Sarcopenia and Cardiovascular Diseases

The association between sarcopenia and cardiovascular disease: An investigative analysis from the NHANES

BACKGROUND AND AIMS

Sarcopenia, a multifaceted chronic condition, exhibits an ambiguous association with cardiovascular disease (CVD). This study aimed to elucidate the connection between sarcopenia and CVD, as well as its implications for cardiovascular prognosis, by analyzing globally representative data from the National Health and Nutrition Examination Survey (NHANES). The findings aim to provide valuable insights for clinical practice and future research endeavors.

METHODS AND RESULTS

We used data from the NHANES database covering the period from 2011 to 2018. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria, while CVD was determined through self-reports. The association between sarcopenia and CVD was assessed via logistic regression analysis, with a nonlinear relationship explored using a restricted cubic spline curve. Cox proportional hazards regression was used to examine the associations between sarcopenia and both all-cause and cardiovascular mortality.Among the 7702 participants, the association between sarcopenia and CVD remained significant after adjusting for confounding factors such as age, sex, smoking status, alcohol consumption, and comorbidities (odds ratio, 1.89; 95 % confidence interval [CI], 1.04-3.43; P = 0.030). The hazard ratios for cardiovascular and all-cause mortality in this fully adjusted model were 1.95 (95 % CI, 0.62-6.12; P = 0.252) and 1.43 (95 % CI, 0.71-2.87; P = 0.319), respectively.

DISCUSSION

Sarcopenia is significantly associated with CVD in the general population, even after adjusting for confounding factors but is not associated with cardiovascular or all-cause mortality.

Association between METS-VF and sarcopenia among middle-aged and older adults in China: The first longitudinal evidence from CHARLS

BACKGROUND

The association between the Metabolic Score for Visceral Fat (METS-VF) and sarcopenia remains unclear. This study aims to explore the relationship between METS-VF and sarcopenia in the middle-aged and older adults in China.

METHODS

Data were collected from 2011 and 2015 of the China Health and Retirement Longitudinal Survey (CHARLS) and 2948 participants were enrolled in this study. METS-VF was calculated using data from CHARLS. Sarcopenia was defined according to the criteria set by the Asian Working Group for Sarcopenia (AWGS) 2019. Potential confounders were identified through the Directed Acyclic Graph (DAG). The association between METS-VF and sarcopenia was then analyzed using multivariate logistic regression and restricted cubic spline (RCS) analysis.

RESULTS

Compared with low METS-VF, high METS-VF (OR = 1.65, 95 % CI = 1.08-2.52) showed a significant association with the occurrence of sarcopenia. Subgroup and interaction analyses revealed that residence (P for interaction = 0.012) influenced the relationship between METS-VF and sarcopenia. Additionally, RCS analysis demonstrated a non-linear relationship between METS-VF and sarcopenia.

CONCLUSIONS

There is a positive non-linear correlation between METS-VF and sarcopenia with residence showing an impact on this association. Early identification of patients with possible sarcopenia by METS-VF is of great value for disease prediction, prevention, early diagnosis and timely treatment to reduce the potential disease burden.

Gender-specific association of oxidative balance score with sarcopenia in American adults: NHANES 2011-2018

BACKGROUND & AIMS

Nutritional status and levels of oxidative stress may be modifiable risk factors for the development of sarcopenia. The Oxidative Balance Score (OBS) is a comprehensive measure of oxidative balance in diet and life exposures. We conducted a cross-sectional study to investigate the association between OBS and sarcopenia in US adults.

METHODS

Based on the 2011-2018 National Health and Nutrition Examination Survey (NHANES), this study included 3084 participants. Weighted logistic regression analysis and restricted cubic spline regression (RCS) were used to assess the association between OBS and sarcopenia, as well as gender differences in this association.

RESULTS

OBS and sarcopenia are negatively associated (OR = 0.951, 0.919-0.983, p = 0.004). Compared with the lowest quartile of OBS, the highest quartile was significantly negatively associated with sarcopenia (OR = 0.431, 0.202-0.917, p for trend = 0.01). Both dietary OBS and lifestyle OBS were significantly negatively associated with sarcopenia (OR = 0.963, 0.930-0.997, p = 0.032; OR = 0.634, 0.562-0.715, p < 0.001). In gender subgroup analysis, a significant negative association between OBS and sarcopenia was observed in women (OR = 0.916, 0.862-0.973, p = 0.005), while the association was not significant in men. The RCS showed a significant linear correlation between total population OBS, female OBS and sarcopenia (p for nonlinear >0.05, p for overall <0.05).

CONCLUSIONS

Higher oxidative balance scores are associated with a lower prevalence of sarcopenia, particularly among women. These findings support the importance of antioxidant-rich diets and healthy lifestyles in mitigating sarcopenia risk, especially in aging female populations.

Exploring the role of cathepsins in sarcopenia-related traits: Insights from a Mendelian randomization study

Sarcopenia, a degenerative loss of skeletal muscle mass, strength, and function, poses a significant public health issue, particularly among aging populations. Cathepsins have recently emerged as key regulators of muscle metabolism and potential contributors to sarcopenia. This study employed Mendelian randomization (MR) to elucidate the causal relationships between 10 specific cathepsins and sarcopenia-related phenotypes, particularly appendicular lean mass (ALM) and handgrip strength, to identify potential therapeutic targets for sarcopenia intervention. A two-sample MR approach was used, employing genetic variants as instrumental variables to explore the impact of cathepsins on ALM and handgrip strength. ALM-related genetic association data were sourced from the UK Biobank, whereas grip strength data were derived from a meta-analysis focused on muscle weakness. Cathepsin levels were obtained using data from the INTERVAL study. The primary analysis method was the inverse variance weighted method, supplemented by MR-Egger, simple mode, weighted median, and weighted mode analyses to confirm the robustness of the findings. Positive associations of cathepsin S and E with ALM were demonstrated, whereas negative associations were observed for cathepsin F and B. No significant associations were identified between any cathepsin and grip strength in the primary inverse variance weighted analysis; however, secondary analyses indicated that cathepsin S may serve as a potential risk factor for reduced grip strength. Cathepsins S, E, F, and B were identified as playing significant roles in regulating muscle mass and strength, with cathepsin S potentially affecting grip strength. Targeting these enzymes may offer a viable strategy for developing treatments for sarcopenia. Although causal insights were provided, limitations include reliance on genetic data predominantly from European populations and the use of summary-level data, which constrains generalizability and hinders exploration of individual-level variability and molecular mechanisms. Future studies should validate these findings across diverse populations and investigate the effects of cathepsin on muscle health.

Sedentary lifestyle and physical inactivity: A mutual interplay with early and overt frailty

AIMS

In recent years medical science and research are increasingly directed towards a holistic approach that considers health as global well-being rather than solely as the absence of disease. In this framework, lifestyle interventions and, in particular, physical exercise, are of crucial importance in prevention and treatment. Therefore, the purpose of this study is to describe this mutual interplay between physical behaviours, sarcopenia, and frailty, as well as to illustrate the role of structured exercise training in aging and disease.

DATA SYNTHESIS

Physical activity and exercise training are determinants of lifelong global wellness and healthy aging. On the contrary, sedentary behaviour and physical inactivity are strictly linked to frailty and pre-frailty, both in adults and the elderly, with or without chronic diseases. On the other hand, the presence of pathological conditions is associated with a more inactive and sedentary behaviour. The co-presence of these factors is characterized by a mutual causal exchange in which they are imbricated in a continuous mechanistic interplay that involves inflammation, sarcopenia, osteopenia, functional impairment and many other pathophysiological aspects that rapidly can lead to a status of frailty.

CONCLUSION

A sedentary lifestyle and physical inactivity critically affect alterations in body composition and loss in functional capacity, typically linked to aging and accelerated by chronic diseases. However, physical activity and exercise can counteract the onset of pre-frailty and frailty by conferring beneficial effects on the individual's overall well-being.

Transcriptomic Signature of Frailty in Older Patients With Cardiovascular Disease Undergoing Cardiac Surgery or TAVI

BACKGROUND

Deterioration of functional capacity mostly determinates frailty in older patients with cardiovascular disease (CVD). Elucidating the pathophysiological mechanisms of physical frailty is an important goal for improving functional health-related outcomes. Our objective was the determination of the transcriptomic signature of physical frailty phenotypes in older patients undergoing cardiac surgery.

METHODS

Patients aged ≥ 70 years, referred for elective cardiac surgery (e.g., coronary artery bypass graft) or transcatheter aortic valve implantation (TAVI) were recruited. At hospital admission, frailty was assessed based on moderately/severely impaired mobility (Timed Up and Go; ≥ 10 and ≥ 20 s), low gait speed (5-m Walk Test; ≥ 6 s) or reduced handgrip strength (male ≤ 27, female ≤ 16 kg). Muscle specimens (M. quadriceps femoris) were collected during surgery/intervention and used for total RNA isolation and sequencing. Differential gene expression analysis was performed using DESeq2 and regression analyses investigated association between frailty and gene expression levels.

RESULTS

Sixty-three patients (77.6 ± 4.3 years; 74% male) referred to cardiac surgery (n = 34, 54%) or TAVI (n = 29, 46%) were included. Overall, 43 patients (70.2%) were characterized as frail by moderately/severely impaired mobility, 19 (30.6%) by low gait speed and 19 (30.2%) by low handgrip strength. In total, 37 patients (59%) experienced ≥ 1 complication (e.g., need of transfusion, atrial fibrillation and delirium); one patient died. Based on transcriptome data, 10 overlapping genes between all physical frailty phenotypes were identified, with S100A1 showing the strongest differences in expression level (e.g., handgrip R2 adj = 0.579; p = 0.001). Additional functional studies in C2C12 myoblasts demonstrated the impact of S100A1 on muscle function, and a second independent human cohort confirmed that higher S100A1 blood levels were correlated with increased handgrip strength.

CONCLUSION

Our data highlight the potential role of S100A1 in the pathophysiological mechanisms of skeletal muscle impairments in older CVD patients and warrants further consideration as a target gene for physical frailty. These findings also advance our understanding of the genetic and biological factors contributing to frailty, potentially guiding future therapeutic strategies to mitigate its impact on health outcomes.

Gromwell (Lithospermum erythrorhizon) ameliorates age-related loss of skeletal muscle mass and function in mice

Sarcopenia, an age-related disease characterized by the loss of skeletal muscle mass and function, is a growing concern in the aging population. This study investigated the potential of Gromwell (Lithospermum erythrorhizon, LE) to ameliorate sarcopenia in aged mice and the effect of lithospermic acid (LA), a bioactive compound found in LE, on cellular senescence in aged human skeletal muscle myoblast (HSMM) cells. Nineteen-month-old male C57BL/6 mice were fed a diet supplemented with 0.05% LE for 9 weeks. LE supplementation mitigated age-related loss of muscle mass and function, promoted the transition of muscle fiber type from type I to type II, and reduced markers associated with muscle atrophy. In vitro, LA treatment decreased β-galactosidase activity and senescence marker expression in senescent HSMM cells. These findings suggest that LE may serve as a valuable food resource for the prevention and mitigation of sarcopenia, with LA contributing to its effectiveness.

The Influence of Mental Fatigue on Physical Performance and Its Relationship with Rating Perceived Effort and Enjoyment in Older Adults

The study investigated the influence of mental fatigue on older people's enjoyment during a series of physical exercises. Using a randomized cross-over design, participants (n = 35) completed a 6-minute walking test - 6MWT, a Timed Up and Go-TUG test and three sets of knee extension exercise (first set: KE1, second set: KE2, third set: KE3) under two experimental conditions (control or mental fatigue). The Nonparametric Analysis of Longitudinal Data in Factorial Experiments was used to compare the number of repetitions performed during three sets of resistance exercise between conditions. The same analysis method was applied to compare the perception of effort and enjoyment across five moments (Post-6MWT, Post-TUG, Post-KE1, Post-KE2, Post-KE3) and two conditions and the Visual Analogue Scales (VAS) across four moments (baseline, Pre-6MWT, Pre-TUG, Pre-KE) and two conditions. Mental fatigue did not affect the physical function, perception of effort and enjoyment of exercise in older people. Participants, however, reported higher enjoyment for walking and dynamic balance compared to strength exercise. Mental fatigue had no effect on the physical function, perception of effort and enjoyment of exercise of older people. Participants presented a higher enjoyment for walking and dynamic balance compared to strength exercise. Given the importance of resistance exercises for health, clinicians should prioritize resources to education programs emphasizing the benefits of resistance exercise in both short- and long-term health. Including social interaction opportunities in physical exercise programs and prescribing activities appropriate to participants' ability levels could enhance engagement and adherence.

Improving analysis of sexual dimorphism in body composition dynamics in the oncology setting: A scoping review

BACKGROUND AND AIMS

Chemotherapy treatments induce loss of skeletal muscle and adipose tissue each of which are important prognostic indicators after a cancer diagnosis. Males and females may respond differently to drugs used to treat cancer. Given the high degree of heterogeneity in the literature, the objective of this scoping review is to evaluate the methodological variability in reporting of muscle and adipose tissue changes comparing males and females during cancer-directed treatment.

METHODS

Relevant databases were searched for papers reporting longitudinal CT based body composition changes separately for males and females in solid tumors.

RESULTS

Of the 29 studies that met inclusion criteria, 22 were retrospective and 7 were prospective. The majority of studies reported on gastrointestinal cancers [n=24]. Among collective participants (n= 5139), 32% were females. Females were under represented in half the studies. For 21/29 studies, baseline characteristics were combined for males and females, hindering the ability to understand the effect of disease stage, chemotherapy type and co-morbidities on muscle and fat changes experienced by each sex. Multiple chemotherapy regimens were combined (n=24) and not reported in a sex-specific way (n=26).

CONCLUSION

While the literature reporting body composition changes during cancer treatment is abundant, study design and reporting is problematic and precludes metaanalysis. Disproportionate numbers of males and females, marked heterogeneity in cancer types and chemotherapy regimens evaluated within a single study collectively pose challenges in analysing the impact of specific chemotherapy regimens on muscle and adipose change by sex. Strategies to standardize this set of literature in a sex specific way are required to improve evidence synthesis.

Impact of physical activities in metabolic dysfunction associated steatotic liver disease, sarcopenia, and cardiovascular disease

BACKGROUND AND AIMS

There are no comprehensive studies that investigated differential effects of physical activity (PA) types on metabolic dysfunction associated steatotic liver disease (MASLD) and their associations with sarcopenia and cardiovascular disease.

METHODS

A cross-sectional analysis using data from 66,021 participants from the Korean National Health and Nutrition Examination Surveys 2007-2020. Aerobic PA (A-PA) was defined as ≥ moderate-intensity 150 min/week or high-intensity 75 min/week; Muscle strengthening PA (MS-PA) was defined as ≥ 2 days/week of muscle strength training. Multicomponent PA included A-PA and MS-PA. The atherosclerotic cardiovascular disease (ASCVD) risk was determined by the pooled ASCVD risk score.

RESULTS

The prevalence of MASLD was lower in all PA groups compared to physically inactive individuals. Among individuals with MASLD, multicomponent PA was associated with a lower ASCVD risk, compared with other groups (OR = 0.74, 95 % CI = 0.73-0.75 for A-PA; OR = 0.70, 95 % CI = 0.68-0.64 for MS-PA; OR = 0.62, 95 % CI = 0.61-0.64 for multicomponent PA). Sarcopenia risk was decreased among physically active individuals with MASLD (OR = 0.77, 95 % CI, 0.76-0.77 for A-PA; OR = 0.97, 95 % CI = 0.96-0.98 for MS-PA; OR = 0.57, 95 % CI = 0.57-0.58 for multicomponent PA).

CONCLUSIONS

Regardless of types of exercise, physically active individuals had lower risks of MASLD, sarcopenia, and ASCVD.

Diet-induced inflammation and its association with sarcopenia in an Iranian population: a case-control study

BACKGROUND

Dietary intake, as one of the critical lifestyle risk factors, plays a crucial role in the risk of sarcopenia, potentially due to its anti-inflammatory properties. The objective of this study was to evaluate the association between the Dietary Inflammatory Index (DII) and the Dietary Inflammatory Score (DIS) with sarcopenia in an Iranian population.

METHODS

In the present study, 80 participants with sarcopenia were included in the case group, and 80 non-sarcopenia participants were included in the control group, matched by gender. Sarcopenia was diagnosed according to the Asian Working Group on Sarcopenia (AWGS) guidelines. Additionally, dietary data obtained from a food frequency questionnaire were used to calculate participants' DIS and DII scores. The association between the DII and DIS and the odds ratio of sarcopenia was assessed by logistic regression in both crude and adjusted models.

RESULTS

In the crude model, the odds of sarcopenia were significantly higher for each unit increase in DIS and DII scores (DIS: odds ratio (OR) = 1.221, 95% confidence interval (CI): 1.128-1.322; DII: OR = 1.271, 95% CI: 1.041-1.553). After adjusting for age, energy, and protein intake, higher odds of sarcopenia were observed for each unit increase in DIS score (OR = 1.129, 95% CI: 1.004-1.268). Similarly, higher odds of sarcopenia were seen for each unit increase in DII score after adjusting for potential confounders (OR = 1.269, 95% CI: 1.032-1.561).

CONCLUSIONS

In conclusion, this study found that greater adherence to the DII and DIS was associated with higher odds of sarcopenia in older adults.

CLINICAL TRIAL NUMBER

Not applicable.

Osteosarcopenia in older adults undergoing transcatheter aortic valve replacement: A narrative review of mortality and frailty implications

This narrative review examines osteosarcopenia, characterized by the concurrent loss of muscle mass and bone density, as a pivotal marker of frailty in older adults. Its implications for patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remain underexplored. This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR, with an emphasis on mortality. It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments. Contemporary studies were reviewed, focusing on older adults undergoing TAVR. Key parameters included pre-procedural assessments of muscle mass (psoas cross-sectional area) and bone density (lumbar trabecular attenuation) using computed tomography. Clinical correlations with frailty indices, nutritional deficiencies, functional disability and mortality were analyzed. Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality. Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications, prolonged hospitalizations, and worsening disability compared to isolated sarcopenia or osteoporosis (P < 0.05). Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes. Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations. Targeted interventions, such as resistance training and nutritional optimization, may mitigate its impact and improve clinical outcomes. Early identification facilitates personalized management strategies, enhancing survival and quality of life in this high-risk cohort.

Exploration of Pathogenesis and Cutting-Edge Treatment Strategies of Sarcopenia: A Narrative Review

Sarcopenia a progressive and multifactorial musculoskeletal syndrome characterized by loss of muscle mass and function, poses a significant global health challenge, particularly in aging populations. Epidemiological studies reveal that sarcopenia affects approximately 5-10% of the general population, with prevalence rates escalating dramatically after age 60 to reach 10-27% in older adults. This age-associated increase contributes significantly to healthcare burdens by elevating risks of disability, frailty, and mortality. Despite its profound impact, current clinical approaches to sarcopenia remain limited. While resistance exercise and protein supplementation form the cornerstone of management, their efficacy is often constrained by poor long-term adherence and variable individual responses, highlighting the urgent need for more comprehensive and personalized treatment strategies. The pathogenesis of sarcopenia is complex and influenced by various factors, including aging, inflammation, nutritional deficits, physical inactivity, and mitochondrial dysfunction. However, the precise molecular mechanisms underlying this condition are still not fully understood. Recent research has made significant strides in elucidating the intricate mechanisms contributing to sarcopenia, revealing novel insights into its molecular and cellular underpinnings. Notably, emerging evidence points to the pivotal role of mitochondrial dysfunction, altered myokine profiles, and neuromuscular junction degeneration in sarcopenia progression. Additionally, breakthroughs in stem cell therapy, exosome-based treatments, and precision nutrition offer promising avenues for clinical intervention. This review aims to synthesize the latest advancements in sarcopenia research, focusing on the novel contributions to its pathogenesis and treatment strategies. We explore emerging trends such as the role of cellular senescence, epigenetic regulation, and targeted therapeutic interventions that could reshape future approaches to managing sarcopenia. By highlighting recent breakthroughs and cutting-edge research, we hope to advance the understanding of sarcopenia and foster the translation of these findings into effective clinical therapies.

The Application of Epigenetic Clocks in Degenerative musculoskeletal diseases: A Systematic Review

OBJECTIVE

Epigenetic clocks have emerged as powerful tools for quantifying biological aging. Degenerative musculoskeletal disorders (e.g., osteoarthritis, osteoporosis) represent a group of age-related conditions characterized by progressive tissue deterioration. While their epidemiological association with aging is well-established, the precise relationship with epigenetic aging markers remains to be systematically elucidated. This review synthesizes current evidence on the application of epigenetic clocks as biomarkers and their clinical potential in managing these conditions.

METHODS

We systematically searched four major biomedical databases (PubMed, PMC, Web of Science, ScienceDirect) from inception through December 2024 for observational studies examining the association between the epigenetic clock and degenerative musculoskeletal diseases using controlled vocabulary (e.g., DNA methylation age) combined with disease-specific terms. The protocol was registered with PROSPERO (CRD42024623554).

RESULTS

After screening, 14 studies (case-control, cross-sectional, cohort) were included. We identified eight epigenetic clocks (based on cartilage, bone, and blood biomarkers) for assessing degenerative musculoskeletal diseases. DunedinPACE showed significant associations with cLBP pain severity (r = 0.39-0.45) and functional impairment, while Horvath's clock revealed tissue-specific epigenetic aging in OA cartilage (ΔAge = 3.7 years). GrimAge exhibited the strongest correlations with chronic pain (ρ = 0.47) and mediated socioeconomic influences (β = 0.81).

CONCLUSIONS

This systematic review of 14 clinical studies establishes epigenetic clocks as promising biomarkers for degenerative musculoskeletal diseases. The differential associations observed across epigenetic metrics highlight the need for disease-specific algorithm development. Future research should prioritize longitudinal validation and mechanistic investigations into socioeconomic influences on epigenetic aging.

Impact of malnutrition on in-hospital outcomes in patients with acute myocardial infarction and no standard modifiable cardiovascular risk factors

BACKGROUND

Individuals who present with acute myocardial infarction (AMI) in the absence of standard modifiable cardiovascular risk factors (i.e. SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the 'SMuRF paradox' would be influenced by patients' baseline nutritional status.

METHODS

We consecutively included patients from a multi-center, prospective registry (NCT05337319) from January 2022 to October 2023. Malnutrition was defined via the Nutritional Risk Index. The primary outcome was in-hospital major adverse cardiovascular events (MACEs), which included mortality, cardiac shock, acute congestive heart failure, reinfarction, and stroke.

RESULTS

A total of 3753 patients with first-presentation AMI were included, of which 10 % were SMuRF-less and over 21 % were malnourished. SMuRF-less malnourished had the highest MACEs (16.1 %), followed by the SMuRF-less nourished (15.5 %), ≥1 SMuRFs malnourished (12.1 %), and ≥1 SMuRFs nourished (5.2 %, p < 0.001). With ≥1 SMuRFs nourished as the reference, SMuRF-less malnourished had the highest increase in MACEs [adjusted OR (95 % CI), 3.385 (2.163-5.298), p < 0.001], followed by SMuRF-less nourished group [adjusted OR (95 % CI), 2.460 (1.214-4.985), p = 0.012], but only a nonsignificant increase in MACEs was observed in the ≥1 SMuRFs malnourished [adjusted OR (95 % CI), 1.297 (0.880-1.911), p = 0.188]. SMuRF-less was not associated with MACEs in the subgroup of malnourished patients [adjusted OR (95 % CI), 1.931 (0.892-4.178), p = 0.095], with a nonsignificant result in interaction analysis (p for interaction = 0.148).

CONCLUSION

Among patients with first-presentation AMI, malnutrition is prevalent, especially in those SMuRF-less. Compared with those with at least one SMuRF, SMuRF-less patients have a significantly higher risk of in-hospital MACEs irrespective of their nutritional status, while the outcome was the most favorable among ≥1 SMuRF and nourished patients.

Sarcopenia: an Aging Perspective and Management Options

There is no doubt that sarcopenia is one of the most defining characteristics of aging that negatively impacts the people's health and quality of life. The condition is characterized by the progressive and generalized loss of muscle mass and strength, affecting physical performance. It is part of aging but can be exacerbated by pathophysiological conditions like cancer and several factors such as a sedentary lifestyle, poor nutrition, chronic diseases, falls and immobilization. Numerous cellular mechanisms have been implicated in its pathogenesis, including hormonal changes, mitochondrial dysfunctions, altered apoptotic and autophagic signaling, muscle fiber composition, and inflammatory pathways. To prevent sarcopenia, exercise is one of the most effective strategies as it has a strong influence on both anabolic and catabolic muscle pathways and helps improve skeletal muscle function. A well-rounded, multicomponent exercise program that targets muscle strength, aerobic capacity, and balance is recommended for optimal results. While nutrition is essential for muscle maintenance, relying solely on dietary interventions is unlikely to fully address sarcopenia. Therefore, a combination of adequate nutrition and regular exercise is recommended to promote muscle health and function. The purpose of this study is to review sarcopenia from an aging viewpoint and discuss the role of exercise and nutrition as prevention and management options.

The association between body roundness index and handgrip strength and muscle quality index: A cross-sectional study

BACKGROUND

Sarcopenic obesity is characterized by a combination of obesity and sarcopenia. Body round index (BRI) is a novel anthropometric index that can more accurately assess body and visceral fat levels than body mass index or waist circumference. This study used data from the National Health and Nutrition Examination Survey (NHANES) to explore the relationship between BRI and handgrip strength (HGS) and muscle quality index (MQI) in American adults aged 20 and over.

METHODS

This study used cross-sectional data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) with complete data on BRI, HGS, and MQI. We used multivariate linear regression models and smooth curve fitting methods to explore the relationship between BRI and HGS and MQI. In addition, subgroup analyses and interaction tests were performed to further analyze the potential association between these variables.

RESULTS

A total of 5466 participants were finally included in this study, of whom 2807 were males and 2659 were females. The results showed that BRI was positively correlated with HGS and negatively correlated with MQI. In the fully adjusted model, the negative correlation between BRI and MQI was (β= -0.08, 95% CI = -0.08, -0.07), while the positive correlation with HGS was (β= 0.3 8, 95% CI = 0.29, 0.46), indicating that for every unit increase in BRI, MQI decreases by 0.08 units and HGS increases by 0.38 units (P < 0.0001). In addition, the relationship between BRI and HGS is an L-shaped curve. An inflection point is determined when BRI reaches 3.42. Before this threshold, for every unit increase in BRI, HGS increases significantly (β = 2.19, 95% CI = 1.66, 2.72).

CONCLUSION

The results showed that BRI was positively correlated with HGS and negatively correlated with MQI, meaning that higher BRI was associated with higher HGS and lower MQI. This highlights the importance of body fat distribution in muscle health and suggests that BRI can be used as an effective anthropometric indicator to predict grip strength and muscle mass.

Subclinical atherosclerosis and sarcopenia: A prospective study

The relationship between subclinical carotid artery atherosclerosis and sarcopenia has not been clarified in many respects. In this study, the possible relationship between composite clinical sarcopenia indices and various levels of subclinical atherosclerosis parameters was revisited. The Ishii score (Ishii-max and Ishii-average) was used to determine sarcopenia in 257 prospectively recruited healthy controls and patients with neurological diseases (age: 65 ± 10 years, 50% female). Carotid artery distensibility indices (stress, strain, modulus, stiffness, and distensibility), intima-media thickness (IMT-max and IMT-mean), and 10 Kate plaque burden score were obtained for ultrasonographic subclinical atherosclerosis evaluation, together with detailed clinical and anthropometric, quality of life, and nutritional assessments. Sarcopenic subjects (n = 75) were older, slimmer, and at higher risk of malnutrition (Malnutrition Universal Screening Tool score > 0) than nonsarcopenic subjects (n = 182). IMT-mean and IMT-max were significantly higher in sarcopenic cases (mean difference: 45 microns and 60 microns, respectively, P < .05). Carotid plaque burden score was significantly higher in sarcopenic patients (average score: 2.2 vs 0.8 in sarcopenic and nonsarcopenic ones, P < .001). There was no difference in terms of carotid artery distensibility parameters. In various regression models, the Ishii score was always determined as an independent predictor of IMT-max and IMT-mean in the models (standardized beta, from 0.132-0.168; partial-r, from 0.156-0.201; p, from 0.019-0.001). Structural indices of subclinical atherosclerosis (carotid IMT and plaque burden), but not functional ones (carotid artery modulus and distensibility), are significantly abnormal in sarcopenic subjects. If future research validates these findings, employing ultrasonographic atherosclerosis indices as surrogate markers in sarcopenia treatments could address a crucial unmet need.

The Association Between Sarcopenia Index and Aortic Valve Sclerosis in Coronary Artery Disease Patients: Insights from a Retrospective Cross-Sectional Analysis and Animal Models

Background

The Sarcopenia Index (SI) is a recognized predictor of cardiovascular risk in patients with coronary artery disease (CAD), yet its association with aortic valve sclerosis (AVSc) remains insufficiently studied. This study aimed to examine the relationship between SI and AVSc in CAD patients.

Methods

In this retrospective study, 1056 CAD patients at Shanghai Ruijin Hospital underwent SI assessment and Doppler echocardiography. SI was calculated as [serum creatinine (mg/dL)/cystatin C (mg/L)] × 100. Logistic regression, subgroup analyses, and restricted cubic splines evaluated the SI-AVSc association. ROC curves determined SI's diagnostic value and its addition to traditional AVSc factors. In parallel with clinical observations, aortic valve changes were analyzed in mice via hematoxylin and eosin, AlizarinRed S, and Masson's trichrome to assess valve thickness, fibrosis and calcification.

Results

Patients with the lowest SI levels showed a higher prevalence of AVSc. Multivariate logistic regression revealed that SI was independently associated with AVSc (P<0.001). The C-statistic for SI in identifying AVSc was 0.708 (95% CI: 0.671, 0.744), and it improved risk stratification when SI was added to traditional clinical models (C-statistic increased from 0.840 to 0.866). In the subgroup analysis, the discriminatory power of SI was enhanced among elderly patients. Findings from animal models supported these results, and Spearman correlation analyses revealed negative correlation between SI and peak systolic aortic valve flow velocity (Spearman's rho=-0.578, P=0.006). Histological analysis demonstrated that aortic valve leaflets in the low SI group were thicker and more fibrotic than those in the high SI group, and this complementary approach provided mechanistic insights into how sarcopenia may promote valve degeneration in elder mice.

Conclusion

Lower Sarcopenia Index is associated with the presence of AVSc in CAD patients. SI improves risk stratification and acts as a valuable associated marker for AVSc, emphasizing its potential clinical utility in enhancing patient management.

Relationship between atherosclerotic burden and sarcopenia in U.S. adults: A cross-sectional study based on the NHANES database

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and strength, significantly impacts the people, leading to increased frailty and mortality. The atherogenic index of plasma (AIP), a biomarker for lipid imbalance, may be linked to sarcopenia due to shared pathways of inflammation and metabolic dysregulation. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles were analyzed. The AIP was calculated as the logarithm of the ratio of triglycerides to High density lipoprotein cholesterol. Sarcopenia was defined using the appendicular skeletal muscle mass index (ASMBMI) adjusted for body mass index (BMI). Multivariable linear regression and logistic regression models were employed to assess the association between AIP and ASMBMI, as well as sarcopenia. Restrictive cubic spline curves were utilized to analyze potential nonlinear associations between AIP and outcome indicators. Additionally, subgroup analyses and intergroup interaction tests were performed. Elevated AIP levels were associated with decreased ASMBMI and an increased risk of sarcopenia. After adjusting for confounding factors, the association between AIP and ASMBMI remained significant (Beta [95% CI] = -0.02 [-0.03, -0.01], P < 0.001). AIP was significantly associated with sarcopenia (OR [95% CI] = 2.6 [1.78, 3.81], P = < 0.001). AIP is significantly associated with reduced muscle mass and potentially with sarcopenia, suggesting that lipid metabolism plays a critical role in muscle health. Identifying AIP as a modifiable risk factor could have important public health implications for managing sarcopenia.

Cardiac Amyloidosis in Older Adults With a Focus on Frailty: JACC: Advances Expert Consensus

Amyloidosis, which is caused by misfolded proteins that form amyloid fibrils, is predominantly diagnosed in older adults. Although previously considered a rare disease, increased awareness and noninvasive diagnostic methods have resulted in a rise in diagnoses. As a multisystem disease that affects multiple organ systems (cardiac, gastrointestinal, renal, and neurological), there is significant overlap with both geriatric conditions and common conditions in heart failure. Frailty is recognized as a distinct biological syndrome of declines across multiple physiological systems, which prevents maintenance of homeostasis and limits the ability to respond to stressors. Frailty was initially characterized as physical frailty alone; however, it is increasingly recognized that it is multidimensional with components including nutrition, cognitive, psychological, and social. Frailty in cardiovascular disease has become an important risk factor, indicator for disease severity, and can help guide decisions around intervention. In certain patients, frailty may be reversible. Given the lack of consensus definitions, tools, and implementation of frailty in both clinical and research settings in the field of amyloidosis, we convened a group of experts from cardiology, geriatric cardiology, geriatrics, hematology, and allied health to form this state-of-the-art review. There are many points of intersectionality between amyloidosis, aging, and frailty which herald a need for multidisciplinary care. This review document aims to provide guidance in how to understand and address frailty in older patients with a specific focus on cardiac amyloidosis.

Unraveling the Metabolic Pathways Between Metabolic-Associated Fatty Liver Disease (MAFLD) and Sarcopenia

Metabolic-Associated Fatty Liver Disease (MAFLD) is a public health concern that is constantly expanding, with a fast-growing prevalence, and it affects about a quarter of the world's population. This condition is a significant risk factor for cardiovascular, hepatic, and oncologic diseases, such as hypertension, hepatoma, and atherosclerosis. Sarcopenia was long considered to be an aging-related syndrome, but today, it is acknowledged to be secondarily related to chronic diseases such as metabolic syndrome, cardiovascular conditions, and liver diseases, among other comorbidities associated with insulin resistance and chronic inflammation, besides inactivity and poor nutrition. The physiopathology involving MAFLD and sarcopenia has still not been solved. Inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance seem to be some of the keys to this relationship since this hormone target is mainly the skeletal muscle. This review aimed to comprehensively discuss the main metabolic and physiological pathways involved in these conditions. MAFLD and sarcopenia are interconnected by a complex network of pathophysiological mechanisms, such as insulin resistance, skeletal muscle tissue production capacity, chronic inflammatory state, oxidative stress, and mitochondrial dysfunction, which are the main contributors to this relationship. In addition, in a clinical analysis, patients with sarcopenia and MAFLD manifest more severe hepatitis fibrosis when compared to patients with only MAFLD. These patients, with both disorders, also present clinical improvement in their MAFLD when treated for sarcopenia, reinforcing the association between them. Lifestyle changes accompanied by non-pharmacological interventions, such as dietary therapy and increased physical activity, undoubtedly improve this scenario.

Defining Reference Values for Skeletal Muscle Metrics on Abdominal CT Using Data From Healthy Young Adult Populations: A Systematic Review and Meta-Analysis

BACKGROUND. CT muscle metrics hold promise for opportunistic sarcopenia screening and individualized clinical risk stratification, but reference values applicable across broad populations are lacking. OBJECTIVE. To estimate reference cutoff values for CT skeletal muscle metrics using data from populations of healthy young adults. EVIDENCE ACQUISITION. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched through January 1, 2025 for studies reporting skeletal muscle index (SMI) and/or skeletal muscle density (SMD) on CT at the L3 vertebral level in healthy young adults (age range, 18-45 years). For SMI and SMD in both men and women, a random effects meta-analysis was used to estimate interstudy SD (as a measure of variance among studies) and mean values for a theoretic global population of healthy young adults. Presence of significant heterogeneity among individual study means was assessed using the Q statistic. Cutoff values for the theoretic global population corresponding with a T-score of -2 (i.e., values ≥ 2 SDs below the population's mean value) were calculated, incorporating the meta-analysis results and pooled intrastudy variance. EVIDENCE SYNTHESIS. The meta-analysis included 14 studies (16,958 individuals; 11,819 men, 5139 women) reporting SMI, of which seven studies (11,175 individuals; 8372 men, 2803 women) also reported SMD. The estimated global mean value for SMI was 54.6 in men and 42.4 in women and for SMD was 47.4 HU in men and 43.6 HU in women. The interstudy SD for SMI was 5.4 in men and 4.3 in women and for SMD was 1.9 in men versus 3.2 in women; significant heterogeneity was present among individual study means for both SMI and SMD in both men and women (all p<.001). The cutoff value corresponding with a T-score of -2 for SMI was 36.3 in men and 27.5 in women and for SMD was 36.4 HU in men and 28.1 HU in women. CONCLUSION. This meta-analysis of studies performed in healthy young adults provides reference mean values and standardized cutoffs analogous to a T-score of -2 for SMI and SMD at the L3 level on abdominal CT. CLINICAL IMPACT. These results can aid opportunistic screening for sarcopenia.

Genetic Liability to Higher Muscle Strength Associates With a Lower Risk of Cardiovascular Disease Mortality in Men Irrespective of Leisure-Time Physical Activity in Adulthood: A Longitudinal Cohort Study

BACKGROUND

Low muscle strength predicts premature mortality. We determined whether genetic liability to muscle strength is associated with mortality and whether this association is influenced by long-term leisure-time physical activity (LTPA).

METHODS AND RESULTS

We estimated the effects of a polygenic score for handgrip strength (PGS HGS) on all-cause and cardiovascular disease (CVD) mortality risk in the older Finnish Twin Cohort (N=8815, 53% women). LTPA was assessed longitudinally using validated questionnaires. During the 16.9-year median follow-up (143 723 person-years), 2896 deaths occurred, of which 1089 were attributable to CVD. We found a significant interaction between sex and PGS HGS (P=0.016) in relation to all-cause mortality. In men, 1-SD increase in the PGS HGS was associated with a decreased risk of all-cause (hazard ratio [HR], 0.93 [95% CI, 0.89-0.98]) and CVD mortality (HR, 0.88 [95% CI, 0.81-0.96]), but was not statistically significantly associated with mortality in women (HR, 1.01 [95% CI, 0.96-1.07]; and HR, 0.96 [95% CI, 0.87-1.05], respectively). In men, associations remained after adjusting for LTPA and persisted for CVD mortality (HR, 0.85 [95% CI, 0.76-0.96]), even after accounting for other lifestyle covariates. This remained statistically significant even when non-CVD death was accounted for as a competing risk event. No PGS HGS×LTPA interactions were found. The predictive area under the curve estimates for PGS HGS alone were limited (0.53-0.64) but comparable to that of several lifestyle factors.

CONCLUSIONS

Higher PGS HGS was associated with a decreased risk of CVD mortality in men. Long-term LTPA in adulthood did not potentiate this association.

Association Between the Serum Creatinine to Cystatin C Ratio and Cardiovascular Disease in Middle-Aged and Older Adults in China: A Nationwide Cohort Study

BACKGROUND

The relationship between the serum creatinine to cystatin C ratio (sarcopenia index [SI]) and the risk of incident cardiovascular disease (CVD) remains unclear. Therefore, this study aims to explore the association between SI and the risk of incident CVD in middle-aged and older Chinese adults using nationally representative data.

METHODS AND RESULTS

We analyzed data from participants in CHARLS (China Health and Retirement Longitudinal Study) conducted in 2015 and 2018. The exposure variable was SI, calculated as the ratio of serum creatinine to cystatin C, multiplied by 100. The outcome variable was self-reported CVD (heart disease or stroke). A cross-sectional analysis was first performed using 2015 CHARLS data, which included 11 115 eligible participants (46.1% men; mean±SD age, 60.28±9.60 years). Logistic regression was used to estimate the association between SI and CVD. Longitudinal analysis was then conducted using the 2018 follow-up data, which included 8589 participants (46.4% men; mean±SD age, 59.57±9.42 years), with a median follow-up period of 3.0 years. Cox proportional hazard models were used to assess the relationship between SI and the risk of incident CVD, and a multivariate-adjusted restricted cubic spline model was used to explore the dose-response relationship. In the cross-sectional analysis, multivariate logistic regression revealed a significant negative association between SI and CVD. The longitudinal analysis identified 854 (9.94%) new CVD cases. Cox models showed that lower SI was significantly associated with an increased risk of incipient CVD. The multivariable adjusted hazard ratios for participants in the quartile 2 to quartile4 groups compared with those in the quartile 1 group were 0.94 (95% CI, 0.79-1.12), 0.63 (95% CI, 0.51-0.78), and 0.60 (95% CI, 0.47-0.75), respectively. Restricted cubic spline curves demonstrated a significant linear relationship between SI and CVD incidence (all P-nonlinear>0.05).

CONCLUSIONS

A lower SI was significantly associated with an increased risk of new-onset CVD in middle-aged and older Chinese adults. This suggests that SI has an important potential application as a serum marker of sarcopenia in predicting CVD.

Impact of Sarcopenia on Mortality in Patients Undergoing TAVI: A Follow-Up Study

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe aortic stenosis who are deemed inoperable. However, sarcopenia may be a determining factor in their survival. The aim of our study is to assess the impact of sarcopenia, evaluated by computed tomography (CT), on mortality in this patient population. Methods: Patients with severe aortic stenosis undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis was performed, and correlations between body composition parameters at the T12 and L3 vertebral levels were assessed. Results: Our sample comprised 97 subjects. Time to mortality was associated with diabetes mellitus (p = 0.050), atrial fibrillation (p = 0.02), and respiratory disease (p = 0.03). Interestingly, sarcopenia (p = 0.039) and normal-density muscle area (p = 0.025) were also associated with time to mortality, with the association between sarcopenia and time to mortality becoming stronger after adjusting for covariates (p < 0.001). The correlation between different body composition parameters at the T12 and L3 vertebral levels was substantial and statistically significant. Conclusions: The use of CT to assess sarcopenia in patients with severe aortic stenosis undergoing TAVI is highly valuable and can predict time to mortality. Sarcopenia should be considered as a relevant parameter in the comprehensive evaluation of these patients.

Bidirectional association between sarcopenia and depression: A systematic review and meta-analysis

PURPOSE

Recent research has reported a potential bidirectional association between sarcopenia and depression, yet systematic evidence supporting this relationship is still lacking. This study evaluated the bidirectional association of sarcopenia with depression to provide reliable evidence for the development of specific prevention and control strategies.

METHODS

Relevant articles were extracted from PubMed, Embase, Cochrane, and Web of Science from inception to July 4, 2024. Quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies. Changes in the association between sarcopenia and depression were compared across different study designs, sources of study subjects, and sarcopenia diagnostic criteria by subgroup analyses. Meta-analysis was conducted using R 4.4.1.

RESULTS

Thirty-three original studies involving 119,421 subjects were incorporated into this review. Pooled analysis revealed a significant reciprocal relationship between sarcopenia and depression in community populations. The risk of depression increased when sarcopenia was the exposure factor [OR = 2.40(95 % CI: 1.87, 3.08)]. Conversely, the risk of sarcopenia significantly increased when depression was the exposure factor [OR = 1.90(95 % CI: 1.44, 2.50)]. Additionally, there was a markedly increased risk of sarcopenia when depressive symptoms were the exposure factor [OR = 1.38(95 % CI: 1.25, 1.53)]. Similar conclusions were obtained in patients with other diseases.

CONCLUSIONS

The significant bidirectional association between sarcopenia and depression enhances the prevention, screening, diagnosis, and treatment of depression, thereby improving quality of life and outcomes.

Association of chair stand performance with all-cause and cardiovascular mortality in older adults with hypertension: A 28-country study

OBJECTIVE

To assess the prospective association of chair stand performance with all-cause and cardiovascular mortality in older adults with hypertension.

METHODS

From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, we included 18,252 adults aged 50 years or more with hypertension from 28 countries (27 European countries and Israel). Chair stand performance was assessed by the time taken to complete five chair stands. We used time-varying Cox regression with restricted cubic splines to determine the prospective association of chair stand time with all-cause and cardiovascular mortality, controlling for various confounders.

KEY RESULTS

Over a mean follow-up of 3.5 years, 648 participants died, with 243 deaths attributed to cardiovascular disease. Using the median chair stand time (11 s) as a reference, both faster and slower times were associated with altered mortality risk in a curvilinear fashion. For all-cause mortality, the 10th percentile of chair stand time (7 s) showed a hazard ratio (HR) of 0.71 (95 % CI 0.60-0.85), while the 90th percentile (19 s) showed a HR of 1.20 (95 % CI 1.10-1.32). For cardiovascular mortality, the 10th percentile showed a subdistribution hazard ratio (SHR) of 0.72 (95 % CI 0.53-0.97), while the 90th percentile showed a SHR of 1.28 (95 % CI 1.10-1.48).

CONCLUSION

Chair stand performance is gradually and inversely associated with risk of all-cause and cardiovascular mortality in older adults with hypertension. These findings highlight the potential of the chair stand test as a prognostic measure.

Association of nutritional and inflammatory status with all-cause and cardiovascular mortality in adults with sarcopenia: Insights from NHANES

OBJECTIVE

Associations between scores on the advanced lung cancer inflammation index (ALI) and mortality among sarcopenic adults remains unknown. This study investigates the relationship between ALI and both all-cause and cardiovascular mortality among adults with sarcopenia.

METHODS

The study involved sarcopenic adults from the National Health and Nutrition Examination Survey (NHANES), conducted between 1999 and 2006 and 2011-2018. Mortality information was acquired from the National Death Index, which tracks deaths through to December 31, 2019. Weighted multivariable Cox proportional hazards regression was employed to calculate hazard ratios (HRs) for mortality in different models. Additionally, the restricted cubic spline (RCS) method was used to investigate non-linear associations. Subgroup analyses and sensitivity analyses were conducted to detect differences and examine the reliability of the findings.

RESULTS

This study included 2074 American adults with sarcopenia categorized into quartiles. 701 deaths occurred from all causes, with 236 linked to cardiovascular issues. Multivariate Cox regression models showed that those in the highest ALI quartile had a lower all-cause mortality rate than those in the lowest quartile (model 1: HR = 0.69, 95 % CI 0.55-0.87, P = 0.002; model 2: HR = 0.73, 95 % CI 0.56-0.94, P = 0.017). Likewise, those in the highest ALI quartile had a lower risk of death from cardiovascular causes (model 1: HR = 0.55, 95 % CI 0.36-0.85, P = 0.007; model 2: HR = 0.59, 95 % CI 0.37-0.95, P = 0.031). RCS results revealed an L-shaped correlation between ALI score and all-cause mortality.

CONCLUSIONS

A higher ALI score was strongly associated with lower rates of both all-cause and cardiovascular mortality among sarcopenic adults, particularly in the older population, males, smokers, and those with hypertension. This suggests that ALI may serve as a risk stratification tool.

Exercise Attenuates Skeletal Muscle Atrophy in Senescent SAMP8 Mice: Metabolic Insights from NMR-Based Metabolomics

Age-related skeletal muscle atrophy is a major health concern in the elderly, contributing to reduced mobility, increased risk of falls, and metabolic dysfunction. The senescence-accelerated prone 8 (SAMP8) mouse model, known for its rapid aging and early cognitive decline, serves as an essential model for studying age-related muscle degeneration. While previous studies have shown that exercise attenuates muscle atrophy by promoting regeneration and improving strength, the underlying metabolic mechanisms remain poorly understood. This study used the SAMP8 model to evaluate the effects of exercise on muscle atrophy and associated metabolic changes. Our results show that exercise promoted muscle growth by reducing body weight, increasing skeletal muscle mass, and decreasing fat accumulation. Furthermore, exercise improved grip strength, muscle tone, and muscle fiber cross-sectional area, thereby preserving muscle functionality. NMR-based metabolomic analysis identified key metabolic pathways modulated by exercise, including glycine, serine, and threonine metabolism; alanine, aspartate, and glutamate metabolism; pyruvate metabolism; and taurine and hypotaurine metabolism. These findings underscore the therapeutic potential of exercise in combating age-related muscle wasting and elucidate the metabolic pathways underlying its benefits.

Comparison of the gut microbiota in older people with and without sarcopenia: a systematic review and meta-analysis

Introduction

Sarcopenia, an age-related disorder marked by decreased skeletal muscle mass, strength, and function, is associated with negative health impacts in individuals and financial burdens on families and society. Studies have suggested that age-related alterations in gut microbiota may contribute to the development of sarcopenia in older people through the gut-muscle axis, thus modulation of gut microbiota may be a promising approach for sarcopenia treatment. However, the characteristic gut microbiota for sarcopenia has not been consistent across studies. Therefore, the aim of this study was to compare the diversity and compositional differences in the gut microbiota of older people with and without sarcopenia, and to identify gut microbiota biomarkers with therapeutic potential for sarcopenia.

Methods

The PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database were searched studies about the gut microbiota characteristics in older people with sarcopenia. The quality of included articles was assessed by the Newcastle-Ottawa Scale (NOS). Weighted standardized mean differences (SMDs) and 95% confidence intervals (CIs) for α-diversity index were estimated using a random effects model. Qualitative synthesis was conducted for β-diversity and the correlation between gut microbiota and muscle parameters. The relative abundance of the gut microbiota was analyzed quantitatively and qualitatively, respectively.

Results

Pooled estimates showed that α-diversity was significantly lower in older people with sarcopenia (SMD: -0.41, 95% CI: -0.57 to -0.26, I²: 71%, P < 0.00001). The findings of β-diversity varied across included studies. In addition, our study identified gut microbiota showing a potential and negative correlation with sarcopenia, such as Prevotella, Slackia, Agathobacter, Alloprevotella, Prevotella copri, Prevotellaceae sp., Bacteroides coprophilus, Mitsuokella multacida, Bacteroides massiliensis, Bacteroides coprocola Conversely, a potential and positive correlation was observed with opportunistic pathogens like Escherichia-Shigella, Eggerthella, Eggerthella lenta and Collinsella aerofaciens.

Discussion

This study showed that α-diversity is decreased in sarcopenia, probably predominantly due to diminished richness rather than evenness. In addition, although findings of β-diversity varied across included studies, the overall trend toward a decrease in SCFAs-producing bacteria and an increase in conditionally pathogenic bacteria. This study provides new ideas for targeting the gut microbiota for the prevention and treatment of sarcopenia.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024573090, identifier CRD42024573090.

New research progress of sarcopenia in surgically resectable malignant tumor diseases

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

Sarcopenia in Patients with Chronic Thromboembolic Pulmonary Hypertension

BACKGROUND

Sarcopenia, or loss of skeletal muscle mass, has been associated with poor outcomes (e.g., functional decline, increased mortality, and low quality of life), but its role in CTEPH remains unclear. The psoas muscle index (PMI) is a validated measure of sarcopenia. We investigated the incidence of sarcopenia using PMI in CTEPH.

METHODS

Retrospective analysis of a single-center cohort of patients with CTEPH with an available computed tomography of the abdomen and pelvis (CTAP). PMI was measured at the L3 level of the CTAP and was then calculated using the formula (left psoas area + right psoas area/height2). Patients in the first quartile of PMI were classified as sarcopenic.

RESULTS

We reviewed 558 patients with CTEPH, and 97 patients had an available CTAP before intervention. Sarcopenia was identified in 26 (24.8%) of the patients and was associated with worse baseline functional status (p = 0.008), higher mean pulmonary artery pressure (48 vs. 39 mmHg; p = 0.002), and higher pulmonary vascular resistance (9.9 vs. 6.8 WU; p = 0.013). Post-PTE, patients with sarcopenia exhibited longer intensive care unit (ICU) (9 vs. 4 days, p < 0.001) and overall hospital stays (24 vs. 11 days, p < 0.001), despite similar post-operative hemodynamics achieved compared to non-sarcopenic patients.

CONCLUSIONS

CTEPH patients with sarcopenia have worse baseline functional class and hemodynamics. For those with sarcopenia requiring surgery, there is longer ICU and total hospitalization stays, but they achieve significant functional improvements and hemodynamics comparable to that of non-sarcopenic patients. Hence, the risk of longer perioperative hospitalization days is justified by the longer-term benefit of hemodynamic improvement. The use of PMI as part of routine pre-operative assessments could improve clinical decision-making in CTEPH patients undergoing surgical or medical intervention.

Chain effect of lifecourse reproductive characteristics and body fat and muscle on cardiovascular disease in women: a Mendelian randomization study

BACKGROUND

Delineating the causal chain effects of reproductive traits and fat- and muscle-related traits on cardiovascular disease (CVD) is essential for optimizing precision prevention and control of cardiovascular health in women.

METHODS

In this study, we applied the two-sample Mendelian randomization (MR) analyses and two-step MR framework to investigate the causal chain effects and the mediating effect pathways among reproductive factors and fat- and muscle-related traits on CVD outcomes in women, applying the genome-wide association study summary statistics of 16 women's reproductive traits across puberty and pre-pregnancy, pregnancy and postpartum, and menopausal transition stages, 16 women's fat- and muscle-related traits, and five CVD outcomes of coronary artery disease (CAD), myocardial infarction (MI), heart failure, atrial fibrillation, and ischemic stroke (IS) from over one million individuals of European descent.

RESULTS

The MR analyses revealed the associations of genetically predicted nine reproductive traits (i.e., age at menarche [odds ratio (OR) for CAD: 0.92], age at first sexual intercourse [AFS; 0.71], age at first birth [AFB; 0.89], hypertensive disorders of pregnancy [HDP; 1.21], pre-eclampsia [PE; 1.34], preterm birth [PTB; 1.09], sex hormone-binding globulin [SHBG; 0.73], bioavailable testosterone [BT; 1.17], and number of stillbirths [OR for IS: 2.14]) and 13 fat- and muscle-related traits with at least one of five CVD outcomes. Two-step MR identified 30 causal pathways where AFS, AFB, HDP, PE, PTB, SHBG, and BT mediated the effects of body composition on five CVD outcomes, and nine pathways where waist-to-hip ratio, trunk-trunk fat ratio, abdominal subcutaneous adipose tissue, and gluteofemoral adipose tissue mediated the effects of reproductive traits on CAD and MI.

CONCLUSIONS

Lifecourse reproductive characteristics and fat- and muscle-related traits manifested reciprocal mediating effects on CVD, informing targeted strategies for bridging cardiovascular health inequalities in women.

Hemoglobin-to-Creatinine Ratio Predicts One-Year Adverse Clinical Outcomes in ST-Elevation Myocardial Infarction: Retrospective and Propensity Score Matched Analysis

Background/Objectives: Anemia and renal impairment are key predictors of adverse outcomes in acute coronary syndromes (ACSs). The hemoglobin-to-creatinine (Hb/Cr) ratio combines these parameters into a simple index. This study aimed to evaluate its prognostic value at discharge in patients with ST-elevation myocardial infarction (STEMI). Methods: The primary endpoint was one-year all-cause mortality; secondary endpoints included major bleeding and the composite of all-cause mortality or reinfarction. Optimal Hb/Cr cut-off values were identified using Liu's method. Multivariable logistic regression and propensity score matching were used to assess associations with outcomes. Results: We analyzed 11,236 STEMI patients from the PRAISE registry with available hemoglobin and creatinine values at discharge. The optimal cut-points were 13.68 for mortality and 14.42 for secondary endpoints. Patients were stratified into low (<13.68; 26.5%) and high (≥13.68; 73.5%) Hb/Cr groups. The low Hb/Cr group was older, had more comorbidities, and received less intensive therapy. At one year, low Hb/Cr patients had significantly higher rates of all-cause mortality (8.7% vs. 2.4%), major bleeding (5.0% vs. 2.4%), and the composite outcome (11.5% vs. 4.9%). In the multivariate logistic regression, the Hb/Cr ratio was inversely associated with all outcomes, namely all-cause mortality (odds ratio [OR] 0.94; 95% confidence interval [CI]: 0.92-0.96), major bleeding (OR 0.96; 95% CI: 0.94-0.97), and the composite endpoint (OR 0.93; 95% CI: 0.91-0.96). The Hb/Cr ratio outperformed hemoglobin and creatinine alone in predicting mortality (AUC 0.684 vs. 0.649 and 0.645; p < 0.001). Conclusions: The Hb/Cr ratio is independently associated with one-year adverse outcomes in STEMI and may serve as a simple marker of increased vulnerability. Prospective studies are needed to validate its clinical utility.

Regulation of SLC7A11 by LncRNA GPRC5D-AS1 mediates ferroptosis in skeletal muscle: Mechanistic exploration of sarcopenia

Sarcopenia is a chronic, progressive disease characterized by the gradual loss of skeletal muscle strength and mass. This study investigates the role of the long non-coding RNA GPRC5D-AS1 in the development and progression of sarcopenia through its regulation of SLC7A11. Skeletal muscle samples were obtained from sarcopenia patients and healthy controls to assess the expression levels of GPRC5D-AS1 and SLC7A11. Flow cytometry was used to evaluate iron content, lipid peroxidation, and antioxidant markers. A ferroptosis model was established in human skeletal muscle cells (HSKM) using the inducer erastin, and GPRC5D-AS1 overexpression plasmids were introduced to observe their effects on cell proliferation and ferroptosis indicators. In the sarcopenia group, both GPRC5D-AS1 and SLC7A11 expression levels decreased significantly, along with SLC7A11 protein translation. Erastin treatment markedly reduced cell viability and increased iron content, elevating ferroptosis marker genes (COX2, ACSL4, PTGS2, NOX1) while reducing GPX4 and FTH1 levels. The overexpression of GPRC5D-AS1 reversed these changes, enhancing antioxidant capacity and cell survival. Conversely, silencing SLC7A11 diminished the protective effects of GPRC5D-AS1 on cell proliferation and ferroptosis. These findings suggest that GPRC5D-AS1 overexpression increases SLC7A11 expression and reduces ferroptosis incidence in HSKM.

The Functions and Regulatory Mechanisms of Histone Modifications in Skeletal Muscle Development and Disease

Skeletal muscle development is a complex biological process regulated by many factors, such as transcription factors, signaling pathways, and epigenetic modifications. Histone modifications are important epigenetic regulatory factors involved in various biological processes, including skeletal muscle development, and play a crucial role in the pathogenesis of skeletal muscle diseases. Histone modification regulators affect the expression of many genes involved in skeletal muscle development and disease by adding or removing certain chemical modifications. In this review, we comprehensively summarize the functions and regulatory activities of the histone modification regulators involved in skeletal muscle development, regeneration, and disease.

Combined effect of skeletal muscle mass loss and elevated insulin resistance on heart failure risk in older adults: a community-based longitudinal cohort study

BACKGROUND

Skeletal muscle mass loss and insulin resistance (IR) are associated with cardiovascular diseases risk. However, it remains unclear whether the combination of skeletal muscle mass loss and elevated IR affects heart failure (HF) risk. Here, we investigate the association between a combination of appendicular skeletal muscle mass index (ASMI) with estimated glucose disposal rate (eGDR) and HF risk in older adults.

METHODS

A prospective analysis and a dual-trajectory analysis were carried out to investigate the association of the combined effect of ASMI and eGDR with HF risk. A total of 11,596 adults aged ≥ 60 years were enrolled from the community for prospective analysis. Among them, 10,489 were eligible for the dual-trajectory analysis. The temporal evolution of ASMI and eGDR was determined using a dual-trajectory model.

RESULTS

In the prospective analysis, 1087 individuals developed HF. Restricted cubic splines analysis showed L-shaped associations between ASMI and eGDR and HF risk. HF risk decreased by 32.3% (hazard ratio (HR): 0.677, 95% confidence interval (CI): 0.623-0.734, Padj < 0.001) for female and 9.0% (HR 0.910, 95% CI 0.831-0.996, Padj = 0.003) for male patients per one standard deviation (SD) AMSI increment and 29.4% (HR 0.706, 95% CI 0.647-0.770, Padj < 0.001) for female and 26.8% (HR 0.732, 95% CI 0.668-0.803, Padj < 0.001) for male patients per one SD eGDR increment. There was a synergistic effect on HF risk per one SD ASMI and eGDR increment (Padj < 0.001). Five distinct dual ASMI and eGDR trajectories were identified in the dual-trajectory analysis. A total of 859 (8.85 per 1000 person-years) individuals developed HF. Compared to group 4 with moderate-stable ASMI and eGDR and the lowest incident HF, the HR in group 5 characterized by low-stable ASMI and eGDR was 1.908 (95% CI 1.482-2.457, Padj < 0.001), followed by 1.716 (95% CI 1.296-2.273, Padj < 0.001) in group 3 with low-decrease ASMI and high-decrease eGDR.

CONCLUSIONS

Skeletal muscle mass loss and elevated IR act synergistically to increase the HF risk in older adults. Comprehensive management of muscle mass and IR might be a useful and effective strategy for preventing and controlling HF.

TRIAL REGISTRATION

Retrospectively registered number ChiCTREOC17013598.

Association between handgrip strength, handgrip strength asymmetry, and anxiety in Korean older adults: The Korean National Health and Nutrition Examination Survey 2022

Low handgrip strength (HGS) and HGS asymmetry are associated with age-related physical and mental disorders in older adults. This study aimed to examine the association between HGS-related factors and anxiety to evaluate whether HGS assessments can assist in identifying anxiety risk. In total, 1,750 participants from the Korea National Health and Nutrition Examination Survey of 2022 were included in this study. Individuals whose HGS values were below the 20th percentile of the study population stratified by sex were classified into the low-HGS group. Anxiety was assessed using the generalized anxiety disorder with a 7-item scale. Multiple logistic regression was used to analyze the relationship between HGS level and asymmetry and anxiety, adjusting for covariates. Overall, 70 (8.7%) men and 123 (13.0%) women had anxiety. Elevated odds of anxiety were observed in older women with low HGS (adjusted odds ratio: 2.17, 95% confidence interval: 1.31-3.61). There was a positive correlation between the degree of asymmetrical HGS and anxiety among women. This study found positive associations between low HGS, HGS asymmetry, and anxiety in older Korean women. This population may require specific interventions to help maintain good mental health.

Oxidative balance score is independently associated with reduced prevalence of sarcopenia among US adults with metabolic syndrome

Background

This research seeks to explore the link between the oxidative balance score (OBS) and sarcopenia in American adults with Metabolic Syndrome (MetS) using data from a national, population-based survey.

Methods

The study included 3,625 participants diagnosed with Metabolic Syndrome, all aged 20 years and above, derived from NHANES datasets spanning 1999-2006 and 2011-2018. OBS evaluation was based on 16 dietary and 4 lifestyle elements. MetS diagnosis followed the NCEP-ATP III guidelines, while sarcopenia identification was based on FNIH standards. We employed multivariate logistic regression analyses to delve into the connections between OBS and sarcopenia within the MetS cohort.

Results

Sarcopenia was found in 17.46% of the participants. In models adjusted for all variables, OBS, dietary OBS, and lifestyle OBS each showed a significant inverse relationship with sarcopenia among MetS individuals [OBS: OR = 0.959, 95%CI: (0.948, 0.982), P trend = 0.0005; dietary OBS: OR = 0.963, 95%CI: (0.939, 0.989), P trend = 0.0055; lifestyle OBS: OR = 0.860, 95%CI: (0.787, 0.939), P trend = 0.0011]. Higher scores in OBS were consistently linked with a decreased incidence of sarcopenia (all P for trend < 0.05). Restricted cubic spline analysis confirmed that these relationships were linear. The impact of age was significant, with OBS benefits only observed in those aged 40 and older.

Conclusions

Maintaining a diet and lifestyle rich in antioxidants is both independently and collectively linked with a lower occurrence of sarcopenia in individuals with MetS. These results bolster the proposition of developing OBS-centered preventive strategies for sarcopenia in MetS patients, particularly those aged 40 years and older.

Endothelial IGF- 1R deficiency disrupts microvascular homeostasis, impairing skeletal muscle perfusion and endurance: implications for age-related sarcopenia

Aging is associated with a progressive decline in circulating insulin-like growth factor- 1 (IGF- 1) levels in humans, which has been implicated in the pathogenesis of sarcopenia. IGF- 1 is an anabolic hormone that plays a dual role in maintaining skeletal muscle health, acting both directly on muscle fibers to promote growth and indirectly by supporting the vascular network that sustains muscle perfusion. However, the microvascular consequences of IGF- 1 deficiency in aging muscle remain poorly understood. To elucidate how impaired IGF- 1 input affects skeletal muscle vasculature, we examined the effects of endothelial-specific IGF- 1 receptor (IGF- 1R) deficiency using a mouse model of endothelial IGF- 1R knockdown (VE-Cadherin-CreERT2/Igf1rf/f mice). These mice exhibited significantly reduced skeletal muscle endurance and attenuated hyperemic response to acetylcholine, an endothelium-dependent vasodilator. Additionally, they displayed microvascular rarefaction and impaired nitric oxide-dependent vasorelaxation, indicating a significant decline in microvascular health in skeletal muscle. These findings suggest that endothelial IGF- 1R signaling is critical for maintaining microvascular integrity, muscle perfusion, and function. Impaired IGF- 1 input to the microvascular endothelium may contribute to reduced muscle blood flow and exacerbate age-related sarcopenia. Enhancing vascular health by modulating IGF- 1 signaling could represent a potential therapeutic strategy to counteract age-related muscle decline.

Association between atherogenic index of plasma, body mass index, and sarcopenia: a cross-sectional and longitudinal analysis study based on older adults in China

OBJECTIVE

To investigate the correlation between the atherogenic index of plasma (AIP), body mass index (BMI), and sarcopenia in the older adults in China, and to analyze the predictive ability of AIP and BMI for sarcopenia.

METHODS

This study utilized data from the 2011-2015 CHARLS database (China Health and Retirement Longitudinal Study, CHARLS), focusing on participants aged 60 years and older. The cross-sectional analysis included 7,744 samples, with 2,398 in the sarcopenia group and 5,346 in the non-sarcopenia group. In the retrospective cohort study, 1,441 participants without sarcopenia at baseline were selected and followed for the development of sarcopenia. Multivariable logistic regression was employed to analyze the association between AIP, BMI, and sarcopenia risk. A restricted cubic spline regression model was used to evaluate the dose-response association, and ROC curve analysis was performed to assess the predictive ability of individual and combined indicators (AIP and BMI). Additionally, subgroup analysis was conducted to explore the association between AIP, BMI, and sarcopenia risk across different demographic groups.

RESULTS

The cross-sectional analysis demonstrated that sarcopenia was significantly associated with various factors, including age, marital status, education level, residence, smoking, BMI, uric acid (UA), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), AIP, as well as hypertension, diabetes, dyslipidemia, and heart disease (p < 0.05). Logistic regression analysis, adjusted for potential confounders, revealed that the low AIP group was significantly associated with an increased risk of sarcopenia (OR = 1.22, 95% CI 1.03-1.44, p = 0.02), while no significant difference was observed in the high AIP group (OR = 0.83, 95% CI 0.69-1.01, p = 0.07). In the retrospective cohort study, the low AIP group showed a positive association with sarcopenia risk (OR = 1.79, 95% CI 1.18-2.72, p = 0.01), and a similar trend was observed in the high AIP group (OR = 1.69, 95% CI 1.03-2.77, p = 0.04). BMI was inversely associated with sarcopenia incidence, consistent with the cross-sectional findings. Both AIP and BMI showed a nonlinear dose-response relationship with sarcopenia risk, with AIP approximating a U-shaped curve and BMI approximating an L-shaped curve. Subgroup analysis indicated that, in the 65-69 age group, low AIP levels were significantly associated with an increased risk of sarcopenia. In participants aged 70 and above, as well as in females, both low and high AIP levels were significantly associated with higher incidence risk. ROC curve analysis showed that the combined use of AIP and BMI for predicting sarcopenia had an Area Under the Curve (AUC) of 0.8913, which was moderately better than the use of AIP (0.6499) or BMI (0.8888) alone.

CONCLUSION

The changes in AIP and BMI are associated with the risk of sarcopenia, and both provide some predictive value for sarcopenia. Taken together, the combined prediction using AIP and BMI appears to be somewhat more effective than using either indicator alone in assessing the risk of sarcopenia.

Exploring the causal relationship between delirium and sarcopenia using bidirectional two-sample Mendelian randomization study

BACKGROUND

Population-based studies have validated the significant associations between delirium and sarcopenia. Nonetheless, the causality remains ambiguous. This study aims to elucidate the causal associations between delirium and sarcopenia, as well as the causal effects of medication use on both conditions.

METHODS

A bidirectional two-sample Mendelian randomization (MR) analysis was performed based on public genome-wide association studies (GWAS) data. Causal effects were evaluated through the inverse-variance weighted (IVW) method as the principal analysis, supplemented by the weighted median, weighted mode. Cochran's Q test, MR-Egger regression, MR-PRESSO test and leave-one-out were applied for sensitivity analyses.

RESULTS

The IVW method indicated a causal relationship between genetically predicted low hand-grip strength and delirium (OR = 1.31, 95 % CI: 1.02-1.67, P = 0.032). Additionally, diuretics (OR = 1.05, 95 % CI: 1.03-1.07, P < 0.001) and glucocorticoids (OR = 1.06, 95 % CI: 1.01-1.12, P = 0.012) were causally associated with appendicular lean mass, and diabetes medications (OR = 1.04, 95 % CI: 1.02-1.06, P = 0.001) and immunosuppressants (OR = 1.05, 95 % CI: 1.02-1.09, P = 0.005) causally associated with low hand-grip strength. Alternative analytic methods yielded consistent results. Heterogeneity and horizontal pleiotropy were evident in associations between medication use and both delirium and sarcopenia, but the results remained consistent after excluding outliers.

CONCLUSION

This study provided evidence of a causal relationship between genetically predicted low hand-grip strength and delirium. However, the analysis revealed that medication use did not appear to act as a mediating factor between these two conditions. Larger population-based studies are needed to validate these findings.

Sarcopenic obesity and the risk of atrial fibrillation in non-diabetic older adults: A prospective cohort study

BACKGROUND

Evidence of an association between sarcopenic obesity (SO) and the risk of long-term atrial fibrillation (AF) is lacking, and the underlying involvement of insulin resistance (IR) and inflammation is not clear.

METHODS

This community-based prospective cohort study evaluated sarcopenia, obesity, and baseline clinical characteristics in 4321 non-diabetic older adults between 2007 and 2011. Sarcopenia was identified using skeletal muscle mass/body weight (SMM/BW), appendicular lean mass (ALM)/BW, and handgrip strength (HGS), and obesity was identified by fat mass (FM)/BW. The association of sarcopenia and obesity with AF risk was determined by Kaplan-Meier analysis and a Cox proportional hazards model. Interaction analysis, a restricted cubic splines model, mediation analysis, and a Fine-Gray competing-risk model were also used.

RESULTS

Over an average of 10.9 years of follow-up, 546 (11.98 per 1000 person-years) participants developed AF. Low SMM/BW, low ALM/BW, low HGS, high FM/BW, sarcopenia and obesity, were significantly associated with an increased AF risk. There was a significant synergistic relationship between sarcopenia and obesity in the increased AF risk [hazard ratio (HR): 2.029, 95 % confidence interval (CI): 1.639-2.512]. Compared with participants without sarcopenia and obesity, AF risk was the highest in those with SO (HR: 2.669, 95 % CI: 2.110-3.377], followed by sarcopenia alone (HR: 1.980, 95%CI: 1.453-2.699) and obesity (HR: 1.839, 95%CI: 1.475-2.292). Mediation analysis found that estimated glucose disposal rate (a surrogate marker of IR), high-sensitivity C-reactive protein, and galectin-3 were mediating factors in the increased AF risk caused by SO, accounting for 34.87 %, 27.56 %, and 21.05 % of the total effect, respectively.

CONCLUSIONS

SO significantly increased AF risk in these non-diabetic older individuals. Sarcopenia and obesity not only acted alone but also exhibit had a synergistic relationship to increase AF risk. IR and inflammation mediated the increased AF risk associated with SO.

Association Between Handgrip Strength and Cardiovascular Disease Risk in MASLD: A Prospective Study From UK Biobank

BACKGROUND

This study aimed to investigate the association between handgrip strength (HGS) and cardiovascular disease (CVD) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) using data from the UK Biobank cohort.

METHODS

A total of 201 563 participants were enrolled in this study. The HGS was measured using a Jamar J00105 hydraulic hand dynamometer. MASLD was defined as the presence of hepatic steatosis accompanied by one or more cardiometabolic criteria. Hepatic steatosis was identified using a fatty liver index ≥ 60. Advanced liver fibrosis was defined by a fibrosis-4 (FIB-4) score > 2.67. To examine the differences in the incidence of CVD, male and female participants were divided into non-MASLD, MASLD with high HGS, MASLD with middle HGS, and MASLD with low-HGS groups.

RESULTS

Of the study participants, 75 498 (37.5%) were diagnosed with MASLD, with a mean age of 56.5 years, and 40.6% were male. The median follow-up duration was 13.1 years. The frequency of incident CVD events increased significantly across groups: 10.9% in non-MASLD, 13.3% in MASLD with high HGS, 14.8% in MASLD with middle HGS, and 18.4% in MASLD with low HGS for males (p < 0.001). In females, the frequency of incident CVD events was 6.1% in non-MASLD, 9.2% in MASLD with high HGS, 10.7% in MASLD with middle HGS, and 13.3% in MASLD with low HGS (p < 0.001). Using the non-MASLD group as a reference, multivariate-adjusted hazard ratios (HRs) (95% confidence intervals [CI]) for CVD varied according to HGS in individuals with MASLD. In males with MASLD, HRs (95% CI) were 1.03 (0.96-1.10) for high HGS, 1.14 (1.07-1.21) for middle HGS, and 1.38 (1.30-1.46) for low HGS; in females with MASLD, they were 1.07 (0.97-1.18) for high HGS, 1.25 (1.14-1.37) for middle HGS, and 1.56 (1.43-1.72) for low HGS. The incidence of CVD events increased as HGS decreased in participants with MASLD, regardless of the presence or absence of advanced liver fibrosis (all p < 0.001).

CONCLUSIONS

This large prospective cohort study using the UK Biobank showed that in MASLD, a decrease in HGS was associated with increased CVD risk.

Causal relationships of circulating amino acids with sarcopenia-related traits: A bidirectional Mendelian randomization study

BACKGROUND AND AIM

Recent studies have indicated a correlation between certain Amino acids (AAs) and sarcopenia. However, the exact causal relationship among these associations is still unclear. This study aims to elucidate the causal relationships between 20 types of AAs and the phenotypic characteristics associated with sarcopenia through Mendelian randomization (MR) analysis.

METHODS AND RESULTS

This MR study employed single nucleotide polymorphisms (SNPs) that were significantly associated with both AAs and the traits of sarcopenia as instrumental variables (IVs). The main method for estimating causal effects was the inverse-variance weighted (IVW) approach. To ensure the robustness of the findings, additional methods such as weighted median, weighted mode, and MR Egger regression were used. Sensitivity analyses included heterogeneity and pleiotropy tests. In this research, we discovered potential causal relationships between AAs and traits associated with sarcopenia. We not only found that AAs previously studied, such as Glutamine, Tyrosine, Glycine, and branched-chain amino acids, play positive roles in muscle metabolism. Additionally, our study identified the role of AAs previously neglected or not considered in earlier research, such as Alanine, Lysine, Cysteine, and Methionine, which exert potential effects on muscle metabolism and offer considerable research potential and value.

CONCLUSIONS

This MR study clarified the reciprocal effects between circulating levels of AAs and sarcopenia-related traits. These results indicate that AAs may be used as biomarkers for diagnosing sarcopenia or as intervention targets for its treatment in clinical practice.

Association of Appendicular Skeletal Muscle Mass Index and Insulin Resistance With Mortality in Multi-Nationwide Cohorts

BACKGROUND

Although sarcopenia and insulin resistance are closely related, there is limited evidence regarding how they interact to influence mortality across different population groups. The purpose of this study was to examine the relationship between skeletal muscle mass and insulin resistance and its impact on mortality and cardiovascular disease risk using large-scale national data from Korea and the United States.

METHODS

We analysed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 and 2011-2018 and the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011, with mortality follow-up through to 2019. Cox regression models were used to assess the effects of muscle mass (appendicular skeletal mass index, ASMI) and insulin resistance on all-cause and major adverse cardiovascular and cerebrovascular events (MACCE)-related mortality. Mediation analysis was performed to examine direct and indirect effects.

RESULTS

The study included 8036 participants from NHANES and 14 449 from KNHANES. The sarcopenia group demonstrated a lower homeostasis model assessment for insulin resistance and better metabolic indices than the normal group despite having a higher mortality rate. Insulin resistance positively correlated with muscle mass (r = 0.203, p < 0.001 in the NHANES; r = 0.143, p < 0.001 in the KNHANES), and both insulin resistance and sarcopenia were identified as independent risk factors for all-cause and MACCE-related mortality. When the participants were categorized into four groups based on the presence or absence of insulin resistance and sarcopenia, those with both conditions exhibited the highest risk of all-cause mortality (hazard ratio [HR]: 2.30, 95% confidence interval [CI]: 1.72-3.08 in the NHANES; HR: 2.60, 95% CI: 2.14-3.16 in the KNHANES) and MACCE-related mortality among the groups (HR: 3.18, 95% CI: 1.99-5.08 in the NHANES; HR: 2.47, 95% CI: 1.66-3.69 in the KNHANES). Mediation analysis revealed that low muscle mass was associated with decreased insulin resistance but directly increased both all-cause mortality and MACCE-related mortality (NHANES: total natural direct effects [TNDE], HR: 2.08, 95% CI: 1.57-2.76; KNHANES: TNDE, HR: 1.69, 95% CI: 1.28-2.23).

CONCLUSIONS

This study found that low ASMI was inversely associated with insulin resistance and positively associated with mortality risk in both cohorts. These findings, consistent across two large national studies, highlight the complex relationships between muscle mass, insulin sensitivity and mortality. Further studies are needed to assess the underlying mechanisms and clinical implications of these associations.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT05616013.

The Effects of Concurrent Training Versus Aerobic or Resistance Training Alone on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition in middle-aged and older adults are less understood, and therefore, the focus of this meta-analysis. Methods: Three databases, including PubMed, Web of Science, and Scopus, were searched from inception to March 2024. Randomized trials were included if they compared CT versus either AT or RT, and included body composition measures such as fat mass, body fat percentage, waist circumference, visceral fat mass, lean body mass (LBM), muscle mass/volume, or muscle or muscle fiber cross-sectional area (CSA), in middle-aged (50 to <65 years) and older adults (≥65 years). Weighted mean differences (WMD) or standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Results: A total of 53 studies involving 2873 participants were included. Overall, CT increased body weight and LBM significantly more, trending toward significantly larger increases in muscle mass and CSA, compared with AT alone. However, there were no significant differences between CT and RT alone, for body weight, BMI, body fat percentage, fat mass, waist circumference, or visceral fat mass. Conclusions: CT is as effective as AT for decreasing body fat measures and as effective as RT for increasing muscle mass in middle-aged and older adults, and it should be recommended accordingly.