Osteosarcopenic obesity and its components-osteoporosis, sarcopenia, and obesity-are associated with blood cell count-derived inflammation indices in older Chinese people

Association of novel inflammatory markers with osteoporosis index in older spine osteoporosis patients: NHANES 1999-2018 cross-sectional study

This study aimed to examine the relationships of osteoporosis with Osteoporosis indices in elderly patients, and investigate the associations of novel inflammatory markers with variations of Osteoporosis indices. Senior citizens were recruited from the National Health and Nutrition Examination Survey (NHANES). Dual-energy X-ray absorptiometry was used to detect bone mineral density tests. Osteoporosis indices and diagnosis of osteoporosis were evaluated using multivariate weighted logistic regression models. Novel inflammatory markers were calculated based on lymphocyte, neutrophil, monocyte, platelet, and albumin counts. The relationships between the Osteoporosis indices and novel inflammatory markers were evaluated with multivariate weighted logistic regression models. Totally 837 elderly patients were enrolled, including 494 men and 343 women, and their weighted average age was 68.28 ± 7.60 years. Our results indicated that the osteoporosis indices were positively correlated with the presence of osteoporosis and that these three indices measured the severity of osteoporosis. After multivariate weighted logistic regression model analysis of the novel inflammatory markers and osteoporosis index, AIRI, SIRI, and SII were significantly correlated with the osteoporosis indices. There may be a close relationship between inflammation and senile osteoporosis. The novel inflammatory markers are convenient and objective for predicting low BMD or osteoporosis risk in older patients. Among these markers, elderly patients with high levels of AISI, SIRI, and SII should focus on the risk of osteoporosis. However, this study has some limitations. It is essential to expand the sample size to a wider population to investigate the relationship between inflammation and osteoporosis.

Relationship between systemic inflammatory response index and bone mineral density in children and adolescents aged 8-19 years: a cross-sectional study based on NHANES 2011-2016

Objective

This study aims to investigate the relationship between the Systemic Inflammatory Response Index (SIRI) and bone mineral density (BMD) in children and adolescents aged 8-19 years.

Methods

A cross-sectional design was used, utilizing NHANES data from 2011-2016, including 3,205 participants aged 8 to 19 years. Weighted multivariable regression analysis was conducted to assess the association between SIRI and BMD at the lumbar spine, pelvis, trunk, and whole body. Additionally, smooth curve fitting was applied to examine the nonlinear relationship between SIRI and BMD, and subgroup analyses were performed to explore potential interaction effects and modifiers.

Results

SIRI was significantly positively correlated with BMD at the pelvis, trunk, and whole body (p < 0.05). After adjusting for covariates, a one-unit increase in ln(SIRI) was associated with increases in BMD of 0.018 g/cm², 0.006 g/cm², and 0.005 g/cm² for the pelvis, trunk, and whole body, respectively. Nonlinear analysis revealed a saturation effect between ln(SIRI) and BMD, with a more pronounced impact at specific threshold values. Subgroup analysis indicated that gender, age, BMI and total calcium levels modulated the relationship between SIRI and BMD.

Conclusion

SIRI is significantly associated with BMD in children and adolescents, with a positive effect on BMD at specific threshold levels. This finding suggests that SIRI may serve as a potential biomarker for assessing the risk of low bone mineral density, offering theoretical support for the prevention and intervention of bone health issues such as osteoporosis.

Osteosarcopenic adiposity and its relation to cancer and chronic diseases: Implications for research to delineate mechanisms and improve clinical outcomes

This is the third review in our series examining the connection between osteosarcopenic adiposity/obesity (OSA/OSO) syndrome and health impairments. The objective here was to examine whether there is a causal and/or bidirectional relationship between OSA and some chronic diseases. The search (in PubMed, Scopus, and WoS), screened for articles from their inception to the end of February 2024. Of n=859 articles retrieved, eleven met the eligibility criteria (having all three body composition compartments measured-bone, muscle, adipose tissue and being conducted in adult humans with chronic disease). The selected articles included four assessing OSA and cancers, one each assessing OSA and HIV, Cushing's disease (CD), chronic kidney disease (CKD), pulmonary function, and two for alcohol abuse-caused liver disease, as well as one 6-year study showing the progression to OSA over time. There was a positive relationship between OSA and each of the chronic diseases, as well as a possible bidirectional relationship between OSA and cancers. The evidence linking OSA with HIV, CD, CKD, liver disease, and pulmonary function, was insufficient to derive firm conclusions about their causal/bidirectional relations. This review emphasizes the need for a multidisciplinary approach in the management and treatment of chronic diseases where body composition assessment should get full attention. To close the knowledge gap, more studies about the role of OSA in chronic diseases are needed.

The Role of Inflammatory and Nutritional Indices in Postmenopausal Osteoporosis: A Retrospective Study

Background: Postmenopausal osteoporosis is characterized by impaired bone metabolism, inflammation, and nutritional deficiencies. This study aimed to evaluate the potential of inflammatory and nutritional markers in identifying decreased bone mineral density (BMD) in postmenopausal women. Methods: This cross-sectional study retrospectively analyzed postmenopausal women from January 2018 and December 2023. A total of 368 women were divided into three groups based on T-scores: 61 women with osteoporosis (T-score ≤ -2.5), 153 women with osteopenia (-1 > T-score > -2.5), and 154 women with normal BMD (T-score > -1). Inflammatory and nutritional biomarkers included the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune inflammation value (PIV), geriatric nutritional risk index (GNRI), triglycerides, total cholesterol, and body weight index (TCBI), prognosis nutritional index (PNI), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, 25-OH Vitamin D level, Na, K, Ca, Mg, and their ratios. Results: The GNRI was significantly lower in the osteoporosis group compared to the control group. The NLR, PLR, SII, SIRI, PIV, TCBI, PNI, and HALP were similar between the groups. The GNRI and TCBI showed a positive correlation with T-scores. The Mg level was lower in the osteoporosis group than in the control group and osteopenia group, and the Na/Mg ratio was higher. Additionally, the Ca/Mg ratio was lower in the osteoporosis group than in the control group. The T-score was positively correlated with Mg and Ca/Mg, while the Na/Mg ratio showed a significant negative correlation. Vitamin D, other minerals, and their ratios did not show significant differences between the groups. Conclusions: Our findings suggest that the GNRI could serve as a useful indicator for assessing bone health and the risk of osteoporosis. Furthermore, maintaining appropriate levels of Mg and balanced Na/Mg and Ca/Mg ratios appears crucial for BMD.

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES-a population-based study

BACKGROUND

The modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.

METHODS

Data from 2007 to 2008, 2009-2010, 2013-2014 and 2017-2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1-L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.

RESULTS

A total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = - 0.0103 (95% CI - 0.0160 to - 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = - 0.0120 (95% CI - 0.0172 to - 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371-0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.

CONCLUSIONS

The results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Association between advanced lung cancer inflammation index and osteoporosis in patients with type 2 diabetes mellitus: evidence from NHANES

Background

Previous studies have shown a significantly increased prevalence of osteoporosis (OP) in patients with type 2 diabetes mellitus (T2DM), which is closely associated with inflammation and nutrition. This study aimed to investigate the relationship between the advanced lung cancer inflammation index (ALI) and OP in patients with T2DM.

Methods

This cross-sectional analysis was conducted based on data from middle-aged and older adults aged 50 years and older with T2DM from the National Health and Nutrition Examination Survey (NHANES).Weighted multivariable logistic regression and linear regression were utilized to investigate the correlation between the ALI and OP with femur bone mineral density (BMD) in individuals with T2DM. Restricted cubic splines (RCS) were employed to assess potential nonlinear relationships, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy.

Results

A total of 1596 patients with T2DM were included in this study, among whom 736 had OP. After adjusting for covariates, the multivariable logistic regression model showed that compared to participants in the fourth quartile of log2-transformed ALI, those in the first quartile had an increased prevalence of OP in T2DM (OR = 1.95, 95% CI=1.28-2.96, p < 0.01). The multivariable linear regression model indicated that a low log2-transformed ALI is associated with a low femur BMD.RCS demonstrated a linear dose-response relationship between the ALI index and OP in T2DM (p = 0.686), with the area under the ROC curve being 0.57 (95% CI: 0.54-0.60, p < 0.001), and the optimal cutoff value was 6.04.

Conclusion

Our findings indicate that low levels of ALI are independently associated with an increased prevalence of OP in middle-aged and older adults with T2DM in the United States. ALI may serve as a potential biomarker for assessing the prevalence of OP in middle-aged and older adults with T2DM.

Association between inflammation-related indicators and vertebral fracture in older adults in the United States: A cross-sectional study based on National Health and Nutrition Examination Survey 2013-2014

OBJECTIVE

This study was to examine the association between inflammation-related indexes SII (systemic immune-inflammation index), NLR (neutrophil-to-lymphocyte ratio), PPN (product of platelet count and neutrophil count), and PLR (platelet-to-lymphocyte ratio), and the occurrence of vertebral fractures in older Americans.

METHODS

Patients ⩾60 years of age from the 2013-2014 NHANES database were selected for this study. Restricted cubic spline models and weighted logistic regression models were used to assess the association between inflammation-related indexes and the occurrence of vertebral fractures in older Americans. The predictive value of the inflammation-related indexes on the occurrence of vertebral fractures was assessed using receiver operating characteristic curves (ROC). To examine the robustness of the main findings, a sensitivity analysis was conducted.

RESULTS

A total of 1281 patients were included in the analysis, of whole 120 suffered vertebral fractures. Fully adjusted logistic regression showed a significant linear relationship between NLR and the occurrence of vertebral fracture in older Americans (p < .05), but no relationship was found between SII, PLR, and the occurrence of vertebral fracture in older Americans. Meanwhile, NLR was slightly better than other indicators in predicting vertebral fracture.

CONCLUSIONS

This study found that NLR, as a novel inflammatory marker, can predict the risk of vertebral fracture in older Americans, which is of clinical significance for the prevention and treatment of vertebral fracture in older adults.

Higher CALLY index levels indicate lower sarcopenia risk among middle-aged and elderly community residents as well as hospitalized patients

The C-reactive protein-albumin-lymphocyte (CALLY) index, which integrates albumin, lymphocytes, and C-reactive protein levels, has emerged as a novel method to assess nutritional and inflammatory statuses in patients. This study examined the correlation between the CALLY index and sarcopenia risk using two cohorts: 1804 community dwellers from the NHANES database in the United States and 139 patients from the Department of Gerontology at Kunshan Hospital, China. In the US community cohort, RCS curve analysis was used to examine the non-linear relationship between inflammatory/nutritional markers and sarcopenia, subgroup analysis was also conducted. Logistic regression was employed to evaluate the association between the CALLY index and the risk of sarcopenia in both cohorts. Results demonstrated a significant non-linear relationship between the CALLY index and the risk of sarcopenia (P < 0.001). Elevated levels of the CALLY index are independently linked to a decreased risk of sarcopenia in both community residents (OR = 0.35, 95% CI 0.20-0.57, Q3 CALLY index and OR = 0.26, 95% CI 0.11-0.56, Q4 CALLY index) and hospitalized patients (OR = 0.35, 95% CI 0.12-0.96). This finding identified low CALLY index as a conveniently measurable parameter, serving as a nutritional and inflammatory risk factor for sarcopenia.

Prevalence of Osteosarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study's population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

Osteosarcopenic adiposity (OSA) phenotype and its connection with cardiometabolic disorders: Is there a cause-and-effect?

The objectives were to examine if there is a causal relationship between osteosarcopenic adiposity (OSA) syndrome (coexistence of osteopenia/osteoporosis, sarcopenia, and excess adiposity) and cardiometabolic disorders or if these disorders initiate the development of OSA and its worsening. The search was conducted in PubMed, Scopus, and Web of Science to include articles up to the end of 2023. Of n=539 articles retrieved, n=15 met the eligibility criteria. Only studies conducted in adults and with all three body composition compartments (bone, muscle/lean, adipose) measured were considered. The results revealed that several cardiometabolic disorders, namely, hypertension, dyslipidemia (elevated total and LDL-cholesterol, lower HDL-cholesterol), insulin resistance, hyperglycemia, lower serum vitamin D, and some inflammatory markers were accompanied by OSA. In most cases, the OSA phenotype was associated with worse outcomes than cases with healthy or less impaired body composition. Our initial questions about the reciprocal cause-and-effect relationships could be surmised with more certainty for the OSA and some cardiovascular risks (hypertension, dyslipidemia) and some metabolic abnormalities (several inflammatory markers). The results of this review underscore the importance of body composition in health and from a clinical perspective, all three body composition compartments should be measured by standardized technologies using regulated diagnostic criteria to identify OSA. Randomized trials and prospective studies in diverse groups of older and younger individuals are necessary to determine if the relationships between OSA and clinical endpoints are causal and reversible through intervention and to uncover the mechanisms.

Diagnostic Value of Nutritional Risk Index and Other Indices for Predicting Sarcopenia in the Middle-Aged and Elderly Population of China Without Cancer: A ROC Curve Analysis

Background

Emerging evidence suggests that systemic inflammatory and nutritional biomarkers, along with derived indices, could serve as predictors for sarcopenia in cancer population. This study aimed to compare these predictors, focusing on the nutritional risk index (NRI) and evaluate its diagnostic value, for sarcopenic patients without cancer.

Methods

This cross-sectional retrospective study included 1674 participants. Sarcopenia is defined by skeletal muscle mass index (SMI). Laboratory data reflected the values of systemic inflammatory and nutritional biomarkers, from which the derived indices were calculated. Multiple logistic regression analysis, ROC curve analysis, and the Youden index were utilized to assess the association between these markers and sarcopenia and determine the cutoff value for predicting sarcopenia.

Results

Among all participants (1110 men and 564 women, mean age 61.97 ± 9.83 years), 398 individuals were diagnosed with sarcopenia, indicating a prevalence of 23.78% in China's middle-aged and elderly population without cancer. Logistic regression analysis revealed significant associations between all biomarkers and derived indices with sarcopenia. Following adjustment for potential confounders, lower NRI values were significantly associated with a higher incidence of sarcopenia. For sarcopenia diagnosis, the area under the curve (AUC) for NRI was 0.769 ([95% CI, 0.742, 0.796], P < 0.001), with a cutoff value of 106.016, sensitivity of 75.6% and specificity of 66.1%. NRI demonstrated greater predictive advantage for sarcopenia incidence in men compared to women.

Conclusion

A lower NRI value was associated with a higher prevalence of sarcopenia. NRI shows promise for early, rapid, and effective sarcopenia screening, particularly in China's middle-aged and elderly male population without cancer.

A comprehensive meta-analysis of risk factors associated with osteosarcopenic obesity: a closer look at gender, lifestyle and comorbidities

This study reviewed the risk factors of Osteosarcopenic obesity (OSO), a condition linking weak bones, muscle loss, and obesity. Notable associations were found with female gender, physical inactivity, hypertension, and frailty. Recognizing these early can aid targeted prevention, emphasizing further research for improved understanding and strategies.

PURPOSE

Osteosarcopenic obesity (OSO) represents a confluence of osteopenia/osteoporosis, sarcopenia, and obesity, contributing to increased morbidity and mortality risks. Despite escalating prevalence, its risk factors remain under-explored, necessitating this comprehensive systematic review and meta-analysis.

METHODS

A diligent search of PubMed, Scopus, and Cochrane databases was conducted for pertinent studies until June 2023. The random-effects model was employed to compute pooled odds ratios (ORs) and 95% confidence intervals (CIs), scrutinizing various risk factors like age, gender, lifestyle factors, and common comorbidities.

RESULTS

Our meta-analysis incorporated 21 studies comprising 178,546 participants. We identified significant associations between OSO and factors such as female gender (OR 1.756, 95% CI 1.081 to 2.858), physical inactivity (OR 1.562, 95% CI 1.127-2.165), and hypertension (OR 1.482, 95% CI 1.207-1.821). Conversely, smoking (OR 0.854, 95% CI 0.672-1.084), alcohol consumption (OR 0.703, 95% CI 0.372-1.328), and dyslipidemia (OR 1.345, 95% CI 0.982-1.841) showed no significant associations. Remarkable heterogeneity was observed across studies, indicating considerable variation in effect sizes. Notably, OSO was strongly associated with frailty (OR 6.091; 95% CI 3.576-10.375).

CONCLUSIONS

Our study underscored the substantial role of female gender, physical inactivity, and hypertension in the development of OSO, whilst suggesting a strong link between OSO and frailty. These findings emphasize the importance of early risk factor identification and targeted interventions in these groups. Further research is warranted to decode the complex pathophysiological interplay and devise effective prevention and management strategies.

Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients

OBJECTIVES

This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients.

METHODS

Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression.

RESULTS

The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 2 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 3 BMD (β = -1.35, 95% CI: -0.23, -0.02), lumbar 4 BMD (β = -0.11, 95% CI: -0.30, -0.10), femur neck BMD (β = -0.11, 95% CI: -0.18, -0.05) and Ward's triangle BMD (β = -0.12, 95% CI: -0.20, -0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders.

CONCLUSIONS

Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.

Relationships between obesity markers and bone parameters in community-dwelling older adults

BACKGROUND

Osteoporosis is an age-related condition that can lead to fragility fractures and other serious consequences. The literature data on the impact of obesity on bone health are contradictory. The main reasons for this discrepancy could be the imperfect nature of the body mass index (BMI) as a marker of obesity, the metabolic status (inflammation and metabolically healthy obesity), and/or heterogeneity in bone variables and architecture or sex.

AIMS

To examine the relationship between bone variables and three validated obesity criteria.

METHODS

In this cross-sectional study, participants were classified as obese according to their BMI, waist circumference (WC), and fat mass (FM). Bone variables and architecture were assessed using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively.

RESULTS

One hundred sixty-eight adults aged 55 or over (men: 68%) were included. 48 (28%) participants were obese according to the BMI, with 108 (64%) according to the FM, and 146 (87%) according to the WC. Bone variables were positively correlated with WC and BMI (Pearson's r = 0.2-0.42). In men only, the obesity measures were negatively correlated with cortical bone density (Pearson's r = - 0.32 to - 0.19) and positively correlated with cortical bone area (Pearson's r = 0.22-0.39).

CONCLUSION

Our findings indicate that independent of sex and obesity criteria, when significant, being obese seems to lead to higher bone parameters than being non-obese, except for cortical bone density. Thus, in the obese population, assessing cortical density might help the physician to identify bone alteration. Further researches are needed to confirm our findings.

The effects of TRX suspension training on sarcopenic biomarkers and functional abilities in elderlies with sarcopenia: a controlled clinical trial

BACKGROUND

Sarcopenia is an age-related progressive loss of muscle mass and strength that can be modulated by resistance training. This study aimed to investigate the effects of TRX Suspension Training (TST) on serum levels of neuromuscular and growth factors and functional indices in elderly men with sarcopenia, an age-related condition characterized by progressive muscle mass and strength loss.

METHODS

Nineteen sarcopenic elderly men (age = 74.87 ± 4.58 years) were randomly assigned into two groups, the TST group (n = 10) and the control group (n = 9). Serum concentrations of regulatory muscle markers, anthropometric and body composition indices, and functional tests were evaluated at baseline and after 8 weeks. The training protocol consisted of eight weeks of TRX exercises, with three weekly sessions.

RESULTS

After 8 weeks of training, growth factors such as Follistatin (FST) (P = 0.001), 22 kDa C-terminal agrin fragment (CAF) (P = 0.031), and growth differentiation factor 15 (GDF15) (P = 0.049) increased significantly in the training group in comparison to the control group and Myostatin (MSTN) (P = 0.002) had a significant decrease. However, there was no significant difference in ASMM/m2 (P = 0.527), SMM/m2 (P = 0.621), or Body fat mass (P = 0.433) within or between groups. In addition, the TRX Suspension Training had a significant effect on the functional tests and improved gait speed (P = 0.037), chair stand (P = 0.016), and TUG (P = 0.016) as well as Handgrip strength (P = 0.035).

CONCLUSION

Our findings highlight the efficacy of TRX Suspension Training in enhancing the serum levels of muscle growth factors and functional capacities among elderly individuals with sarcopenia. Therefore, considering the ongoing COVID-19 pandemic, this protocol can prove beneficial for this demographic group.

TRIAL REGISTRY

Iranian Registry of Clinical Trials identifier: IRCT20230727058944N1, prospectively registered 20-09-2023, https://en.irct.ir/trial/71635.

Aftereffects in Epigenetic Age Related to Cognitive Decline and Inflammatory Markers in Healthcare Personnel with Post-COVID-19: A Cross-Sectional Study

Purpose

Epigenetic age and inflammatory markers have been proposed as indicators of severity and mortality in patients with COVID-19. Furthermore, they have been associated with the occurrence of neurological symptoms, psychiatric manifestations, and cognitive impairment. Therefore, we aimed to explore the possible associations between epigenetic age, neuropsychiatric manifestations and inflammatory markers (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], monocyte-lymphocyte ratio [MLR], and systemic immune-inflammation index [SII]) in healthcare personnel with post-COVID condition.

Patients and Methods

We applied the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) tests to 51 Mexican healthcare workers with post-COVID-19 condition; we also estimated their epigenetic age using the PhenoAge calculator.

Results

The participants had a post-COVID condition that lasted a median of 14 months (range: 1-20). High NLR (>1.73) had association with mild cognitive impairment by MMSE (p=0.013). Likewise, high MLR (>0.24) were associated with language domain in MOCA (p=0.046). Low PLR (<103.9) was also related to delayed recall in MOCA (p=0.040). Regarding comorbidities, hypertension was associated with SII (p=0.007), overweight with PLR (p=0.047) and alcoholism was associated with MLR (p=0.043). Interestingly, we observed associations of low PLR (<103.9) and low SII (<1.35) levels with increased duration of post-COVID condition (p=0.027, p=0.031). Likewise, increases in PhenoAge were associated with high levels of SII (OR=1.11, p=0.049), PLR (OR=1.12, p=0.035) and MLR (OR=1.12, p=0.030).

Conclusion

We observed neurocognitive changes related to inflammatory markers and increases in epigenetic age in healthcare personnel with post-COVID-19 condition. Future research is required to assess mental and physical health in individuals with post-COVID-19 symptoms.

Understanding the Consequences of Fatty Bone and Fatty Muscle: How the Osteosarcopenic Adiposity Phenotype Uncovers the Deterioration of Body Composition

Adiposity is central to aging and several chronic diseases. Adiposity encompasses not just the excess adipose tissue but also body fat redistribution, fat infiltration, hypertrophy of adipocytes, and the shifting of mesenchymal stem cell commitment to adipogenesis. Bone marrow adipose tissue expansion, inflammatory adipokines, and adipocyte-derived extracellular vesicles are central to the development of osteopenic adiposity. Adipose tissue infiltration and local adipogenesis within the muscle are critical in developing sarcopenic adiposity and subsequent poorer functional outcomes. Ultimately, osteosarcopenic adiposity syndrome is the result of all the processes noted above: fat infiltration and adipocyte expansion and redistribution within the bone, muscle, and adipose tissues, resulting in bone loss, muscle mass/strength loss, deteriorated adipose tissue, and subsequent functional decline. Increased fat tissue, typically referred to as obesity and expressed by body mass index (the latter often used inadequately), is now occurring in younger age groups, suggesting people will live longer with the negative effects of adiposity. This review discusses the role of adiposity in the deterioration of bone and muscle, as well as adipose tissue itself. It reveals how considering and including adiposity in the definition and diagnosis of osteopenic adiposity, sarcopenic adiposity, and osteosarcopenic adiposity will help in better understanding the pathophysiology of each and accelerate possible therapies and prevention approaches for both relatively healthy individuals or those with chronic disease.

Association of inflammatory markers with all-cause mortality and cardiovascular mortality in postmenopausal women with osteoporosis or osteopenia

BACKGROUND

The objective of the present study was to investigate whether associations exist between inflammatory biomarkers and all-cause mortality and cardiovascular disease (CVD) mortality in women with postmenopausal osteoporosis (PMOP) or osteopenia.

METHODS

In this retrospective cohort study, data were obtained from the National Health and Nutrition Examination Survey database from the years 2007 to 2010, 2013 to 2014, and 2017 to 2018. The inflammatory biomarkers including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), neutrophil × platelet/lymphocyte (SII), neutrophil × monocyte/lymphocyte (SIRI), and neutrophil × monocyte × platelet/lymphocyte ratio (AISI) were calculated.

RESULTS

A total of 2,834 women were included, with a median survival of 113.51 (3.15) months. During follow-up, 602 women died of all-cause mortality and 185 women died of CVD. NLR, MLR, SIRI, and AISI were significantly associated with all-cause mortality in postmenopausal women with osteoporosis or osteopenia. NLR, MLR, SIRI, and AISI were related to CVD mortality in postmenopausal women with osteoporosis or osteopenia (All P < 0.05). Based on the results of the subgroup analysis, AISI, SIRI, and MLR were associated with all-cause mortality and CVD mortality in postmenopausal women with PMOP or osteopenia who had a history of CVD and diabetes. AISI, SII, MLR, and NLR were associated with all-cause mortality and CVD mortality in PMOP or osteopenia women with a body mass index (BMI) > 25 kg/m2. PLR was associated with all-cause mortality in PMOP or osteopenia women aged ≥ 65 years.

CONCLUSION

Inflammatory biomarkers were correlated with mortality risk in the PMOP or osteopenia population. This finding may be helpful for the prognosis management of PMOP or osteopenia in postmenopausal women.

PCDH7 as the key gene related to the co-occurrence of sarcopenia and osteoporosis

Sarcopenia and osteoporosis, two degenerative diseases in older patients, have become severe health problems in aging societies. Muscles and bones, the most important components of the motor system, are derived from mesodermal and ectodermal mesenchymal stem cells. The adjacent anatomical relationship between them provides the basic conditions for mechanical and chemical signals, which may contribute to the co-occurrence of sarcopenia and osteoporosis. Identifying the potential common crosstalk genes between them may provide new insights for preventing and treating their development. In this study, DEG analysis, WGCNA, and machine learning algorithms were used to identify the key crosstalk genes of sarcopenia and osteoporosis; this was then validated using independent datasets and clinical samples. Finally, four crosstalk genes (ARHGEF10, PCDH7, CST6, and ROBO3) were identified, and mRNA expression and protein levels of PCDH7 in clinical samples from patients with sarcopenia, with osteoporosis, and with both sarcopenia and osteoporosis were found to be significantly higher than those from patients without sarcopenia or osteoporosis. PCDH7 seems to be a key gene related to the development of both sarcopenia and osteoporosis.

Sarcopenic Obesity in People with Alcoholic Use Disorder: Relation with Inflammation, Vascular Risk Factors and Serum Vitamin D Levels

In recent years, the terms sarcopenia, sarcopenic obesity, and osteosarcopenic obesity (OSO) were coined to define a situation in elderly people strongly associated with frailty and increased mortality. Possibly, a complex interplay of several hormones and cytokines are involved in its development. Ongoing research detected that OSO may occur at any age and in several conditions. The prevalence of OSO in alcoholism was poorly analyzed. The aim of this study was to analyze the prevalence of OSO in alcoholism and its relationship with proinflammatory cytokines and/or common complications of alcoholism, such as cirrhosis, cancer, or vascular disease. We included 115 patients with alcoholic use disorder. Body composition analysis was performed by double X-ray absorptiometry. Handgrip strength was recorded using a dynamometer. We assessed liver function according to Child's classification, and determined serum levels of proinflammatory cytokines (TNF-α, IL-6, IL-8), routine laboratory variables, and vitamin D. People with alcoholic use disorder showed a high prevalence of OSO, especially regarding OSO obesity (60%), OSO osteopenia (55.65%), and OSO lean mass (60.17%). OSO handgrip was closely, independently, related to the presence of vascular calcification (χ² = 17.00; p < 0.001). OSO handgrip was related to several proinflammatory cytokines and vitamin D. Vitamin D deficiency kept a close correlation with OSO handgrip (rho = -0.54, p < 0.001). Therefore, among people with alcohol use disorder, OSO prevalence was high. OSO handgrip is related to serum proinflammatory cytokine levels supporting the possible pathogenetic role of these cytokines on OSO development. Vitamin D deficiency is related to OSO handgrip suggesting its pathogenetic involvement in sarcopenia in patients with alcohol use disorder. The close association between OSO handgrip and vascular calcification is clinically relevant and suggests that OSO handgrip may constitute a prognostic tool in these patients.

Association between fibrinogen and bone mineral density in postmenopausal women

OBJECTIVE

There is very limited of evidence linking fibrinogen and bone mineral density (BMD) in postmenopausal women. Therefore, this study intended to examine the relationship between fibrinogen and total BMD in postmenopausal women.

METHODS

This cross-sectional analysis included 2043 postmenopausal women aged 50 years and older from the 1999 to 2002 National Health and Nutrition Examination Survey. The independent variable was fibrinogen and the outcome variable was total BMD. The association between fibrinogen and total BMD in postmenopausal women was examined using multivariate linear regression models, with subgroup analyses stratified by race. Smoothing curve fitting and generalized additive models further analyzed the sample data.

RESULTS

In multiple regression models adjusted for potential confounders, fibrinogen was negatively associated with total BMD (model 1: - 0.0002 [- 0.0002, - 0.0001], model 2: - 0.0000 [- 0.0001, - 0.0000], model 3: - 0.0001 [- 0.0001, - 0.0001]). In subgroup analysis stratified by race, fibrinogen levels were negatively associated with total BMD in postmenopausal women, Non-Hispanic Whites, and Mexican Americans. However, in Non-Hispanic Blacks, the correlation between fibrinogen levels and total BMD was not significant. For individuals that identify as Other Races, fibrinogen levels were positively correlated with total BMD.

CONCLUSION

Our findings show a negative association between fibrinogen levels and total BMD in most postmenopausal women aged 50 years and older, however, is variable by race. In postmenopausal women, Non-Hispanic Whites and Mexican Americans, relatively high fibrinogen levels may be adverse to bone health.

Global prevalence of osteosarcopenic obesity amongst middle aged and older adults: a systematic review and meta-analysis

PURPOSE

Osteosarcopenic obesity syndrome (OSO) is a recently recognized disorder encompassing osteopenia/osteoporosis, sarcopenia, and obesity. However, evidence in pooling knowledge regarding the prevalence of OSO worldwide is scarce. Hence, this review aimed to determine the pooled prevalence of OSO in middle-aged and older adults.

METHODS

We conducted systematic searches in Scopus, Embase, PubMed Central, MEDLINE, ScienceDirect, and Google Scholar from inception until October 2022. We evaluated the quality of the included studies using the Newcastle-Ottawa scale. The meta-analysis results using a random-effects model included the pooled prevalence and 95% confidence intervals (CIs).

RESULTS

We included 20 studies with a total of 23,909 participants. Most of the studies were of good quality. The final pooled prevalence of OSO in middle-aged and older adults worldwide was 8% (95% CI: 6%-11%; n = 20). Females (pooled prevalence = 9%; 95% CI:7%-12%; n = 17) had a higher burden of OSO than males (pooled prevalence = 5%; 95% CI:3%-8%; n = 11). We also found that the burden was higher among studies reporting OSO prevalence only in the elderly population (pooled prevalence = 13%; 95% CI: 9%-17%). The asymmetric nature of the funnel plot indicates the presence of publication bias. Additional sensitivity analysis did not reveal any significant variation in the pooled effect size estimation.

CONCLUSION

Approximately one in ten middle-aged and older adults suffer from OSO. The burden was highest among females and older adults. Diagnostic and intervention packages targeting such patients should be developed and implemented in high-risk settings.

Association between inflammatory markers and bone mineral density: a cross-sectional study from NHANES 2007-2010

PURPOSE

Monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) are acknowledged as novel inflammatory markers. However, studies investigating the correlation between inflammatory markers and osteoporosis (OP) remain scarce. We aimed to investigate the relationship between NLR, MLR, PLR and bone mineral density (BMD).

METHODS

A total of 9054 participants from the National Health and Nutrition Examination Survey were included in the study. MLR, NLR and PLR were calculated for each patient based on routine blood tests. Given the complex study design and sample weights, the relationship between inflammatory markers and BMD was evaluated through weighted multivariable-adjusted logistic regression and smooth curve fittings. In addition, several subgroup analyses were conducted to assess the robustness of the outcomes.

RESULTS

This study observed no significant relationship between MLR and lumbar spine BMD (P = 0.604). However, NLR was positively correlated with lumbar spine BMD (β = 0.004, 95% CI: 0.001 to 0.006, P = 0.001) and PLR was negatively linked to lumbar spine BMD (β = - 0.001, 95% CI: - 0.001 to - 0.000, P = 0.002) after accounting for covariates. When bone density measurements were changed to the total femur and femoral neck, PLR was still significantly positively correlated with total femur (β = - 0.001, 95% CI: - 0.001, - 0.000, P = 0.001) and femoral neck BMD (β = - 0.001, 95% CI: - 0.002, - 0.001, P < 0.001). After converting PLR to a categorical variable (quartiles), participants in the highest PLR quartile had a 0.011/cm² lower BMD than those in the lowest PLR quartile (β = - 0.011, 95% CI: - 0.019, - 0.004, P = 0.005). According to subgroup analyses stratified by gender and age, the negative correlation with PLR and lumbar spine BMD remained in males and age < 18 groups, but not in female and other age groups.

CONCLUSIONS

NLR and PLR were positively and negatively correlated with lumbar BMD, respectively. And PLR might serve as a potential inflammatory predictor of osteoporosis outperforming MLR and NLR. The complex correlation between the inflammation markers and bone metabolism requires further evaluation in large prospective studies.

Serum Myostatin among Excessive Drinkers

Myostatin acts as a negative regulator of muscle growth. Its effect on fat mass is subject to debate. Among alcoholics, there is a high prevalence of muscle atrophy, and increased fat deposition has been also described in these patients. Myostatin could be involved in these alterations, but its relationships with body composition have been scarcely studied in alcoholic patients. To analyze the behavior of myostatin among alcoholics and its relationship with alcohol intake, liver function, and body composition. We investigated serum myostatin in 59 male patients and 18 controls. Patients were all heavy drinkers admitted with organic complications related to excessive ethanol ingestion. Densitometry analysis was used to assess body composition in 46 patients. Handgrip was assessed in 51 patients. Patients showed lower myostatin values than controls (Z = 3.80; p < 0.001). There was a significant relationship between myostatin and fat at the right leg (ρ = 0.32; p = 0.028), left leg (ρ = 0.32; p = 0.028), trunk (ρ = 0.31, p = 0.038), total fat proport ion (ρ = 0.33, p = 0.026), and gynecoid fat distribution (ρ = 0.40, p = 0.006) but not with lean mass (total lean ρ = 0.07; p = 0.63; trunk lean ρ = 0.03; p = 0.85; lower limbs ρ = 0.08; p = 0.58; upper limbs ρ = 0.04 p = 0.82; android ρ = 0.02; p = 0.88, or gynoid lean mass ρ = 0.20; p = 0.19). In total, 80.43% of patients showed at least one criterion of osteosarcopenic adiposity (OSA). Myostatin was related to OSA obesity. We also observed higher myostatin values among patients with body mass index > 30 kg/m². Serum myostatin was lower among excessive drinkers, and it was related to increased fat deposition among these patients but not to lean mass, handgrip, or bone mineral density.

Levels of systemic inflammation response index are correlated with tumor-associated bacteria in colorectal cancer

The relationship between systemic inflammation and tumor-associated bacteria is largely unknown in colorectal cancer (CRC). The primary aim of this study was to investigate the prognostic effects of the systemic inflammation response index (SIRI) on the survival outcomes of CRC patients who experienced surgical therapy, and the second aim was to reveal the potential association between SIRI levels and tumor-associated bacteria in CRC. We recruited a cohort of 298 CRC patients who experienced surgical resection in Wuhan Union Hospital. These patients were assigned to the low and high groups based on the cut-off value of SIRI. We utilized 1:1 propensity score matching (PSM) to reduce the potential confounding factors between the low SIRI group (N = 83) and the high SIRI group (N = 83). The total DNA of 166 paraffin-embedded tumor tissues and 24 frozen tumor tissues was extracted and amplified, and 16 S rRNA sequencing was employed to uncover the composition of microbiota between low and high SIRI groups. Survival analysis uncovered that the high SIRI cohort exhibited significantly shorter overall and disease-free survival time than low SIRI companions after PSM. The ROC analyses showed that the prediction abilities of SIRI were much higher than other serum inflammatory biomarkers for survival outcomes. The microbial richness and diversity in the low SIRI group were remarkably higher than those in the high SIRI group. At the phylum level, we found that Proteobacteria, Synergistetes, WPS-2, Thermil, Fusobacteria were enriched in the high SIRI group. Cupriavidus, Thermus, Ochrobactrum, Cupriavidus, Acidovorax were enriched in the high SIRI group at the genus level. 16 S rRNA based on frozen samples also obtained similar results. SIRI is a promising and novel prognostic biomarker among CRC sufferers who underwent surgical removal. There existed significant differences in the diversity and compositions of tumor-associated bacteria between the low and high SIRI groups.

Relationship between diet-related inflammation and bone health under different levels of body mass index

BACKGROUND

Osteoporosis is a major public health problem. Dietary inflammatory preference and body mass index (BMI) are emerging factors that tends to affect bone health. There is limited evidence regarding the joint influence of BMI and dietary status on the bone health. This study aimed to investigate the relationship between dietary inflammatory index (DII) and bone health among adults under different levels of BMI utilizing the National Health and Nutrition Examination Survey (NHANES).

METHODS

Data were collected from 2005-2010, 2013-2014 to 2017-2018 in NHANES. In total, 10,521 participants who aged ≥ 20 years and had complete data for dietary intake interview, bone mineral density (BMD) and bone mineral content (BMC) were included. DII was performed to evaluate the dietary inflammatory potential based on dietary intake interview. We evaluated bone health by femoral neck BMD and BMC measured by dual energy X-ray absorptiometry. Weighted multivariable linear regression and BMI-stratified subgroup analysis were performed.

RESULTS

The average DII score for 10,521 participants was 1.24 ± 0.04, mean femoral neck BMD was 0.82 ± 0.00 g/cm² and mean BMC was 4.37 ± 0.01 g. In the fully adjusted model, there was a negative correlation between DII with BMD (β = - 0.016, P < 0.001) and BMC (β = - 0.011, P < 0.001) in the most anti-inflammatory diet. Using BMI-stratified subgroup analysis, this correlation became more evident in both the overweight (BMD: β = - 0.024, P < 0.001; BMC: β = - 0.058, P = 0.042) and obese groups (BMD: β = - 0.015, P = 0.049; BMC: β = - 0.009, P = 0.042), while this correlation was opposite in DII tertile 2 (middle DII score) in the underweight group (BMD: β = 0.047, P = 0.038; BMC: β = 0.274, P = 0.010).

CONCLUSION

Relationship between higher consumption of pro-inflammatory and increased risk of lower BMD and BMC was only existed in overweight and obese participants.