Correlation between hand grip strength and regional muscle mass in older Asian adults: an observational study

Which pathway of the possible sarcopenia algorithm of the AWGS 2019 guideline is the best in Korean community-dwelling older men and women?

OBJECTIVE

To compare the diagnostic accuracy of possible sarcopenia identification pathways, as suggested by Asian Working Group for Sarcopenia (AWGS) in 2019, by gender among Korean community-dwelling older adults.

DESIGN

Cross-sectional analysis of data from 2,129 community-dwelling adults (70-84 years, 50.4% men) enrolled in Korean Frailty and Aging Cohort Study.

METHODS

Based on AWGS 2019 guideline, possible sarcopenia was defined by low handgrip strength (HGS) or slow five-times chair stand test (5CST) time, referred to as "assessments." "Case-findings" (low calf circumference [CC], SARC-F ≥4, or SARC-CalF ≥11) were recommended for screening 'possible sarcopenia' before assessment. For the six 'possible sarcopenia' pathways (combining three case-finding and two assessment tools), area under the curve (AUC) and F1 score are compared.

RESULTS

For case-finding in men, CC demonstrated the highest AUC (0.657) and F1 score (0.504) for predicting sarcopenia compared with SARC-F and SARC-CalF (p <0.001, =0.001). Among men with low CC, ΔAUC between HGS and 5CST was not significant as assessment (p=0.079) (AUCs: 0.763 vs. 0.707; F1 scores: 0.713 vs. 0.650). For case-finding in women, SARC-CalF demonstrated the highest AUC (0.631) and F1 score (0.389) compared with CC and SARC-F (p=0.012, <0.001). Subsequently, ΔAUC between HGS and 5CST was not significant in women (p=0.069) (AUCs: 0.566 vs. 0.636; F1 scores: 0.387 vs. 0.514).

CONCLUSIONS

Based on AWGS 2019 guideline, CC in men and SARC-CalF in women was the best case-finding tool for community-dwelling older adults. After the best case-finding in each gender, two assessment pathways demonstrated insignificant difference in both genders.

BRIEF SUMMARY

For case-finding of possible sarcopenia, using calf circumference in older men and using SARC-CalF in older women demonstrated the highest diagnostic accuracy for predicting sarcopenia. After the best case-finding in each gender, two assessment pathways (handgrip strength and five-times chair stand test) of possible sarcopenia demonstrated insignificant difference in both genders.

The relationship between age related changes in strength and fitness with body size, shape and composition

Handgrip strength (HGS), cardiorespiratory fitness (CRF) and body size, shape, and composition are all related to cardiometabolic health and are associated in cross-sectional settings. Their longitudinal relationship is less clear. We used observational data from the Study of Health in Pomerania at baseline (SHIP-TREND-0; 2008-2012) and follow-up (SHIP-TREND-1; 2016-2019) with 1,214 men and 1,293 women. HGS was measured with a hand dynamometer. CRF was assessed using cardiopulmonary exercise testing. Linear regression models were adjusted appropriately. Several sensitivity analyses were performed. From baseline to follow-up (7 years) HGS decreased in men (3.5 kg) and women (0.8 kg). VO2peak lessened in men (36 ml/min) and increased in women (53 ml/min). We only found significant relations in men where a 1 l decline in VO2peak was associated with a 0.87 kg larger decrease in fat free mass and with a 1.15 kg stronger decline in body weight. All other analysis revealed non-significant findings. This longitudinal analysis suggests that age related changes in strength and CRF are not related to body size and shape but only composition (in men). A novelty of our findings are the sex-specific aspects given that strength decreased much stronger in men compared to women.

The use of portable A-mode ultrasound in appendicular lean mass measurements among older adults: a comparison study with dual-energy X-ray absorptiometry and handgrip strength

BACKGROUND/OBJECTIVES

Strength and muscle mass are key factors for the diagnosis of sarcopenia. The EWGSOP2 recommended using ultrasound (US) as a reliable device to measure muscle mass (MM), but A-mode US still needs to be validated for older adults. This study aimed to evaluate the association between measurements of muscle thickness (MT) by portable A-mode US and, muscle quantity by Dual-Energy X-ray absorptiometry (DXA) in older adults.

METHODS

Cross-sectional study, with 115 participants included. Muscle mass was assessed by DXA and MT of the biceps, triceps, anterior thigh, and calf by A-mode US and handgrip strength by a dynamometer.

RESULTS

The majority were women (n = 96; 83%), 69 ± 6 years. The MT sum (biceps, triceps, thigh, and calf) assessed by the US was not associated with the appendicular lean mass (ALM) assessed by DXA after controlling for sex and age (R2 = 0.524; p = 0.139; effect size = 0.53). The MT sum biceps and triceps was still significantly associated with MM arms/2 even when controlling for sex and age (which were also significant) (R2 = 0.551; p < 0.001; effect size = 0.56). The MT sum thigh and calf was not associated with MM legs/2 in adjusted models (R2 = 0.499; p = 0.688; effect size = 0.51).

CONCLUSIONS

This finding shows that the portable A-mode US may not be an appropriate method for estimating MM in extremities (the sum of arms and legs), but can be appropriate for estimating only MM arms in healthy older adults.

Effects of outdoor play on body composition and physical performance in children: the Yamanashi Adjunct study of the Japan Environment and Children's Study

INTRODUCTION

Childhood is a pivotal developmental stage that substantially affects lifelong habits. Recent research has emphasized the vital role of outdoor play in children's mental and physical well-being. Despite the World Health Organization recommending 1 hour of daily physical activity for children, a knowledge gap exists regarding the specific link between children's physical performance, body composition (evaluated through bioelectrical impedance analysis [BIA]), and outdoor play habits.

METHODS

Utilizing data from the Japan Environment and Children's Study, a national birth cohort study, this study included 494 eight-year-old participants. The assessment included body composition (height, weight, body fat percentage, predicted muscle weight, and phase angle using BIA) and physical performance (50 m sprint, standing long jump, 20 m shuttle run, and handgrip strength). Parents provided information on children's outdoor playtime.

RESULTS

The group with more outdoor play demonstrated superior sports test results, particularly among boys. Girls engaged in increased outdoor play exhibited higher predicted muscle weights, whereas boys showed greater phase angles in the lower limbs. Handgrip strength correlated with phase angle and predicted muscle weight. Notably, the association between body composition and sports test results was more pronounced in boys than in girls, with phase angles exhibiting stronger links to running and jumping.

CONCLUSION

This pioneering study explored the relationship between outdoor play, body composition, and physical performance in children. Outdoor play positively correlated with improved sports performance, revealing sex disparities in body composition changes. Unlike previous studies focusing on general physical development, this study scrutinized specific physical functions, uncovering correlations between phase angle and muscle quality. Findings suggest that outdoor play positively impacts muscle quality, especially in boys, contributing to enhanced physical performance in children. Understanding these effects on body composition and physical activity is imperative for promoting children's health.

Low trunk muscle mass could predict severe stress urinary incontinence in Asian women

AIM

Adequate pelvic floor support for the urethra is crucial for preventing stress urinary incontinence (SUI). Obesity is an established risk factor for SUI. This study aimed to explore the relationship between SUI and body composition, specifically focusing on muscle and fat mass.

METHODS

This single-center, prospective, cross-sectional study enrolled women who visited the genitourinary clinic of Taipei City Hospital-Zhongxiao Branch between 1 February 2020 and 31 January 2021. SUI severity was classified according to the type of daily activity in which SUI occurred. Potential risk factors for SUI, including age, labor and history of hysterectomy, were also included. All participants underwent a bioelectric impedance analysis of their body composition. Independent t-tests and Pearson's χ2-tests were used to compare the differences in continuous and categorical parameters between groups. Logistic regression analysis was used to characterize the predictive value of body composition for severe SUI.

RESULTS

Of the 256 included patients, 37 had severe SUI. The participants with severe SUI were older and were more likely to have undergone a hysterectomy. They also had a considerably higher prevalence of sarcopenia. In the univariate analysis, a sarcopenia diagnosis was associated with severe SUI. Furthermore, a history of hysterectomy correlated with severe SUI, although with borderline significance. In the multivariate analysis, a history of hysterectomy and lower trunk muscle mass index were found to be independent predictors of severe SUI.

CONCLUSIONS

A history of hysterectomy and a lower trunk muscle mass index are correlated with severe SUI. Geriatr Gerontol Int 2025; 25: 226-231.

Associations between 6-min walk distance and cardiopulmonary parameter in non-obese older adults: An observational study

BACKGROUND

The 6-min walk test (6MWT) has established itself as a classical field-test for assessing exercise capacity across diverse populations, including older adults. Despite its widespread use, the specific contribution of cardiopulmonary factors to the 6-min walk distance (6MWD) remains relatively unexplored.

OBJECTIVE

The primary objective of this investigation was to examine any potential associations between 6MWD and various cardiopulmonary parameters in older adults.

METHODS

Ninety-two non-obese older adults (66.9 ± 4.1 years) were recruited for this study. Real-time assessments of cardiohemodynamic parameters were conducted using impedance cardiography, while cardiopulmonary parameters were evaluated using a gas analyzer during the administration of the 6MWT.

RESULTS

Our findings revealed mild-to-strong positive correlations between 6MWD and several cardiohemodynamic parameters, including left cardiac work index, heart rate, cardiac output, and cardiac index, as well as cardiopulmonary parameters such as oxygen consumption (V˙˙O2), carbon dioxide consumption (V˙˙CO2), minute ventilation, oxygen pulse, tidal volume, respiratory exchange ratio (RER), and breath frequency at the end of walking task (p < 0.05). Additionally, a negative moderate association was observed between 6MWD and systemic vascular resistance index (SVRi), while no significant correlation was found between stroke volume and 6MWD. Furthermore, a combination of SVRi, V˙˙O2, V˙˙CO2, and RER appeared to predict 6MWD with reasonable accuracy (R2 = 0.567, p < 0.001).

CONCLUSIONS

Our investigation highlights a robust association between cardiopulmonary parameters and 6MWD among non-obese older adults. These results also emphasize the potential impact of systemic vascular health on submaximal exercise capacity evaluation within the community-dwelling older adults.

Prognostic significance of novel muscle quality index utilization in hospitalized adults with cancer: A secondary analysis

BACKGROUND

This study aimed to investigate and propose novel approaches to calculate muscle quality index (MQI) using muscle mass derived from single-frequency bioelectrical impedance analysis (SF-BIA) and calf circumference in both unadjusted and body mass index (BMI)-adjusted forms. In addition, we examined their prognostic significance in patients with cancer.

METHODS

A secondary analysis was conducted on a prospective cohort study of patients with cancer. Handgrip strength was measured. SF-BIA was conducted to estimate appendicular lean soft tissue (ALST, in kilograms). MQI was calculated using three approaches: (1) the ratio of handgrip strength to ALST (MQISF-BIA), (2) the ratio of handgrip strength to calf circumference (MQIcalf circumference), and (3) the ratio of handgrip strength to BMI-adjusted calf circumference (MQIadj. calf circumference). Maximally selected log-rank was calculated to estimate their cutoff values to predict survival.

RESULTS

Two hundred eighty-four patients were included (51.1% men; median age, 61 years). Solid tumors were the most frequent (89.8%). All approaches to MQI (MQISF-BIA, MQIcalf circumference, and MQIadj. calf circumference) were independent predictors of 6-month mortality. The found cutoffs were (1) MQISF-BIA (<1.52 for men, <0.63 for women), (2) MQIcalf circumference (<0.74 for men, <0.24 for women), and (3) MQIadj. calf circumference (<0.75 for men, <0.25 for women).

CONCLUSION

This study introduces MQISF-BIA, MQIcalf circumference, and MQIadj. calf circumference as future potential surrogate methods for computing MQI in clinical practice when other robust procedures are unavailable, pending further validation.

Association of relative handgrip strength on the development of diabetes mellitus in elderly Koreans

BACKGROUND

Diabetes mellitus (DM) is a significant public health concern, particularly in the elderly population. Absolute handgrip strength (HGS) serves to quantify muscle strength. It is recommended that the risk of low muscle strength and increased body mass index be concurrently evaluated using relative HGS. There are currently insufficient evidence regarding the relationship between relative HGS and DM in the elderly Korean population. Therefore, the association between relative HGS and the development of DM in Korean elderly was investigated.

METHODS

Data from the Korean Longitudinal Study of Ageing were used to determine the odds ratio (OR) between relative HGS and DM during the follow-up period from 2006-2020 among Korean men and women aged ≥65 years without DM when they first participated in this survey. Analysis was conducted using the Generalized Estimating Equation method. Trend analysis was performed for DM development based on relative HGS.

RESULTS

Among elderly males, higher relative HGS groups had reduced odds of developing DM (Middle tertile: OR 0.87, 95% CI 0.61-1.23, p = 0.419.) (Upper tertile: OR 0.82, 95% CI 0.56-1.18, p = 0.281.) Among elderly females, the reductions were similar. (Middle tertile: OR 0.82, 95% CI 0.66-1.03, p = 0.087.) (Upper tertile: OR 0.79, 95% CI 0.50-1.25, p = 0.306.) However, these differences were not statistically significant. Significant predictors of new-onset DM included age, BMI (overweight/obese), household income, alcohol consumption, hypertension, and chronic liver disease. Trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05).

CONCLUSION

Relative HGS did not achieve statistical significance. Our findings indicate that BMI, particularly overweight and obesity, significantly predicts new-onset DM. However, trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05), even after adjusting for BMI categories. Despite the lack of statistical significance in some cases, the trend suggests that promoting resistance exercises to enhance HGS could be beneficial in DM prevention. Comprehensive DM prevention strategies should include managing obesity and chronic conditions for elderly.

Feasibility, Safety, and Effects of an Aerobic Training Program with Blood Flow Restriction on Functional Capacity, and Symptomatology in Women with Fibromyalgia: A Pilot Study

BACKGROUND

Evidence suggests that aerobic training with blood flow restriction is beneficial for treating fibromyalgia. This study evaluated the feasibility, safety, and effects of an aerobic training program with blood flow restriction for women with fibromyalgia.

METHODS

Thirty-seven women with fibromyalgia were included, and thirteen with an average age of 59 ± 3, a BMI of 26 ± 3, and who were polymedicated started the intervention period. The intervention group performed aerobic exercise with blood flow restriction using occlusive bands placed in the upper part of the rectus femoris, with a total duration of 14 min of restriction divided into two periods of 7 min with a rest period of 3 min and a total session duration of 17 min. Pressure intensity was measured using the visual pain scale (VAS), scoring 7 out of 10 (n = 7). The non-intervention group performed aerobic exercise without restriction of blood flow for the same periods, rest periods, and total duration of the session (n = 6). The intervention included 2 weekly sessions with 72 h between aerobic walking for 9 weeks. Walking was measured individually using the rating of perceived exertion scale (RPE) with an intensity between 6 and 7 out of 10. Visual and verbal support for the VAS and RPE scale was always provided throughout the sessions supervised by the investigator. Functional capacity was assessed using tests (six-minute walk test, incremental shuttle walk test, knee extension and handgrip test by dynamometer, 30 s chair stand test, and timed up-and-go test). Symptomatology was assessed using questionnaires (Widespread Pain Index, Symptom Severity Score, Fibromyalgia Impact Questionnaire, and Multidimensional Fatigue Inventory), and blood samples were collected.

RESULTS

There were no adverse effects, and only one participant in the intervention group withdrew. Between-group and intragroup differences showed that the intervention group obtained improvements in the functional tests; CST p = 0.005; 6MWT p = 0.011; Handgrip p = 0.002; TUGT p = 0.002 with reduced impact of the disease according to the questionnaires; FIQ Stiffness p = 0.027 compared with the nonintervention group. Biochemical results remained within normal ranges in both groups.

CONCLUSIONS

Blood flow-restricted aerobic training may be feasible, safe, and more effective than unrestricted aerobic training as a physical exercise prescription tool to improve cardiorespiratory fitness, strength, balance, and stiffness in women with fibromyalgia.

CCL2 signaling promotes skeletal muscle wasting in non-tumor and breast tumor models

Despite advancements in treatment, approximately 25% of patients with breast cancer experience long-term skeletal muscle wasting (SMW), which limits mobility, reduces drug tolerance and adversely impacts survival. By understanding the underlying molecular mechanisms of SMW, we may be able to develop new strategies to alleviate this condition and improve the lives of patients with breast cancer. Chemokines are small soluble factors that regulate homing of immune cells to tissues during inflammation. In breast cancers, overexpression of C-C chemokine ligand 2 (CCL2) correlates with unfavorable prognosis. Elevated levels of CCL2 in peripheral blood indicate possible systemic effects of this chemokine in patients with breast cancer. Here, we investigated the role of CCL2 signaling on SMW in tumor and non-tumor contexts. In vitro, increasing concentrations of CCL2 inhibited myoblast and myotube function through C-C chemokine receptor 2 (CCR2)-dependent mechanisms involving JNK, SMAD3 and AMPK signaling. In healthy mice, delivery of recombinant CCL2 protein promoted SMW in a dose-dependent manner. In vivo knockdown of breast tumor-derived CCL2 partially protected against SMW. Overall, chronic, upregulated CCL2-CCR2 signaling positively regulates SMW, with implications for therapeutic targeting.

Therapeutic targets for muscle weakness in older adults: proteome-wide Mendelian randomization and colocalization analyses

BACKGROUND

Recent research highlights the importance of muscular strength as a key factor in physical fitness, a strong indicator of overall mortality risk, and a vital target for preventing chronic diseases. This study used a proteome-wide Mendelian randomization analysis plus colocalization analysis for low hand grip strength to explore potential therapeutic targets for muscle weakness.

METHODS

We conducted two two-sample Mendelian randomization analyses from four cohorts to identify and validate the causal relationship between plasma proteins and low grip strength. We also employed bidirectional Mendelian randomization analysis with Steiger filtering, Bayesian co-localization, and phenotype scanning to detect reverse causality, thereby consolidating our Mendelian randomization findings. Downstream analyses were also undertaken of identified proteins, including knockout models, enrichment analyses, and protein-protein interaction networks. Finally, we assessed the druggability of the identified proteins.

RESULTS

At Bonferroni significance (P < 6.82 × 10-5), Mendelian randomization analysis revealed that three proteins were causally associated with low grip strength. Increased MGP (OR = 0.85) and HP (OR = 0.96) decreased the risk of low grip strength, whereas elevated ART4 (OR = 1.06) increased the risk of low grip strength. None of the three proteins had reverse causality with low grip strength. Bayesian co-localization suggested that MGP shared the same variant with low grip strength (coloc.abf-PPH4 = 0.826). Further downstream analyses showed that MGP, which is highly expressed in musculoskeletal system, is a potential novel target for muscle weakness.

CONCLUSIONS

The proteome-wide Mendelian randomization investigation identified three proteins associated with the risk of muscle weakness. MGP, HP, and ART4 deserve further investigation as potential therapeutic targets for muscle weakness.

A Novel Method for Identifying Frailty and Quantifying Muscle Strength Using the Six-Minute Walking Test

The six-minute walking test (6MWT) is an essential test for evaluating exercise tolerance in many respiratory and cardiovascular diseases. Frailty and sarcopenia can cause rapid aging of the cardiovascular system in elderly people. Early detection and evaluation of frailty and sarcopenia are crucial for determining the treatment method. We aimed to develop a wearable measuring system for the 6MWT and propose a method for identifying frailty and quantifying walking muscle strength (WMS). In this study, 60 elderly participants were asked to wear accelerometers behind their left and right ankles during the 6MWT. The gait data were collected by a computer or smartphone. We proposed a method for analyzing walking performance using the stride length (SL) and step cadence (SC) instead of gait speed directly. Four regions (Range I-IV) were divided by cutoff values of SC = 2.0 [step/s] and SL = 0.6 [m/step] for a quick view of the frail state. There were 62.5% of frail individuals distributed in Range III and 72.4% of non-frail individuals in Range I. A concept of a WMS score was proposed for estimating WMS quantitatively. We found that 62.5% of frail individuals were scored as WMS1 and 41.4% of the non-frail elderly as WMS4. The average walking distances corresponding to WMS1-4 were 207 m, 370 m, 432 m, and 462 m, respectively. The WMS score may be a useful tool for quantitatively estimating sarcopenia or frailty due to reduced cardiopulmonary function.

The impact of handgrip strength and waist circumference on glycemic control: Prospective, observational study using outpatient clinical data in Japanese patients with type 2 diabetes mellitus

INTRODUCTION

Loss of muscle mass and the accumulation of visceral fat are known risk factors for the deterioration of glycemic control in type 2 diabetes mellitus. This study looked at the effects of such factors on glycemic control in Japanese patients with type 2 diabetes mellitus in the form of handgrip strength (HGS) and waist circumference (WC).

MATERIALS AND METHODS

In this prospective, observational study, 233 patients with type 2 diabetes mellitus and a HbA1c level of ≥7.0% were followed for around 1 year, during which time they were studied for an understanding of the association between handgrip strength, waist circumference, and glycemic control (HbA1c <7.0%). Hazard ratios (HRs) and 95% confidence intervals (CIs) for glycemic control improvement by Cox hazards models were analyzed for handgrip strength and waist circumference.

RESULTS

Compared with the low tertile, patients in the middle and high tertiles of handgrip strength when adjustment was carried out for waist circumference were 2.117 (1.142-3.924) and 4.670 (2.526-8.632), respectively. The HRs of patients in the middle and high tertiles of WC when adjustment was made for HGS were 0.442 (0.269-0.725) and 0.339 (0.191-0.604), respectively. Within the low, middle, and high HGS tertiles, the HRs for WC were 0.863 (0.797-0.934), 0.940 (0.899-0.982), and 1.009 (0.984-1.035), respectively, although the HRs for HGS within each WC tertile remained significant.

CONCLUSIONS

Handgrip strength and waist circumference demonstrated independent associations for glycemic control, but the effect of waist circumference appeared to be at least partially canceled out by increased handgrip strength. The data suggest that handgrip strength might help to mitigate the negative impact of waist circumference on glycemic control.

Identifying the potential therapeutic effects of miR‑6516 on muscle disuse atrophy

Muscle atrophy is a debilitating condition with various causes; while aging is one of these causes, reduced engagement in routine muscle‑strengthening activities also markedly contributes to muscle loss. Although extensive research has been conducted on microRNAs (miRNAs/miRs) and their associations with muscle atrophy, the roles played by miRNA precursors remain underexplored. The present study detected the upregulation of the miR‑206 precursor in cell‑free (cf)RNA from the plasma of patients at risk of sarcopenia, and in cfRNAs from the muscles of mice subjected to muscle atrophy. Additionally, a decline in the levels of the miR‑6516 precursor was observed in mice with muscle atrophy. The administration of mimic‑miR‑6516 to mice immobilized due to injury inhibited muscle atrophy by targeting and inhibiting cyclin‑dependent kinase inhibitor 1b (Cdkn1b). Based on these results, the miR‑206 precursor appears to be a potential biomarker of muscle atrophy, whereas miR‑6516 shows promise as a therapeutic target to alleviate muscle deterioration in patients with muscle disuse and atrophy.

A Cross-Sectional Study on Metabolic Syndrome Parameters, the Nutritional Index, and Physical Status Associated with or Without the Possible Diagnosed Sarcopenia in Older Women Using A Propensity Score Matching Method

Objectives

To develop strategies against sarcopenia, physiological and biochemical data in older women were analyzed using propensity score matching.

Methods

Fifty-six women aged ≥75 years with the AWGS calf circumference <33 cm were included in the sarcopenia risk group. Low muscle strength (handgrip strength <18kg) or low physical performance (five-times-sit-to-stand test ≥12s) were used the possible-sarcopenia group. Propensity score matching adjusted for age and BMI was performed between the possible-sarcopenia group with low muscle strength (or physical performance) and the sarcopenia risk group without low muscle strength (or physical performance). The comparison included nutritional index, metabolic syndrome parameters, BMD, and skeletal muscle mass index score between both groups.

Results

The possible-sarcopenia group with low muscle strength exhibited significantly lower BMD (p=0.014) and skeletal muscle mass index score (p=0.002) compared to the sarcopenia risk group without low muscle strength. The possible-sarcopenia group with low physical performance exhibited significantly lower AST (p=0.034) compared to the sarcopenia risk group without low physical performance.

Conclusion

These results suggest that older women with possible sarcopenia and low muscle strength may have reduced BMD and skeletal muscle mass index.

Are accelerometer-measured sitting and physical activity times associated with muscle mass and strength in healthy young adults in the UAE?

Background

A high prevalence of obesity, sedentary behavior, and physical inactivity could affect muscle mass and strength in young adults in the United Arab Emirates (UAE). Therefore, we investigated the association of sex, body mass index (BMI), and accelerometer-measured sitting and physical activity (PA) times with skeletal muscle mass index (SMI), hand grip, and thigh muscle strength in healthy young adults in the UAE.

Methods

In this cross-sectional study, 156 healthy young adults (age 21.68 ± 3.01 years, BMI 25.40 ± 4.79 kg/m2, 52.6 % women) were included. BMI and muscle mass were recorded using a bioelectrical impedance analyzer. Maximum hand grip strength and thigh muscle torque were assessed using the Jamar-smart hand-dynamometer and Biodex System-4-Pro, respectively. Participants wore a triaxial Fibion accelerometer on their anterior thigh for >10 h per day for 4-7 days to measure their sitting and PA times. Multiple linear regression analyses were used.

Results

Participants spent most of their time sitting (11.37 ± 1.10 h), followed by standing (2.92 ± 0.86 h), walking (1.58 ± 0.55 h), and vigorous intensity PA (4.79 ± 5.85 min) per 16-h day. Sex (p < 0.001) and BMI (p < 0.001) were negatively associated with all muscle mass and strength variables. Men had more muscle mass and strength than women. As BMI increased, muscle mass and muscle strength decreased. Accelerometer-measured sitting and walking times were negatively associated with concentric hamstrings (p = 0.044) and quadriceps torques (p = 0.031), respectively.

Conclusion

Sex, BMI, and accelerometer-measured sitting and walking times were associated with muscle mass and/or muscle strength in healthy young adults. Women and those with a high BMI need interventions to improve their muscle mass and strength. The paradox regarding the association of PA with muscle mass and strength in younger adults may be due to possible influences from other factors (e.g., resistance training, dietary intakes, etc.) superseding that of accelerometer-measured PA.

Dexamethasone-induced muscle atrophy and bone loss in six genetically diverse collaborative cross founder strains demonstrates phenotypic variability by Rg3 treatment

Background

Osteosarcopenia is a common condition characterized by the loss of both bone and muscle mass, which can lead to an increased risk of fractures and disability in older adults. The study aimed to elucidate the response of various mouse strains to treatment with Rg3, one of the leading ginsenosides, on musculoskeletal traits and immune function, and their correlation.

Methods

Six Collaborative Cross (CC) founder strains induced muscle atrophy and bone loss with dexamethasone (15 mg/kg) treatment for 1 month, and half of the mice for each strain were orally administered Rg3 (20 mg/kg). Different responses were observed depending on genetic background and Rg3 treatment.

Results

Rg3 significantly increased grip strength, running performance, and expression of muscle and bone health-related genes in a two-way analysis of variance considering the genetic backgrounds and Rg3 treatment. Significant improvements in grip strength, running performance, bone area, and muscle mass, and the increased gene expression were observed in specific strains of PWK/PhJ. For traits related to muscle, bone, and immune functions, significant correlations between traits were confirmed following Rg3 administration compared with control mice. The phenotyping analysis was compiled into a public web resource called Rg3-OsteoSarco.

Conclusion

This highlights the complex interplay between genetic determinants, pathogenesis of muscle atrophy and bone loss, and phytochemical bioactivity and the need to move away from single inbred mouse models to improve their translatability to genetically diverse humans. Rg3-OsteoSarco highlights the use of CC founder strains as a valuable tool in the field of personalized nutrition.

Factors Leading to a Decrease in Grip Strength Among the Oldest Old: A Large, Representative, Longitudinal Survey

OBJECTIVES

Grip strength is an indicator for physical performance and highly correlated with general health among older adults. To date, there is limited knowledge regarding the factors contributing to grip strength exclusively among the oldest old based on data from large representative samples and also including institutionalized individuals. Consequently, the purpose of our current study was to address this gap in knowledge.

DESIGN

A large representative, longitudinal study.

SETTING AND PARTICIPANTS

Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+), including individuals ≥80 years (residing in institutionalized settings and living in private households) in North Rhine-Westphalia (n = 1824, mean age was 86.7 years, 80 to 104 years).

METHODS

In accordance with other large cohort studies, isometric grip strength was measured using a dynamometer (Smedley Dynamometer, 100 kg).

RESULTS

Linear fixed effects regressions showed that decreases in grip strength were significantly associated with increases in age (β = -0.70, P < .001), decreases in social network size (β = 0.08, P < .05), and worsening self-rated health (β = 0.80, P < .01). In contrast, decreases in grip strength were not significantly associated with changes in marital status, changes in living situation, changes in the number of chronic conditions, changes in depressive symptoms, and changes in health literacy.

CONCLUSIONS AND IMPLICATIONS

It has been shown that age, social network size, and self-rated health were associated with grip strength among the oldest old longitudinally. Our current study may assist in identifying individuals at risk for low grip strength. For example, efforts to maintain social contacts may be beneficial to maintain grip strength. This is relevant because low grip strength contributes to unfavorable outcomes such as poor quality of life, functional impairment, cognitive decline, and reduced longevity.

Comparison of the cachexia index based on hand-grip strength (H-CXI) with the original CXI for the prediction of cancer cachexia and prognosis in patients who underwent radical colectomy for colorectal cancer

Background and aims

The cachexia index (CXI) is a novel biomarker for estimating cancer cachexia. The cachexia index based on hand-grip strength (H-CXI) has been recently developed as a simple proxy for CXI. The present study aims to compare both the H-CXI and CXI for the prediction of cancer cachexia and postoperative outcomes in patients who underwent radical colectomy for colorectal cancer.

Methods

Patients who underwent radical operations for colorectal cancer were included in this study. Cancer cachexia was diagnosed according to the international consensus outlined by Fearon et al. The cachexia index (CXI) was calculated as [skeletal muscle index (SMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR)]. The H-CXI was calculated as [hand-grip strength (HGS)/height2 × serum albumin/NLR]. The SMI was measured based on the preoperative CT images at the third lumbar vertebra (L3) level. HGS was measured before surgery.

Results

From July 2014 to May 2021, a total of 1,411 patients were included in the present study, of whom 361 (25.6%) were identified as having cancer cachexia. Patients with cachexia had a lower CXI (p < 0.001) and lower H-CXI (p < 0.001) than those without cachexia. A low CXI but not low H-CXI independently predicted cancer cachexia in the multivariate analysis (OR 1.448, p = 0.024). Both a low CXI (HR 1.476, p < 0.001 for OS; HR 1.611, p < 0.001 for DFS) and low H-CXI (HR 1.369, p = 0.007 for OS; HR 1.642, p < 0.001 for DFS) were independent predictors for overall survival (OS) and disease-free survival (DFS) after adjusting for the same covariates. A low H-CXI but not low CXI was an independent risk factor for postoperative complications (OR 1.337, p = 0.044). No significant association was found between cancer cachexia and postoperative complications.

Conclusion

The CXI and H-CXI exhibited better prognostic value than cancer cachexia for the prediction of postoperative outcomes in patients who underwent radical colectomy for colorectal cancer. The H-CXI was a superior index over the CXI in predicting short-term clinical outcomes, whereas the CXI demonstrated a closer correlation with Fearon's criteria for cancer cachexia. Ideal tools for the assessment of cancer cachexia should incorporate not only weight loss but also muscle mass, physical function, and inflammatory state.

The value of whole-body dual-energy x-ray absorptiometry in assessing body composition in patients with inflammatory bowel disease: a prospective study

OBJECTIVES

Low skeletal muscle index (SMI) is common in inflammatory bowel disease (IBD) but has an uncertain relationship with active intestinal inflammation. This study evaluated body composition by whole-body dual-energy X-ray absorptiometry (DXA) in patients with IBD and healthy controls to enable the value of formal body composition analysis to be judged.

METHODS

Patients with IBD and sex/age-matched controls prospectively underwent full body composition assessment by DXA, assessment by BMI, eating questionnaires and handgrip strength. Disease activity was assessed by faecal calprotectin (active ≥150 µg/g). A cohort undergoing biologic induction therapy were assessed at baseline and after ≥13 weeks.

RESULTS

Total fat mass was higher in 54 patients with IBD (56% Crohn's disease, 61% male) than in 30 controls (median 25.1 vs. 18.7 kg, P  = 0.042). DXA offered little more than BMI. Low SMI was more common than in controls (15% vs. 0%, P  = 0.027). A normal BMI was seen in many patients with low SMI and handgrip strength was a poor marker of change in SMI. Body composition was similar in 28 patients with active vs. 22 with inactive disease. However, SMI increased specifically by 9.7% ( P  = 0.004) and BMI by 6.4% ( P  = 0.012) in 9 responders to therapy.

CONCLUSION

DXA identifies many patients with reduced SMI who are not detected by standard methodologies. While disease activity is not associated with low SMI, resolution of inflammation leads to improved SMI. The potential for recognition of such patients to influence therapeutic decisions underlines the need for DXA assessment in clinical practice.

Development and validation of equations for predicting appendicular skeletal muscle mass in male patients with head and neck cancer and normal hydration status

OBJECTIVE

Muscle mass is typically assessed by abdominal computed tomography, magnetic resonance imaging, and dual-energy x-ray absorptiometry. However, these tests are not routinely performed in patients with head and neck cancer (HNC), making sarcopenia assessment difficult. The aim of this study was to develop and validate equations for predicting appendicular skeletal muscle mass (ASM) from data obtained in daily medical practice, with bioelectrical impedance analysis (BIA)-measured appendicular skeletal muscle mass (BIA-ASM) as a reference.

METHODS

This cross-sectional study included 103 men with HNC who were randomly placed into development and validation groups. The prediction equations for BIA-ASM were developed by multiple regression analysis and validated by Bland-Altman analyses. The estimated skeletal muscle mass index (eSMI) was also statistically evaluated to discriminate the cutoff value for BIA-measured SMI according to the Asian Working Groups for Sarcopenia.

RESULTS

Two practical equations, which included 24-h urinary creatinine excretion volume (24hUCrV), handgrip strength (HGS), body weight (BW), and body height (BHt), were developed: ASM (kg) = -39.46 + (3.557 × 24hUCrV [g]) + (0.08872 × HGS [kg]) + (0.1263 × BW [kg]) + (0.2661 × BHt [cm]) if available for 24hUCrV (adjusted R2 = 0.8905), and ASM (kg) = -42.60 + (0.1643 × HGS [kg]) + (0.1589 × BW [kg]) + (0.2807 × BHt [cm]) if not (adjusted R2 = 0.8589). ASM estimated by these two equations showed a significantly strong correlation with BIA-ASM (R > 0.900). Bland-Altman analyses showed a good agreement, and eSMI accuracy was high (>80%) in both equations.

CONCLUSIONS

These two equations are a valid option for estimating ASM and diagnosing sarcopenia in patients with HNC in all facilities without special equipment.

The relation between synovitis of individual finger joints and grip force over the first 5 years in early rheumatoid arthritis - a cohort study

OBJECTIVE

The objective of this study was to investigate the relation between swelling and tenderness of individual finger joints and grip force in patients with early rheumatoid arthritis (RA).

METHODS

In an inception cohort of patients with early RA (symptom duration < 12 months), all patients were examined by the same rheumatologist, and grip force was measured using the Grippit instrument at inclusion, 1 and 5 years. The average grip force values of each hand were evaluated and expressed as % of expected values, based on age- and sex-specific reference values. Linear regression analyses were used to assess the cross-sectional relation between the involvement of individual finger joints and grip force. In generalized estimating equations, the impact of time-varying synovitis/tenderness on grip force over time was estimated. Analyses were adjusted for wrist involvement, erythrocyte sedimentation rate, and patient-reported pain.

RESULTS

In 215 patients with early RA, grip force was 39% of expected at diagnosis, and increased to 56% after 5 years. Synovitis of the first metacarpophalangeal (MCP) joint (60% and 69% at baseline in the right and left hand) was associated with reduced grip force at inclusion (adjusted ß - 9.2 percentage unit of expected grip force; 95% CI - 13.6 to - 4.8 for both hands combined) and at all follow-up evaluations. Synovitis of MCP I and MCP IV (12% at baseline) was significantly associated with reduced grip force over time in both hands. Proximal interphalangeal (PIP) joint swelling, and tenderness of MCP or PIP joints, had less impact on grip force.

CONCLUSION

MCP I synovitis is the major contributor to reduced grip force in patients with early RA. This underlines the importance of the involvement of the thumb for impaired hand function in RA. MCP IV synovitis, but not PIP involvement or finger joint tenderness, also has a substantial impact on grip force.

Hand grip strength, vitamin D status, and diets as predictors of bone health in 6-12 years old school children

BACKGROUND

Vitamin D and calcium-rich foods, exposure to sunlight, and physical activities (PA) play a pivotal role in promoting the production of sufficient vitamin D and improving grip strength needed for better bone health among school children.

PURPOSE

This study aimed to determine the effects of hand grip muscle strength (HGS), vitamin D in addition to diets, and PA on bone health status among 6-12 years old schoolchildren.

METHODS

This study was based on a cross-sectional observational design, which was descriptive in nature. A diverse sample of 560 elementary school children aged 6-12 years old were invited to participate in this descriptive cross-sectional study. The Dual-Energy X-Ray Absorptiometry (DXA), QUS technique, and ACTi graph GT1M accelerometer were used respectively as a valid tools to identify BMD, BMC, and other parameters of bone health like c-BUA values and bone stiffness (SI), and physical activity (PA) of all individuals participated in this study. In addition, a hydraulic dynamometer was used to measure hand grip strength among the participants. Moreover, an immunoassay technique was used to measure the serum levels of vitamin 25(OH)D level, and bone metabolism markers; NTX, DPD, Ca, and sBAP in all participants. Bone loss (osteoporosis) was cross-sectionally predicted in 19.64% of the total population, most of whom were girls (14.3% vs. 5.4% for boys; P = 0.01). Compared to boys, the incidence of osteoporosis was higher and significantly correlated in girls with lower HGS, deficient vitamin D, inadequate vitamin D and Ca intake, greater adiposity, poor PA, and lower sun exposure. Also, in girls, lower vitamin 25(OH)D levels, and poor HGS were shown to be significantly associated with lower values of BMD, BMC, SI, and higher values of bone resorption markers; NTX, DPD, and sBAP and lower serum Ca than do in boys. The findings suggested that deficient vitamin D, lower HGS, adiposity, PA, and sun exposure as related risk factors to the pravelence of bone loss among school children, particularly in girls. In addition, these parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts; however, more studies are required.

Effect of 8-week frequency-specific electrical muscle stimulation combined with resistance exercise training on muscle mass, strength, and body composition in men and women: a feasibility and safety study

In recent years, electrical muscle stimulation (EMS) devices have been developed as a complementary training technique that is novel, attractive, and time-saving for physical fitness and rehabilitation. While it is known that EMS training can improve muscle mass and strength, most studies have focused on the elderly or specific patient populations. The aim of this study was to investigate the effects of frequency-specific EMS combined with resistance exercise training for 8 weeks on muscle mass, strength, power, body composition, and parameters related to exercise fatigue. Additionally, we aimed to evaluate the feasibility and safety of EMS as an exercise aid to improve body composition. We recruited 14 male and 14 female subjects who were randomly assigned to two groups with gender parity (seven male and seven female/group): (1) no EMS group (age: 21.6 ± 1.7; height: 168.8 ± 11.8 cm; weight: 64.2 ± 14.4 kg) and (2) daily EMS group (age: 21.8 ± 2.0; height: 167.8 ± 9.9 cm; weight: 68.5 ± 15.5 kg). The two groups of subjects were very similar with no significant difference. Blood biochemical routine analysis was performed every 4 weeks from pre-intervention to post-intervention, and body composition, muscle strength, and explosive power were evaluated 8 weeks before and after the intervention. We also performed an exercise challenge analysis of fatigue biochemical indicators after 8 weeks of intervention. Our results showed that resistance exercise training combined with daily EMS significantly improved muscle mass (p = 0.002) and strength (left, p = 0.007; right, p = 0.002) and significantly reduced body fat (p < 0.001) than the no EMS group. However, there was no significant advantage for biochemical parameters of fatigue and lower body power. In summary, our study demonstrates that 8 weeks of continuous resistance training combined with daily upper body, lower body, and abdominal EMS training can significantly improve muscle mass and upper body muscle strength performance, as well as significantly reduce body fat percentage in healthy subjects.

Physical strength and mental health mediate the association between pain and falls (recurrent and/or injurious) among community-dwelling older adults in Singapore

OBJECTIVE

This study aims to understand if poor physical strength and depression mediate the association between pain and recurrent and/or injurious falls in a community of older adults.

METHODS

Data was obtained from a nationally representative longitudinal cohort study conducted in Singapore, PHASE (Wave I and II), which collected information from community-dwelling older adults above 60 years old. A hurdle negative binomial regression and binomial logistic regression were used to assess the association between pain and recurrent falls, and pain and injurious falls respectively. A subsequent mediation analysis was conducted.

RESULTS

Almost half of the participants (N = 1144, 39.7%) reported having either mild, moderate, or severe pain at baseline, 166 (5.4%) participants experienced injurious falls and 144 (4.7%) participants experienced recurrent falls at Wave II. After adjusting for covariates, the presence of pain significantly influenced recurrent (OR 2.8; 95% CI: 1.8, 4.4) and injurious falls (OR: 1.8; 95% CI: 1.3, 2.5). Mediation analyses demonstrated that poor physical strength and depression had a significant mediation effect between all pain characteristics on recurrent falls. Poor physical strength partially mediates the effects of pain and injurious falls as well. However, the mediating effect of poor physical strength and depression was not observed between other pain characteristics and injurious falls.

CONCLUSIONS

The findings highlighted differences in the underlying mechanisms between pain characteristics affecting recurrent and injurious falls. These insights will be useful for identifying patients most at risk for recurrent or injurious falls, and for tailoring future community-based fall intervention programmes.

Sex-specific associations of single metal and metal mixture with handgrip strength: a cross-sectional study among Chinese adults

Metallic elements are ubiquitous in the natural environment and always collaborate to affect human health. The relationship of handgrip strength, a marker of functional ability or disability, with metal co-exposure remains vague. In this study, we aimed to investigate the effect of metal co-exposure on sex-specific handgrip strength. A total of 3594 participants (2296 men and 1298 women) aged 21 to 79 years recruited from Tongji Hospital were included in the present study. Urinary concentrations of 21 metals were measured by inductively coupled plasma mass spectrometer (ICP-MS). We used linear regression, restricted cubic spline (RCS) model, and weighted quantile sum (WQS) regression to evaluate the association of single metal as well as metal mixture with handgrip strength. After adjusting for important confounding factors, the results of linear regression showed that vanadium (V), zinc (Zn), arsenic (As), rubidium (Rb), cadmium (Cd), thallium (Tl), and uranium (U) were adversely associated with handgrip strength in men. The results of RCS showed a non-linear association between selenium (Se), silver (Ag), and nickel (Ni) with handgrip strength in women. The results of WQS regression revealed that metal co-exposure was inversely related to handgrip strength for men (β = -0.65, 95% CI: -0.98, -0.32). Cd was the critical metal in men (weighted 0.33). In conclusion, co-exposure to a higher level of metals is associated with lower handgrip strength, especially among men, and Cd may contribute most to the conjunct risk.

Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs

Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12-24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78-1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42-1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.

Effect of Electrical Muscle Stimulation and Resistance Exercise Intervention on Physical and Brain Function in Middle-Aged and Older Women

This study investigated the effectiveness of electrical muscle stimulation (EMS) with resistance exercise training (ERT) and resistance exercise training (RT) on physical and brain function in middle-aged and older women. Method: Forty-eight participants were randomly allocated into three groups: (i) ERT (n = 16), (ii) RT (n = 16), and (iii) control group (n = 16). The intervention session was 50 min long and performed three times/week for four weeks. The ERT group performed quadriceps setting, straight leg raises, and ankle pump exercises while constantly receiving EMS on their quadriceps muscle on both legs. The RT group performed the same exercise without EMS. Physical function was measured using skeletal muscle mass index (SMI), handgrip strength, gait speed, five times sit-to-stand test (FTSS) and timed up-and-go test (TUG). Brain function was assessed with electroencephalogram measurement of whole brain activity. Results: After four-week intervention, significant improvements were observed in SMI (p < 0.01), phase angle (p < 0.05), and gait speed (p < 0.05) in the ERT group compared to the control group. ERT also increased muscle strength (p < 0.05) and mobility in lower limbs as observed in FTSS and TUG tests (p < 0.05) at post-intervention compared to the baseline. In the ERT group, significant positive changes were observed in Beta1 band power, Theta band power, and Alpha1 band whole brain connectivity (p < 0.005) compared to the control group. Conclusions: Our findings showed that ERT can improve muscle and brain function in middle-aged and older adults during a four-week intervention program whereas significant improvements were not observed with RT. Therefore might be one of the feasible alternative intervention to RT for the prevention of muscle loss whilst improving brain function for middle-aged and older population.

Exploratory analysis using machine learning of predictive factors for falls in type 2 diabetes

We aimed to investigate the status of falls and to identify important risk factors for falls in persons with type 2 diabetes (T2D) including the non-elderly. Participants were 316 persons with T2D who were assessed for medical history, laboratory data and physical capabilities during hospitalization and given a questionnaire on falls one year after discharge. Two different statistical models, logistic regression and random forest classifier, were used to identify the important predictors of falls. The response rate to the survey was 72%; of the 226 respondents, there were 129 males and 97 females (median age 62 years). The fall rate during the first year after discharge was 19%. Logistic regression revealed that knee extension strength, fasting C-peptide (F-CPR) level and dorsiflexion strength were independent predictors of falls. The random forest classifier placed grip strength, F-CPR, knee extension strength, dorsiflexion strength and proliferative diabetic retinopathy among the 5 most important variables for falls. Lower extremity muscle weakness, elevated F-CPR levels and reduced grip strength were shown to be important risk factors for falls in T2D. Analysis by random forest can identify new risk factors for falls in addition to logistic regression.