Estimation of skeletal muscle mass by bioelectrical impedance analysis

Bidirectional longitudinal associations between estimated muscle mass and self-reported chronic lung disease in middle-aged and older adults: findings from the China health and retirement longitudinal study

BACKGROUND

The bidirectional relationship between muscle mass and chronic lung diseases (CLD) in middle-aged and older adults remains inadequately explored. This study aims to investigate the bidirectional association between estimated muscle mass and self-reported chronic lung diseases while elucidating the mediating mechanisms underlying this relationship.

METHODS

This study utilized data from the nationally representative China Health and Retirement Longitudinal Study (2011-2018), focusing on individuals aged 45 years or older. Cox regression was used to investigate the bidirectional relationship between estimated muscle mass and self-reported CLD. Causal mediation analysis was employed to evaluate the role of 16 blood biomarkers as potential mediators. Sensitivity analysis using cross-lagged models was conducted to verify the robustness of the bidirectional association between estimated muscle mass and self-reported CLD.

RESULTS

Among 10,591 participants, 1,742 (16%) self-reported CLD during a median follow-up of 4.4 years. Participants with low estimated muscle mass had a 27% higher risk of developing self-reported CLD compared to those with normal muscle mass (HR = 1.27, 95% CI: 1.12-1.44). In a separate analysis of 6,067 participants, 708 (12%) experienced new-onset estimated low muscle mass, with those reporting CLD showing a 26% increased risk of muscle loss during a median follow-up of 2.5 years (HR = 1.26, 95% CI: 1.06-1.49). Notably, individuals with insufficient physical activity exhibited a significantly higher risk of self-reported CLD compared to those who engaged in regular exercise (HR = 1.91; 95% CI: 1.37-2.66). Additionally, the negative impact of low estimated muscle mass was more pronounced in male participants than in females (HR = 1.65; 95% CI: 1.33-2.03) over the same follow-up period. Causal mediation analysis suggested that cystatin C may mediate 0.61% of the association between estimated muscle mass and self-reported CLD.

CONCLUSION

There is a bidirectional relationship between self-reported CLD and low estimated muscle mass. Self-reported CLD may cause varying degrees of estimated muscle mass reduction across different population subgroups. Understanding this dynamic and its variations can enhance prevention and treatment strategies for both conditions.

Respiratory Muscle Strength as a Predictor of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is closely related to skeletal muscle dysfunction, and the evaluation of respiratory muscle function has recently been recommended. We aimed to investigate the effects of respiratory muscle dysfunction on clinical outcomes.

METHODS

We retrospectively reviewed the medical records of patients with COPD whose respiratory muscle strength was measured between June 2015 and December 2021. We then analysed the effects of respiratory muscle strength on moderate-to-severe exacerbations after adjusting for confounding factors, including sex, age, forced expiratory volume in 1-s percent predicted, hand grip strength, and skeletal muscle mass index. We also compared the temporal relationship between respiratory and systemic skeletal muscle dysfunctions.

RESULTS

Respiratory muscle weakness (RMW) was observed in 48.1% (100) of the 208 patients. Low percent predicted maximal inspiratory pressure was an independent risk factor for moderate-to-severe exacerbations within 1 year in the Cox regression analysis (adjusted hazard ratio per 1 standard deviation increase, 0.521; 95% confidence interval, 0.317-0.856). Approximately half of the patients already exhibited RMW at the mild systemic skeletal muscle dysfunction, while those with sarcopenia had higher RMW rates. More patients with RMW experienced progressive systemic skeletal muscle dysfunction within 1 year compared to those without RMW.

CONCLUSION

Lower respiratory muscle strength is associated with an increased risk of exacerbation. Respiratory muscle function could serve as a marker of disease status and early prognosis in COPD.

Physical fitness predicts post-esophagectomy complications after chemoradiotherapy: a pilot study

BACKGROUND

Esophagectomy following neoadjuvant chemoradiotherapy or definitive chemoradiotherapy has been shown to yield favorable oncological outcomes in patients with locally advanced esophageal squamous cell carcinoma. However, postoperative complications are frequent and can adversely affect patient survival. This study aimed to identify physical fitness factors across multiple domains associated with major postoperative complications.

METHODS

This study enrolled patients with esophageal squamous cell carcinoma who were treated with neoadjuvant chemoradiotherapy or definitive chemoradiotherapy and underwent esophagectomy between 2020 and 2022. Multivariate logistic regression analysis was conducted to identify the factors associated with major postoperative complications. Additionally, a tree-based learning process was employed to assess all the variables influencing major complications.

RESULTS

A total of 142 esophageal cancer patients who underwent esophagectomy were screened. Of these, 72 eligible patients were included in the study, and 29 (40.2%) experienced major postoperative complications. In the full model, factors such as low body weight, low body mass index, low peak oxygen consumption (V̇O2peak), low V̇O2peak/skeletal muscle mass (SMM), low appendicular skeletal muscle index (ASMI), and low ASMI-V̇O2peak/SMM product (AV̇P) were found to be significantly associated with major postoperative complications. However, in the parsimonious model, only low AV̇P (P < 0.01) was associated with major complications. Additionally, AV̇P, EqO2nadir, and hand grip strength emerged as the key predictors of major post-esophagectomy complications in the tree-based learning analysis, which showed a sensitivity of 0.448, specificity of 0.977, and accuracy of 76.4%, with false negative and false positive rates of 55.2% and 2.3%. AV̇P alone yielded similar results.

CONCLUSIONS

Patients with low AV̇P, high EqO2nadir, and low HGS are at a very high risk of experiencing major postoperative complications, with low AV̇P showing the strongest correlation. Preoperative physical fitness screening can help identify high-risk patients and guide appropriate perioperative management.

Probable and confirmed sarcopenia are still better predictors of disability than sarcopenic obesity following ESPEN/EASO consensus steps

BACKGROUND

Studies comparing different operational definitions of sarcopenia (S) and sarcopenic obesity (SO) defined according to the ''European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity'' (ESPEN/EASO) criteria with functionality are scarce. Our aim is to investigate whether SO or S with different skeletal muscle mass (SMM) adjustments is better associated with functional disability.

METHODS

This retrospective study was carried out in older individuals ≥ 65 years of age in a geriatric outpatient clinic. Probable and confirmed sarcopenia were evaluated with the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, and SO with ESPEN/EASO consensus steps. For SMM component for both S and SO, different adjustments (weight, body mass index, and height square (W, BMI, H2 respectively)) were used. Functional disability was examined with activities of daily living (ADL), and instrumental ADL (IADL). Receiver operating characteristic (ROC) curves were drawn and area under ROC curve (AUC) were calculated to find which operational definition best predicts disability.

RESULTS

Data from 1477 older adults were screened. 408 participants (median age; 73 (65-101), 65% female) were included. Prevelance of SO was 6.9%. Probable sarcopenia, confirmed sarcopenia BMI-adjusted and confirmed sarcopenia W-adjusted were significantly associated with impaired IADL (p < 0.001), and showed fair accuracy for predicting IADL disability. Sarcopenic obesity did not show significant associations with ADL and IADL disability and didn't predict ADL and IADL disability. Only confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Among operational definitions of sarcopenia, probable sarcopenia had the highest sensitivity (83.6%) and negative predictive value (NPV) (94.2%) for predicting IADL disability.

CONCLUSION

We found that probable sarcopenia (with the highest sensitivity and NPV) and confirmed sarcopenia (BMI-adjusted with higher sensitivity and NPV than W-adjusted) were the most relevant for predicting IADL disability, but their diagnostic accuracy was limited. Confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Other operational definitions, including SO did not predict functional disability in our study. Future studies need to refine the definitions of SO and investigate its distinct impact on functional impairment compared to sarcopenia alone.

Assessment of sub-maximal aerobic capacity in North African patients with chronic hepatitis B: a pilot case-control study

Background

Studies assessing sub-maximal aerobic capacity in non-cirrhotic chronic hepatitis B (CHB) patients are scarce. This study aimed to evaluate sub-maximal aerobic capacity in CHB patients compared to apparently healthy participants (control-group (CG)).

Methods

A 6-min walk test (6MWT) was performed. The 6-min walk distance (6MWD) was recorded, along with heart-rate (HR), oxy-hemoglobin saturation (SpO 2), blood-pressure, and dyspnea ( ie ; visual analogue scale) at rest (Rest) and at the end (End) of the 6MWT. Additionally, the 6-min walk work (6MWW), and estimated cardiorespiratory and muscular chain age were calculated. Signs of physical intolerance were determined including abnormal 6MWD ( ie ; 6MWD < lower limit of normal), chronotropic insufficiency (ie ; HREnd < 60% of maximal predicted HR (MPHR)), high dyspnea ( ie ; dyspneaEnd > 5), and desaturation ( ie ; drop in SpO 2 > 5 points).

Results

Compared to the CG (n=28), the CHB-group (n=26) exhibited significantly lower 6MWD by 61 meters (8%), lower 6MWW by 10%, and lower HR End by 21% (when expressed in bpm) and 17% (when expressed in %MPHR). The CHB-group, compared to the CG, included higher percentages of participants with chronotropic insufficiency and abnormal 6MWD (23.08% vs. 3.57%, and 34.61% vs. 3.57%, respectively). The CHB-group was 8.1 and 14.3 times more likely to have chronotropic insufficiency and abnormal 6MWD than the CG, respectively. CHB accelerated the aging of the cardiorespiratory and muscular chain by 11 years.

Conclusion

Non-cirrhotic CHB may contribute to reduced submaximal aerobic capacity and acceleration of cardiorespiratory and muscular chain aging.

Childhood muscle growth: Reference curves for lower leg muscle volumes and their clinical application in cerebral palsy

Skeletal muscles grow substantially during childhood. However, quantitative information about the size of typically developing children's muscles is sparse. Here, the objective was to construct muscle-specific reference curves for lower leg muscle volumes in children aged 5 to 15 y. Volumes of 10 lower leg muscles were measured from magnetic resonance images of 208 typically developing children and 78 ambulant children with cerebral palsy. Deep learning was used to automatically segment the images. Reference curves for typical childhood muscle volumes were constructed with quantile regression. The median total leg muscle volume of a 15-y-old child is nearly five times that of a 5-y-old child. Between the ages of 5 and 15, boys typically have larger muscles than girls, both in absolute terms (medians are greater by 5 to 20%) and per unit of body weight (1 to 13%). Muscle volumes vary widely between children of a particular age: the range of volumes for the central 80% of the distribution (i.e., between the 10th and 90th centiles) is more than 40% of the median volume. Reference curves for individual muscle volumes have a similar shape to reference curves for total lower leg muscle volume. Confidence bands about the centile curves were wide, especially at the youngest and oldest ages. Nonetheless, the reference curves can be used with confidence to identify small-for-age muscles (centile < 10). We show that 56% of children with cerebral palsy in our cohort had total lower leg muscle volumes that were small-for-age and that 80% had at least one lower leg muscle that was small-for-age.

Age-related prevalence of radiographic lumbar spondylolisthesis and its associations with low back pain, walking speed, and muscle index: findings from the second survey of the ROAD study

OBJECTIVES

To determine the prevalence of lumbar spondylolisthesis (LS) and its association with low back pain, walking speed, grip strength, and muscle mass in the general population.

METHODS

Participants included 1551 members of the general population from the 2nd ROAD (Research on Osteoarthritis/osteoporosis Against Disability) study conducted in Wakayama Prefecture, Japan, between 2008 and 2010. Lumbar radiography diagnosed LS when the slip was ≥ 3 mm in the lateral views. Logistic regression analysis (adjusted for sex, age, area, and BMI) assessed the association between LS and low back pain, walking speed, grip strength, and appendicular lean mass.

RESULTS

Complete data from 1522 participants (510 men, 1012 women, mean age 65.7 ± 12.2 years) were analyzed. The prevalence of LS increases with age, with an estimated one in five men aged 80 years or older and one in four women aged 70-79 years affected. Logistic regression showed LS was significantly associated with low back pain (OR: 1.36, CI: 1.03-1.80). Walking speed, grip strength, and appendicular lean mass were not significantly associated with LS. The prevalence of LS at any level was 17.4% in the total sample, 13.3% in men, and 19.5% in women (P = 0.005).

CONCLUSION

LS was prevalent in 17.4% of the general population, with a higher prevalence in women. Patients with LS had more low back pain than those without LS.

The predictive values of sarcopenia screening tools in preoperative elderly patients with colorectal cancer: applying the diagnostic criteria of EWGSOP2 and AWGS2019

BACKGROUND

Sarcopenia predicts worse postoperative outcomes and lower survival rates in patients with colorectal cancer (CRC). There is a scarcity of studies on the most effective assessment tools for detecting sarcopenia in preoperative elderly patients with CRC. Our objective was to compare the diagnostic accuracy of various tools such as calf circumference (CC), strength, need for assistance with walking, rising from a sitting position, climbing stairs, and the incidence of falls (SARC-F), SARC-F plus CC (SARC-CalF), the short version of mini sarcopenia risk assessment (MSRA-5), the full version of mini sarcopenia risk assessment (MSRA-7), and Ishii score chart in screening sarcopenia in preoperative elderly patients with CRC.

METHODS

During the period of April 2021 to September 2023, we conducted a cross-sectional study involving consecutive elderly patients who were undergoing colorectal surgery. Sarcopenia was defined using the diagnostic criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) and the 2019 Asian Working Group for Sarcopenia (AWGS2019). The screening tools' performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses, based on the criteria proposed by EWGSOP2 and AWGS2019.

RESULTS

We enrolled 482 patients with an average age of 71.86 ± 5.60 years. According to the EWGSOP2 and AWGS2019 diagnostic standards, the incidence of sarcopenia was 19.5% and 21.6% respectively. The sensitivity of SARC-F, SARC-CalF, MSRA-5, MSRA-7, and Ishii score chart ranged from 51.92 to 56.38%, 84.62-85.11%, 86.54-88.30%, 65.96-67.31%, and 73.08-74.47% respectively, while the specificity ranged from 84.92 to 85.05%, 70.36-71.69%, 36.86-37.04%, 60.57-61.64%, and 77.32-78.31% respectively. Regardless of the sarcopenia diagnostic criteria used, the AUCs of Ishii score chart (0.87 to 0.88) and SARC-CalF (0.89 to 0.90) were significantly larger than those of other tools (P<0.05). There was no significant difference in AUCs among SARC-F, SARC-CalF, and Ishii score chart in females.

CONCLUSION

Among the five sarcopenia screening tools, Ishii score chart and SARC-CalF had the largest overall diagnostic accuracy for sarcopenia in preoperative elderly patients with CRC.

Factors influencing changes in body composition and nutritional status in patients with hyperacute stroke: prospective study

Background and aims

Muscle loss not only reduce the effectiveness of the recovery period of rehabilitation after stroke but also prolongs the length of hospital stay. Therefore, it is crucial to maintain muscle mass during the hyperacute phase of stroke. We aimed to investigate the factor that influence changes in muscle mass and quality in patients with hyperacute stroke by using a body composition analyzer.

Methods

Body composition assessment was performed on 156 patients admitted to the stroke care unit at the time of admission and 1 week later. Additionally, associations between rehabilitation intervention time, nutritional dosage and administration method, and stroke severity were examined to which factors were affecting body composition.

Results

Muscle mass and quality significantly decreased in both men (SMI: 7.41 ± 1.26 to 7.22 ± 1.23 kg/m2, p < 0.005, phA: 5.5 ± 1.24 to 5.31 ± 1.29 degree, p < 0.005) and women (SMI: 6.04 ± 1.30 to 5.08 ± 1.20 kg/m2, p < 0.005, phA: 4.58 ± 0.85 to4.18 ± 0.82 degree, p < 0.005)1 week after admission. Rehabilitation intervention time [odds ratio (OR) = 2.12; 95% CI: 1.28-4.47, p = 0.01], and high calorie dosage (OR = 1.53; 95% CI: 1.14-3.21, p = 0.03) significantly reduced the loss of muscle mass. However, stroke severity did not affect variations in body composition.

Conclusion

Deterioration in muscle mass and quality was observed during the hyperacute phase of stroke. The risk of muscle mass loss may be reduced with appropriate rehabilitation intervention and diet therapy from the early stage of hospitalization. Therefore, providing early rehabilitation intervention and nutritional management in the hospitalization phase are important to improve treatment effectiveness. In hyperacute stroke treatment, rehabilitation and nutritional administration should be provided as early as possible.

Clinical trial registration

https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053017, identifier UMIN-CTR UMIN000046467.

Association between the coexistence of chronic kidney disease and sarcopenia with cardiovascular disease and mortality

BACKGROUND

Chronic kidney disease (CKD) and sarcopenia are independently associated with adverse cardiovascular and mortality outcomes. However, the combined impact of CKD and sarcopenia remains poorly understood. To evaluate the combined effects of CKD and sarcopenia on cardiovascular disease (CVD) and mortality risks in a large population-based cohort.

METHODS

We analyzed data from 477,380 participants in the UK Biobank, categorized into four groups based on the presence or absence of CKD and sarcopenia: Non-CKD Non-Sarcopenia, Non-CKD Sarcopenia, CKD Non-Sarcopenia, and CKD Sarcopenia. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for CVD and mortality outcomes. Kaplan-Meier survival analyses compared event-free survival across the groups.

RESULTS

Participants with both CKD and sarcopenia exhibited the highest risks across all outcomes compared to those without either condition. For stroke, the adjusted HR was 2.17 (95% CI: 1.65-2.86), significantly higher than CKD alone (HR: 1.69, 95% CI: 1.47-1.94) or sarcopenia alone (HR: 1.28, 95% CI: 1.03-1.59). Similar trends were observed for coronary artery disease (CAD) and heart failure (HF), with HRs of 1.53 (95% CI: 1.38-1.69) and 2.22 (95% CI: 1.99-2.47), respectively, in the CKD-sarcopenia group. The coexistence of CKD and sarcopenia was also associated with significantly elevated all-cause mortality (HR: 2.59, 95% CI: 2.17-3.09) and cardiovascular-specific mortality (HR: 4.08, 95% CI: 2.95-5.66).

CONCLUSION

The coexistence of CKD and sarcopenia significantly amplifies the risks of CVD and mortality, highlighting the need for integrated management strategies to address this high-risk population. Early detection and tailored interventions targeting these dual risk factors may mitigate their compounded burden and improve clinical outcomes.

Essential amino acids and branched-chain amino acids are associated with skeletal muscle and inflammatory parameters in older age

Aging is associated with a decline in muscle mass and function, increasing the risk of adverse health outcomes. Amino acid profiling has emerged as a potential tool for assessing skeletal muscle health. This study examines the associations between fasting plasma amino acids, muscle function, and inflammation in healthy older and young adults. Data from 131 participants (101 older adults, 71.5±4.9 years; 30 young adults, 25.5±3.9 years) were analyzed. Skeletal muscle mass was assessed using bioimpedance analysis, and hand grip strength was measured with a dynamometer. Plasma amino acids, kynurenine, and inflammatory markers (CRP, IL-6) were quantified using ultraperformance liquid chromatography with tandem mass spectrometry and commercial immunosorbent assays, respectively. Older adults exhibited lower levels of glutamic acid, isoleucine, leucine, phenylalanine, kynurenine, and kynurenine-to-tryptophan (KYN:TRP) ratio compared to younger individuals (all p<0.05). In older adults, branched-chain and essential amino acids correlated positively with skeletal muscle index (SMI) and hand grip strength, whereas in young adults, only glutamic acid, proline, and KYN:TRP showed positive associations with SMI (all p<0.05). CRP and IL-6 were associated with several amino acids in older adults but not in younger individuals. These findings suggest that age-related shifts in amino acid profiles may reflect underlying changes in muscle metabolism and function, highlighting their potential as early indicators of muscle decline.

Subphenotypes of body composition and their association with cardiometabolic risk - Magnetic resonance imaging in a population-based sample

BACKGROUND

For characterizing health states, fat distribution is more informative than overall body size. We used population-based whole-body magnetic resonance imaging (MRI) to identify distinct body composition subphenotypes and characterize associations with cardiovascular disease (CVD) risk.

METHODS

Bone marrow, visceral, subcutaneous, cardiac, renal, hepatic, skeletal muscle and pancreatic adipose tissue were measured by MRI in n = 299 individuals from the population-based KORA cohort. Body composition subphenotypes were identified by data-driven k-means clustering. CVD risk was calculated by established scores.

RESULTS

We identified five body composition subphenotypes, which differed substantially in CVD risk factor distribution and CVD risk. Compared to reference subphenotype I with favorable risk profile, two high-risk phenotypes, III&V, had a 3.8-fold increased CVD risk. High-risk subphenotype III had increased bone marrow and skeletal muscle fat (26.3 % vs 11.4 % in subphenotype I), indicating ageing effects, whereas subphenotype V showed overall high fat contents, and particularly elevated pancreatic fat (25.0 % vs 3.7 % in subphenotype I), indicating metabolic impairment. Subphenotype II had a 2.7-fold increased CVD risk, and an unfavorable fat distribution, probably smoking-related, while BMI was only slightly elevated. Subphenotype IV had a 2.8-fold increased CVD risk with comparably young individuals, who showed high blood pressure and hepatic fat (17.7 % vs 3.0 % in subphenotype I).

CONCLUSIONS

Whole-body MRI can identify distinct body composition subphenotypes associated with different degrees of cardiometabolic risk. Body composition profiling may enable a more comprehensive risk assessment than individual fat compartments, with potential benefits for individualized prevention.

Characterization and Mortality Risk of Impaired Left Ventricular Filling in Chronic Obstructive Pulmonary Disease

Rationale: In chronic obstructive pulmonary disease (COPD), impaired left ventricular (LV) filling might be associated with coexisting heart failure with preserved ejection fraction (HFpEF) or due to reduced pulmonary venous return indicated by small LV size. Objectives: We investigated the all-cause mortality associated with small LV or HFpEF and clinical features discriminating between both patterns of impaired LV filling in patients with COPD. Methods: We performed transthoracic echocardiography (TTE) in patients with stable COPD from the COSYCONET (COPD and Systemic Consequences and Comorbidities Network) cohort to define small LV as LV end-diastolic diameter below the normal range and HFpEF features according to recommendations of the European Society of Cardiology. We assessed the ratio of early to late ventricular filling velocity (E/A), ratio of early mitral inflow velocity to annular early diastolic velocity (E/e'), serum N-terminal pro-brain natriuretic peptide, high-sensitivity troponin I, airflow limitation (FEV1), lung hyperinflation (residual volume), and gas transfer capacity (DlCO) and discriminated patients with small LV from those with HFpEF features or no relevant cardiac dysfunction as per TTE (normalTTE). The primary outcome was all-cause mortality after 4.5 years. Measurements and Main Results: In 1,752 patients with COPD, the frequency of small LV, HFpEF features, and normalTTE was 8%, 16%, and 45%, respectively. Patients with small LV or HFpEF features had higher all-cause mortality rates than patients with normalTTE: hazard ratio, 2.75 (95% confidence interval, 1.54-4.89) and 2.16 (95% confidence interval, 1.30-3.61), respectively. Small LV remained an independent predictor of all-cause mortality after adjusting for confounders including exacerbation frequency and measures of residual lung volume, DlCO, or FEV1. Compared with normalTTE, patients with small LV had reduced LV filling, as indicated by lowered E/A. Yet, in contrast to patients with HFpEF features, patients with small LV had normal LV filling pressure (E/e') and lower concentrations of N-terminal pro-brain natriuretic peptide and high-sensitivity troponin I. Conclusions: In COPD, both small LV and HFpEF features are associated with increased all-cause mortality and represent two distinct patterns of impaired LV filling. Clinical trial registered with www.clinicaltrials.gov (NCT01245933).

Assessment of Factors Related to Sarcopenia in Patients with Systemic Sclerosis

Objectives: Systemic sclerosis (SSc) patients exhibit a heightened vulnerability to sarcopenia, a condition characterized by the loss of muscle mass and strength. This study aims to determine the prevalence of sarcopenia in patients with SSc and to investigate the associated factors contributing to this condition. Methods: Eighty patients with SSc were included in the study, and their demographic and clinical characteristics, body composition by bioelectrical impedance analysis, SARC-F score, chair-stand test performance, and 4 m walking speed were recorded. Results: Among the 80 participants, 91.3% were female, with a median age of 56.5 years (range 45-65). The majority (70%) had limited SSc, and 71.3% reported at least one comorbidity. According to the International Physical Activity Questionnaire, only 12.5% of participants met the criteria for an active lifestyle. The SARC-F questionnaire indicated that 20% of patients were at risk for sarcopenia. The prevalence of sarcopenia among patients showed considerable variability: 5% (95% CI 0.1-9) were identified through the appendicular skeletal muscle index (ASMI), 8.8% (95% CI 2.4-15) via the fat-free mass index (FFMI), and a concerning 20% (95% CI 11-29) according to the skeletal muscle mass index (SSMI). A multivariate logistic regression analysis identified age as the only factor significantly influencing the SARC-F score, with an odds ratio of 1.081 (95% CI 1.012-1.154, p = 0.020). Additionally, the older age group demonstrated a lower level of physical activity, poorer chair-stand test outcome, and slower 4 m gait speeds (p = 0.013, p = 0.008, p = 0.001, respectively), as well as a higher reported frequency of falls (p = 0.039). Conclusions: Sarcopenia is a prevalent issue among individuals with SSc, particularly in the older population. This study did not identify a direct correlation between sarcopenia and SSc subtype, disease activity, or other clinical parameters. However, the need for an improved cut-off value for diagnosing sarcopenia in this specific cohort is evident.

Obesity, Sarcopenia, Sarcopenic Obesity, and Hypertension: Mediating Role of Inflammation and Insulin Resistance

BACKGROUND

This study aimed to assess the association between obesity, sarcopenia, and sarcopenic obesity with hypertension and to explore the potential mediation of inflammation indicators and insulin resistance.

METHODS

Data from the UK Biobank, a large-scale prospective cohort, were utilized. Obesity was defined using percentage of fat mass, whereas sarcopenia was defined as low muscle mass and low muscle strength. The primary outcome assessed was new-onset hypertension within a 5-year follow-up period. The association analysis was examined using a Cox regression model.

RESULTS

A total of 183 091 participants were enrolled in this study. During 5 years of follow-up, 3 812 (2.08%) developed hypertension. In the fully adjusted model, compared to men without these conditions, those with obesity, sarcopenia, and sarcopenic obesity had 2.32 times (95% confidence interval [95% CI], 2.12-2.55), 3.10 times (95% CI, 2.35-4.08), and 3.66 times (95% CI, 2.98-4.50) higher risks of developing hypertension, respectively. Women with obesity, sarcopenia, and sarcopenic obesity had 2.27 times (95% CI, 2.03-2.54), 2.93 times (95% CI, 1.95-4.39), and 4.04 times (95% CI, 3.32-4.91) higher risks of hypertension, respectively. Significant mediating effects of C-reactive protein, neutrophils, white blood cells, triglyceride-glucose index, and triglyceride-to-high-density lipoprotein cholesterol ratio were found, with mediations ranging from 6% to 13% for men and 2% to 21% for women in the association between sarcopenic obesity and hypertension.

CONCLUSIONS

Obesity, sarcopenia, and sarcopenic obesity significantly increased the risk of hypertension. Inflammation and insulin resistance appeared to mediate the association between sarcopenic obesity and hypertension.

Comparison study of bioelectrical impedance analyzers for measuring lower limb muscle mass in middle-aged and elderly adults

OBJECTIVE

Lower limb muscle mass (LLMM) accounts for more than 50% of the total body skeletal muscle mass. Assessing leg muscle mass in middle-aged and elderly individuals is crucial for the prevention and diagnosis of sarcopenia. Current bioelectrical impedance analysis (BIA) devices are capable of measuring LLMM, but validation studies are limited. This study compares the accuracy of BIA devices with different frequencies for measuring LLMM in middle-aged and elderly populations.

METHODS

LLMM measurements were obtained using the following devices: foot-to-foot dual-frequency (StarBIA201, 5, 50 KHz), multi-segment single-frequency (Tanita BC418, 50 KHz), dual-frequency (InBody270, 20, 100 KHz), triple-frequency (Tanita MC780MA, 5, 50, 250 KHz), and six-frequency (InBody770, 1, 5, 50, 250, 500, 1,000 KHz). Dual-energy X-ray absorptiometry (DXA) served as the reference standard. Comparisons were conducted using the following metrics: (1) mean difference (bias), (2) limits of agreement (LOA), (3) Pearson correlation coefficients, and (4) ordinary least product (OLP) regression analysis.

RESULTS

A total of 153 community-dwelling individuals aged over 55 years (102 females, 51 males) were recruited. The average age of participants was 67.5 ± 8.9 years, with a BMI of 23.9 ± 3.9 kg/m2 and a body fat percentage of 35.8 ± 6.5%. The correlation coefficients of StarBIA201, BC418, InBody270, MC780, and InBody770 with DXA were 0.902, 0.903, 0.917, 0.925, and 0.928, respectively. Their mean differences were -0.141, -2.731, -0.587, -1.613, and -0.625 kg, with LOAs of 4.3, 5.7, 4.0, 5.1, and 3.8 kg, respectively. StarBIA201 and InBody270 showed no fixed or proportional biases.

CONCLUSION

This study demonstrates that the four-electrode foot-to-foot BIA method shows significant practicality and potential in assessing LLMM. Compared to multi-frequency BIA and DXA, this method is simpler to operate and more convenient, making it particularly suitable for preliminary screening and assessment of sarcopenia in clinical and community settings.

Sex disparity in the association between alcohol consumption and sarcopenia: a population-based study

BACKGROUND

Previous studies have shown inconsistent findings regarding the association of alcohol consumption with sarcopenia. Therefore, this study comprehensively investigated the association of alcohol consumption with sarcopenia in a nationally representative sample of US adults.

METHODS

This population-based study included adults aged 18 years and older from the National Health and Nutrition Examination Survey (NHANES) III. Alcohol exposure was defined as daily alcohol intake, alcohol drinking history, number of drinking days per week, and frequency of binge drinking days per month. Weighted logistic regressions were used to determine associations.

RESULTS

Four cohorts were selected from the NHANES III: cohort 1 (n = 7,592), cohort 2 (n = 12,060), cohort 3 (n = 7,608), and cohort 4 (n = 7,649), corresponding to alcohol exposure categories of daily alcohol intake, drinking history, number of drinking days per week, and frequency of binge drinking days per month. In the full model, the risk of sarcopenia was significantly associated with mild (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.08-2.51), moderate (OR: 2.04; 95% CI: 1.12-3.71), and heavy drinkers (OR: 2.42; 95% CI: 1.17-4.97) compared to nondrinkers. There was an association between the development of sarcopenia and current drinkers (OR: 1.69; 95% CI: 1.12-2.56) but not former drinkers (OR: 1.21; 95% CI: 0.88-1.66). Compared to nondrinkers, an increased risk of developing sarcopenia was observed in participants who consumed alcohol 2 days (OR: 2.36; 95% CI: 1.40-3.99) or > 2 days (OR: 1.84; 95% CI: 1.10-3.07) per week, and those who engaged in binge drinking for ≤1 day per month (OR: 1.68; 95% CI: 1.09-2.60) or > 1 day per month (OR: 2.10; 95% CI: 1.10-4.01). Sensitivity analyses based on different definitions of sarcopenia yielded similar results. Stratified analyses revealed that these associations were present in females but not males.

CONCLUSION

Alcohol intake was associated with an increased risk of sarcopenia in all individuals, with this association being primarily observed in females rather than males.

C-Terminal Agrin Fragment as a Biomarker for Sarcopenia: A Systematic Review and Meta-Analysis

BACKGROUND

Sarcopenia is a gradual decline in skeletal muscle mass and strength, which eventually leads to reduced physical performance. 50% of people aged 60-80 years suffer from sarcopenia. Considering the devastating outcomes and the importance of promoting healthy ageing, the diagnosis and prevention of sarcopenia is of utmost importance. Recently, C-terminal agrin fragment (CAF) has been identified as an indicator for early diagnosis of sarcopenia. So far, systematic reviews demonstrating CAF as a biomarker for sarcopenia have been conducted, but a meta-analysis is still needed. This study contains systematic review as well as detailed meta-analysis to better understand the association of CAF and sarcopenia.

METHODS

Articles were primarily obtained from four different databases. Studies demonstrating the association between CAF and sarcopenia were selected. Data extraction and analysis were performed using STATASE 16 software. The risk of bias and quality assessment of each study was carried out using Joanna Briggs Institute (JBI) Critical Appraisal Tool. Meta-regression, subgroup and sensitivity analysis were conducted to identify the source of heterogeneity.

RESULTS

Seventeen studies were included in the qualitative analysis, out of which 10 were included in the quantitative analysis. The meta-analysis showed that CAF levels were significantly higher in sarcopenia patients, with an effect size of 1.93 (ROM = 1.93, 95% CI [1.49 to 2.36]; p = 0.00) and 1.38 (ROM = 1.38, 95% CI [0.94 to 1.83], p = 0.00) when compared with non-sarcopenic and non-sarcopenic (other co-morbidities) group, respectively. CAF levels were also negatively associated with hand grip strength (HGS) and skeletal muscle index (SMI) with an effect size of 1.09 (ROM = 1.09 with 95% CI [1.05 to 1.13], p = 0.00) and 1.10 (ROM = 1.10 with 95% CI [1.05 to 1.14], p = 0.00), respectively. Meta-regression and subgroup analysis revealed that although sarcopenia is associated with increasing age, the correlation between CAF and age was statistically insignificant (p = 0.44), suggesting that the variation of age among sarcopenia patients could be source of heterogeneity among studies. All the studies included in the meta-analysis reported low risk of bias.

CONCLUSIONS

Our meta-analysis concluded that elevated CAF levels were associated with sarcopenia and decreased HGS and SMI. CAF could serve as a valuable marker for the early detection and monitoring of sarcopenia, ultimately facilitating the management and treatment of this debilitating condition.

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Could Sarcopenia Be Related to Chemotherapy in Gastrointestinal Cancer? A Cross-Sectional Study Including Comprehensive Geriatric Assessment

Background: Sarcopenia, which is characterized by the progressive loss of skeletal muscle mass, strength, and functionality, adversely affects cancer outcomes. This study aims to evaluate the development and progression of sarcopenia in patients with gastrointestinal cancer undergoing chemotherapy and its impact on comprehensive geriatric assessment outcomes in older participants. Methods: This cross-sectional study included 351 gastrointestinal cancer patients from October 2018 to December 2019. Pre- and post-chemotherapy measurements were taken for 243 participants. Sarcopenia was assessed using EWGSOP-2 criteria, including muscle mass, strength, and performance evaluations. A comprehensive geriatric assessment was conducted for patients aged 65 years and older. Results: The median age of participants was 57.84 years, with 31.7% being female and 29.2% being aged 65 years or older. A significant increase in the prevalence of sarcopenia post-chemotherapy was observed. The factors significantly associated with sarcopenia included low hand grip strength (-0.264; p < 0.001) and slow gait speed (0.222; p = 0.007). The muscle mass and albumin levels of older patients declined significantly post-treatment. Conclusions: This study highlights a strong association between chemotherapy and sarcopenia in gastrointestinal cancer patients, emphasizing the need for early detection and tailored interventions. Comprehensive geriatric assessments can provide critical insights that improve patient outcomes during chemotherapy.

Association of Initial and Changes in Serum A-FABP Level With the Development and Improvement of Presarcopenia

CONTEXT

Several cross-sectional studies have reported the association between serum adipocyte fatty acid-binding protein (A-FABP) level and presarcopenia. However, data on the effects of serum A-FABP level and its changes over time on the development and improvement of presarcopenia are scarce.

OBJECTIVE

This study aimed to explore the association of serum A-FABP level with the incidence and improvement of presarcopenia in a community-based cohort, and further investigated the association of changes in serum A-FABP level with the incidence and improvement of presarcopenia.

METHODS

This longitudinal cohort study included 1496 adults (41.2% men; median age, 58 [53-63] years) in 2013 to 2014 and was followed up to 2015 to 2016. Participants underwent serum A-FABP level measurements at baseline and a follow-up visit. Visceral fat area (VFA) was measured using magnetic resonance imaging. Skeletal muscle mass (SMM) was estimated by bioelectrical impedance analysis and converted to a skeletal muscle index (SMI). Presarcopenia was defined as SMI less than 1 SD of the sex-specific mean for the young reference group.

RESULTS

During an average follow-up period of 2.1 years, baseline serum A-FABP level was positively associated with the incidence of presarcopenia (standardized by weight: risk ratio [RR] 3.22; 95% CI, 1.96-5.38; standardized by VFA: RR 2.11, 95% CI, 1.29-3.51) and negatively associated with the improvement of presarcopenia (standardized by weight: RR 0.66; 95% CI, 0.45-0.97; standardized by VFA: RR 0.71; 95% CI, 0.54-0.94), regardless of whether SMM was standardized by weight or VFA. Moreover, changes in serum A-FABP level provided additional information on the incidence and improvement of presarcopenia, independent of baseline serum A-FABP level (all P < .05).

CONCLUSION

Baseline serum A-FABP level and its changes were positively associated with the incidence and negatively associated with the improvement of presarcopenia.

Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass

Assessing muscle mass in critically ill patients remains challenging. This retrospective cohort study explores the potential of phase angle (PA°) derived from bioelectrical impedance analysis (BIA) as a surrogate marker for muscle mass monitoring by associating it with daily creatinine excretion (DCE), a structural and metabolic muscle mass marker. In 20 ICU patients, we observed a linear relationship between PA° and DCE at initial (S1) and follow-up (S2) points, with Rho values of 0.78 and 0.65, respectively, as well as between their percentage changes (Rho = 0.80). Multivariate analysis confirmed a strong association between changes in PA° and DCE (adjusted R2 of 0.73), while changes in the extracellular water to total body water (ECW/TBW) ratio showed no significant association. This study establishes a relationship between a BIA-derived independent-weight parameter and DCE, highlighting the potential of PA° for muscle mass monitoring during acute changes, such as those seen in ICU settings. Integrating PA° into clinical practice could provide a non-invasive and reliable tool to enhance muscle assessment and support targeted interventions in critically ill patients.

Altered body composition in obesity: Prevalence, associated factors and comparison of two methods

BACKGROUND & AIMS

There is still some uncertainty towards the best method to diagnose the sarcopenic obesity, and specifically, altered body composition. A recent international consensus proposes the association of increased fat mass (FM) with reduced skeletal muscle mass adjusted by weight (SMM/W) (method 1). The ratio of fat mass index (FMI)/fat free mass index (FFMI) (method 2) has also been proposed.

AIMS

to determine and compare the prevalence of altered body composition by the two methods, and its associated factors, in obese patients referred to a specialized center.

METHODS

Anthropometry, single-frequency bioimpedance analysis (BIA), and risk factors for sarcopenia were collected. SMM, according to the Janssen equation, and the FMI/FFMI ratio, were calculated. The agreement between the two methods was determined by the kappa coefficient. Multivariable analysis identified the factors associated with altered body composition according to the two methods.

RESULTS

253 consecutive patients were retrospectively included: 81 % women, age 44.4 ± 13 yr, body mass index (BMI) 43.0 ± 6.8 kg/m2, severe obesity, 94 %. Altered body composition was reported in 90 % of the obese patients (n = 227/253) with method 1, and 35 % (83/253) with method 2. The agreement between the two methods was very low (kappa = 0.10). The factors associated with altered body composition were: method 1, age (odds ratio = 1.05 [95 % confidence interval, 1.01; 1.10], P = 0.02), arterial hypertension (0.18 [0.06; 0.57], P = 0.04), hip circumference (1.13 [1.07; 1.20], P < 0.0001), previous obesity follow-up (3.78 [1.30; 10.96], P = 0.002); method 2, female gender (3.12 [1.02; 9.5], P = 0.04), age (1.10 [1.06; 1.14], P < 0.0001), BMI (1.37 [1.26; 1.50], P < 0.0001), history of cancer (5.35 [1.20; 23.84], P < 0.028), phase angle (0.42 [0.27; 0.66], P < 0.001).

CONCLUSION

Altered body composition is common in severely obese patients. The two methods are not comparable. Further work will aim at refining the methods of body composition measurements in the obese patients, and especially for the sarcopenic obesity diagnosis.

Sarcopenia and cachexia: molecular mechanisms and therapeutic interventions

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

Development and clinical application of bioelectrical impedance analysis method for body composition assessment

Obesity, which is characterized by excessive body fat, increases the risk of chronic diseases, such as type 2 diabetes, cardiovascular diseases, and certain cancers. Sarcopenia, a decline in muscle mass, is also associated with many chronic disorders and is therefore a major concern in aging populations. Body composition analysis is important in the evaluation of obesity and sarcopenia because it provides information about the distribution of body fat and muscle mass. It is also useful for monitoring nutritional status, disease severity, and the effectiveness of interventions, such as exercise, diet, and drugs, and thus helps assess overall health and longevity. Computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry are commonly used for this purpose. However, they have limitations, such as high cost, long measurement time, and radiation exposure. Instead, bioelectrical impedance analysis (BIA), which was introduced several decades ago and has undergone significant technological advancements, can be used. It is easily accessible, affordable, and importantly, poses no radiation risk, making it suitable for use in hospitals, fitness centers, and even at home. Herein, we review the recent technological developments and clinical applications of BIA to provide an updated understanding of BIA technology and its strengths and limitations.

The proliferation and differentiation of skeletal muscle stem cells are enhanced in a bioreactor

Skeletal muscle (SKM) is the largest organ in mammalian body and it can repair damages by using the residential myogenic stem cells (MuSC), but this repairing capacity reduces with age and in some genetic muscular dystrophy. Under these circumstances, artificial amplification of autologous MuSC in vitro might be necessary to repair the damaged SKM. The amplification of MuSC is highly dependent on myogenic signals, such as sonic hedgehog (Shh), Wnt3a, and fibroblast growth factors, so formulating an optimum myogenic kit composed of specific myogenic signals might increase the proliferation and differentiation of MuSC efficiently. In this study, various myogenic signals have been tested on C2C12 myoblasts and primary MuSC, and a myogenic kit consists of insulin, lithium chloride, T3, and retinoic acid has been formulated, and we found it significantly increased the fusion index and MHC expression level of both C2C12 and MuSC myotubes. A novel bioreactor providing cyclic stretching (CS) and electrical stimulation (ES) has been fabricated to enhance the myogenic differentiation of both C2C12 and MuSC. We further found that coating the bioreactor substratum with collagen gave the best effect on proliferation and differentiation of MuSC. Furthermore, combining the collagen coating and physical stimuli (CS + ES) in the bioreactor can generate more proliferative primary MuSC cells. Our results have demonstrated that the combination of myogenic kit and bioreactor can provide environment for efficient MuSC proliferation and differentiation. These MuSC and mature myotubes amplified in the bioreactor might be useful for clinical grafting into damaged SKM in the future.

Correlation and predictive value of novel anthropometric indicators with adult sarcopenia and sarcopenia obesity

The present study leverages the comprehensive data from the National Health and Nutrition Examination Survey (NHANES) to examine the Influencing factors of sarcopenia (SA) and sarcopenic obesity (SO). The investigation is designed to a non-invasive, cost-effective, and convenient method that is applicable to the adult population, enabling the accurate and simultaneous detection of risks associated with SA and SO. Furthermore, this research will evaluate the critical values of effective anthropometric indicators, providing early warning for risk management in self-health care and offering valuable insights for subsequent research and clinical practice. The data pertaining to NHANES participants were meticulously selected from the databases of six cycles, spanning from 2001 to 2004 and 2011 to 2018. Utilizing the diagnostic criteria established by the American Foundation for the National Institutes of Health (FNIH), anthropometric measurement data were extracted to construct composite indices. These indices were then cross-referenced with diagnostic assessments from dual-energy X-ray absorptiometry and bioelectrical impedance analysis to examine the correlations between various metrics and the incidence of diseases. R software (version 4.3.3) was used for analysis, and the primary analytical methods employed included logistic regression, restricted cubic splines (RCS), and the Receiver Operating Characteristic (ROC) curve analysis (AUC). Sarcopenia and sarcopenic obesity are commonly observed in individuals within the middle-aged and elderly demographics. The prevalence of these conditions is higher among middle-aged men of a given age when contrasted with women at the age of 40. All anthropometric indexes demonstrated a positive correlation with the onset of SA and SO, with the association with waist-to-height ratio (WHtR) showcasing a heightened strength subsequent to the adjustment for all covariates. The predictive models of all ROC curves performed commendably, particularly with the body roundness index and WHtR forecasting models exhibiting superior performance, the area under the AUC curve is 0.87 (95 CI% 0.85, 0.88) and 0.86 (95 CI% 0.85, 0.88), respectively. The RCS curve delineated a distinctive J-shaped distribution for each physical index in concurrence with SA and SO, signifying an optimal value at which the incidence of these conditions is minimal; conversely, deviations from this optimal value entailed an escalated risk of disease. Diverse anthropometric index metrics bear a strong correlation with adult onset of sarcopenia and sarcopenic obesity, each displaying commendable predictive capability. Notably, the body roundness index and waist-to-height ratio may harbor heightened potential as indicative anthropometric indexes. Furthermore, the dose-effect relationship analysis inferred that the lowest disease risk is manifested among individuals with specific index profiles, thereby advocating for autonomous health monitoring to promote physical activity and bolster nutrient intake, thus mitigating the risk of sarcopenia and sarcopenic obesity.

The Health Effects of Dietary Nitrate on Sarcopenia Development: Prospective Evidence from the UK Biobank

Nitrate is abundant in natural foods, especially plant-based foods, having the potential to enhance muscle function. However, its relationship with sarcopenia in the context of daily diet remains unexplored. This cohort study investigated the associations between dietary nitrate intake and sarcopenia, as well as related symptoms, using data including 28,229 participants with a mean follow-up of 9.37 years from the UK Biobank. Dietary nitrate intake was estimated using a comprehensive nitrate food database. Adjusted logistic regression models suggested potential inverse associations between total nitrate intake and risks of sarcopenia plus pre-sarcopenia (Sarc-Presarc), low hand grip strength (HGS), and low walking pace. Similar results were primarily observed for nitrate from plant-based foods. With higher intake, females appeared to have higher HGS and a decreased risk of Sarc-Presarc, while males exhibited a reduced risk of low walking pace. The inverse association between nitrate intake and low skeletal muscle mass index was more evident in individuals aged 65 and above. These associations seemed independent of antioxidants, though higher antioxidants might augment the protective effect against low walking pace. Mediation analyses indicated that protein homeostasis and blood pressure might mediate these associations. These findings suggested that a higher dietary nitrate intake from plant-based foods could contribute to sarcopenia prevention, though further research is needed to confirm these observations.

Muscle Biomarkers in Colorectal Cancer Outpatients: Agreement Between Computed Tomography, Bioelectrical Impedance Analysis, and Nutritional Ultrasound

BACKGROUND

Muscle quality and mass in cancer patients have prognostic and diagnostic importance.

OBJECTIVES

The objectives are to analyze agreement between gold-standard and bedside techniques for morphofunctional assessment.

METHODS

This cross-sectional study included 156 consecutive colorectal cancer outpatients that underwent computed tomography (CT) scanning at lumbar level 3 (L3), whole-body bioelectrical impedance analysis (BIA), point-of-care nutritional ultrasound® (US), anthropometry, and handgrip strength in the same day. Measured muscle biomarkers were stratified by sex, age, BMI-defined obesity, and malnutrition using Global Leadership in Malnutrition (GLIM) criteria. Whole-body estimations for muscle mass (MM) and fat-free mass were calculated using two different equations in CT (i.e., Shen, and Mourtzakis) and four different equations for BIA (i.e., Janssen, Talluri, Kanellakis, and Kotler). Muscle cross-sectional area at L3 was estimated using the USVALID equation in US. Different cut-off points for muscle atrophy and myosteatosis were applied. Sarcopenia was defined as muscle atrophy plus dynapenia. Intra-technique and inter-technique agreement were analyzed with Pearson, Lin (ρ), and Cohen (k) coefficients, Bland-Altman analyses, and hypothesis tests for measures of central tendency.

RESULTS

Intra-technique agreements on muscular atrophy (CT k = 0.134, BIA k = -0.037, US k = 0.127) and myosteatosis (CT k = 0.122) were low, but intra-technique agreement on sarcopenia in CT was fair (k = 0.394). Inter-technique agreement on muscular atrophy and sarcopenia were low. Neither CT and BIA (ρ = 0.468 to 0.772 depending on equation), nor CT and US (ρ = 0.642), were interchangeable. Amongst the BIA equations, MM by Janssen proved the best, with a 1.5 (3.6) kg bias, (-5.6, 8.6) kg LoA, and 9/156 (5.7%) measurements outside the LoA. Muscle biomarkers in all techniques were worse in aged, female, or malnourished participants. Obesity was associated with higher muscle mass or surface biomarkers in all techniques.

CONCLUSIONS

Bedside techniques adequately detected patterns in skeletal muscle biomarkers, but lacked agreement with a reference technique in the study sample using the current methodology.

Predicting sarcopenia risk in stroke patients: a comprehensive nomogram incorporating demographic, anthropometric, and biochemical indicators

Objective

Although there is a strong correlation between stroke and sarcopenia, there has been a lack of research into the potential risks associated with post-stroke sarcopenia. Predictors of sarcopenia are yet to be identified. We aimed at developing a nomogram able to predict sarcopenia in patients with stroke.

Methods

The National Health and Nutrition Examination Survey (NHANES) cycle year of 2011 to 2018 was divided into two groups of 209 participants-one receiving training and the other validation-in a random manner. The Lasso regression analysis was used to identify the risk factors of sarcopenia, and a nomogram model was created to forecast sarcopenia in the stroke population. The model was assessed based on its discrimination area under the receiver operating characteristic curve, calibration curves, and clinical utility decision curve analysis curves.

Results

In this study, we identified several predictive factors for sarcopenia: Gender, Body Mass Index (kg/m2), Standing Height (cm), Alkaline Phosphatase (ALP) (IU/L), Total Calcium (mg/dL), Creatine Phosphokinase (CPK) (IU/L), Hemoglobin (g/dL), and Waist Circumference (cm). Notably, female patients with stroke exhibited a higher risk of sarcopenia. The variables positively associated with increasing risk included Alkaline Phosphatase, Body Mass Index, Waist Circumference, and Hemoglobin, while those negatively associated with risk included Height, Total Calcium, and Creatine Phosphokinase. The nomogram model demonstrated remarkable accuracy in distinguishing between training and validation sets, with areas under the curve of 0.97 and 0.90, respectively. The calibration curve showcased outstanding calibration, and the analysis of the decision curve revealed a broad spectrum of beneficial clinical outcomes.

Conclusion

This study creates a new nomogram which can be used to predict pre-sarcopenia in stroke. The new screening device is accurate, precise, and cost-effective, enabling medical personnel to identify patients at an early stage and take action to prevent and treat illnesses.

Influence of sarcopenia as determined by bioelectrical impedance analysis in acute pancreatitis

Sarcopenia can be defined as the loss of muscle mass and strength. It is a poor prognostic factor for many diseases. Our study aims to assess the prevalence of sarcopenia in patients with acute pancreatitis using bioelectrical impedance analysis (BIA) and hand dynamometry while also investigating its impact on acute pancreatitis. Sixty patients admitted with a diagnosis of acute pancreatitis were included in this prospective study. Following their admissions, prognostic markers were calculated, muscle strengths were measured using a hand dynamometer, and body compositions were determined using a BIA device. Accordingly, acute pancreatitis patients were divided into 2 groups: sarcopenic and nonsarcopenic. The demographic characteristics, anthropometric measurements, Ranson score, Glasgow-Imrie score, Balthazar score, APACHE-II score, disease severity according to the Atlanta classification, length of hospital stay, and laboratory findings of the 2 groups were compared. Sarcopenia was identified in 11 cases among those with acute pancreatitis included in the study. In the sarcopenic group, the mean age, Glasgow-Imrie score and number of cases with severe acute pancreatitis according to the Atlanta classification were significantly higher; body mass index, upper arm circumference, skeletal muscle mass index, and grip strength were significantly lower (P < .05). This study is the first to evaluate sarcopenia in acute pancreatitis cases using BIA and hand dynamometry. Sarcopenia may play a significant role in predicting the prognosis of acute pancreatitis.

Improving the functional detection of sarcopenic obesity: prevalence and handgrip scoring in the OBESAR cohort

OBJECTIVE

The study objectives were: 1) to detect early signs of low muscle function and assess sarcopenic obesity (SO) prevalence in patients with obesity; and 2) to introduce a new online diagnostic tool for scoring handgrip strength (HGS), adjusted for age and sex.

METHODS

Patients from the OBESAR cohort (184 men and 499 women) were tested for body composition and functional testing (chair stand test or HGS based on the cutoffs from the European Society for Clinical Nutrition and Metabolism [ESPEN]/European Association for the Study of Obesity [EASO] or adjusted HGS [adHGS] based on reference values), and SO prevalence was calculated accordingly.

RESULTS

Among the 683 patients (mean [SD], age 42.6 [12.8] years; BMI 44.4 [6.3] kg/m2), HGS averaged 25.6 (6.8) kg for women and 43.2 (10.4) kg for men. A total of 25.2% of patients had adHGS lower than the 10th percentile, but this was true for only 5.6% using ESPEN/EASO cutoffs of HGS. SO prevalence rates were different according to functional tests: 5.4%, 24.5%, and 3.2% for HGS, adHGS, and the chair stand test, respectively.

CONCLUSIONS

Using adHGS through a scoring process considering age and sex may help to detect early signs of SO in a primary care setting in order to better prevent SO through a personalized approach in adults with obesity. A free online application, "GRip And Sarcopenia Prediction" (GRASP), is proposed to diagnose probable SO.

Comparison of diagnostic accuracy of the SARC-F, SARC-CalF, and Ishii tests for diagnosis of sarcopenia in hospitalized older patients: A cross-sectional study

BACKGROUND

Several screening tools have been developed to identify sarcopenia. However, data on the use of these screening tools in hospital settings are limited. This study assessed the diagnostic accuracy of three screening methods-strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F); SARC-F combined with calf circumference (SARC-CalF); and the Ishii tests-for detecting sarcopenia in older individuals who are hospitalized.

METHODS

This study included 204 older people who were hospitalized. Sarcopenia was assessed relative to the diagnostic criteria established by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Muscle mass, muscle strength, and physical performance were evaluated using bioimpedance analysis, handgrip strength, and usual gait speed, respectively. Sensitivity and specificity analyses were conducted for the SARC-F, SARC-CalF, and Ishii tests to determine their effectiveness. Receiver operating characteristics curves were generated, and the area under curve was calculated to compare the overall diagnostic accuracy of the SARC-F, SARC-CalF, and Ishii tests.

RESULTS

The SARC-F, SARC-CalF, and Ishii tests demonstrated sensitivities of 72%, 88.6%, and 93.5%, respectively, and specificities of 41%, 78.5%, and 30.3%, respectively.

CONCLUSIONS

SARC-CalF demonstrates the highest performance in terms of sensitivity and specificity compared with the other two tests, making it a valuable tool for detecting sarcopenia in hospital settings. In contrast, the Ishii test exhibits high sensitivity but low specificity within this population. Based on our results, we found that SARC-CalF can be used as a simple, effective test for identifying sarcopenia in older patients in the hospital setting.

Quadriceps electromyography during flywheel-based inertial training (FIT) and dynamic constant external resistance (DCER) squats at similar tempo

Flywheel-based iso-inertial training (FIT) has been purported to provide enhanced adaptations to muscle overload compared to dynamic constant external resistance (DCER), but previous studies have not controlled for exercise intensity. We compared quadriceps electromyography (EMG) amplitude between FIT- and DCER-squats with similar tempo. Eleven (5 M and 6F) resistance-trained participants completed sets of five maximal velocity FIT (0.025 kg∙m2) and DCER (55 ± 15 %1RM) squats. Sagittal plane knee joint angles and surface EMG activity of the vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) were measured. Repetition time and peak knee angles were similar between FIT and DCER squats. Mean knee angular velocity during the concentric (122.2 ± 23.6 vs. 108.9 ± 22.9, p = 0.022, Cohen's D: 0.820), but not eccentric, phase was significantly greater during FIT. Peak VM (210.4 ± 49.3 vs. 177.5 ± 56.3 %MVIC, p = 0.001; Cohen's D: 1.416), but not VL or RF, EMG amplitude was significantly greater in FIT compared to DCER. Mean EMG amplitude was significantly (p < 0.001) greater during the concentric than the eccentric phase for the VL and VM but not RF. Mean EMG amplitude was not significantly different between modes during either the concentric or eccentric phase. Quadriceps EMG amplitude is largely similar between FIT and DCER squats when matched for movement velocity.

Nutritional Management in Stricturing Crohn's Disease: A Pilot Study

BACKGROUND

More than half of patients with Crohn's disease develop intestinal fibrosis induced intestinal obstruction with debilitating symptoms throughout their disease course. The incidence of stricture formation in CD has remained unchanged over the last several decades. Factors promoting intestinal fibrosis are currently unclear, but diet may represent an underestimated risk factor for intestinal fibrosis by modification of both the host immune response and intestinal microbial composition. Evaluating the impact of diet on the course of IBD is very complex. Sarcopenia is a common problem in IBD patients and correlates with an increased rate of disease. Skeletal muscle index (SMI) is an important parameter to measure sarcopenia and is an easily accessible tool for evaluating the likelihood of complications in individuals with CD.

METHODS

Using a randomized and controlled pilot design, we aimed to investigate the efficacy of 12 months of short-term dietary intervention based on essential amino acid (EAA) and sodium butyrate (NaB) supplementation in the management of stricturing Crohn's disease patients.

RESULTS

After the treatment in the diet EAA/NaB group, we revealed a statistically significant improvement of muscle mass (61.49 ± 5.47 vs. control 86 ± 10.70, p = 0.01) and SMI index (9.97 ± 1.79 vs. control 7.60 ± 2.29, p = 0.02). In addition, the measurement of skeletal muscle mass in CD patients has been suggested to be crucial for predicting the disease course. Indeed, after one year, surgery was required in 4/10 control group patients (40%) and 1/10 study group (10%) patients, underlining the importance of body composition alterations and adequate dietary intake in the management of these patients.

CONCLUSIONS

Further prospective studies are needed to confirm these results; nonetheless this nutritional approach could become an integral part in the treatment of stricturing CD patients to improve disease outcomes and increase the quality of life in these patients.

IMPACT OF SARCOPENIA ON THE PROGNOSIS OF PATIENTS WITH CIRRHOSIS HOSPITALIZED FOR ACUTE DECOMPENSATION OR ACUTE-ON-CHRONIC LIVER FAILURE

BACKGROUND

Cirrhosis is a prevalent disease and ranks among the leading causes of death worldwide. Sarcopenia is believed to be associated with a poorer prognosis in patients with cirrhosis.

OBJECTIVE

To evaluate the impact of sarcopenia on the prognosis of patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure.

METHODS

This prospective cohort study evaluated patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People, using skeletal muscle mass analysis by bioelectrical impedance and handgrip strength testing. The data was collected between March-2019 and April-2020. Qualitative variables were presented as frequencies and percentages, and quantitative variables as means and standard deviations when symmetrical, or medians and 25th and 75th percentiles when asymmetrical. The association of sarcopenia and mortality with quantitative variables was tested using Student's t-test or the Mann-Whitney test, while associations with qualitative variables were tested using the Chi-square test or Fisher's Exact test. For significant associations, crude and adjusted (multivariate analysis) relative risk estimates with a 95% confidence interval were calculated using Poisson regression analysis. Results with P<0.05 were considered significant.

RESULTS

Fifty patients were included, with a mean age of 60.5 years (±10.4) and a slight predominance of men (56%). The main causes of cirrhosis were alcohol use disorder (28%) and hepatitis C (24%). The median Child-Pugh score was 8 points (7-10), and the median Model for End-stage Liver Disease score was 15 points (12.5-21). Ten patients were diagnosed with acute-on-chronic liver failure. Sarcopenia was present in 50% of the sample. Sarcopenia was present in 70.0% of patients with acute-on-chronic liver failure and in 43.2% of those without acute-on-chronic liver failure (P=0.168). Overall mortality was 48% in patients with sarcopenia and 44% in those without sarcopenia (P=1.000). In multivariate analysis, overall mortality was associated only with leukocyte count (relative risk=1.01, 95% confidence interval=1.01-1.01) and Model for End-stage Liver Disease score (relative risk=1.07, 95% confidence interval =1.03-1.10).

CONCLUSION

In this study, sarcopenia was not associated with mortality in patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure. There was a non-significant trend towards a higher prevalence of sarcopenia among individuals with acute-on-chronic liver failure.

Validation of Ultrasound Measurement of Vastus Lateralis for Appendicular Skeletal Muscle Mass in Chronic Kidney Disease Patients with Hemodialysis

BACKGROUND

Chronic kidney disease patients undergoing hemodialysis (HD) are at a high risk of developing sarcopenia. This study aimed to validate the performance of ultrasound (US) measurements of the vastus lateralis (VL) for estimating muscle mass and diagnosing sarcopenia in CKD patients with HD.

METHODS

Forty-six patients were enrolled in this study. Muscle thickness (MT) and echo intensity (EI) of VL, physical performance, and biochemical markers were collected to establish a linear regression model for predicting appendicular skeletal muscle mass (ASM), using dual-energy X-ray absorptiometry (DXA) as the reference standard. The model's performance was validated, and its diagnostic accuracy for sarcopenia was also evaluated.

RESULTS

An ASM prediction model was derived: -20.17 + 1.90 × MT_VL (cm) + 1.58 × male + 0.16 × Height (cm) + 0.09 × Weight (kg) + 0.05 × Age (year), with a standard estimated error of 1.44 kg and adjusted R-squared of 0.84. The model exhibited high correlation and an acceptable limit of agreement, compared to DXA measurement. EI displayed a negative correlation with ASM and MT.

CONCLUSIONS

The ASM adjusted with BMI demonstrated superior performance in diagnosing sarcopenia compared to the ASM adjusted with height. Ultrasound provides a cost-effective bedside tool for evaluating muscle conditions in HD patients.

Phase Angle (PhA) Is an Easy and Complementary Tool for Assessing Nutritional Status in Ulcerative Colitis (UC) Patients: A Cross-Sectional Study

BACKGROUND

Accumulating evidence has proposed phase angle (PhA) as a marker for assessing cellular integrity and nutritional status in ulcerative colitis (UC) patients; the aim of the study was to evaluate the efficacy of PhA in assessing nutritional status in patients with UC, investigating its potential as a biomarker of disease activity.

METHODS

We conducted a cross-sectional study in patients with UC and healthy controls. We determined PhA by electrical bioimpedance and categorized participants through bioelectrical impedance analysis. They were classified as normal PhA > 6.1° and low PhA < 6.1° in men and normal PhA > 5.6° and low PhA < 5.6° in women.

RESULTS

PhA was significantly lower in UC patients than in controls (5.8 ± 0.8 vs. 6.6 ± 0.7°; p < 0.001). Among UC patients, participants with low PhA showed a decrease in lean, dry mass (LDM) (p < 0.001), total body water (p = 0.008), and intracellular water (p = 0.005), accompanied by an increase in extracellular water (p = 0.001) compared to UC patients with normal PhA.

CONCLUSIONS

PhA significantly decreases in UC patients compared to healthy controls and is even more reduced when UC is active. A cut-off point of <6.1 for men and <5.6 for women could be suitable for nutritional diagnosis in patients with UC, but it still needs to be validated.

Development and validation of a screening tool for sarcopenia in Chinese nursing home residents

Sarcopenia, characterized by the loss of muscle mass and function, is a critical health issue in nursing home residents. Given the high prevalence of sarcopenia in care settings, effective screening is crucial. This study compared the diagnostic accuracy of two conventional sarcopenia screening tools, SARC-F and SARC-CalF, and developed an alternative tool, SEAC, specifically for nursing home residents. In a sample of 679 older adults from Zhejiang Province, SARC-CalF exhibited better sensitivity and diagnostic accuracy compared to SARC-F. The SEAC tool, incorporating strength, exhaustion, assistance in walking, and calf circumference, demonstrated the highest diagnostic accuracy and sensitivity among the three screening tools. These findings suggest that SEAC could serve as a valuable tool for large-scale sarcopenia screening in nursing homes, potentially improving early detection and management of sarcopenia in this vulnerable population.

Ten-Year Incidence of Sarcopenia in a Population-Based Cohort: Results from the Research on Osteoarthritis/Osteoporosis Against Disability Study

OBJECTIVES

To investigate the prevalence and incidence rates of sarcopenia in Japanese community-dwelling people according to the criteria of the Asian Working Group for Sarcopenia 2019 recommendations, using a large-scale population-based cohort over a 10-year follow-up period.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

This study was conducted using data from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. In total, 1551 participants (521 men and 1030 women; mean age, 65.8 years) from the second ROAD survey (2008-2-10) were included in this study.

METHODS

The participants from the second survey were followed-up at 4, 7, and 10 years. Skeletal muscle mass, handgrip strength, and walking speed were assessed. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The incidence of sarcopenia was calculated using the person-year method. Cox proportional hazard model was used to assess risk factors for incident sarcopenia.

RESULTS

The prevalence of sarcopenia was 8.1% (8.8% in men and 7.7% in women), and the prevalence of severe sarcopenia was 2.9% (2.7% in men and 3.1% in women). The incidence rates of sarcopenia were 17.8 per 1000 and 14.5 per 1000 person-years in men and women, respectively. Additionally, the incidence rates of severe sarcopenia were 6.4 per 1000 and 4.2 per 1000 person-years in men and women, respectively. The significant risk factors for the incidence of sarcopenia were age [+1 year; hazard ratio (HR), 1.10; 95% CI, 1.08-1.12] and body mass index (-1 kg/m2; HR, 1.27; 95% CI, 1.20-1.35). The significant risk factors for the incidence of severe sarcopenia were age (+1 year; HR, 1.18; 95% CI, 1.14-1.22) and body mass index (-1 kg/m2; HR, 1.21; 95% CI, 1.10-1.33).

CONCLUSIONS AND IMPLICATIONS

The prevalence and incidence rates of sarcopenia in Japan were clarified in this study.

Bioelectrical impedance-derived phase angle (PhA) in people living with obesity: Role in sarcopenia and comorbidities

BACKGROUND AND AIM

Obesity is characterized by alterations in fat and muscle mass. Phase angle (PhA) is considered an index of muscle mass, and is related to comorbidities in SO. This work aimed to assess the relationship between PhA, muscle mass, inflammation, and comorbidities in obesity.

METHODS AND RESULTS

We included 198 outpatients with obesity (BMI≥30) divided into tertiles according to PhA distribution (<5°, 5°-6°, >7°). Body composition was analyzed using bioimpedance (Tanita MC-780P Multi-Frequency Segmental Body Composition Analyzer). Quantitative variables were compared using the Kruskal-Wallis test and qualitative variables using the chi-square test. A correspondence analysis was built to show the influence of qualitative variables on subjects in each tertile. Patients in the lowest tertile had the lowest skeletal muscle mass and appendicular skeletal muscle mass index (ASMI); the highest inflammatory index (albumin and derived neutrophil-to-lymphocyte ratio, Alb-dNLR); and the highest percentage of individuals with a history of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF). The correspondence analysis showed an association between the lowest tertile and presence of HF with preserved ejection fraction (HFpEF) and CKD. On the logistic regression model, ASMI (OR 0.9, 95%CI 0.85-0.95, p = 0.0004), Alb-dNLR (OR 1.04, 95%CI 1.04-16.4, p = 0.04) and HFpEF and T2DM were significantly associated with the lowest PhA.

CONCLUSIONS

Identifying high-risk individuals living with obesity is a priority. These results show that lower PhA is related to inflammation, poorer skeletal muscle mass and consequently, their impact on obesity-related comorbidities and clinical outcomes.

Energy Availability and Body Composition in Professional Athletes: Two Sides of the Same Coin

BACKGROUND/OBJECTIVES

Energy availability (EA) is essential for maintaining physiological functions, significantly influencing athletes' health and performance. Nutritional behaviors, however, vary across sports. This study aims to assess EA levels in athletes from different disciplines, focusing on the relationship between EA and body composition in endurance athletes compared to rugby players.

METHODS

This study involved 18 endurance athletes (15 men, 3 women) and 36 rugby players (all men). Data were gathered through interviews, questionnaires, and bioimpedance analysis. Energy intake (EI) was measured with a 24 h dietary recall, and exercise energy expenditure (EEE) was calculated using the IPAQ questionnaire. EA was calculated as EA = (EI - EEE)/fat-free mass (FFM), with results categorized into clinical, subclinical, and optimal ranges.

RESULTS

The endurance group had a lower average FFM (57.81 kg) compared to the rugby players (67.61 kg). EA was also significantly lower in endurance athletes (11.72 kcal/kg FFM) than in rugby players (35.44 kcal/kg FFM). Endurance athletes showed more restrictive nutritional behavior with lower EI and higher EEE, but both groups maintained body composition within normal ranges.

CONCLUSIONS

Endurance athletes exhibit greater nutritional restrictions compared to rugby players, though their body composition remains healthy. Further research is required to investigate the long-term effects of low EA on performance, injury risk, and potential impairment when EA falls below the optimal threshold of 45 kcal/kg FFM/day.

Performance of SARC-F and SARC-CalF scores to predict risk of mortality in hemodialysis patients: a cohort study

This study aimed to evaluate the association between the questionnaires SARC-F and SARC-CalF with risk of mortality in patients undergoing hemodialysis (HD). A cohort study, with patients on HD age ≥ 18 years, both sex, between June 2019 and April 2023. Body composition (anthropometry and bioelectrical impedance), muscle functional (handgrip strength and gait speed), screening of sarcopenia using the SARC-F and SARC-CalF, nutritional status and laboratory data were assessed. Follow-up for mortality up to 47 months. The sample consisted of 243 participants and the prevalence of risk of sarcopenia using SARC-F and SARC-CalF were 30% and 45%, respectively; 65 died for all reasons and three patients were censored due to transplantation. Multivariate analysis identified SARC-CalF as predictor of mortality in HD patients [hazard ratio 1.96; 95% CI (1.01-3.79); p = 0.04]. The survival analysis showed that there was a significant difference in the survival curves among the groups stratified by SARC-F and SARC-CalF for log-rank test. A higher specificity was found for SARC-CalF than SARC-F (80% vs. 77%) in receiver operating characteristic (ROC) curve. Both questionnaires were associated with anthropometric, parameters of body composition, physical measurements, and SARC-CalF was predictor of risk for mortality in HD patients.

Integrative effects of resistance training and endurance training on mitochondrial remodeling in skeletal muscle

Resistance training activates mammalian target of rapamycin (mTOR) pathway of hypertrophy for strength gain, while endurance training increases peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) pathway of mitochondrial biogenesis benefiting oxidative phosphorylation. The conventional view suggests that resistance training-induced hypertrophy signaling interferes with endurance training-induced mitochondrial remodeling. However, this idea has been challenged because acute leg press and knee extension in humans enhance both muscle hypertrophy and mitochondrial remodeling signals. Thus, we first examined the muscle mitochondrial remodeling and hypertrophy signals with endurance training and resistance training, respectively. In addition, we discussed the influence of resistance training on muscle mitochondria, demonstrating that the PGC-1α-mediated muscle mitochondrial adaptation and hypertrophy occur simultaneously. The second aim was to discuss the integrative effects of concurrent training, which consists of endurance and resistance training sessions on mitochondrial remodeling. The study found that the resistance training component does not reduce muscle mitochondrial remodeling signals in concurrent training. On the contrary, concurrent training has the potential to amplify skeletal muscle mitochondrial biogenesis compared to a single exercise model. Concurrent training involving differential sequences of resistance and endurance training may result in varied mitochondrial biogenesis signals, which should be linked to the pre-activation of mTOR or PGC-1α signaling. Our review proposed a mechanism for mTOR signaling that promotes PGC-1α signaling through unidentified pathways. This mechanism may be account for the superior muscle mitochondrial remodeling change following the concurrent training. Our review suggested an interaction between resistance training and endurance training in skeletal muscle mitochondrial adaptation.

Modified creatinine index as a marker of skeletal muscle mass in peritoneal dialysis patients

Background

Sarcopenia is common in peritoneal dialysis (PD) patients. Modified creatinine index (MCrI) by the Canaud's formula and single-pool Kt/V value is an accurate surrogate marker for muscle mass in hemodialysis patients. However, the method of calculation and validity of MCrI has not been tested in PD.

Methods

In the exploratory cohort, we studied 138 consecutive patients converted from PD to hemodialysis. Their MCrI during PD, calculated by the Canaud's formula with total weekly Kt/V, and the conventional MCrI after conversion to HD, were compared by the Bland-Altman method. Their correlation with muscle mass as determined by bioimpedance spectroscopy and creatinine kinetic methods was explored. The result was then validated in a second cohort of 605 incident PD patients.

Results

In the exploratory cohort, the average bias of computing MCrI during PD and hemodialysis was 0.758 mg/kg/day (95%CI -4.356 to 5.873 mg/kg/day). The MCrI during PD significantly correlated with the muscle mass by creatinine kinetics (r = .684, P < .0001) and by bioimpedance spectroscopy (r = .641, P < .0001), but not with protein nitrogen appearance, overhydration, or adipose tissue mass, and the result was similar in the validation cohort. For incident PD patients, MCrI quartile was significantly associated with the risk of death from all cause in 12 months (Gray's test, P = .013) but not conversion to chronic hemodialysis (P = .14).

Conclusion

In PD patients, MCrI computed by the Canaud's formula and total weekly Kt/V is a simple and reliable marker of skeletal muscle mass and may serve as a short-term prognostic indicator.

Sarcopenia in older patients with idiopathic normal pressure hydrocephalus: an observational study from a single geriatric clinic in Turkey

OBJECTIVE

Idiopathic normal pressure hydrocephalus (iNPH), a classical triad of gait abnormality, cognitive disturbance, and urinary incontinence, increases in prevalence with aging. Sarcopenia is also characterized by low muscle strength and mass, contributing to gait difficulty. Gait abnormality and lower physical activity also lead to the development of sarcopenia. Therefore, this study aims to investigate the relationship between sarcopenia and iNPH.

METHODS

A total of 327 participants were included in this retrospective cross-sectional study. Demographic and clinical characteristics, including age, sex, comorbidity index, number of medications, recurrent falls in the last year, laboratory findings and comprehensive geriatric assessment (CGA) parameters were recorded. Sarcopenia was defined according to the EGWSOP2 criteria. The relationship between sarcopenia and iNPH was assessed with regression analysis.

RESULTS

There were 51 participants with iNPH, 49% female, mean age 78 years (SD 5.7) and 276 control participants, 74% female, mean age 72 years (SD 6.1). The sarcopenia rates in patients with iNPH and controls were 19.6% and 2.5%, respectively (p < 0.01). The odds of probable sarcopenia were 3.89 times, and the slow gait speed was 8.47 times higher in iNPH patients than in controls after adjusting for age, sex, and the other confounders. The Mini-Mental State Examination score (p = 0.042, OR = 0.869 with 95% CI:0.759-0.995) was associated with probable sarcopenia among patients with iNPH.

CONCLUSION

This study demonstrated that sarcopenia was common in older patients with iNPH, which seems to be closely associated with decreased muscle strength and slowed gait speed. Thus, considering the potential untoward effects of both diseases, it is important for physicians to evaluate sarcopenia routinely in the follow-up and treatment of older patients with iNPH.

Muscle quality and major adverse cardiovascular events in post-acute myocardial infarction: A prospective cohort study

BACKGROUND & AIMS

Functional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI.

METHODS AND RESULTS

This is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54-69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01-0.84).

CONCLUSION

Functional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI.

Muscle Strength and Phase Angle Are Potential Markers for the Efficacy of Multidisciplinary Weight-Loss Program in Patients with Sarcopenic Obesity

Background/Objectives: Traditional weight-loss methods often result in the loss of both fat and muscle mass. For individuals with sarcopenic obesity (SO), additional muscle loss can exacerbate sarcopenia, leading to further declines in muscle strength and function, ultimately worsening quality of life. To mitigate this risk, weight-loss strategies should emphasize the preservation and building of muscle mass through adequate protein intake and tailored resistance training. This study aimed to evaluate changes in SO status following a 4-week multidisciplinary weight-loss intervention program in hospitalized patients with obesity. Methods: This study included adult patients with obesity (BMI > 30 kg/m2, aged 18-90 years). The SO diagnosis was performed using the handgrip strength (HGS) test and skeletal muscle mass (SMM) by bioelectrical impedance analysis (BIA) according to ESPEN/EASO-2022 guidelines. Results: A total of 2004 patients were enrolled, 64.8% female, with a mean age of 56 (±14) years and a BMI of 40.7 (±6.48) kg/m2. SO was present in 9.38% (188 patients) at baseline. At discharge, 80 patients (42.55%) were no longer classified as sarcopenic and showed significant improvements in HGS. The likelihood of resolving SO was not modified in patients with only phase angle (PhA) improvement (p-value = 0.141). Patients with HGS increment had a 65% probability to be No-SO at discharge and this probability, with the concomitant PhA increment, rose to 93% (p-value < 0.0001), indicating that functional changes and good nutrition status are crucial in improvement of SO. Muscle mass (MM) and SMMI remained unchanged in the studied cohort. Conclusions: Improvements in HGS and the PhA are potential markers for the efficacy of weight-loss programs tailored to patients with SO. These findings suggest that specific interventions focusing on these markers could be beneficial in managing SO patients.