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Frille A, Arends J, Abenavoli EM, Duke SA, Ferrara D, Gruenert S, Hacker M, Hesse S, Hofmann L, Holm SH, Lund TB, Rullmann M, Sandøe P, Sciagrà R, Shiyam Sundar LK, Tönjes A, Wirtz H, Yu J, Sabri O, Beyer T. "Metabolic fingerprints" of cachexia in lung cancer patients. Eur J Nucl Med Mol Imaging 2024; 51:2067-2069. [PMID: 38504039 PMCID: PMC11139725 DOI: 10.1007/s00259-024-06689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Armin Frille
- Department of Respiratory Medicine, Leipzig University, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Jann Arends
- Department of Medicine I, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Elisabetta M Abenavoli
- Nuclear Medicine, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Shaul A Duke
- Department of Food and Resource Economics (IFRO), University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Copenhagen, Denmark
| | - Daria Ferrara
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Gruenert
- Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Swen Hesse
- Department of Nuclear Medicine, Leipzig University, Liebigstrasse 18, 04103, Leipzig, Germany
| | - Lukas Hofmann
- Department of Respiratory Medicine, Leipzig University, Liebigstrasse 20, 04103, Leipzig, Germany
- Department of Nuclear Medicine, Leipzig University, Liebigstrasse 18, 04103, Leipzig, Germany
| | - Sune H Holm
- Department of Food and Resource Economics (IFRO), University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Copenhagen, Denmark
| | - Thomas B Lund
- Department of Food and Resource Economics (IFRO), University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Copenhagen, Denmark
| | - Michael Rullmann
- Department of Nuclear Medicine, Leipzig University, Liebigstrasse 18, 04103, Leipzig, Germany
| | - Peter Sandøe
- Department of Food and Resource Economics (IFRO), University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, Grønnegårdsvej 8, 1870, Frederiksberg C, Copenhagen, Denmark
| | - Roberto Sciagrà
- Nuclear Medicine, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, 3, 50134, Florence, Italy
| | - Lalith Kumar Shiyam Sundar
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Anke Tönjes
- Department of Endocrine Medicine, Leipzig University, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine, Leipzig University, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Josef Yu
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Division of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Osama Sabri
- Department of Nuclear Medicine, Leipzig University, Liebigstrasse 18, 04103, Leipzig, Germany
| | - Thomas Beyer
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Xia SF, Liu Y, Chen Y, Li ZY, Cheng L, He JY, Hang L, Maitiniyazi G, Cheng XX, Sun SR, Gu DF. Association between dietary inflammatory potential and frailty is mediated by inflammation among patients with colorectal cancer: A cross-sectional study. Nutr Res 2024; 125:79-90. [PMID: 38552503 DOI: 10.1016/j.nutres.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 06/01/2024]
Abstract
Patients with colorectal cancer (CRC) are at high risk of frailty, leading to reduced quality of life and survival. Diet is associated with frailty in the elderly through regulating inflammation. Thus, we hypothesized that dietary inflammatory potential (as assessed by dietary inflammatory index [DII]) might be associated with frailty in patients with CRC through regulating inflammatory biomarkers. A total of 231 patients with CRC were included in this cross-sectional study. Dietary intake was evaluated by 3-day, 24-hour dietary recalls, and frailty status was assessed in accordance with the Fried frailty criteria. Plasma inflammatory cytokines were determined in 126 blood samples. A total of 67 patients (29.0%) were frail, with significantly higher DII scores than nonfrail patients, accompanied with significantly increased interleukin-6 (IL-6) and decreased interleukin-10 (IL-10) concentrations. Each 1-point increase of DII was related to a 25.0% increased risk of frailty. IL-6 was positively correlated with frailty and DII, whereas IL-10 was negatively correlated. After adjusting for age, sex, body mass index, education level, smoking status, and energy, mediation analysis revealed that the association between DII and frailty was significantly mediated by IL-6 (average causal mediation effect [ACME], 0.052; 95% confidence interval, 0.020-0.087; P = .002) and IL-10 (ACME, 0.025; 95% confidence interval, 0.004-0.063; P = .016). The ρ values for the sensitivity measure at which estimated ACMEs were zero were 0.3 and -0.2 for IL-6 and IL-10, respectively. Therefore, a pro-inflammatory diet was associated with frailty in patients with CRC possibly in part by affecting circulating IL-6 and IL-10 concentrations.
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Affiliation(s)
- Shu-Fang Xia
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yuan Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Yue Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Zi-Yuan Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Lan Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Jian-Yun He
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Hang
- Department of Nursing, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | | | - Xin-Xin Cheng
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shi-Ru Sun
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Dan-Feng Gu
- Department of Nursing, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
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Carroll AM, Chanes N, Shah A, Dzubinski L, Aftab M, Reece TB. Personalizing patient risk of a life-altering event: An application of machine learning to hemiarch surgery. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00366-0. [PMID: 38685466 DOI: 10.1016/j.jtcvs.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/30/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The study objective was to assess a machine learning model's ability to predict the occurrence of life-altering events in hemiarch surgery and determine contributing patient characteristics and intraoperative factors. METHODS In total, 602 patients who underwent hemiarch replacement at a high-volume aortic center from 2009 to 2022 were included. Patients were randomly divided into training (80%) and testing (20%) sets with various eXtreme gradient boosting candidate models constructed to predict the risk of experiencing life-altering events, including stroke, mortality, or new renal replacement therapy requirement. A total of 64 input parameters from the index hospitalization were identified, including 24 demographic characteristics as well as 8 preoperative and 32 intraoperative variables. A SHapley Additive exPlanation beeswarm plot was generated to identify and interpret the impact of individual features on the predictions of the final model. RESULTS A life-altering event was noted in 15% (90/602) of patients who underwent hemiarch replacement, including urgent/emergency cases and dissections. The final eXtreme Gradient Boosting model demonstrated a cross-validation accuracy of 88% on the testing set and was well calibrated as evidenced by a low Brier score of 0.12. The best performing model achieved an area under the receiver operating characteristic curve of 0.76 and an area under the precision recall curve of 0.55. The SHapley Additive exPlanation beeswarm plot provided insights into key features that significantly influenced model prediction. CONCLUSIONS Machine learning demonstrated superior accuracy in predicting hemiarch patients who would experience a life-altering event. This model may help to guide patients and clinicians in stratifying risk on an individual basis, which may in turn influence clinical decision-making.
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Affiliation(s)
- Adam M Carroll
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo.
| | - Nicolas Chanes
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Ananya Shah
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Lance Dzubinski
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
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Liu J, Zhu Y, Tan JK, Ismail AH, Ibrahim R, Hassan NH. Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis. J Clin Med 2024; 13:2382. [PMID: 38673654 PMCID: PMC11050860 DOI: 10.3390/jcm13082382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.
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Affiliation(s)
- Jia Liu
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Yuezhi Zhu
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Jen Kit Tan
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (Y.Z.); (J.K.T.)
| | - Azera Hasra Ismail
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
| | - Roszita Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Nor Haty Hassan
- Department of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.L.); (A.H.I.)
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Lopez Kolkovsky AL, Matot B, Baudin PY, Caldas de Almeida Araujo E, Reyngoudt H, Marty B, Fromes Y. Multiparametric Aging Study Across Adulthood in the Leg Through Quantitative MR Imaging, 1H Spectroscopy, and 31P Spectroscopy at 3T. J Magn Reson Imaging 2024. [PMID: 38593265 DOI: 10.1002/jmri.29368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Improved characterization of healthy muscle aging is needed to establish early biomarkers in age-related diseases. PURPOSE To quantify age-related changes on multiple MRI and clinical variables evaluated in the same cohort and identify correlations among them. STUDY TYPE Prospective. POPULATION 70 healthy subjects (30 men) from 20 to 81 years old. FIELD STRENGTH/SEQUENCE 3T/water T2 (multiecho SE, multi-TE STEAM), water T1 (GRE MR Fingerprinting), fat-fraction (multiecho GRE, multi-TE STEAM), carnosine (PRESS), multicomponent water T2 (ISIS-CPMG SE train), and 31P pulse-acquire spectroscopy. ASSESSMENT Age- and sex-related changes on: Imaging: fat-fraction (FFMRI), water T1 (T1-H2O), and T2 (T2-H2O-MRI) and their heterogeneities ΔT1-H2O and ΔT2-H2O-MRI in the posterior compartment (PC) and anterior compartment (AC) of the leg. 1H spectroscopy: Carnosine concentration, pH, water T2 components (T2-H2O-CPMG), fat-fraction (FFMRS), and water T2 (T2-H2O-MRS) in the gastrocnemius medialis. 31P spectroscopy: Phosphodiesters (PDE), phosphomonoesters, inorganic phosphates (Pi), and phosphocreatine (PCr) normalized to adenosine triphosphate (ATP) and pH in the calf. Clinical evaluation: Body-mass index (BMI), gait speed (GS), plantar flexion strength, handgrip strength (HS), HS normalized to wrist circumference (HSnorm), physical activity assessment. STATISTICAL TESTS Multilinear regressions with sex and age as fixed factors. Spearman correlations calculated between variables. Benjamini-Hochberg procedure for false positives reduction (5% rate). A P < 0.05 significance level was used. RESULTS Significant age-related increases were found for BMI (ρAge = 0.04), HSnorm (ρAge = -0.01), PDE/ATP (ρAge = 2.8 × 10-3), Pi/ATP (ρAge = 2.0 × 10-3), Pi/PCr (ρAge = 0.3 × 10-3), T2-H2O-MRS (ρAge = 0.051 msec), FFMRS (ρAge = 0.036) the intermediate T2-H2O-CPMG component time (ρAge = 0.112 msec), and fraction (ρAge = -0.3 × 10-3); and in both compartments for FFMRI (ρAge = 0.06, PC; ρAge = 0.06, AC), T2-H2O-MRI (ρAge = 0.05, PC; ρAge = 0.05, AC; msec), ΔT2-H2O-MRI (ρAge = 0.02, PC; ρAge = 0.02, AC; msec), T1-H2O (ρAge = 1.08, PC; ρAge = 1.06, AC; msec), and ΔT1-H2O (ρAge = 0.22, PC; ρAge = 0.37, AC; msec). The best age predictors, accounting for sex-related differences, were HSnorm (R2 = 0.52) and PDE/ATP (R2 = 0.44). In both leg compartments, the imaging measures and HSnorm were intercorrelated. In PC, T2-H2O-MRS and FFMRS also showed numerous correlations to the imaging measures. PDE/ATP correlated to T1-H2O, T2-H2O-MRI, ΔT2-H2O-MRI, FFMRI, FFMRS, the intermediate T2-H2O-CPMG, BMI, Pi/PCr, and HSnorm. DATA CONCLUSION Our multiparametric MRI approach provided an integrative view of age-related changes in the leg and revealed multiple correlations between these parameters and the normalized HS. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
| | - Beatrice Matot
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Pierre-Yves Baudin
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | | | - Harmen Reyngoudt
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Benjamin Marty
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Yves Fromes
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
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Bunch PM, Rigdon J, Niazi MKK, Barnard RT, Boutin RD, Houston DK, Lenchik L. Association of CT-Derived Skeletal Muscle and Adipose Tissue Metrics with Frailty in Older Adults. Acad Radiol 2024; 31:596-604. [PMID: 37479618 PMCID: PMC10796847 DOI: 10.1016/j.acra.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 07/23/2023]
Abstract
RATIONALE AND OBJECTIVES Tools are needed for frailty screening of older adults. Opportunistic analysis of body composition could play a role. We aim to determine whether computed tomography (CT)-derived measurements of muscle and adipose tissue are associated with frailty. MATERIALS AND METHODS Outpatients aged ≥ 55 years consecutively imaged with contrast-enhanced abdominopelvic CT over a 3-month interval were included. Frailty was determined from the electronic health record using a previously validated electronic frailty index (eFI). CT images at the level of the L3 vertebra were automatically segmented to derive muscle metrics (skeletal muscle area [SMA], skeletal muscle density [SMD], intermuscular adipose tissue [IMAT]) and adipose tissue metrics (visceral adipose tissue [VAT], subcutaneous adipose tissue [SAT]). Distributions of demographic and CT-derived variables were compared between sexes. Sex-specific associations of muscle and adipose tissue metrics with eFI were characterized by linear regressions adjusted for age, race, ethnicity, duration between imaging and eFI measurements, and imaging parameters. RESULTS The cohort comprised 886 patients (449 women, 437 men, mean age 67.9 years), of whom 382 (43%) met the criteria for pre-frailty (ie, 0.10 < eFI ≤ 0.21) and 138 (16%) for frailty (eFI > 0.21). In men, 1 standard deviation changes in SMD (β = -0.01, 95% confidence interval [CI], -0.02 to -0.001, P = .02) and VAT area (β = 0.008, 95% CI, 0.0005-0.02, P = .04), but not SMA, IMAT, or SAT, were associated with higher frailty. In women, none of the CT-derived muscle or adipose tissue metrics were associated with frailty. CONCLUSION We observed a positive association between frailty and CT-derived biomarkers of myosteatosis and visceral adiposity in a sex-dependent manner.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.).
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Muhammad Khalid Khan Niazi
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (M.K.K.N.)
| | - Ryan T Barnard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (J.R., R.T.B.)
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, California (R.D.B.)
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, North Carolina (D.K.H.)
| | - Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard,Winston-Salem, NC 27157 (P.M.B., L.L.)
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Sun R, Zhou Z, Li X, Xu Q, Zhou B, Yu H, Zhang W, Sun Q, Zhang X, Luo X, Li S, Luo A. Prognostic significance of preoperative nutritional status for postoperative acute kidney injury in older patients undergoing major abdominal surgery: a retrospective cohort study. Int J Surg 2024; 110:873-883. [PMID: 37921644 PMCID: PMC10871641 DOI: 10.1097/js9.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The association between malnutrition and postoperative acute kidney injury (AKI) has not been well studied. In this study, the authors examined the association between preoperative nutritional status and postoperative AKI in older patients who underwent major abdominal surgery, as well as the predictive value of malnutrition for AKI. MATERIALS AND METHODS The authors retrospectively included patients aged 65 or older who underwent major elective abdominal surgery. The nutritional status of the patient was evaluated using three objective nutritional indices, such as the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT). AKI was determined using the KDIGO criteria. The authors performed logistic regression analysis to investigate the association between preoperative nutritional status and postoperative AKI, as well as the predictive value of nutritional scores for postoperative AKI. RESULTS A total of 2775 patients were included in the study, of which 707 (25.5%), 291 (10.5%), and 517 (18.6%) had moderate to severe malnutrition according to GNRI, PNI, and CONUT calculations. After surgery, 144 (5.2%) patients developed AKI, 86.1% at stage 1, 11.1% at stage 2, and 2.8% at stage 3 as determined by KDIGO criteria. After adjustment for traditional risk factors, worse nutritional scores were associated with a higher AKI risk. In addition to traditional risk factors, these nutritional indices improved the predictive ability of AKI prediction models, as demonstrated by significant improvements in integrated discrimination and net reclassification. CONCLUSIONS Poor preoperative nutritional status, as assessed by GNRI, PNI, and CONUT scores, was associated with an increased risk of postoperative AKI. Incorporating these scores into AKI prediction models improved their performance. These findings emphasize the need for screening surgical patients for malnutrition risk. Further research is needed to determine whether preoperative malnutrition assessment and intervention can reduce postoperative AKI incidence.
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Affiliation(s)
- Rao Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Zhiqiang Zhou
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Xinhua Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Qiaoqiao Xu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Biyun Zhou
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Honghui Yu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Wanjun Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Qi Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Xiang Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Xiaoxiao Luo
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shiyong Li
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
| | - Ailin Luo
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital
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Chen Z, Hao Q, Sun R, Zhang Y, Fu H, Liu S, Luo C, Chen H, Zhang Y. Predictive value of the geriatric nutrition risk index for postoperative delirium in elderly patients undergoing cardiac surgery. CNS Neurosci Ther 2024; 30:e14343. [PMID: 37408469 PMCID: PMC10848042 DOI: 10.1111/cns.14343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/07/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The aims of the study were to determine the relationship between preoperative geriatric nutritional risk index (GNRI) and the occurrence of postoperative delirium (POD) in elderly patients after cardiac surgery and to evaluate the additive value of GNRI for predicting POD. METHODS The data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database. Patients who underwent cardiac surgery and were aged 65 or older were included. The relationship between preoperative GNRI and POD was investigated using logistic regression. We determined the added predictive value of preoperative GNRI for POD by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS A total of 4286 patients were included in the study, and 659 (16.1%) developed POD. Patients with POD had significantly lower GNRI scores than patients without POD (median 111.1 vs. 113.4, p < 0.001). Malnourished patients (GNRI ≤ 98) had a significantly higher risk of POD (odds ratio, 1.83, 90% CI, 1.42-2.34, p < 0.001) than those without malnutrition (GNRI > 98). This correlation remains after adjusting for confounding variables. The addition of GNRI to the multivariable models slightly but not significantly increases the AUCs (all p > 0.05). Incorporating GNRI increases NRIs in some models and IDIs in all models (all p < 0.05). CONCLUSIONS Our results showed a negative association between preoperative GNRI and POD in elderly patients undergoing cardiac surgery. The addition of GNRI to POD prediction models may improve their predictive accuracy. However, these findings were based on a single-center cohort and will need to be validated in future studies involving multiple centers.
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Affiliation(s)
- Zhiqiang Chen
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Quanshui Hao
- Department of AnesthesiologyHuanggang Central Hospital of Yangtze UniversityHuanggangChina
| | - Rao Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yanjing Zhang
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Hui Fu
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Shile Liu
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Chenglei Luo
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Hanwen Chen
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
| | - Yiwen Zhang
- Department of Anesthesiology, Shunde HospitalSouthern Medical University (The First People's Hospital of Shunde)FoshanChina
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Ida S, Imataka K, Morii S, Katsuki K, Murata K. Frequency and Overlap of Cachexia, Malnutrition, and Sarcopenia in Elderly Patients with Diabetes Mellitus: A Study Using AWGC, GLIM, and AWGS2019. Nutrients 2024; 16:236. [PMID: 38257129 PMCID: PMC10821182 DOI: 10.3390/nu16020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
This study aimed to estimate the frequency and overlap of cachexia, malnutrition, and sarcopenia in elderly patients with diabetes mellitus. Patients who were aged at least 65 years, had diabetes mellitus, and were regularly visiting the Ise Red Cross Hospital on an outpatient basis were included. The patients were assessed to determine whether they had cachexia, malnutrition, and sarcopenia according to the Asian Working Group for Cachexia criteria, the Global Leadership Initiative on Malnutrition criteria, and the Asian Working Group for Sarcopenia 2019 criteria. A total of 510 patients (310 men and 200 women) were analyzed in this study. Sarcopenia, cachexia, and malnutrition were found in 84 patients (16.4%), 40 patients (7.8%) (17.8% among patients with chronic diseases), and 110 patients (21.5%), respectively. Among patients with sarcopenia, the frequencies of cachexia and malnutrition were 30% and 71.4%, respectively. Among patients with cachexia, the frequencies of sarcopenia and malnutrition were 65% and 90%, respectively, and among those with malnutrition, the frequencies of sarcopenia and cachexia were 54% and 32.7%, respectively. The overlap among cachexia, malnutrition, and sarcopenia appears to be an important factor to be considered in the treatment of elderly patients with diabetes mellitus.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise 516-8512, Japan; (K.I.); (S.M.); (K.K.); (K.M.)
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10
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Valdiviesso R, Amaral TF, Moreira E, Sousa-Santos AR, Fernandes M, Aguiar MJV, Martins S, Azevedo LF, Fernandes L, Silva-Cardoso J, Borges N. Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:594. [PMID: 38053018 PMCID: PMC10696669 DOI: 10.1186/s12872-023-03632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction. METHODS Participants in this cross-sectional study were recruited from a HF outpatients' clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People. RESULTS A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30). CONCLUSIONS The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.
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Affiliation(s)
- Rui Valdiviesso
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal.
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Teresa F Amaral
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- LAETA-INEGI / FEUP, Associated Laboratory of Energy, Transports and Aerospace, Institute of Science and Innovation in Mechanical and Industrial Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Rita Sousa-Santos
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- TOXRUN, Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal
- CESPU, University Cooperative, CRL, Gandra, Portugal
| | - Mário Fernandes
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - Maria J V Aguiar
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - Sónia Martins
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luís F Azevedo
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal
- Psychiatry Service, University Hospital Center of São João, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - Nuno Borges
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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11
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Jogiat UM, Baracos V, Turner SR, Eurich D, Filafilo H, Rouhi A, Bédard A, Bédard ELR. Changes in Sarcopenia Status Predict Survival Among Patients with Resectable Esophageal Cancer. Ann Surg Oncol 2023; 30:7412-7421. [PMID: 37466867 DOI: 10.1245/s10434-023-13840-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Sarcopenia is a predictor of survival in patients with esophageal cancer. The objective of this research was to obtain insight into how changes in sarcopenia influence survival in resectable esophageal cancer. PATIENTS AND METHODS A retrospective cohort of patients with esophageal cancer undergoing tri-modality therapy was selected. Body composition parameters from the staging, post-neoadjuvant, and 1-year surveillance computed tomography (CT) scans were calculated. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier method and log-rank test, as well as multivariable Cox-proportional hazards models. RESULTS Of 141 patients, 118 had images at all three timepoints. The median DFS and OS were 33.2 [95% confidence interval (CI) 19.1-73.7] and 34.5 (95% CI 23.1-57.6) months, respectively. Sarcopenia classified by the staging CT was present in 20 (17.0%) patients. This changed to 45 (38.1%) patients by the post-neoadjuvant scan, and 44 (37.3%) by the surveillance scan. In multivariable analysis, sarcopenia at the post-neoadjuvant scan was significantly associated with OS [hazards ratio (HR) 2.65, 95% CI 1.59-4.40; p < 0.001] and DFS (HR 1.80, 95% CI 1.03-3.13; p = 0.038). The net change in skeletal muscle index was associated with OS (HR 0.93, 95% CI 0.90-0.97; p < 0.001) and DFS (HR 0.94, 95% CI 0.91-0.98; p = 0.001). CONCLUSIONS Patients who develop sarcopenia as a consequence of skeletal muscle wasting during neoadjuvant therapy are at risk for worse DFS and OS. Patients who have a net loss of muscle over time may be at high risk for early disease recurrence.
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Affiliation(s)
- Uzair M Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Heather Filafilo
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Armin Rouhi
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Alexandre Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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12
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Bosnić Z, Babič F, Wittlinger T, Anderková V, Šahinović I, Majnarić LT. Influence of Age, Gender, Frailty, and Body Mass Index on Serum IL-17A Levels in Mature Type 2 Diabetic Patients. Med Sci Monit 2023; 29:e940128. [PMID: 37837182 PMCID: PMC10583604 DOI: 10.12659/msm.940128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The cytokine IL-17A is emerging as a marker of chronic inflammation in cardio-metabolic conditions. This study aimed to identify relevant factors that in older primary care patients with type 2 diabetes (T2D) could influence serum IL-17A concentrations. The results have a potential to improve risk stratification and therapy options for these patients. MATERIAL AND METHODS The study was conducted during a period of 4 months, in 2020, in the south-eastern region of Croatia. Patients from primary health care, diagnosed with T2D (N=170, M: F 75: 95, ≥50 years old), were recruited at their visits. Those with malignant diseases, on chemotherapy or biological therapy, with amputated legs, or at hemodialysis, were excluded. The multinomial regression models were used to determine independent associations of the groups of variables, indicating sociodemographic and clinical characteristics of these patients, with increasing values (quartiles) of serum IL-17A. RESULTS The regression models indicated the frailty index and sex bias are the key modifying factors in associations of other variables with IL-17A serum values. CONCLUSIONS Sex bias and the existence of different frailty phenotypes could be the essential determining factors of the serum IL-17A levels in community-dwelling patients with T2D age 50 years and older. The results support the concept of T2D as a complex disorder.
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Affiliation(s)
- Zvonimir Bosnić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital, Goslar, Germany
- University of Göttingen, Göttingen, Germany
| | - Viera Anderková
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Ines Šahinović
- Department of Clinical Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
| | - Ljiljana Trtica Majnarić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Dunlop RAN, Van Zundert A. A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality. Saudi J Anaesth 2023; 17:575-580. [PMID: 37779562 PMCID: PMC10540983 DOI: 10.4103/sja.sja_358_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 10/03/2023] Open
Abstract
Frailty, as an age-related syndrome of reduced physiological reserve, contributes significantly to post-operative outcomes. With the aging population, frailty poses a significant threat to patients and health systems. Since 2012, preoperative frailty assessment has been recommended, yet its implementation has been inhibited by the vast number of frailty tests and lack of consensus. Since the anesthesiologist is the best placed for perioperative care, an anesthesia-tailored preoperative frailty test must be simple, quick, universally applicable to all surgeries, accurate, and ideally available in an app or online form. This systematic review attempted to rank frailty tests by predictive accuracy using the c-statistic in the outcomes of extended length of stay, 3-month post-operative complications, and 3-month mortality, as well as feasibility outcomes including time to completion, equipment and training requirements, cost, and database compatibility. Presenting findings of all frailty tests as a future reference for anesthesiologists, Clinical Frailty Scale was found to have the best combination of accuracy and feasibility for mortality with speed of completion and phone app availability; Edmonton Frailty Scale had the best accuracy for post-operative complications with opportunity for self-reporting. Finally, extended length of stay had too little data for recommendation of a frailty test. This review also demonstrated the need for changing research emphasis from odds ratios to metrics that measure the accuracy of a test itself, such as the c-statistic.
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Affiliation(s)
- Richard A. N. Dunlop
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - André Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
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14
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Wang H, Wang S, Li C, Yang W, Guo G, Hui Y, Wang X, Cui B, Fan X, Jiao H, Sun C. Coexistent GLIM-Defined Malnutrition and Sarcopenia Increase the Long-Term Mortality Risk in Hospitalized Patients with Decompensated Cirrhosis. ANNALS OF NUTRITION & METABOLISM 2023; 79:423-433. [PMID: 37725950 DOI: 10.1159/000534152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION The synergistic impact of coexistent malnutrition and sarcopenia on morality in hospitalized patients with decompensated cirrhosis remains elusive. This prospective cohort study aimed to delineate the prevalence concerning coexistence of malnutrition and sarcopenia and the prognosticating role on long-term mortality among cirrhosis. METHODS Adult cirrhotic patients with decompensated episodes between 2019 and 2021 were consecutively enrolled. Malnutrition and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, respectively. The entire cohort was divided into three groups: non-malnutrition and non-sarcopenia (NN), malnutrition or sarcopenia, and coexistent malnutrition and sarcopenia (MS). Log-rank test and multivariate Cox regression model were utilized to evaluate survival status and independent risk factors for mortality, respectively. RESULTS Our findings indicated that malnutrition manifested in 44.6% of inpatients with decompensated cirrhosis, while sarcopenia presented in 16.4% of the entire cohort, indicative of a prevalence of 14.7% regarding coexistent malnutrition and sarcopenia. The Kaplan-Meier graphic demonstrated a significant difference regarding survival curves among the three groups, referring to the MS group presented with the lowest survival rate (log-rank test: p < 0.001). Moreover, coexistent malnutrition and sarcopenia were associated with nearly 4 times higher mortality risk (model 1: hazard ratio [HR] = 3.31, 95% confidence interval [CI]: 1.20-9.13, p = 0.020; model 2: HR = 4.34, 95% CI: 1.52-12.4, p = 0.006) in comparison with patients without any condition (NN group). CONCLUSIONS Malnutrition and sarcopenia had superimposed negative impacts on inpatients with decompensated cirrhosis. It is imperative to identify this vulnerable subset to provide prompt therapeutic intervention for better prognosis.
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Affiliation(s)
- Han Wang
- Department of Health Management, Tianjin Hospital, Tianjin, China
| | - Sipu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chaoqun Li
- Department of Internal Medicine, Tianjin Hexi Hospital, Tianjin, China
| | - Wanting Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Gaoyue Guo
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huanli Jiao
- Department of Health Management, Tianjin Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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15
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López-Gómez JJ, García-Beneitez D, Jiménez-Sahagún R, Izaola-Jauregui O, Primo-Martín D, Ramos-Bachiller B, Gómez-Hoyos E, Delgado-García E, Pérez-López P, De Luis-Román DA. Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition. Nutrients 2023; 15:3923. [PMID: 37764706 PMCID: PMC10534706 DOI: 10.3390/nu15183923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.
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Affiliation(s)
- Juan José López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | | | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - David Primo-Martín
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Beatriz Ramos-Bachiller
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Esther Delgado-García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Paloma Pérez-López
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Daniel A. De Luis-Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
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McSweeney DM, Raby S, Radhakrishna G, Weaver J, Green A, Bromiley PA, van Herk M, McWilliam A. Low muscle mass measured at T12 is a prognostic biomarker in unresectable oesophageal cancers receiving chemoradiotherapy. Radiother Oncol 2023; 186:109764. [PMID: 37385375 DOI: 10.1016/j.radonc.2023.109764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Low muscle mass is an imaging biomarker of patient frailty that has been associated with increased toxicity and decreased survival in a number of cancers. Patients with unresectable oesophageal cancer receive chemoradiotherapy as standard of care. Muscle mass is not yet an established prognostic marker in this population. Muscle mass is usually assessed by segmenting skeletal muscle at the L3 vertebral level. But radiotherapy planning scans for oesophageal cancers do not always image this level, which has limited previous studies of body composition. Skeletal muscle is known to regulate immune function, but the association of muscle mass with lymphopenia in cancer patients has not been shown. MATERIALS AND METHODS We retrospectively analyse 135 oesophageal cancer patients who received chemoradiotherapy and investigate the prognostic value of skeletal muscle area assessed at T12. We also examine the association between muscle mass and radiation-induced lymphopenia. RESULTS We find that low muscle mass is associated with poorer overall survival (hazard ratio [95% confidence interval]: 0.72 [0.53-0.97]). However, this effect interacts with body mass index (BMI) such that the prognostic value of low muscle mass is removed by high BMI. In our study, patients with low muscle mass were more prone to radiation-induced lymphopenia (75% vs. 50% in patients with high muscle mass). A significant decrease in circulating lymphocytes was associated with poorer overall survival (hazard ratio [95% confidence interval]: 0.68 [0.47-0.99]). CONCLUSION Our study shows that assessing muscle mass at T12 is feasible and provides prognostic information. Low muscle mass at T12 is associated with poorer overall survival and increased risk of radiation-induced lymphopenia. Muscle mass provides additional information over performance status and BMI. Low BMI patients are most affected by low muscle mass, highlighting the importance of close nutritional support in this population.
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Affiliation(s)
- Dónal Michael McSweeney
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK; Radiotherapy Related Research, The Christie Foundation Trust, Manchester M20 4BX, UK.
| | - Sophie Raby
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
| | - Ganesh Radhakrishna
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
| | - Jamie Weaver
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
| | - Andrew Green
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK; Radiotherapy Related Research, The Christie Foundation Trust, Manchester M20 4BX, UK
| | - Paul Alan Bromiley
- Division of Informatics, Imaging and Data Sciences, University of Manchester, M13 9PL, UK
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK; Radiotherapy Related Research, The Christie Foundation Trust, Manchester M20 4BX, UK
| | - Alan McWilliam
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, UK; Radiotherapy Related Research, The Christie Foundation Trust, Manchester M20 4BX, UK
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17
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Ansaripour A, Arjomandi Rad A, Koulouroudias M, Angouras D, Athanasiou T, Kourliouros A. Sarcopenia Adversely Affects Outcomes following Cardiac Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5573. [PMID: 37685640 PMCID: PMC10488406 DOI: 10.3390/jcm12175573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia on cardiac surgery outcomes. METHODS A systematic review and meta-analysis followed PRISMA guidelines from inception to April 2023 in EMBASE, MEDLINE, Cochrane database, and Google Scholar. Twelve studies involving 2717 patients undergoing cardiac surgery were included. Primary outcomes were early and late mortality; secondary outcomes included surgical time, infection rates, and functional outcomes. Statistical analyses were performed using appropriate methods. RESULTS Sarcopenic patients (906 patients) had a significantly higher risk of early mortality (OR: 2.40, 95% CI: 1.44 to 3.99, p = 0.0007) and late mortality (OR: 2.65, 95% CI: 1.57 to 4.48, p = 0.0003) compared to non-sarcopenic patients (1811 patients). There were no significant differences in overall surgical time or infection rates. However, sarcopenic patients had longer ICU stays, higher rates of renal dialysis, care home discharge, and longer intubation times. CONCLUSION Sarcopenia significantly increases the risk of early and late mortality following cardiac surgery, and sarcopenic patients also experience poorer functional outcomes.
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Affiliation(s)
- Ali Ansaripour
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
| | | | - Marinos Koulouroudias
- Department of Cardiac Surgery, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Dimitrios Angouras
- Department of Cardiac Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
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18
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Matei B, Winters-Stone KM, Raber J. Examining the Mechanisms behind Exercise's Multifaceted Impacts on Body Composition, Cognition, and the Gut Microbiome in Cancer Survivors: Exploring the Links to Oxidative Stress and Inflammation. Antioxidants (Basel) 2023; 12:1423. [PMID: 37507961 PMCID: PMC10376047 DOI: 10.3390/antiox12071423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
This review focuses on the effects of exercise on various health-related outcomes in cancer survivors, encompassing body composition, cognitive function (including sleep), and gut microbiome health. By analyzing multiple studies, we aimed to summarize the existing evidence and shed light on underlying mechanisms. The findings strongly suggest that exercise serves as a multifaceted non-pharmacological strategy, playing a significant role in improving the overall health of cancer survivors by effectively reducing inflammation and oxidative stress. Exercise plays a crucial role in preventing muscle wasting, diminishing the presence of reactive oxygen species and pro-inflammatory cytokines, and enhancing antioxidant systems. Furthermore, exercise displays notable benefits in terms of executive cognitive functioning and fatigue alleviation, largely attributed to its anti-inflammatory impact on the central nervous system and its ability to induce neurogenesis via growth factors. Additionally, exercise positively influences microbial diversity, reduces gut inflammation, and enhances neurogenesis through the gut-brain axis. Our key findings underscore the reduction of oxidative stress and inflammation as primary mechanisms by which exercise effectively enhances health outcomes in cancer survivors. By delving deeper into these candidate mechanisms, we aim to provide valuable guidance for future research and interventions targeting the symptoms experienced by cancer survivors.
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Affiliation(s)
- Benjamin Matei
- Department of Behavioral Neuroscience, L470, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Kerri M Winters-Stone
- Division of Oncological Sciences, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jacob Raber
- Department of Behavioral Neuroscience, L470, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
- Division of Oncological Sciences, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA
- College of Pharmacy, Oregon State University, Corvallis, OR 97331, USA
- Departments of Neurology and Radiation Medicine, Division of Neuroscience ONPRC, Oregon Health & Science University, Portland, OR 97239, USA
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19
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Calles M, Wirth R, Labeit B, Muhle P, Suntrup-Krueger S, Dziewas R, Lueg G, Trampisch US. Sarcopenic Dysphagia Revisited: A Cross-Sectional Study in Hospitalized Geriatric Patients. Nutrients 2023; 15:2662. [PMID: 37375566 PMCID: PMC10302961 DOI: 10.3390/nu15122662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a frequent finding in older patients with potentially lethal complications such as aspiration pneumonia, malnutrition, and dehydration. Recent studies describe sarcopenia as a causative factor for OD, which is occasionally referred to as "sarcopenic dysphagia" in the absence of a neurogenic etiology. In most of the previous studies on sarcopenic dysphagia, the diagnosis was based only on clinical assessment. In this study, flexible endoscopic evaluation of swallowing (FEES) was used as an objective method to evaluate the presence of OD, its association with sarcopenia, and the presence of pure sarcopenic dysphagia. In this retrospective cross-sectional study, 109 acute care geriatric hospital patients with suspected OD received FEES examination and bioimpedance analysis (BIA) in clinical routine. 95% of patients had at least one neurological disease, 70% fulfilled the criteria for sarcopenia, and 45% displayed moderate or severe OD. Although the prevalence of sarcopenia and OD was high, there was no significant association between OD and sarcopenia. Considering these results, both the association between sarcopenia and OD and pure sarcopenic dysphagia appear questionable. Further prospective studies are needed to elucidate if sarcopenia is merely an epiphenomenon of severe disease or whether it plays a causative role in the development of OD.
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Affiliation(s)
- Marcel Calles
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Bendix Labeit
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany (P.M.); (S.S.-K.)
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, 49076 Osnabrück, Germany;
| | - Gero Lueg
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
| | - Ulrike Sonja Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, 44625 Herne, Germany; (M.C.); (R.W.); (G.L.)
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20
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Meißner C, Meyer F, Ridwelski K. Prehabilitation in elective surgical interventions - what must the general and abdominal surgeon know. Innov Surg Sci 2023; 8:93-101. [PMID: 38058772 PMCID: PMC10696941 DOI: 10.1515/iss-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives For years, many efforts have been invested to prepare patients, in particular, those with reduced physical and psychic status, much better to provide and finally achieve better outocme if there is time available to provide several beneficial measures. Methods Therefore, the objective was to illustrate the concept and various single elements of a complex prehabilitation concept based on (i) selective references from the medical literature and (ii) own clinical experiences from clinical practice in general and abdominal surgery. Results Prehabiliation can be considered the solution of the efforts to improve preoperative status for patients in a disadvantageous status for almost all types of surgery and all other operative and/or interventional procedures. It is the targeted process to improve individual functionality and organ function before a planned (elective) surgical intervention; P. comprises basically nutritional, physical and psychological measures; P. focusses especially onto the elderly, frail and malnourished patients before a planned surgical intervention; the overall aim is to significantly improve final outcome characterized by shorter length of stay, lower complication rate and mortality as well as cost efficiency; P. is especially important in cancer surgery, in which the beneficial effects can be particularly implemented; P. programs and/or "Standard Operating Protocols" (SOP) may help to establish and materialize its single aspects and enhanced recovery after surgery (ERAS). There is still further potential to reliably establish and to utilize the options of prehabilitation measures as listed above. Conclusions Prehabiliation is an indispensable aspect in today's preparation for elective surgery, which needs to become obligatory part of the preparation measures to planned surgical interventions, which can further contribute to a better final outcome and ERAS as well as, in addtion, needs to be further developed and accomplished.
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Affiliation(s)
- Carl Meißner
- MVZ “Im Altstadtquartier”, General Surgery, Magdeburg, Germany
- Otto-von-Guericke University at Magdeburg, Institute for Quality Assurance in Operative Medicine, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University at Magdeburg with University Hospital, Magdeburg, Germany
| | - Karsten Ridwelski
- Department of General and Abdominal Surgery, Municipal Hospital (“Klinikum Magdeburg gGmbH”), Magdeburg, Germany
- Otto-von-Guericke University at Magdeburg, Institute for Quality Assurance in Operative Medicine, Magdeburg, Germany
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21
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Mangalesh S, Daniel KV, Dudani S, Joshi A. Combined nutritional and frailty screening improves assessment of short-term prognosis in older adults following percutaneous coronary intervention. Coron Artery Dis 2023; 34:185-194. [PMID: 36762656 DOI: 10.1097/mca.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Frailty and malnutrition are well-known factors influencing outcomes of myocardial infarction (MI) in older adults. Due to considerable overlap between both entities, whether the simultaneous assessment of frailty and nutrition adds nonredundant value to risk assessment is unknown. METHODS We performed a prospective cohort study on 402 patients aged at least 65 years diagnosed with ST-elevation MI that underwent percutaneous coronary intervention. Nutritional status was assessed by Controlling Nutritional Status score (CONUT), Prognostic Nutritional Index, and Geriatric Nutritional Response Index. Frailty was assessed by Clinical Frailty Scale (CFS), Derby frailty index, and acute frailty network. Primary outcome was major adverse cardiac events (MACE), comprising all-cause mortality, non-fatal MI, and unplanned repeat revascularization during 28-day follow-up. Increment in Global Registry of Acute Coronary Events (GRACE) score performance following the addition of nutrition and frailty was assessed. RESULTS The incidence of MACE was 8.02 (6.38-9.95) per 1000 person-days. The CONUT score and CFS were the best predictors of MACE and independent predictors in the multivariate Cox-regression models [hazard ratios, 2.80 (1.54-5.09) and 2.54 (1.50-4.29)]. CONUT score classified 151 (37.6%) patients as malnourished, and CFS classified 131 (32.6%) as frail. The addition of both CONUT and CFS to the GRACE score led to better model discrimination and calibration through improved c-statistic (+0.165) ( P < 0.0001) and Akaike and Bayesian information criteria. CONCLUSION Combining CONUT and CFS provides nonredundant prognostic value despite their overlapping nature. Combined nutritional and frailty screening may improve risk prognostication in older adults following MI.
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Affiliation(s)
| | | | | | - Ajay Joshi
- Cardiology, Army College of Medical Sciences, New Delhi, India
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22
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Erne F, Wallmeier V, Ihle C, Braun BJ, Ehnert S, Histing T, Nüssler AK, Maurer E. The modified 5-item frailty index determines the length of hospital stay and accompanies with mortality rate in patients with bone and implant-associated infections after trauma and orthopedic surgery. Injury 2023; 54:1125-1131. [PMID: 36754703 DOI: 10.1016/j.injury.2023.01.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Bone and implant-associated infections are severe complications after trauma and orthopedic surgery. The modified 5-item frailty index (mFI-5) is an easily applicable score to predict adverse outcome after surgery. The current literature regarding mFI-5 is focused on a period of 30-days postoperative. PURPOSE This study aims to assess the impact of frailty in orthopedic trauma patients with bone and implant-associated infections. mFI-5 was calculated from a database, which prospectively collects data about factors potentially correlated with peri- and postoperative complications since 2014. METHODS In a level I trauma center a total of 345 patients with surgical site infections were enrolled in this study. Hereof, patients with fracture-related infections after osteosynthesis, periprosthetic joint infections of the hip and knee and post-operative osteomyelitis were included. Extensive medical baseline examination was performed in 2013/14, a three-year follow-up was organized as a telephone interview. The mFI-5 score was calculated based on the 5 factor-principle as established by Subramaniam. The nutritional status was assessed using the Nutritional Risk Screening (NRS-2002). RESULTS 130 patients were included, whereof seven had died, resulting in 123 patients. A grouping of our patients was performed in mFI-5 = 0 (n = 46; 36,4%), mFI-5 = 1 (n = 41; 33,3%) or mFI-5 ≥ 2 (n = 36; 29,3%). Sex distribution showed 69,1% male and 30,9% female patients. Frailty did neither impact on the re-admission (p = 0,433) nor the reoperation (p = 0,327) rate in our cohort. The mortality risk nearly doubled (1,7 times) in frail patients, but did not reach significance. In hospital stay was prolonged due to frailty (12,1 ± 11,8; p = 0,004) compared to those with a mFI-5 = 0 (5,9 ± 5,1) or mFI-5 = 1 (6,9 ± 5,9). Frailty goes along with a risk of malnutrition and increases with age. CONCLUSION The modified 5-item frailty index is not a suitable screening tool for predicting revision rate, re-admission rate, and mortality in our orthopedic trauma patient population with bone and implant-associated infections. Nevertheless, frailty is associated with an increased risk of malnutrition and increases with age.
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Affiliation(s)
- Felix Erne
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Vera Wallmeier
- Klinik für Hals-Nasen-Ohrenkrankheiten, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Christoph Ihle
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Sabrina Ehnert
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Andreas K Nüssler
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany
| | - Elke Maurer
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Research Institute, BG Unfallklinik, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, Tuebingen 72076, Germany.
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23
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Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions. Eur Arch Otorhinolaryngol 2023; 280:1893-1902. [PMID: 36484854 PMCID: PMC9988738 DOI: 10.1007/s00405-022-07728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC. METHODS In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors. RESULTS In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients. CONCLUSIONS Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
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24
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Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev 2023; 103:1137-1191. [PMID: 36239451 PMCID: PMC9886361 DOI: 10.1152/physrev.00037.2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.
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Affiliation(s)
- Joseph A Taylor
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - David B Bartlett
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Thomas A Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
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25
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Dahlbäck C, Karlsson N, Samuelsson C, Jörgren F, Buchwald P. Muscle mass and quality as predictors for complications, recurrence and length of hospital stay in acute uncomplicated diverticulitis: a retrospective cohort study. Scand J Gastroenterol 2023; 58:375-379. [PMID: 36305429 DOI: 10.1080/00365521.2022.2139154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the potential correlation between muscle mass/muscle quality and risk of complications or recurrence in patients presenting with acute uncomplicated diverticulitis. It was also to study if low muscle mass/quality correlated to prolonged hospital stay. MATERIALS AND METHODS The study population comprised 501 patients admitted to Helsingborg Hospital or Skåne University Hospital between 1 January 2015 and 31 December 2017, who had been diagnosed with acute uncomplicated diverticulitis and undergone computed tomography upon admission. The scans were used to estimate skeletal muscle mass and muscle radiation attenuation (an indicator for muscle quality). Skeletal muscle index was obtained by adjusting skeletal muscle mass to the patients' height. Values of below the fifth percentile of a normal population were considered low. RESULTS There were no differences between the patients with normal versus those with low skeletal muscle mass, skeletal muscle index or muscle radiation attenuation regarding risk of complications or recurrence of diverticular disease. However, as only 11 patients had complications, no conclusion as to a potential correlation can be made. Low muscle quality correlated to longer hospital stay, also when adjusting for other potential confounders. CONCLUSIONS Muscle mass/quality do not seem to serve as predictor of risk for recurrent disease in patients with acute uncomplicated diverticulitis. However, low muscle radiation attenuation was associated with prolonged hospital stay. This indicates that muscle quality, assessed by computed tomography scan, might be used in clinical practise to identify patients at risk of longer hospitalisation.
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Affiliation(s)
- Cecilia Dahlbäck
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Niklas Karlsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Carolina Samuelsson
- Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University and Halland Hospital, Halmstad, Sweden
| | - Fredrik Jörgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
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26
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Chan HCN, Fei X, Leung ELY, Langston K, Marshall S, van der Meij BS. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review. Clin Nutr ESPEN 2023; 54:382-397. [PMID: 36963884 DOI: 10.1016/j.clnesp.2023.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.
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Affiliation(s)
- Hei Chun Nicholas Chan
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xinzhu Fei
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eden Long Yin Leung
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Keanne Langston
- Department of Nutrition and Dietetics, Robina Hospital, Gold Coast, Queensland, Australia
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Barbara Suzanne van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia; Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
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Er B, Mızrak B, Aydemir A, Binay S, Doğu C, Kazancı D, Turan S. Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients. Tuberk Toraks 2023; 71:1-6. [PMID: 36912403 PMCID: PMC10795233 DOI: 10.5578/tt.20239901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Introduction Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among critically ill elderly patients. Materials and Methods Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated. Result Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ± 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ± 0.9 vs 6.5 ± 1.7, p= 0.035), sepsis (18 vs 7, p<0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p<0.001). Conclusions Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.
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Affiliation(s)
- Berrin Er
- Intensive Care Unit, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Başak Mızrak
- Department of Anaesthesiology and Reanimation, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Aras Aydemir
- Department of Anaesthesiology and Reanimation, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Songül Binay
- Intensive Care Unit, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Cihangir Doğu
- Intensive Care Unit, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Dilek Kazancı
- Intensive Care Unit, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
| | - Sema Turan
- Intensive Care Unit, University of Health Sciences Ankara City Hospital, Ankara, Türkiye
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Soto ME, Pérez-Torres I, Rubio-Ruiz ME, Cano-Martínez A, Manzano-Pech L, Guarner-Lans V. Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures. Int J Mol Sci 2023; 24:ijms24054534. [PMID: 36901968 PMCID: PMC10003713 DOI: 10.3390/ijms24054534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Frailty is a global health problem that impacts clinical practice. It is complex, having a physical and a cognitive component, and it is the result of many contributing factors. Frail patients have oxidative stress and elevated proinflammatory cytokines. Frailty impairs many systems and results in a reduced physiological reserve and increased vulnerability to stress. It is related to aging and to cardiovascular diseases (CVD). There are few studies on the genetic factors of frailty, but epigenetic clocks determine age and frailty. In contrast, there is genetic overlap of frailty with cardiovascular disease and its risk factors. Frailty is not yet considered a risk factor for CVD. It is accompanied by a loss and/or poor functioning of muscle mass, which depends on fiber protein content, resulting from the balance between protein breakdown and synthesis. Bone fragility is also implied, and there is a crosstalk between adipocytes, myocytes, and bone. The identification and assessment of frailty is difficult, without there being a standard instrument to identify or treat it. Measures to prevent its progression include exercises, as well as supplementing the diet with vitamin D and K, calcium, and testosterone. In conclusion, more research is needed to better understand frailty and to avoid complications in CVD.
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Affiliation(s)
- María Elena Soto
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Israel Pérez-Torres
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - María Esther Rubio-Ruiz
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Agustina Cano-Martínez
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Linaloe Manzano-Pech
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
- Correspondence:
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Abstract
Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.
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Anwar M, Pradhan R, Dey S, Kumar R. The Role of Sirtuins in Sarcopenia and Frailty. Aging Dis 2023; 14:25-32. [PMID: 36818553 PMCID: PMC9937701 DOI: 10.14336/ad.2022.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
The population of older individuals is increasing rapidly, but only a small fraction among them is able to experiences a healthy life. Due to lack of physical exercise and oxidative stress, aging leads to sarcopenia and finally end up with frailty. Sarcopenia is a component of the frailty and described as age related degenerative changes in the skeletal muscle mass, strength and quality. Though the loss of muscle strength and mass gradually seem inevitable during aging, it can be partially prevented or overcome by a deeper insight into the pathogenesis. Sirtuin protein leads to longevity across different organisms ranging from worms to mammals. Expression of sirtuin protein increases during physical exercise and thus strengthens muscle mass. Satellite cells leads to muscle repair in a SIRT1 dependent manner. In addition, SIRT1 improves insulin sensitivity and induces autophagy in the aged mice. The current paper discussed the putative role of sirtuins in sarcopenia and frailty. Moreover, it highlighted the pathways by which sirtuins can inhibit ROS production, inflammation and mitochondrial dysfunctions and therefore confers a protective role against frailty and sarcopenia. The critical role of sirtuins in the sarcopenia and frailty pathogenesis can eventually fuel the development of novel interventions by targeting sirtuins.
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Affiliation(s)
- Masroor Anwar
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmita Pradhan
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Sharmistha Dey
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India,Correspondence should be addressed to: Dr. Rahul Kumar, GITAM Institiute of Sciences, GITAM (Deemed to be) University, Gandhi Nagar, Rushikonda, Andhra Pradesh-53004, India.; Dr. Sharmitha Dey, All India Institute of Medical Sciences, New Delhi-110059, India.
| | - Rahul Kumar
- Department of Biotechnology, GITAM Institute of Sciences, GITAM (Deemed to be) University, Vishakhapatnam, India,Correspondence should be addressed to: Dr. Rahul Kumar, GITAM Institiute of Sciences, GITAM (Deemed to be) University, Gandhi Nagar, Rushikonda, Andhra Pradesh-53004, India.; Dr. Sharmitha Dey, All India Institute of Medical Sciences, New Delhi-110059, India.
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Loria A, Glance LG, Melucci AD, Boodry C, Justiniano CF, Dunne RF, Mustian KM, Becerra AZ, Jusko TA, Temple LK, Fleming FJ. Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery. Ann Surg 2023; 277:246-251. [PMID: 36448909 DOI: 10.1097/sla.0000000000005760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess the association between low preoperative serum creatinine and postoperative outcomes. BACKGROUND The association between low creatinine and poor surgical outcomes is not well understood. METHODS We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications. RESULTS Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively. CONCLUSIONS A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.
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Affiliation(s)
- Anthony Loria
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.,RAND Health, Rand, Boston, MA
| | - Alexa D Melucci
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Courtney Boodry
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Carla F Justiniano
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Karen M Mustian
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Todd A Jusko
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Larissa K Temple
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
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Fons A, Kalisvaart K, Maljaars J. Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence. J Clin Med 2023; 12:jcm12020533. [PMID: 36675461 PMCID: PMC9860672 DOI: 10.3390/jcm12020533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.
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Affiliation(s)
- Anne Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
- Correspondence: ; Tel.: +31-71-526-3507
| | - Kees Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
| | - Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Li Y, Shen J, Hou X, Su Y, Jiao Y, Wang J, Liu H, Fu Z. Geriatric nutritional risk index predicts all-cause mortality in the oldest-old patients with acute coronary syndrome: A 10-year cohort study. Front Nutr 2023; 10:1129978. [PMID: 36960208 PMCID: PMC10027908 DOI: 10.3389/fnut.2023.1129978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
Background and objective Nutritional status assessment in acute coronary syndrome (ACS) patients has been neglected for a long time. The geriatric nutritional risk index (GNRI) is a sensitive indicator for assessing the nutritional status of the elderly. This study aims to explore the association between GNRI and all-cause mortality in the oldest-old patients with ACS. Methods The patients who met the inclusion criteria were consecutively enrolled from January 2006 to December 2012. Clinical data were collected on admission, and all subjects were followed after being discharged. The nutritional status was evaluated using GNRI. The relationship between GNRI and all-cause mortality was assessed by using different analyses. Results A total of 662 patients with a mean age of 81.87 ± 2.14 years old were included in our study, and followed (median: 63 months, IQR 51-71). Patients whose GNRI ≤ 98 were reported as at risk of malnutrition (31.11%, n = 206). In multivariable analysis, we found that for each SD increase in GNRI, the risk of all-cause mortality lowered by 23%, and the HR for GNRI ≤ 98 was 1.39 (95% CI 1.04-1.86). After stratifying patients into three groups by tertiles of GNRI, we found that the HRs for tertile 2 and tertile 3 were 1.49 (95% CI 1.02-2.19) and 1.74 (95% CI 1.22-2.50), respectively. The trend test revealed a dose-response relationship between GNRI and all-cause mortality in the oldest-old with ACS. Lastly, in subgroup analyses, we found a reliable association between GNRI and all-cause mortality. Conclusion Malnutrition is common in the oldest-old patients with ACS, and GNRI could predict their long-term all-cause mortality in a dose-dependent manner. GNRI may be a prospective index for risk-stratification and secondary-prevention in the oldest-old patients with ACS.
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Affiliation(s)
- Ying Li
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Jian Shen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Xiaoling Hou
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | | | - Yang Jiao
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Jihang Wang
- Chinese PLA Medical School, Beijing, China
- Department of Cardiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Henan Liu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Zhenhong Fu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- *Correspondence: Zhenhong Fu,
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Impact of the preoperative nutritional status on postoperative kyphosis in geriatric patients undergoing cervical laminoplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:374-381. [PMID: 36471185 DOI: 10.1007/s00586-022-07481-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to determine the association of preoperative malnutrition with an increased risk of cervical kyphosis after laminoplasty in geriatric patients with cervical spondylotic myelopathy (CSM). METHODS Geriatric patients who underwent cervical laminoplasty were included. Malnutrition was defined as a geriatric nutritional risk index < 98 before surgery. The C2-7 angle and the global alignment parameters were analyzed on standing radiographs. The postoperative kyphosis was defined as a C2-7 angle < 0° during a 2-year follow-up. RESULTS Ninety patients without preoperative kyphotic alignment were enrolled (mean age, 73.5 years old; 41.1% female). Twenty-one patients (23.3%) had malnutrition status (74.2 years old). Preoperatively, the global alignment parameters were comparable between the malnutrition and normal nutrition groups (SVA, 43.3 mm vs. 42.4 mm; T1S, 29.7° vs. 28.4°; TPA, 21.4° vs. 17.8°), with no significant difference in the C2-7 angle (15.1° vs. 15.2°). At 2 years postoperatively, the malnutrition group showed a significantly lower C2-7 angle than the normal nutrition group (9.3° vs. 15.8°, P = 0.03). Postoperative kyphosis was more prevalent in the malnutrition group (33.3% vs. 7.2%, P = 0.005). The preoperative nutritional status and C2-7 angle were independent predictors of postoperative kyphosis. The predictive C2-7 angles differed by preoperative nutritional status (malnutrition group, 11°; normal nutrition group, 7°). CONCLUSION Among geriatric CSM patients, preoperative malnutrition was closely associated with the increased occurrence of cervical kyphosis after laminoplasty. Our results underscore the importance of preoperative nutritional assessment and management in geriatric populations undergoing cervical spine surgery, as malnutrition is a perioperative modifiable risk factor.
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Lenardt MH, Rodrigues JAM, Cechinel C, Kuznier TP, Kraus R, Guedez JBB. Fatores de risco associados ao delirium em idosos hospitalizados para tratamento clínico. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objetivo: identificar fatores de risco associados ao desenvolvimento de delirium em pessoas idosas hospitalizadas para tratamento clínico. Método: revisão integrativa da literatura. Busca realizada em fevereiro de 2022 através da aplicação de estratégia de busca em portais e bases de dados eletrônicas, como a Biblioteca Virtual em Saúde, o PubMed/MEDLINE e o Web of Science. Resultados: a busca resultou em 965 artigos. Após retirada de duplicatas, 583 tiveram títulos e resumos lidos. Respeitados critérios de elegibilidade, chegou-se a 127 estudos para leitura completa, dos quais 110 foram excluídos e 17 analisados, totalizando amostra de 6.170 pacientes. Foram incluídos estudos com pacientes ≥ 60 anos de idade, tratamento clínico, avaliação de fatores de risco para delirium; e excluídos estudos que utilizaram instrumentos não validados, relatos de casos, teses, monografias, artigos de revisão ou que não responderam à questão de pesquisa. Os fatores de risco mais encontrados foram a presença de déficit cognitivo e demência. Outros fatores também encontrados foram: idade avançada, presença de febre/infecção, desidratação, déficit funcional, uso de psicotrópicos antes do internamento, severidade das doenças de base, polifarmácia, déficit visual, dor ao repouso, presença de diabetes mellitus, fragilidade e tempo de internamento na emergência. Conclusões: os estudos apontam diversos fatores de risco associados ao delirium e destacam a relevância do reconhecimento do delirium pela equipe assistencial. Ação rápida e eficaz na prevenção do delirium em idosos depende da sua identificação. A equipe de saúde deve estar atenta durante o cuidado de populações vulneráveis para que o rastreio de sinais, muitas vezes flutuantes, seja facilitado.
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36
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AlMohaisen N, Gittins M, Todd C, Burden S. What is the overlap between malnutrition, frailty and sarcopenia in the older population? Study protocol for cross-sectional study using UK Biobank. PLoS One 2022; 17:e0278371. [PMID: 36472992 PMCID: PMC9725160 DOI: 10.1371/journal.pone.0278371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In an increasingly older adult population, understanding the inter-relationship between three age related conditions malnutrition, frailty and sarcopenia is important in order to improve their recognition, treatment and prevention. This study aims to determine the overlap between malnutrition, frailty and sarcopenia by measuring estimates of prevalence for each individual condition. In addition, we will compare two models of frailty which are the accumulation of deficits and phenotype models. METHODS/DESIGN This is a cross-sectional study that will use the UK Biobank database, which will include a subset of 381,000 participants: males and females aged 50 years and above who completed the baseline assessments. For the baseline assessments, details of the participants' characteristics will be included. All three conditions will be identified and mapped to variables collected at the baseline assessment. Variables for malnutrition will be mapped according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty will be defined according to two models: the 36 deficits and the phenotype model. Finally, sarcopenia will be assessed according to the European Working Group on Sarcopenia in Older People (EWGSOP) standard. DISCUSSION This proposed study will help to understand the presence of malnutrition, frailty and sarcopenia in the older population and describe any overlap between the conditions. There is little published research on the overlap between these three conditions. Despite the similarity and shared criteria used for the identification of malnutrition, frailty and sarcopenia there is still a lack of cohesive thinking around the overlap of applied definitions and identification criteria. TRIAL REGISTRATION ClinicalTrials.gov NCT04655456 approved on the 10th of December 2020.
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Affiliation(s)
- Nada AlMohaisen
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthew Gittins
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University Foundation NHS Trust, Manchester, United Kingdom
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Salford Royal Foundation NHS Trust, Salford, United Kingdom
- * E-mail:
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Troutman AD, Arroyo E, Lim K, Moorthi RN, Avin KG. Skeletal Muscle Complications in Chronic Kidney Disease. Curr Osteoporos Rep 2022; 20:410-421. [PMID: 36149594 PMCID: PMC10064704 DOI: 10.1007/s11914-022-00751-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the recent literature investigating the pathophysiology of skeletal muscle changes, interventions for skeletal muscle, and effects of exercise in chronic kidney disease (CKD). RECENT FINDINGS There are multiple CKD-related changes that negatively impact muscle size and function. However, the variability in the assessment of muscle size, in particular, hinders the ability to truly understand the impact it may have in CKD. Exercise interventions to improve muscle size and function demonstrate inconsistent responses that warrant further investigation to optimize exercise prescription. Despite progress in the field, there are many gaps in the knowledge of the pathophysiology of sarcopenia of CKD. Identifying these gaps will help in the design of interventions that can be tested to target muscle loss and its consequences such as impaired mobility, falls, and poor quality of life in patients with CKD.
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Affiliation(s)
- Ashley D Troutman
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, CF-326, 1140 W. Michigan St., Indianapolis, IN, 46202, USA
| | - Eliott Arroyo
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenneth Lim
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ranjani N Moorthi
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Keith G Avin
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, CF-326, 1140 W. Michigan St., Indianapolis, IN, 46202, USA.
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Jogiat UM, Bédard ELR, Sasewich H, Turner SR, Eurich DT, Filafilo H, Baracos V. Sarcopenia reduces overall survival in unresectable oesophageal cancer: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:2630-2636. [PMID: 36151845 PMCID: PMC9745498 DOI: 10.1002/jcsm.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in oesophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable oesophageal cancer. On 30 January 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable oesophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of oesophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n = 638, 81%), with a mean age of 68 ± 2.3 years were included. 641 (82%) patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared with the non-sarcopenia group (HR = 1.51; 95% CI 1.21-1.89; P = 0.0003; I2 = 0%; Figure 1). No significant publication bias was noted on assessment of funnel plot and Egger's test (P = 0.295). Sarcopenia as defined by SMI is predictive of overall survival among patients with nonoperative oesophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and oesophageal stenting, is needed to identify the degree of prognostication offered by body composition analysis. Studies on the modifiability of sarcopenia will help determine the utility of nutritional interventions.
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Affiliation(s)
- Uzair M Jogiat
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sasewich
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Filafilo
- Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Predictive Value of Temporal Muscle Thickness for Sarcopenia after Acute Stroke in Older Patients. Nutrients 2022; 14:nu14235048. [PMID: 36501078 PMCID: PMC9739439 DOI: 10.3390/nu14235048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The assessment of sarcopenia is part of the nutritional assessment index and is essential in stroke management. This study aimed to identify and validate cutoff values of temporal muscle thickness (TMT) measured using computed tomography to identify sarcopenia after acute stroke. The participants were patients with stroke aged ≥65 years who were admitted to rehabilitation units. The recruited patients were randomly divided into the calculation and validation cohort. In the calculation cohort, TMT cutoff values for identifying sarcopenia were calculated using receiver operating characteristic analysis. The obtained values were validated in the validation cohort using sensitivity and specificity. The calculation cohort included 230 patients (125 men, mean age, 77.2 ± 7.2 years), whereas the validation cohort included 235 patients (125 men, mean age, 76.4 ± 6.95 years). The TMT cutoff values for identifying sarcopenia and low skeletal muscle index were the same: 3.83 mm for men and 2.78 mm for women. The TMT cutoff value for identifying sarcopenia showed a sensitivity and specificity of 0.642 and 0.750, respectively, for men, and 0.660 and 0.567, respectively, for women. We identified a valid cutoff value of temporal muscle thickness for identifying sarcopenia after acute stroke. TMT is easy to measure and may be useful for the early detection of sarcopenia.
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Alvear-Vega S, Vargas-Garrido H. Social Determinants of the Non-Utilization of the Supplementary Feeding Program (PACAM) Aimed at Older Adults' Nutritional Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14580. [PMID: 36361459 PMCID: PMC9656771 DOI: 10.3390/ijerph192114580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving the program. First, the CASEN Survey 2017 was used (960,498 observations); the inclusion criterion was PACAM recipients (Yes/No). Next, a probit model was performed with a dichotomous response to determine the marginal effects of each independent variable (e.g., demographic, health, and social). The model shows a good fit (64.4%) with an explained variance between 10.5% to 14.1%. Those variables with more significant marginal effects are people aged 70-75, having tertiary and secondary education, urban living, not participating in social organizations, immigrants, and living in the austral zone. On the other hand, a higher likelihood of consumption was found among people of greater vulnerability (lowest income, lowest education, low health insurance, and aged over 80) and, therefore, in greater fragility. To conclude, the program achieves effective targeting, although improvement actions are required to expand coverage in some groups (indigenous people, immigrants, and people with disabilities). Moreover, authorities should evaluate and reinforce the program with tailored strategies for the older adults who actually withdraw food.
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Pucci G, D'Abbondanza M, Curcio R, Alcidi R, Campanella T, Chiatti L, Gandolfo V, Veca V, Casarola G, Leone MC, Rossi R, Alberti A, Sanesi L, Cavallo M, Vaudo G. Handgrip strength is associated with adverse outcomes in patients hospitalized for COVID-19-associated pneumonia. Intern Emerg Med 2022; 17:1997-2004. [PMID: 35930184 PMCID: PMC9362345 DOI: 10.1007/s11739-022-03060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/18/2022] [Indexed: 12/25/2022]
Abstract
Handgrip strength (HGS), a simple tool for the evaluation of muscular strength, is independently associated with negative prognosis in many diseases. It is unknown whether HGS is prognostically relevant in COVID-19. We evaluated the ability of HGS to predict clinical outcomes in people with COVID-19-related pneumonia. 118 patients (66% men, 63 ± 12 years), consecutively hospitalized to the "Santa Maria" Terni University Hospital for COVID-19-related pneumonia and respiratory failure, underwent HGS measurement (Jamar hand-dynamometer) at ward admission. HGS was normalized to weight2/3 (nHGS) The main end-point was the first occurrence of death and/or endotracheal intubation at 14 days. Twenty-two patients reached the main end-point. In the Kaplan-Meyer analysis, the Log rank test showed significant differences between subjects with lower than mean HGS normalized to weight2/3 (nHGS) (< 1.32 kg/Kg2/3) vs subjects with higher than mean nHGS. (p = 0.03). In a Cox-proportional hazard model, nHGS inversely predicted the main end-point (hazard ratio, HR = 1.99 each 0.5 kg/Kg2/3 decrease, p = 0.03), independently from age, sex, body mass index, ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio), hypertension, diabetes, estimated glomerular filtration rate and history of previous cardiovascular cardiovascular disease. These two latter also showed independent association with the main end-point (HR 1.30, p = 0.03 and 3.89, p < 0.01, respectively). In conclusion, nHGS measured at hospital admission, independently and inversely predicts the risk of poor outcomes in people with COVID-19-related pneumonia. The evaluation of HGS may be useful in early stratifying the risk of adverse prognosis in COVID-19.
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Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy.
- COVID Unit, Terni University Hospital, Terni, Italy.
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Maria Comasia Leone
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Alessio Alberti
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Leandro Sanesi
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Massimiliano Cavallo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy
- COVID Unit, Terni University Hospital, Terni, Italy
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Effect of Pre-Existent Sarcopenia on Oncological Outcome of Advanced Thyroid Cancer Patients Treated with Tyrosine Kinase Inhibitors. Cancers (Basel) 2022; 14:cancers14194569. [PMID: 36230491 PMCID: PMC9559209 DOI: 10.3390/cancers14194569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Sarcopenia is associated with poor survival and treatment outcomes in several human cancers. The aim of the study was to investigate the prevalence of sarcopenia in a cohort of 58 Caucasian patients with advanced thyroid cancer before and during TKI treatment. The impact of this condition on the outcome of patients was also evaluated. (2) Methods: Sarcopenia was evaluated using the Skeletal Muscle Index (SMI). (3) Results: Pre-treatment sarcopenia was found in 20.7% of patients and this condition significantly affected treatment outcome, emerging as the parameter that has the greatest impact on Progression Free Survival (PFS) (HR 4.29; 95% CI, 1.21−15.11, p = 0.02). A significant reduction in SMI values was observed 3 (p = 0.002) and 12 months (p < 0.0001) after TKI treatment. At a 12-month follow-up, sarcopenia prevalence increased up to 38.5%. Here, 12-month sarcopenia was predicted by a lower SMI (p = 0.029), BMI (p = 0.02) and weight (p = 0.04) and by the presence of bone metastases (p = 0.02). (4) Conclusions: This is the first study that evaluated sarcopenia prevalence and its change over time in Caucasian patients with advanced thyroid cancer under TKI therapy. Sarcopenia seems to be a prognostic factor of TKI treatment outcome, suggesting the importance of the assessment of the nutritional status and body composition in advanced thyroid cancer patients.
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Welch C, Greig C, Majid Z, Masud T, Moorey H, Pinkney T, Jackson T. Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults. J Frailty Sarcopenia Falls 2022; 7:103-116. [PMID: 36119557 PMCID: PMC9433945 DOI: 10.22540/jfsf-07-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To determine the effects of hospitalisation upon frailty and sarcopenia. Methods Prospective cohort study at single UK hospital including adults ≥70 years-old admitted for elective colorectal surgery, emergency abdominal surgery, or acute infections. Serial assessments for frailty (Fried, Frailty Index, Clinical Frailty Scale [CFS]), and sarcopenia (handgrip strength, ultrasound quadriceps and/or bioelectrical impedance analysis, and gait speed and/or Short Physical Performance Battery) were conducted at baseline, 7 days post-admission/post-operatively, and 13 weeks post-admission/post-operatively. Results Eighty participants were included (mean age 79.2, 38.8% females). Frailty prevalence by all criteria at baseline was higher among medical compared to surgical participants. Median and estimated marginal CFS values and Fried frailty prevalence increased after 7 days, with rates returning towards baseline at 13 weeks. Sarcopenia incidence amongst those who did not have sarcopenia at baseline was 20.0%. However, some participants demonstrated improvements in sarcopenia status, and overall sarcopenia prevalence did not change. There was significant overlap between diagnoses with 37.3% meeting criteria for all four diagnoses at 7 days. Conclusions Induced frailty and acute sarcopenia are overlapping conditions affecting older adults during hospitalisation. Rates of frailty returned towards baseline at 13 weeks, suggesting that induced frailty is reversible.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Corresponding author: Dr Carly Welch, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, B152TT, UK E-mail:
| | - Carolyn Greig
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tahir Masud
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Hannah Moorey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Thomas Jackson
- Medical Research Council (MRC) – Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Rao A, Singh M, Maini M, Anderson KM, Crowell NA, Henderson PR, Gholami SS, Sheikh FH, Najjar SS, Groninger H. Bridge to nowhere: A retrospective single-center study on patients using chronic intravenous inotropic support as bridge therapy who do not receive surgical therapy. Front Cardiovasc Med 2022; 9:918146. [PMID: 36110411 PMCID: PMC9468486 DOI: 10.3389/fcvm.2022.918146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy. Methods Single-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics. Results Of 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001). Conclusion Patients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy.
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Affiliation(s)
- Anirudh Rao
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- Section of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United States
- *Correspondence: Anirudh Rao
| | - Manavotam Singh
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Mansi Maini
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Kelley M. Anderson
- Georgetown University School of Nursing and Health Studies, Washington, DC, United States
| | - Nancy A. Crowell
- Georgetown University School of Nursing and Health Studies, Washington, DC, United States
| | - Paul R. Henderson
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Sherry S. Gholami
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Farooq H. Sheikh
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Samer S. Najjar
- MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC, United States
| | - Hunter Groninger
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, United States
- Section of Palliative Medicine, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, United States
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Liu L, Chen X, Liu L, Qin H. Clostridium butyricum Potentially Improves Immunity and Nutrition through Alteration of the Microbiota and Metabolism of Elderly People with Malnutrition in Long-Term Care. Nutrients 2022; 14:nu14173546. [PMID: 36079806 PMCID: PMC9460359 DOI: 10.3390/nu14173546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Recent research advances examining the gut microbiome and its association with human health have indicated that microbiota-targeted intervention is a promising means for health modulation. In this study, elderly people in long-term care (aged 83.2 ± 5.3 year) with malnutrition (MNA-SF score ≤ 7) were recruited in a community hospital for a 12-week randomized, single-blind clinical trial with Clostridium butyricum. Compared with the basal fluctuations of the control group, an altered gut microbiome was observed in the intervention group, with increased (p < 0.05) Coprobacillus species, Carnobacterium divergens, and Corynebacterium_massiliense, and the promoted growth of the beneficial organisms Akketmanse muciniphila and Alistipes putredinis. A concentrated profile of 14 increased Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologs (KOs) that were enriched in cofactor/vitamin production and carbohydrate metabolism pathways were discovered; the genes were found to be correlated (p < 0.05) with an elevated abundance of plasma metabolites and short-chain fatty acids (SCFAs), unsaturated medium- to long-chain fatty acids (MFA, LFA), carnitines, and amino acids, thus suggesting a coordinated ameliorated metabolism. Proinflammatory factor interferon-gamma (IFN-γ) levels decreased (p < 0.05) throughout the intervention, while the gut barrier tight junction protein, occludin, rose in abundance (p = 0.059), and the sensitive nutrition biomarker prealbumin improved, in contrast to the opposite changes in control. Based on our results obtained during a relatively short intervention time, C. butyricum might have great potential for improving nutrition and immunity in elderly people in long-term care with malnutrition through the alteration of gut microbiota, increasing the abundance of beneficial bacteria and activating the metabolism in SCFA and cofactor/vitamin production, bile acid metabolism, along with efficient energy generation.
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Affiliation(s)
- Lin Liu
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Correspondence: (L.L.); (H.Q.)
| | - Xiang Chen
- Realbio Genomics Institute, Shanghai 200123, China
| | - Lu Liu
- Pengpu Community Medical Service Center, Shanghai 200436, China
| | - Huanlong Qin
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
- Correspondence: (L.L.); (H.Q.)
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Stalmach A, Boehm I, Fernandes M, Rutter A, Skipworth RJE, Husi H. Gene Ontology (GO)-Driven Inference of Candidate Proteomic Markers Associated with Muscle Atrophy Conditions. Molecules 2022; 27:molecules27175514. [PMID: 36080280 PMCID: PMC9457532 DOI: 10.3390/molecules27175514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Skeletal muscle homeostasis is essential for the maintenance of a healthy and active lifestyle. Imbalance in muscle homeostasis has significant consequences such as atrophy, loss of muscle mass, and progressive loss of functions. Aging-related muscle wasting, sarcopenia, and atrophy as a consequence of disease, such as cachexia, reduce the quality of life, increase morbidity and result in an overall poor prognosis. Investigating the muscle proteome related to muscle atrophy diseases has a great potential for diagnostic medicine to identify (i) potential protein biomarkers, and (ii) biological processes and functions common or unique to muscle wasting, cachexia, sarcopenia, and aging alone. We conducted a meta-analysis using gene ontology (GO) analysis of 24 human proteomic studies using tissue samples (skeletal muscle and adipose biopsies) and/or biofluids (serum, plasma, urine). Whilst there were few similarities in protein directionality across studies, biological processes common to conditions were identified. Here we demonstrate that the GO analysis of published human proteomics data can identify processes not revealed by single studies. We recommend the integration of proteomics data from tissue samples and biofluids to yield a comprehensive overview of the human skeletal muscle proteome. This will facilitate the identification of biomarkers and potential pathways of muscle-wasting conditions for use in clinics.
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Affiliation(s)
- Angelique Stalmach
- Centre for Health Science, Division of Biomedical Sciences, Institute of Health Research and Innovation, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Ines Boehm
- Edinburgh Cancer Research UK Tissue Group, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XR, UK
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Marco Fernandes
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Alison Rutter
- Centre for Health Science, Division of Biomedical Sciences, Institute of Health Research and Innovation, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Richard J. E. Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Holger Husi
- Centre for Health Science, Division of Biomedical Sciences, Institute of Health Research and Innovation, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness IV2 3JH, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Correspondence:
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Prado CM, Landi F, Chew STH, Atherton PJ, Molinger J, Ruck T, Gonzalez MC. Advances in Muscle Health and Nutrition: A Toolkit for Healthcare Professionals. Clin Nutr 2022; 41:2244-2263. [DOI: 10.1016/j.clnu.2022.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/03/2022] [Accepted: 07/31/2022] [Indexed: 11/03/2022]
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Bernier M, Enamorado IN, Gómez-Cabrera MC, Calvo-Rubio M, González-Reyes JA, Price NL, Cortés-Rodríguez AB, Rodríguez-Aguilera JC, Rodríguez-López S, Mitchell SJ, Murt KN, Kalafut K, Williams KM, Ward CW, Stains JP, Brea-Calvo G, Villalba JM, Cortassa S, Aon MA, de Cabo R. Age-dependent impact of two exercise training regimens on genomic and metabolic remodeling in skeletal muscle and liver of male mice. NPJ AGING 2022; 8:8. [PMID: 35927269 PMCID: PMC9237062 DOI: 10.1038/s41514-022-00089-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
Abstract
Skeletal muscle adapts to different exercise training modalities with age; however, the impact of both variables at the systemic and tissue levels is not fully understood. Here, adult and old C57BL/6 male mice were assigned to one of three groups: sedentary, daily high-intensity intermittent training (HIIT), or moderate intensity continuous training (MICT) for 4 weeks, compatible with the older group's exercise capacity. Improvements in body composition, fasting blood glucose, and muscle strength were mostly observed in the MICT old group, while effects of HIIT training in adult and old animals was less clear. Skeletal muscle exhibited structural and functional adaptations to exercise training, as revealed by electron microscopy, OXPHOS assays, respirometry, and muscle protein biomarkers. Transcriptomics analysis of gastrocnemius muscle combined with liver and serum metabolomics unveiled an age-dependent metabolic remodeling in response to exercise training. These results support a tailored exercise prescription approach aimed at improving health and ameliorating age-associated loss of muscle strength and function in the elderly.
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Affiliation(s)
- Michel Bernier
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Ignacio Navas Enamorado
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
- Translational Medicine Section, Akouos, Inc., 645 Summer St, Boston, MA, 02210, USA
| | - Mari Carmen Gómez-Cabrera
- Freshage Research Group, Department of Physiology, Faculty of Medicine, University of Valencia, and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Miguel Calvo-Rubio
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
- Departamento de Biología Celular, Fisiología e Inmunología, Campus de Excelencia Internacional Agroalimentario, ceiA3, Universidad de Córdoba, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Jose Antonio González-Reyes
- Departamento de Biología Celular, Fisiología e Inmunología, Campus de Excelencia Internacional Agroalimentario, ceiA3, Universidad de Córdoba, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Nathan L Price
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | | | | | - Sandra Rodríguez-López
- Departamento de Biología Celular, Fisiología e Inmunología, Campus de Excelencia Internacional Agroalimentario, ceiA3, Universidad de Córdoba, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Sarah J Mitchell
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Kelsey N Murt
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Krystle Kalafut
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Katrina M Williams
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Christopher W Ward
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Joseph P Stains
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Gloria Brea-Calvo
- Centro Andaluz de Biología del Desarrollo and CIBERER, Instituto de Salud Carlos III, Universidad Pablo de Olavide - CSIC - JA, Sevilla, 41013, Spain
| | - Jose M Villalba
- Departamento de Biología Celular, Fisiología e Inmunología, Campus de Excelencia Internacional Agroalimentario, ceiA3, Universidad de Córdoba, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Sonia Cortassa
- Laboratory of Cardiovascular Science, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Miguel A Aon
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
- Laboratory of Cardiovascular Science, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Rafael de Cabo
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA.
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Soh CH, Lim WK, Maier AB. Predictors for the Transitions of Poor Clinical Outcomes Among Geriatric Rehabilitation Inpatients. J Am Med Dir Assoc 2022; 23:1800-1806. [PMID: 35760091 DOI: 10.1016/j.jamda.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the associations of morbidity burden and frailty with the transitions between functional decline, institutionalization, and mortality. DESIGN REStORing health of acutely unwell adulTs (RESORT) is an ongoing observational, longitudinal inception cohort and commenced on October 15, 2017. Consented patients were followed for 3 months postdischarge. SETTING AND PARTICIPANTS Consecutive geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards. METHODS Patients' morbidity burden was assessed at admission using the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS). Frailty was assessed using the Clinical Frailty Scale (CFS) and modified Frailty Index based on laboratory tests (mFI-lab). A multistate model was applied at 4 time points: 2 weeks preadmission, admission, and discharge from geriatric rehabilitation and 3 months postdischarge, with the following outcomes: functional decline, institutionalization, and mortality. Cox proportional hazards regression was applied to investigate the associations of morbidity burden and frailty with the transitions between outcomes. RESULTS The 1890 included inpatients had a median age of 83.4 (77.6-88.4) years, and 56.3% were female. A higher CCI score was associated with a greater risk of transitions from preadmission and declined functional performance to mortality [hazard ratio (HR) 1.28, 95% CI 1.03-1.59; HR 1.32, 95% CI 1.04-1.67]. A higher CIRS score was associated with a higher risk of not recovering from functional decline (HR 0.80, 95% CI 0.69-0.93). A higher CFS score was associated with a greater risk of transitions from preadmission and declined functional performance to institutionalization (HR 1.28, 95% CI 1.10-1.49; HR 1.23, 95% CI 1.04-1.44) and mortality (HR 1.12, 95% CI 1.01-1.33; HR 1.11, 95% CI 1.003-1.31). The mFI-lab was not associated with any of the transitions. None of the morbidity measures or frailty assessment tools were associated with the transitions from institutionalization to other outcomes. CONCLUSIONS AND IMPLICATIONS This study demonstrates that greater frailty severity, assessed using the CFS, is a significant risk factor for poor clinical outcomes and demonstrates the importance of implementing it in the geriatric rehabilitation setting.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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50
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Amasene M, Medrano M, Echeverria I, Urquiza M, Rodriguez-Larrad A, Diez A, Labayen I, Ariadna BB. Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults. Front Nutr 2022; 9:920485. [PMID: 35811947 PMCID: PMC9263978 DOI: 10.3389/fnut.2022.920485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background The Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. Methods A total of 597 hospitalized older adults (84.3 ± 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). Results Better nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408–3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326–6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). Conclusions The current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.
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Affiliation(s)
- Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Medrano
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Iñaki Echeverria
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Department of Physical Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Diez
- Nurse Supervisor, Bioaraba Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Idoia Labayen
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Besga-Basterra Ariadna
- Ageing and Frailty Research Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- Internal Medicine Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- *Correspondence: Besga-Basterra Ariadna
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