates that sarcopenia, preoperative comorbidities, and longer duration of intraoperative oxygen saturation <95% were risk factors for PPCs. Sarcopenia is an independent risk factor for postoperative complications. Given that our results provided a correlation rather than causation, future prospective randomized trials are needed to confirm the relationship between sarcopenia and prognosis.

Diet was less significant than physical activity in the prognosis of people with sarcopenia and metabolic dysfunction-associated fatty liver diseases: Analysis of the National Health and Nutrition Examination Survey III

BACKGROUND

Sarcopenia is prevalent in metabolic dysfunction-associated fatty liver diseases (MAFLD), and the primary treatment for both diseases is lifestyle modification. We studied how dietary components and physical activity affect individuals with sarcopenia and MAFLD.

MATERIALS AND METHODS

We conducted a study utilizing National Health and Nutrition Examination Survey (NHANES) III (1988-1994) data with Linked Mortality file (through 2019). The diagnosis of fatty liver disease (FLD) was based on ultrasound images revealing moderate and severe steatosis. Using bioelectrical measures, sarcopenia was assessed. Using self-report data, dietary intake and physical activity levels were evaluated.

RESULTS

Among 12,259 participants, 2,473 presented with MAFLD, and 290 of whom had sarcopenia. Higher levels of physical activity (odds ratio [OR] = 0.51 [0.36-0.95]) and calorie (OR = 0.58 [0.41-0.83]) intake reduced the likelihood of sarcopenia in MAFLD patients. During a median follow-up period of 15.3 years, 1,164 MAFLD and 181 MAFLD patients with sarcopenia perished. Increased activity levels improved the prognosis of patients with sarcopenia (Insufficiently active, HR = 0.75 [0.58-0.97]; Active, HR = 0.64 [0.48-0.86]), which was particularly pronounced in older patients.

CONCLUSION

In the general population, hyperglycemia was highly related to MAFLD prognosis. Physical inactivity and a protein-restricted diet corresponded to sarcopenia, with physical inactivity being connected to poor outcomes. Adding protein supplements would be beneficial for older people with sarcopenia who are unable to exercise due to frailty, while the survival benefits were negligible.

Preoperative skeletal muscle fat infiltration is a strong predictor of poorer survival in gallbladder cancer underwent surgery

BACKGROUND & AIMS

Recently, a decrease in skeletal muscle, termed sarcopenia, has been reported to be associated with poorer survival of patients in several types of cancer. However, few studies have investigated the association between sarcopenia and the survival of patients with gallbladder cancer.

METHODS

A total of 88 patients undergoing curative resection for advanced gallbladder cancer were included in this study. The quality of skeletal muscle was assessed by the intramuscular adipose tissue content (IMAC), and the quantity of skeletal muscle was assessed by the psoas muscle index (PMI), measured on preoperative computed tomography. The optimum cutoff values for IMAC and PMI for predicting the overall survival in each sex were determined using a minimum p value approach. Clinicopathological factors, IMAC and PMI were retrospectively analyzed to identify the predictors of overall survival (OS).

RESULTS

The cutoff values for IMAC were -0.3 in males and 0.04 in females. The numbers of patients with low IMAC and high IMAC were 42 and 46, respectively. The cutoff values for PMI were 7.3 cm²/m² in males and 5.0 cm²/m² in females. The numbers of patients with low PMI and high PMI were 22 and 66, respectively. A multivariate analysis revealed that pT stage (pT3/4, hazard ratio [HR] = 6.72, p = 0.004), high IMAC (HR = 4.12, p < 0.001), Bile duct infiltration (present, HR = 2.82, p = 0.046), high age (≥72 years old, HR = 2.64, p = 0.010), major hepatectomy (performed, HR = 2.50, p = 0.031) and pN1/2 (HR = 2.17, p = 0.010) as independent prognostic factors.

CONCLUSION

IMAC was independent prognostic factor for resected advanced gallbladder cancer, so the quality of skeletal muscle more strongly predicted survival than the quantity of skeletal muscle.

Contribution of muscle satellite cells to sarcopenia

Sarcopenia, a disorder characterized by age-related muscle loss and reduced muscle strength, is associated with decreased individual independence and quality of life, as well as a high risk of death. Skeletal muscle houses a normally mitotically quiescent population of adult stem cells called muscle satellite cells (MuSCs) that are responsible for muscle maintenance, growth, repair, and regeneration throughout the life cycle. Patients with sarcopenia are often exhibit dysregulation of MuSCs homeostasis. In this review, we focus on the etiology, assessment, and treatment of sarcopenia. We also discuss phenotypic and regulatory mechanisms of MuSC quiescence, activation, and aging states, as well as the controversy between MuSC depletion and sarcopenia. Finally, we give a multi-dimensional treatment strategy for sarcopenia based on improving MuSC function.

Sarcopenia is as common in older patients with dementia with Lewy bodies as it is in those with Alzheimer's disease

AIM

Alzheimer's disease (AD) and dementia with Lewy body (DLB) constitute the most common types of dementia, and are two common geriatric syndromes; however, sarcopenia has not been elaborately evaluated in DLB so far. Therefore, this study aimed to investigate the relationship between sarcopenia and DLB in older adults.

METHODS

In this retrospective and cross-sectional study, 662 participants, who were followed in a memory clinic at the Geriatrics department of a university hospital, were included. Comprehensive Geriatric Assessment, including the activities of daily living, malnutrition and malnutrition risk, frailty, cognition, and sarcopenia were assessed. Sarcopenia was defined according to the revised European Working Group on Sarcopenia in Older People-2 criteria.

RESULTS

A total of 662 participants (461 healthy controls, 133 with AD and 68 with DLB) with a mean age of 73.60 ± 7.50 years were included. The prevalence of probable sarcopenia and sarcopenia was 53.4% and 19.5%, respectively, in patients with AD, whereas it was 55.9% and 19.1%, respectively, in patients with DLB. After adjustment analyses, probable sarcopenia, sarcopenia and low muscle mass were related to AD (P < 0.001, P = 0.001, P < 0.001, respectively). Probable sarcopenia and slow gait speed were associated with DLB (P < 0.01, P < 0.001, respectively).

CONCLUSIONS

Sarcopenia is common in patients with DLB and in those with AD, and seems to be closely related to low muscle strength and slow gait speed in DLB patients. Considering sarcopenia-related negative health outcomes in older adults, the evaluation of sarcopenia, therefore, should also be among the follow-up and treatment goals of DLB patients. Geriatr Gerontol Int 2022; 22: 418-424.

Association between protein intake and lean body mass in a group of Masters Athletes

Recommendations for protein intake are based on total body weight; however, these recommendations do not consider lean body mass (LBM). The purpose of the present study was to identify the average protein intake in g/kg LBM in a group of healthy Masters Athletes (≥26 years of age, exercising ≥2 d/week). Data were obtained from a cross-sectional study. Body weight (kg), height (cm) and LBM via dual-energy X-ray absorptiometry were measured. Dietary intake was measured using a 2005 Block Food Frequency Questionnaire. The average energy intake, the percent energy from protein and the average protein intake in g/kg LBM were calculated. Differences between protein intake and the US Recommended Dietary Allowance (US RDA) (0⋅8 g/kg body weight) were determined. Alpha levels were set a priori to P < 0⋅05. A total of 176 participants (94 women, 82 men; 39 ± 11 years of age; body mass index: 24⋅6 ± 3⋅4 kg/m²) were analysed. The average energy intake, the percent protein energy and the average protein intake were 7996⋅9 ± 110⋅9 kilojoules (kJ)/d (1,910⋅4 ± 26⋅5 kcal), 15⋅5 ± 2⋅6 % and 1⋅43 ± 0⋅53 g/kg LBM, respectively. No differences existed between women and men for protein intake/kg LBM. Both sexes had significantly higher protein intakes than the US RDA (P < 0⋅001). We identified the average protein intake (g/kg LBM) in healthy Masters Athletes that may contribute to evolving perspectives on the determination of protein needs. The present study helps establish the relationship between protein intake and LBM so that we may further increase our accuracy when developing future protein recommendations.

Cardiovascular protection associated with cilostazol, colchicine and target of rapamycin inhibitors

ABSTRACT

An alteration in extracellular matrix production by vascular smooth muscle cells is a crucial event in the pathogenesis of vascular diseases such as aging-related, atherosclerosis and allograft vasculopathy. The human target of rapamycin (TOR) is involved in the synthesis of extracellular matrix by vascular smooth muscle cells. TOR inhibitors reduce arterial stiffness, blood pressure, and left ventricle hypertrophy and decrease cardiovascular risk in kidney graft recipients and patients with coronary artery disease and heart allograft vasculopathy. Other drugs that modulate extracellular matrix production such as cilostazol and colchicine have also demonstrated a beneficial cardiovascular effect. Clinical studies have consistently shown that cilostazol confers cardiovascular protection in peripheral vascular disease, coronary artery disease, and cerebrovascular disease. In patients with type 2 diabetes, cilostazol prevents the progression of subclinical coronary atherosclerosis. Colchicine reduces arterial stiffness in patients with Familial Mediterranean Fever and patients with coronary artery disease. Pathophysiological mechanisms underlying the cardioprotective effect of these drugs may be related to interactions between the cytoskeleton, TOR signaling and cyclic AMP synthesis that remain to be fully elucidated. Adult vascular smooth muscle cells exhibit a contractile phenotype and produce little extracellular matrix. Conditions that upregulate extracellular matrix synthesis induce a phenotypic switch toward a synthetic phenotype. TOR inhibition with rapamycin reduces extracellular matrix production by promoting the change to the contractile phenotype. Cilostazol increases the cytosolic level of cyclic AMP, which in turn leads to a reduction in extracellular matrix synthesis. Colchicine is a microtubule-destabilizing agent that may enhance the synthesis of cyclic AMP.

Changes in physical activity levels and relationship to balance performance, gait speed, and self-rated health in older Swedish women: a longitudinal study

Background and aim

Physical activity levels in older people often decrease and may mean impaired physical functioning leading to an increased fall risk. The aim of this study was to investigate self-reported change in physical activity dose and deterioration in balance performance, gait speed, and self-rated health (SRH) in older women between two time points in a follow-up study.

Methods

A cohort of community-living women, aged 69–79 years (n = 351) were evaluated by questionnaire and clinical tests on balance, gait speed, and SRH at baseline. One hundred and eighty-six women were followed-up by these tests 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann–Whitney U test were used for the analysis.

Results

The greatest changes were seen in one-leg standing time (OLST) with eyes closed (− 60%) and eyes open (− 42%). The population was divided into high exercise (HE, n = 49) and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences between HE and LE concerning tandem walk forwards (steps) (HE = 8.5; LE = 2.5) and backwards (HE = 11; LE = 3.5) emerged. The HE group estimated SRH (VAS-scale) 30 mm higher at baseline and 17 mm higher at follow-up than the LE group.

Conclusion

Greater physical activity seems to be an important predictor for maintaining physical function and SRH in older women.

Sex and genetic background define the metabolic, physiologic, and molecular response to protein restriction

Low-protein diets promote metabolic health in humans and rodents. Despite evidence that sex and genetic background are key factors in the response to diet, most protein intake studies examine only a single strain and sex of mice. Using multiple strains and both sexes of mice, we find that improvements in metabolic health in response to reduced dietary protein strongly depend on sex and strain. While some phenotypes were conserved across strains and sexes, including increased glucose tolerance and energy expenditure, we observed high variability in adiposity, insulin sensitivity, and circulating hormones. Using a multi-omics approach, we identified mega-clusters of differentially expressed hepatic genes, metabolites, and lipids associated with each phenotype, providing molecular insight into the differential response to protein restriction. Our results highlight the importance of sex and genetic background in the response to dietary protein level, and the potential importance of a personalized medicine approach to dietary interventions.

Fasting-Mimicking-Diet does not reduce skeletal muscle function in healthy young adults: a randomized control trial

PURPOSE

The aim of this study was to evaluate the short- and long-term effects of the Fasting-Mimicking-Diet (FMD) intervention on neuromuscular parameters of force production in healthy young men.

METHODS

Twenty-four physically active men completed the study. Participants were randomly assigned to Fasting-Mimicking (FMD) or Normal Diet (ND) and asked to follow three cycles of dietary intervention. Neuromuscular parameters of force production during maximal voluntary isometric contractions (MVCs) with the leg extensors muscles and anthropometrics were measured at baseline (T0), at the end of the first cycle (T1), and 7-10 days after the 3rd cycle of the nutritional intervention (T2). The study was registered on Clinicaltrials.gov (No. NCT04476615).

RESULTS

There was a significant decrease in body mass at T1 for FMD (- 2.6 kg, ∆ from baseline, on average; p < 0.05) but not in ND (- 0.1 kg;). Neuromuscular parameters of force production, muscle volume, and MVC torque did not change or differ between groups across visits. Results were similar even when parameters were normalized by muscle volume.

CONCLUSION

The consumption of FMD in a group of young healthy male subjects showed to be feasible, and it did not affect neuromuscular parameters of force production. The results suggest that FMD could be safely adopted by strength athletes without detrimental effects on force and muscle volume. Further research in clinical population at risk of muscle mass loss, such as elderly and obese subjects with sarcopenia, is warranted.

De-Training Effects Following Leucine-Enriched Whey Protein Supplementation and Resistance Training in Older Adults with Sarcopenia: A Randomized Controlled Trial with 24 Weeks of Follow-Up

OBJECTIVES

This study aimed to evaluate the effectiveness of de-training after a combined intervention of leucine-enriched whey protein supplementation and resistance training on skeletal muscle mass and strength in older adults with sarcopenia.

DESIGN

A randomized controlled trial.

SETTING

A community in Hyogo, Japan.

PARTICIPANTS

The study included older adults aged ≥ 65 years who were screened for sarcopenia at the Care Center from, a community in Hyogo, Japan. The participants were randomly allocated to one of three groups: whey protein supplementation after resistance training (RT + PRO; n = 27), resistance training only (RT; n = 27), and whey protein supplementation only (PRO; n = 27).

INTERVENTIONS

An intervention program was conducted over a period of 24 weeks. The program included RT and/or PRO supplementation twice a week for 24 weeks, followed by a de-training period for another 24 weeks. PRO supplementation included 11.0 g of protein and 2,300 mg of leucine. The total energy and protein intake amounts for the participants in all groups were controlled to achieve at least 30 kcal/kg ideal body weight (IBW)/day and 1.2 g/kg IBW/day, respectively, during the intervention and de-training periods.

MEASUREMENTS

The primary outcomes, such as mean change of appendicular skeletal muscle mass index (ΔASMI), and secondary outcomes, such as handgrip strength (ΔHGS), were measured at baseline, the end of intervention, and at 12 and 24 weeks of de-training.

RESULTS

Compared to baseline, ASMI and HGS increased significantly at the end of the intervention period in the RT+PRO group (ASMI and HGS, p < 0.01); however, there were no significant differences in ΔASMI and ΔHGS between each group. At 24 weeks of the de-training period, ΔASMI and ΔHGS were higher in the RT + PRO group than in the RT group (p < 0.05 and p < 0.01, respectively).

CONCLUSION

We demonstrated that combined intervention of RT and PRO showed long-term maintenance in treating sarcopenia than RT only at 24 weeks after de-training. Therefore, PRO intake after RT may be useful in the treatment of sarcopenia in older adults.

The importance of protein sources to support muscle anabolism in cancer: An expert group opinion

This opinion paper presents a short review of the potential impact of protein on muscle anabolism in cancer, which is associated with better patient outcomes. Protein source is a topic of interest for patients and clinicians, partly due to recent emphasis on the supposed non-beneficial effect of proteins; therefore, misconceptions involving animal-based (e.g., meat, fish, dairy) and plant-based (e.g., legumes) proteins in cancer are acknowledged and addressed. Although the optimal dietary amino acid composition to support muscle health in cancer is yet to be established, animal-based proteins have a composition that offers superior anabolic potential, compared to plant-derived proteins. Thus, animal-based foods should represent the majority (i.e., ≥65%) of protein intake during active cancer treatment. A diet rich in plant-derived proteins may support muscle anabolism in cancer, albeit requiring a larger quantity of protein to fulfill the optimal amino acid intake. We caution that translating dietary recommendations for cancer prevention to cancer treatment may be inadequate to support the pro-inflammatory and catabolic nature of the disease. We further caution against initiating an exclusively plant-based (i.e., vegan) diet upon a diagnosis of cancer, given the presence of elevated protein requirements and risk of inadequate protein intake to support muscle anabolism. Amino acid combination and the long-term sustainability of a dietary pattern void of animal-based foods requires careful and laborious management of protein intake for patients with cancer. Ultimately, a dietary amino acid composition that promotes muscle anabolism is optimally obtained through combination of animal- and plant-based protein sources.

Major dietary patterns in relation to muscle strength status among middle-aged people: A cross-sectional study within the RaNCD cohort

Grip strength in midlife can predict physical disability in senior years. Recent evidence shows the critical role of nutritional status on muscle function. We aimed to elucidate whether adherence to a particular dietary pattern would be associated with abnormal muscle strength among middle-aged people. In this cross-sectional study, a semiquantitative Food Frequency Questionnaire was used to assess the dietary intake of 2781 participants in the Ravansar Non-Communicable Chronic Disease (RaNCD) cohort. Major dietary patterns from 28 main food groups were extracted using principal component analysis. Binary logistic regression was used to determine the association between the tertiles of the major dietary patterns and muscle strength status. Two major dietary patterns were identified: the "mixed dietary pattern" that heavily loaded with fruits, vegetables, nuts, dairies, sweets, legumes, dried fruits, fish, red meat, butter, whole grains, natural juices, poultry, pickles, olive, industrial juice, egg, processed meat, and snacks and "unhealthy dietary pattern" that heavily loaded by fats, sugar, refined grains, soft drink, salt, organ meat, tea, and coffee. Adherence to the mixed dietary pattern (OR = 1.03, 95% CI = 0.8-1.33, P for trend = 0.77) and the unhealthy dietary pattern (OR = 1.01, 95% CI = 0.79-0.13, P for trend = 0.89) did not associate with abnormal muscle strength. This study suggests that the dietary pattern involving the consumption of healthy and unhealthy food does not have an effect on muscle strength in middle-aged adults.

Effect of Dietary Protein Intake on Bone Mineral Density and Fracture Incidence in Older Adults in the Health, Aging, and Body Composition Study

BACKGROUND

Dietary recommendations may underestimate the protein older adults need for optimal bone health. This study sought to determine associations of protein intake with bone mineral density (BMD) and fracture among community-dwelling White and Black older adults.

METHOD

Protein as a percentage of total energy intake (TEI) was assessed with a Food Frequency Questionnaire in 2160 older adults (73.5 ± 2.8 years; 51.5% women; 35.8% Black) in the Health, Aging, and Body Composition prospective cohort. Hip, femoral neck, and whole body BMD was assessed by dual-energy x-ray absorptiometry at baseline and 4 years, and lumbar trabecular, cortical, and integral BMD was assessed by computed tomography at baseline and 5 years. Fragility fractures over 5 years were adjudicated from self-report data collected every 6 months. Associations with tertiles of protein intake were assessed using analysis of covariance for BMD and multivariate Cox regression for fracture, adjusting for confounders.

RESULTS

Participants in the upper protein tertile (≥15% TEI) had 1.8%-6.0% higher mean hip and lumbar spine BMD compared to the lower protein tertile (<13% TEI; p < .05). Protein intake did not affect change in BMD at any site over the follow-up period. Participants in the upper protein tertile had a reduced risk of clinical vertebral fracture over 5 years of follow-up (hazard ratio: 0.36 [95% confidence interval: 0.14, 0.97] vs lower protein tertile, p = .04).

CONCLUSIONS

Older adults with higher protein intake (≥15% TEI) had higher BMD at the hip, whole body, and lumbar spine, and a lower risk of vertebral fracture.

Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations

Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19.

Hypothesizing Nutrigenomic-Based Precision Anti-Obesity Treatment and Prophylaxis: Should We Be Targeting Sarcopenia Induced Brain Dysfunction?

Background: The United States Centers for Disease Control and Prevention (CDC) estimates a total obesity rate of 30% for 12 states and a 20% obesity rate nationwide. The obesity epidemic continues to increase in spite of preventative measures undertaken worldwide. Pharmacological treatments promise to reduce total fat mass. However, medications may have significant side effects and can be potentially fatal. Data Retrieval: This brief review, based on a PUBMED search of the key terms "Obesity" and" Sarcopenia," will present evidence to corroborate the existence of Reward Deficiency Syndrome (RDS) in obesity and the involvement of catecholaminergic pathways in substance seeking behavior, particularly as it relates to carbohydrates cravings. Expert Opinion: The genetic basis and future genetic testing of children for risk of aberrant generalized craving behavior are considered a prevention method. Here we present evidence supporting the use of precursor amino acid therapy and modulation of enkephalinase, MOA, and COMT inhibition in key brain regions. Such treatments manifest in improved levels of dopamine/norepinephrine, GABA, serotonin, and enkephalins. We also present evidence substantiating insulin sensitivity enhancement via Chromium salts, which affect dopamine neuronal synthesis regulation. We believe our unique combination of natural ingredients will influence many pathways leading to the promotion of well-being and normal healthy metabolic functioning. Sarcopenia has been shown to reduce angiogenesis and possible cerebral blood flow. Exercise seems to provide a significant benefit to overcome this obesity-promoting loss of muscle density. Conclusion: Utilization of proposed nutrigenomic formulae based on coupling genetic obesity risk testing promotes generalized anti-craving of carbohydrates and can inhibit carbohydrate bingeing, inducing significant healthy fat loss and relapse prevention.

Dietary Protein Intake Is Positively Associated with Appendicular Lean Mass and Handgrip Strength among Middle-Aged US Adults

BACKGROUND

Sarcopenia, a progressive loss of skeletal muscle mass and strength, can begin in the 4th decade of life. Protein intake predicts skeletal muscle mass and strength among older adults, but knowledge of similar associations among middle-aged adults is lacking.

OBJECTIVES

We aimed to assess associations between protein intake and skeletal muscle mass, characterized by appendicular lean mass adjusted for BMI [in kg/m2 (ALMBMI)], and muscle strength, represented by handgrip strength adjusted for BMI (GSMAXBMI), among middle-aged adults.

METHODS

We analyzed cross-sectional data from 1209 men and 1208 women aged 40-59 y in the 2011-2014 NHANES. Protein intake per kilogram actual body weight (BW), assessed by two 24-h recalls, was examined as continuous and categorical parameters [low (<RDA, 0.8 g/kg BW), moderate (≥RDA, <1.2 g/kg BW), and high (≥1.2 g/kg BW)]. ALM was measured using DXA, and GSMAX was measured using handgrip dynamometer. "Low lean mass" and "weakness" were defined using NIH criteria for ALMBMI and GSMAXBMI, respectively. Linear and logistic regression models were performed.

RESULTS

Among middle-aged adults, 15.6% of men and 13.4% of women had low lean mass and 3.5% of men and 2.3% of women exhibited weakness. Protein intakes per kilogram BW were positively associated with ALMBMI and GSMAXBMI among men and women after adjustment for age, race/Hispanic origin, physical activity, and self-rated health. Compared with the moderate protein group, the high protein group had a higher GSMAXBMI and the low protein group had a lower GSMAXBMI among men and women. The low protein group had a lower ALMBMI (women) and had a higher OR for low lean mass (men) compared with the moderate protein group.

CONCLUSIONS

Higher protein intakes were associated with greater ALMBMI and GSMAXBMI in this representative sample of US middle-aged adults. Our findings highlight the need for further research on dietary protein as a potential modifying factor of sarcopenia risk in middle age.

Dietary Protein Requirement Threshold and Micronutrients Profile in Healthy Older Women Based on Relative Skeletal Muscle Mass

Although multiple nutrients have shown protective effects with regard to preserving muscle function, the recommended amount of dietary protein and other nutrients profile on older adults for maintenance of high muscle mass is still debatable. The aims of this paper were to: (1) identify dietary differences between older women with low and high relative skeletal muscle mass, and (2) identify the minimal dietary protein intake associated with high relative skeletal muscle mass and test the threshold ability to determine an association with skeletal muscle phenotypes. Older women (n = 281; 70 ± 7 years, 65 ± 14 kg), with both low and high relative skeletal muscle mass groups, completed a food questionnaire. Skeletal muscle mass, fat-free mass (FFM), biceps brachii thickness, vastus lateralis anatomical cross-sectional area (VL_ACSA), handgrip strength (HGS), maximum elbow flexion torque (MVC_EF), maximum knee extension torque (MVC_KE), muscle quality (HGS/Body mass), and fat mass were measured. Older women with low relative skeletal muscle mass had a lower daily intake of protein, iodine, polyunsaturated fatty acid (PUFA), Vit E, manganese, milk, fish, nuts and seeds (p < 0.05) compared to women with high relative skeletal muscle mass. The minimum required dietary protein intake for high relative skeletal muscle mass was 1.17 g/kg body mass/day (g/kg/d) (sensitivity: 0.68; specificity: 0.62). Women consuming ≥1.17 g/kg/d had a lower BMI (B = -3.9, p < 0.001) and fat mass (B = -7.8, p < 0.001), and a higher muscle quality (B = 0.06, p < 0.001). The data indicate that to maintain muscle mass and function, older women should consume ≥1.17 g/kg/d dietary protein, through a varied diet including milk, fish and nuts that also contain polyunsaturated fatty acid (PUFA) and micronutrients such as iodine, Vit E and manganese.

Preoperative computed tomography-assessed sarcopenia as a predictor of complications and long-term prognosis in patients with colorectal cancer: a systematic review and meta-analysis

BACKGROUND

The relationship between computed tomography (CT)-assessed sarcopenia and colorectal cancer (CRC) prognosis varies in different studies. This systematic review aimed to examine the impact of preoperative CT-assessed sarcopenia on complications and long-term survival in CRC patients.

METHODS

The PubMed, Web of Science, Cochrane Library, and Embase databases were searched for relevant literature up to September 10, 2020. Data and characteristics for each study were extracted. Long-term outcomes were assessed using a comprehensive HR with a 95% CI. Complications were assessed using a comprehensive OR with 95% CI. The heterogeneity and publication bias were also investigated, and subgroup and sensitivity analyses were performed.

RESULTS

A total of 19 studies comprising 15,889 patients were included. The comprehensive results demonstrated that sarcopenia is significantly associated with overall survival of CRC patients (HR = 1.40, 95% CI = 1.25-1.58, p < 0.001). Patients with sarcopenia have a higher risk of complications compared to those without sarcopenia. In addition, sarcopenia is strongly associated with poor cancer-specific survival (HR = 1.49, 95% CI = 1.32-1.68, p < 0.001) and disease-free survival (HR = 1.59, 95% CI = 1.32-1.92, p < 0.001) in CRC patients. There is no significant relationship between sarcopenia and recurrence-free survival (HR = 1.32, 95% CI = 0.92-1.89, p = 0.126).

CONCLUSIONS

Preoperative CT-assessed sarcopenia can be employed as an effective predictor of complications and long-term prognosis in CRC patients. Standardization of CT-assessed sarcopenia requires comprehensive consideration of race, muscle mass index, body mass index, and gender.

Decreased fasting serum glucogenic amino acids with a higher compared to normal protein diet during energy restriction in women: a randomized controlled trial

Dietary protein alters circulating amino acid (AAs) levels and higher protein intake (HP) is one means of losing weight. We examined 34 overweight and obese women (57 ± 4 years) during 6 months of energy restriction (7.3 ± 3.8% weight loss) divided into groups consuming either normal protein (NP; 18.6 energy% protein) or HP (24.3 energy% protein). There was a reduction in fasting serum glucogenic AAs (p = 0.015) that also associated with greater weight loss (p < 0.05) in the HP group, but not in the NP group. These findings have implications for nutrient prioritization during energy restriction.

Low Protein Intakes and Poor Diet Quality Associate with Functional Limitations in US Adults with Diabetes: A 2005-2016 NHANES Analysis

Type 2 diabetes is associated with an increased risk for sarcopenia. Moreover, sarcopenia correlates with increased risk for falls, fractures, and mortality. This study aimed to explore relationships among nutrient intakes, diet quality, and functional limitations in a sample of adults across levels of glycemic control. Data were examined from 23,487 non-institutionalized adults, 31 years and older, from the 2005–2016 National Health and Nutrition Examination Survey. Hemoglobin A1c (%) was used to classify level of glycemic control: non-diabetes (<5.7%); pre-diabetes (5.7–6.4%); diabetes (≥6.5%). Dietary data were collected from a single 24-h dietary recall. Participants were categorized as meeting or below the protein recommendation of 0.8 g/kg of body weight. Physical functioning was assessed across 19-discrete physical tasks. Adults below the protein recommendation consumed significantly more carbohydrate and had lower diet quality across all glycemic groups compared to those who met the protein recommendation (p < 0.001). Adults with diabetes who did not meet protein recommendations had significantly poorer diet quality and significantly higher mean number of functional limitations. A greater percent of adults with diabetes who did not meet the protein recommendation reported being physically limited for most activities, with more than half (52%) reporting limitations for stooping, crouching, and kneeling. This study underscores the potential for physical limitations associated with low protein intakes, especially in adults with diabetes. In the longer term, low protein intakes may result in increased risk of muscle loss, as protein intake is a critical nutritional factor for prevention of sarcopenia, functional limitations, and falls.

Effects of Protein-Rich Nutritional Composition Supplementation on Sarcopenia Indices and Physical Activity during Resistance Exercise Training in Older Women with Knee Osteoarthritis

Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. Protein-rich nutritional composition supplementation (PS) combined with resistance exercise training (RET) improves muscle gains and facilitates physical activity in older adults. However, whether PS augments the effects of RET on muscle mass and PA in patients with KOA remains unclear. Therefore, this study identified the effects of PS on sarcopenic indices and PA in older women with KOA subjected to an RET program. Eligible older women aged 60–85 years and diagnosed as having KOA were randomly assigned to either the experimental group (EG) or the control group (CG). Both groups performed RET twice a week for 12 weeks. The EG received additional PS during this period. Outcome measures included appendicular lean mass index, walking speed, physical activity, and scores on the Western Ontario and McMaster Universities Osteoarthritis Index—WOMAC). All measures were tested at baseline and after intervention. With participant characteristics and baseline scores as covariates, analysis of variance was performed to identify between-group differences in changes in all outcome measures after intervention. Statistical significance was defined as p < 0.05. Compared with the CG, the EG achieved greater changes in appendicular lean mass index (adjusted mean difference (aMD) = 0.19 kg/m², p < 0.01), physical activity (aMD = 30.0 MET-hour/week, p < 0.001), walking speed (aMD = 0.09 m/s, p < 0.05), and WOMAC global function (aMD = −8.21, p < 0.001) after intervention. In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.

Relationship Between Protein Intake and Sarcopenia in the Elderly with Nonalcoholic Fatty Liver Disease Based on the Fourth and Fifth Korea National Health and Nutrition Examination Survey

Background: The association between sarcopenia and protein intake has been well studied. However, limited data are available on the association between sarcopenia and protein intake in people with nonalcoholic fatty liver disease (NAFLD). This study aimed to investigate the association between protein intake and sarcopenia among elderly participants with NAFLD using the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Data of 4179 participants (1576 men and 2603 women, age ≥60 years) who participated in the KNHANES during 2008-2011 were obtained. Sarcopenia was defined as appendicular skeletal muscle mass/wt (%) of 1 standard deviation below the gender-specific mean for healthy adults and NAFLD as liver fat score using the fatty liver prediction models. According to their daily protein intake, participants were grouped into the high protein intake group (>1.2 g/kg/day), middle protein intake group (0.8-1.2 g/kg/day), and low protein intake group (<0.8 g/kg/day). Generalized linear models and logistic regression models were used. Results: The overall prevalence of sarcopenia in participants with NAFLD was 16.53%. Compared with the highest protein intake group, the low protein intake group had a significantly higher risk of sarcopenia (adjustment odds ratio = 1.707; 95% confidence interval = 1.009-2.886). In the fully adjusted model, the highest protein intake group had significantly lower levels of insulin, total body fat, vitamin B, and fat intake, whereas muscle proportions, energy, carbohydrates, vitamin A, and vitamin C intake of high protein intake participants were significantly higher than other groups. Conclusion: The prevalence of sarcopenia and sarcopenia-related factors were significantly lower in NAFLD elderly participants with high protein intake. These results suggest that high protein intake can help prevent and manage sarcopenia in people with NAFLD.

Jiangnan dietary pattern actively prevents muscle mass loss: Based on a cohort study

BACKGROUND

The proportion of sarcopenia in the elderly is very high, although muscle mass loss before sarcopenia covers a wider population. The present study aimed to analyse the effects of different dietary patterns on muscle mass.

METHODS

In both 2015 and 2018, using multilayer random sampling, the same participants were selected, and the same questionnaires and machines were used.

RESULTS

In total, 502 participants were selected. The >65-year-old group showed maximum muscle mass loss in males and females (-1.53 kg ± 4.42 and -1.14 kg ± 2.6 on average, respectively). The cumulative variance of four dietary patterns reached 52.28%. Logistical regression revealed significant differences between 'Jiangnan Dietary' groups: Q2 vs. Q1 [odds ratio (OR) = 0.356, 95% confidence interval (CI) = 0.202-0.629]; Q3 vs. Q1 (OR = 0.457, 95% CI = 0.262-0.797). Relative influence factors for muscle mass loss were age (>65 vs. <45, OR = 2.027, 95% CI = 1.117-3.680), physical activity (OR = 0.550, 95% CI = 0.315-0.960), income (high vs. low, OR = 0.413, 95% CI = 0.210 -0.810), sex (female vs. male, OR = 0.379, 95% CI = 0.235-0.519).

CONCLUSIONS

After 3 years of follow-up, participants' muscle mass declined significantly. The 'Jiangnan Dietary' pattern prevented muscle mass loss and is recommended to the wider population.

The effects of glucagon and the target of rapamycin (TOR) on skeletal muscle protein synthesis and age-dependent sarcopenia in humans

BACKGROUND AND AIMS

Human target of rapamycin (TOR) is a kinase that stimulates protein synthesis in the skeletal muscle in response to amino acids and physical activity.

METHODS

A comprehensive literature search was conducted on the PubMed database from its inception up to May 2021 to retrieve information on the effects of TOR and glucagon on muscle function. Articles written in English regarding human subjects were included.

RESULTS

l-leucine activates TOR to initiate protein synthesis in the skeletal muscle. Glucagon has a crucial role suppressing skeletal muscle protein synthesis by increasing l-leucine oxidation and the irreversible loss of this amino acid. Glucagon-induced l-leucine oxidation suppresses TOR and attenuates the ability of skeletal muscle to synthesize proteins. Conditions associated with increased glucagon secretion typically feature reduced ability to synthesize proteins in the skeletal muscle that may evolve into sarcopenia. Animal protein ingestion, unlike vegetable protein, stimulates glucagon secretion. High intake of animal protein increases l-leucine oxidation and promotes the use of amino acids as fuel. Sarcopenia and arterial stiffness characteristically occur together in conditions featuring insulin resistance, such as aging. Insulin resistance mediates the relationship between aging and sarcopenia and arterial stiffness. The loss of skeletal muscle fibers that characterizes sarcopenia is followed by collagen and lipid accumulation. Likewise, insulin resistance is associated with arterial stiffness and intima-media thickening due to adaptive accretion of collagen and lipids in the arterial wall.

CONCLUSIONS

Human TOR participates in the pathogenesis of sarcopenia and arterial stiffness, although its effects remain to be fully elucidated.

Prevalence of sarcopenia in older women with pelvic floor dysfunction

BACKGROUND

Sarcopenia is a determinant of age-related skeletal muscle weakness. In this sense, it is believed that there may be a pathophysiological association between pelvic floor dysfunction (PFD) and sarcopenia; however, few articles investigating an association between these two pathologies have been published.

OBJECTIVES

To identify the prevalence of sarcopenia in older women with PFD and verify the association between the severity of PFD and the severity of sarcopenia.

METHODS

This cross-sectional study was undertaken in urogynaecology outpatient clinics in Fortaleza, Ceará, Brazil. Women with PFD aged ≥ 60 years were included. Women with cognitive impairments, amputations and/or limb fractures were excluded. Sociodemographic, anthropometric and PFD data were evaluated, and tests for measuring muscle strength, muscle mass and physical performance were performed.

RESULTS

In total, 217 women were included in this study; of these, 121 (55.8%) presented without sarcopenia, 71 (32.7%) presented with probable sarcopenia, 23 (10.6%) presented with confirmed sarcopenia, and two (0.9%) presented with severe sarcopenia. Regarding sarcopenia related to PFD, a higher prevalence of probable sarcopenia was observed in women with urinary incontinence (UI) (n = 55, 77.5%). Confirmed sarcopenia was more prevalent in women with pelvic organ prolapse (POP) (n = 19, 82.6%); among these cases, most women had POP of the anterior, posterior and apical compartments (n = 8, 42.1%). All the women with severe sarcopenia had UI and POP and, considering the specific types of these dysfunctions, the prevalence of severe sarcopenia was 50.0% in the women with UI and POP of the anterior and apical wall. The most severe stages of POP were associated with sarcopenia (p = 0.002).

CONCLUSION

The prevalence of sarcopenia in women with PFD was high. Healthcare providers who assist women with PFD should consider the possibility of assessing sarcopenia, especially when faced with more extensive POP in older women. The evaluation of sarcopenia may play a role in the management of women with PFD.

Metabolic syndrome and unfavorable outcomes on body composition and in visceral adiposities indexes among early breast cancer women post-chemotherapy

PURPOSE

The study objected to investigate potential changes in metabolic, dietary, and nutritional status in women with stages I-III breast cancer exposed to chemotherapy.

METHODS

Women who were starting chemotherapy with no previous treatment were recruited. Anthropometrics, bioelectrical impedance analysis, handgrip strength, blood pressure and blood sample were collected. Visceral adiposity index and lipid accumulation product were calculated. Dietary intake was evaluated, and the multiple source methods program was applied. Metabolic syndrome (MetS) was assessed following the NCEP-ATP III criteria (defined as 3 of 5 components of MetS). All data were collected at 2-time points: diagnosis (T0) and after 1 month of completion of therapy (T1). Mean, standard deviation, percentage, and ANOVA in SAS Studio® were used to explore the results.

RESULTS

61 women were included. We did not find any changes in anthropometrics and body composition. However, phase angle, extracellular water (EX) and ratio EX to total body water had expressive changes (p < 0.001). The results showed changes in lipid profile (p < 0.001), and greater unfavorable outcomes on adiposities index (p < 0.001). At the end of the study, 68,8% (N = 42) of the women developed MetS post-chemotherapy.

CONCLUSION

We have found supporting evidence for chemotherapy treatment resulting in worsening of nutritional markers, lipid profile and adiposity markers. After chemotherapy part of the sample developed MetS, even without changes in body weight, fat mass, and food intake. Breast cancer patients may benefit from targeted interventions before starting chemotherapy to prevent MetS post-treatment, and therefore reduce the risk of cardiovascular disease. Further investigation into this theme is needed.

The relationship between primary sarcopenia and SARC-F, serum MMP9, TIMP1 levels, and MMP9/TIMP1 ratio in the geriatric patients

PURPOSE

The purpose of this study is to evaluate the relationship between serum MMP9 (Matrix metalloproteinase), TIMP1 (Tissue inhibitor of metalloproteinase) levels and MMP9/TIMP1 ratio and primary sarcopenia in geriatric patients, and compare the diagnostic accuracy of such biomarkers with that of the SARC-F score.

METHODS

A total of 88 patients aged 65 years and older were assessed in the study. Comorbidities and geriatric syndromes were determined and patients with secondary sarcopenia were excluded. EWGSOP2 criteria were used as diagnostic criteria for sarcopenia and SARC-F questionnaire was used to find individuals at risk for sarcopenia. Serum MMP9 and TIMP1 levels were analyzed by ELISA method.

RESULTS

SARC-F, serum MMP9 and MMP9/TIMP1 ratio were significantly higher in the group with sarcopenia compared to the group without sarcopenia (p = 0.001, p = 0.026 and p = 0.006, respectively). In univariate logistic regression analysis, while SARC-F score and MMP9/TIMP1 ratio were significant, MMP9, TIMP1, age and gender were not. In the multivariate logistic regression analysis of the SARC-F score and the MMP9/TIMP1 ratio, it was determined that both of them were associated with sarcopenia [Odds ratio (OR) 1.447 (95%) confidence interval (CI) 1.170-1.791, p = 0.001; OR 1.127, (95%) CI 1.016-1.249, p = 0.023, respectively]. ROC curve analysis showed that the area under ROC curve (AUC) of SARC-F and MMP9/TIMP1 was 0.703 (p = 0.001, %95 CI 0.594-0.812) and 0.670 (p = 0.006, %95 CI 0.557-0.783), respectively.

CONCLUSION

Although this study supports the use of SARC-F questionnaire in daily practice; if SARC-F can't be applicable, the MMP9/TIMP1 ratio could be an alternative choice to the SARC-F.

Influence of Age on Skeletal Muscle Hypertrophy and Atrophy Signaling: Established Paradigms and Unexpected Links

Skeletal muscle atrophy in an inevitable occurrence with advancing age, and a consequence of disease including cancer. Muscle atrophy in the elderly is managed by a regimen of resistance exercise and increased protein intake. Understanding the signaling that regulates muscle mass may identify potential therapeutic targets for the prevention and reversal of muscle atrophy in metabolic and neuromuscular diseases. This review covers the major anabolic and catabolic pathways that regulate skeletal muscle mass, with a focus on recent progress and potential new players.

Association of Pre-ESRD Serum Bicarbonate with Post-ESRD Mortality in Patients with Incident ESRD

BACKGROUND

Serum bicarbonate or total carbon dioxide (CO2) concentrations decline as chronic kidney disease (CKD) progresses and rise after dialysis initiation. While metabolic acidosis accelerates the progression of CKD and is associated with higher mortality among patients with end stage renal disease (ESRD), there are scarce data on the association of CO2 concentrations before ESRD transition with post-ESRD mortality.

METHODS

A historical cohort from the Transition of Care in CKD (TC-CKD) study includes 85,505 veterans who transitioned to ESRD from October 1, 2007, through March 31, 2014. After 1,958 patients without follow-up data, 3 patients with missing date of birth, and 50,889 patients without CO2 6 months prior to ESRD transition were excluded, the study population includes 32,655 patients. Associations between CO2 concentrations averaged over the last 6 months and its rate of decline during the 12 months prior to ESRD transition and post-ESRD all-cause, cardiovascular (CV), and non-CV mortality were examined by using hierarchical adjustment with Cox regression models.

RESULTS

The cohort was on average 68 ± 11 years old and included 29% Black veterans. Baseline concentrations of CO2 were 23 ± 4 mEq/L, and median (interquartile range) change in CO2 were -1.8 [-3.4, -0.2] mEq/L/year. High (≥28 mEq/L) and low (<18 mEq/L) CO2 concentrations showed higher adjusted mortality risk while there was no clear trend in the middle range. Consistent associations were observed irrespective of sodium bicarbonate use. There was also a U-shaped association between the change in CO2 and all-cause, CV, and non-CV mortality with the lowest risk approximately at -2.0 and 0.0 mEq/L/year among sodium bicarbonate nonusers and users, respectively, and the highest mortality was among patients with decline in CO2 >4 mEq/L/year.

CONCLUSION

Both high and low pre-ESRD CO2 levels (≥28 and <18 mEq/L) during 6 months prior to dialysis transition and rate of CO2 decline >4 mEq/L/year during 1 year before dialysis initiation were associated with greater post-ESRD all-cause, CV, and non-CV mortality. Further studies are needed to determine the optimal management of CO2 in patients with advanced CKD stages transitioning to ESRD.

How Can Malnutrition Affect Autophagy in Chronic Heart Failure? Focus and Perspectives

Chronic heart failure (CHF) is a disease with important clinical and socio-economic ramifications. Malnutrition and severe alteration of the protein components of the body (protein disarrangements), common conditions in CHF patients, are independent correlates of heart dysfunction, disease progression, and mortality. Autophagy, a prominent occurrence in the heart of patients with advanced CHF, is a self-digestive process that prolongs myocardial cell lifespan by the removal of cytosolic components, such as aging organelles and proteins, and recycles the constituent elements for new protein synthesis. However, in specific conditions, excessive activation of autophagy can lead to the destruction of molecules and organelles essential to cell survival, ultimately leading to organ failure and patient death. In this review, we aim to describe the experimental and clinical evidence supporting a pathophysiological role of nutrition and autophagy in the progression of CHF. The understanding of the mechanisms underlying the interplay between nutrition and autophagy may have important clinical implications by providing molecular targets for innovative therapeutic strategies in CHF patients.

Measures Derived from Panoramic Ultrasonography and Animal-Based Protein Intake Are Related to Muscular Performance in Middle-Aged Adults

Ultrasonography advantageously measures skeletal muscle size and quality, but some muscles may be too large to capture with standardized brightness mode (B-mode) imaging. Panoramic ultrasonography can capture more complete images and may more accurately measure muscle size. We investigated measurements made using panoramic compared to B-mode ultrasonography images of the rectus femoris with muscular performance. Concurrently, protein intake plays an important role in preventing sarcopenia; therefore, we also sought to investigate the association between animal-based protein intake (ABPI) and muscular performance. Ninety-one middle-aged adults were recruited. Muscle cross-sectional area (CSA) and thickness were obtained using B-mode and panoramic ultrasound and analyzed with Image J software. Muscular performance was assessed using isokinetic dynamometry, a 30-s chair test, and handgrip strength. Three-day food diaries estimated dietary intakes. Linear regression models determined relationships between measures from ultrasonography and muscular performance. Mixed linear models were used to evaluate the association between ABPI and muscular performance. Muscle CSA from panoramic ultrasonography and ABPI were positively associated with lower-body strength (β ± S.E.; CSA, 42.622 ± 20.024, p = 0.005; ABPI, 65.874 ± 19.855, p = 0.001), lower-body endurance (β ± S.E.; CSA, 595 ± 200.221, p = 0.001; ABPI, 549.944 ± 232.478, p = 0.020), and handgrip strength (β ± S.E.; CSA, 6.966 ± 3.328, p = 0.004; ABPI, 0.349 ± 0.171, p = 0.045). Panoramic ultrasound shows promise as a method for assessing sarcopenia. ABPI is related to better muscular performance.

Impact of Oral and Swallowing Function on the Feeding Status of Older Adults in Nursing Homes

BACKGROUND

To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food.

OBJECTIVE

We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies.

METHODS

Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters.

RESULTS

No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance.

CONCLUSION

The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

A current hypothesis is that dialysis-treated patients are "anabolic resistant" i. e., their muscle protein synthesis (MPS) response to anabolic stimuli is blunted, an effect which leads to muscle wasting and poor physical performance in aging and in several chronic diseases. The importance of maintaining muscle mass and MPS is often neglected in dialysis-treated patients; better than to describe mechanisms leading to energy-protein wasting, the aim of this narrative review is to suggest possible strategies to overcome anabolic resistance in this patient's category. Food intake, in particular dietary protein, and physical activity, are the two major anabolic stimuli. Unfortunately, dialysis patients are often aged and have a sedentary behavior, all conditions which per se may induce a state of "anabolic resistance." In addition, patients on dialysis are exposed to amino acid or protein deprivation during the dialysis sessions. Unfortunately, the optimal amount and formula of protein/amino acid composition in supplements to maximixe MPS is still unknown in dialysis patients. In young healthy subjects, 20 g whey protein maximally stimulate MPS. However, recent observations suggest that dialysis patients need greater amounts of proteins than healthy subjects to maximally stimulate MPS. Since unneccesary amounts of amino acids could stimulate ureagenesis, toxins and acid production, it is urgent to obtain information on the optimal dose of proteins or amino acids/ketoacids to maximize MPS in this patients' population. In the meantime, the issue of maintaining muscle mass and function in dialysis-treated CKD patients needs not to be overlooked by the kidney community.