Healthcare cost expenditures associated to frailty and sarcopenia

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

AIMS

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

DATA SYNTHESIS

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

CONCLUSION

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

Gait parameters and daily physical activity for distinguishing pre-frail, frail, and non-frail older adults: A scoping review

OBJECTIVE

This scoping review aimed to gather current knowledge on accurately identifying and distinguishing between non-frail, pre-frail, and frail older adults using gait and daily physical activity (DPA) parameters and/or models that combine gait with DPA parameters in both controlled and daily life environments.

METHODS

Following PRISMA-ScR guidelines, a systematic search was conducted across seven databases using key terms: "frail", "gait or walk", "IMU", and "age". Studies were included if they focused on gait analysis using Inertial Measurement Units (IMUs) for walking distances greater than 10 meters. Extracted data included study design, gait and DPA outcomes, walking conditions, and classification model performance. Gait parameters were grouped into four domains: spatio-temporal, frequency, amplitude, and dynamic gait. DPA parameters were synthesized into three categories: postural and transition, variability, and physical activity pattern.

RESULTS

A total of 15 cross-sectional studies involving 2,366 participants met the inclusion criteria. Gait analysis showed (pre)frail individuals had slower, shorter steps with longer stride times compared to non-frail individuals. Pre-frail individuals showed distinct gait patterns in periodicity, magnitude range, and variability. In daily activities, (pre)frail individuals displayed shorter, fragmented walking periods and longer transitions between positions. Walking variation identified pre-frail status, showing progressive decreases from non-frail to frail states. Combined gait and daily physical activity models achieved over 97% accuracy, sensitivity and specificity in distinguishing between groups.

DISCUSSION

This review provides an updated synthesis of the relationship between various gait and/or DPA parameters and physical frailty, highlighting gaps in pre-frailty detection and the variability in measurement protocols. It underscores the potential of long-term, sensor-based monitoring of daily physical activity for advancing pre-frailty screening and guiding future clinical trials. Structured Abstract BACKGROUND: Changes in gait and physical activity are critical indicators of frailty. With advancements in wearable sensor technology, long-term gait analysis using acceleration data has become more feasible. However, the contribution of parameters beyond gait speed, such as gait dynamics and daily physical activity (DPA), in identifying frail and pre-frail individuals remains unclear.

OBJECTIVE

This scoping review aimed to gather knowledge on accurately identifying and differentiating physical pre-frail and frail individuals from non-frail individuals using gait parameters alone or models that combine gait and DPA parameters, both in controlled settings and daily life environments.

METHODS

The review followed PRISMA-ScR guidelines. A search strategy incorporating key terms-"frail", "gait or walk", "IMU", and "age"-was applied across seven databases from inception to March 1, 2024. Studies were included if they focused on gait analysis in controlled or daily environments using Inertial Measurement Units (IMUs) and involved walking distances longer than 10 meters. Data on walking conditions, gait outcomes, classification methods, and results were extracted. Gait parameters were categorized into four domains: spatio-temporal, frequency, amplitude, and dynamic gait. DPA parameters were synthesized into three categories: postural and transition, variability, physical activity pattern.

RESULTS

A total of 15 cross-sectional observational studies met the eligibility criteria, covering 2,366 participants, with females representing 27%-80% of the sample and ages ranging from 60 to 92 years. Regarding gait parameters, (pre)frail individuals exhibited longer stride times, slower walking speeds, shorter steps, and reduced cadence compared to non-frail individuals. In three studies, pre-frail could be distinguished from the non-frail and frail group through gait periodicity, range of magnitude, and gait variability. DPA patterns differed between groups, with (pre)frail individuals showing shorter and more fragmented walking periods, brief walking bouts and longer postural transitions. Walking bout variation (CoV) effectively identified pre-frail status, decreasing 53.73% from non-frail to pre-frail, and another 30.87% from pre-frail to frail. Models combining both gait and DPA parameters achieved the highest accuracy (97.25%), sensitivity (98.25%), and specificity (98.25%) in distinguishing between groups.

DISCUSSION

This scoping review provides an updated overview of the current knowledge and gaps in understanding the relationship between gait parameters across different domains and DPA parameters along with physical frailty. Significant variability in gait measurement methods and protocols complicates direct comparisons between studies. The review emphasizes the need for further research, particularly in pre-frailty screening, and underscores the potential of inertial sensor-based long-term monitoring of daily physical activity for future clinical trials.

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

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

Protein supplementation alone or combined with exercise for sarcopenia and physical frailty: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sarcopenia and physical frailty are age-related syndromes characterized by progressive loss of muscle mass and function, significantly impacting mortality and quality of life in older adults. This systematic review evaluated the effectiveness of protein supplementation interventions for these conditions.

METHODS

We systematically searched Medline, CENTRAL, and Ichushi Web from January 2000 to March 2023, with additional manual searching extended to March 2024. Randomized controlled trials investigating protein supplementation, alone or combined with exercise, in adults aged ≥65 years with sarcopenia or physical frailty were included. The primary outcomes were changes in muscle mass, strength, and physical performance.

RESULTS

The systematic literature search identified 1,506 records through database searching (Medline: 357, CENTRAL: 275, Ichushi Web: 639) and 235 additional records through hand searching. Finally, 13 randomized controlled trials (n=1,057) met the inclusion criteria. Combined protein and exercise interventions demonstrated significant improvements in skeletal muscle index (MD = 0.89 kg/m², 95 % CI: 0.45 to 1.33) and handgrip strength (MD: +2.64 kg, 95 % CI: +0.75 to +4.53) compared to exercise alone. Protein supplementation alone showed modest benefits in muscle strength but limited effects on physical performance. No serious adverse events were reported.

CONCLUSIONS

While protein supplementation combined with exercise shows promising effects on muscle mass and strength in older adults with sarcopenia or physical frailty, the evidence quality was consistently rated as very low. Further high-quality trials are needed to establish optimal supplementation strategies.

REGISTRATION

PROSPERO: CRD42023408529.

Empowering Physical Functions in Older Women With Sarcopenia Through Aomori Gymnastics: A Prospective, Observational, Nested Case-Control Study in Aomori Prefecture

BACKGROUND

Japan faces rapid population aging, resulting in significant health challenges such as sarcopenia and frailty, which affect the independence and quality of life of older adults. This study evaluated the effectiveness of Aomori gymnastics, a culturally tailored exercise program, in improving physical function in older women with sarcopenia, over a three-month period.

METHODS

This prospective observational study included 24 older women divided into three groups based on their living conditions: community-dwelling participants attending preventive care programs (Groups 1 and 2) and residents of a long-term care facility (Group 3). The participants performed Aomori gymnastics daily for three months. Physical function was assessed at baseline, 1 month, and three months using the Short Physical Performance Battery (SPPB), grip strength, curl-ups, forward bend from a long sitting position, one-leg stance, and 10-m walk tests. Data were analyzed using generalized linear mixed models and the Mann-Whitney U test.

RESULTS

Significant improvements in SPPB scores were observed between the sarcopenia and non-sarcopenia groups at baseline and one month (p < .05), these differences were not observed at three months. Participants with sarcopenia showed marked improvement in physical function, approaching the level of those without sarcopenia after three months of daily exercise. Adherence was higher among long-term care facility residents than among community-dwelling participants, which is likely due to the severe winter weather in the Aomori Prefecture.

CONCLUSION

Aomori gymnastics is an effective and low-cost intervention that can significantly improve physical function in older women with sarcopenia. Implementing this program in communities and care facilities can enhance the quality of life and independence of older adults, particularly in regions with harsh weather conditions.

Are There Differences in Postural Control and Muscular Activity in Individuals with COPD and with and Without Sarcopenia?

AIM

The aim of this study was to compare balance performance and electromyographic activity in individuals with COPD, with and without sarcopenia.

METHOD

Thirty-five patients with COPD were classified with and without sarcopenia according to EWGSOP criteria. Balance was assessed using a force platform under four conditions: standing with feet apart and eyes opened (FHEO), eyes closed (FHEC), on an unstable surface (US), and on one leg (OLS). The surface electromyography activity of lower limb muscles and trunks was recorded. Additionally, the timed up and go test (TUG) and the Brief Balance Evaluation Systems Test (Brief-BESTest) were also utilized.

RESULTS

Under the FHEO, FHEC, and US conditions, individuals with sarcopenia demonstrated increased velocities, larger oscillation amplitudes, and greater center of pressure displacements under the US condition (p ≤ 0.02). They also showed a higher activation of the scalene, sternocleidomastoid, and abdominal muscles during OLS, along with a reduced activation of the tibialis anterior during OLS and US, and a decreased activation of the vastus medialis during FHEC and US (p ≤ 0.04). Furthermore, sarcopenic COPD patients exhibited poorer performance on the TUG and Brief-BESTest compared to their non-sarcopenic counterparts (p ≤ 0.02).

CONCLUSIONS

Individuals with COPD and sarcopenia demonstrated greater instability in both bipedal stances and on unstable surfaces, as well as poorer performance in both dynamic and static balance assessments. Furthermore, these individuals exhibited reduced muscular activation in the lower limbs compared to those without sarcopenia.

Cost of illness analysis of frailty for older adults: a systematic review and meta-analysis

PURPOSE

The increasing burden of out-of-pocket expenses borne by older adults with frailty can be a considerable challenge in efforts toward improving societal health. This study estimated the cost of frailty for older adults by employing cost of illness theory.

METHODS

Five electronic databases were searched (without any language or year restriction) for relevant articles from their inception to April 2024. Studies investigating the cost of frailty and prefrailty for older adults (aged ≥ 60 years) were included.

RESULTS

A total of 51 studies were included. The findings revealed that frailty significantly increased mean total costs by US$3286 and US$4653 compared with the costs for individuals with prefrailty and robustness, respectively. The cost difference between the prefrailty and robust groups was US$2729. The increases in indirect costs did not significantly differ between the prefrailty and robust groups or between the frailty and robust groups. The total cost by setting was significantly increased in the frailty group relative to the prefrailty and robust groups. The results stratified by continent or region revealed that only the frailty and prefrailty groups in North America experienced significant increases in total costs relative to the robust group. However, in the Asia-Pacific region and Europe, no significant results were noted.

CONCLUSIONS

This is the first meta-analysis to employ cost of illness theory to investigate the cost of frailty. Our findings can help providers of health-care services and professional workers develop effective and comprehensive intervention plans and services that can be provided for older adults with frailty.

Frailty across the adult age spectrum and its effects on outcomes: Experience from a level 1 trauma centre

BACKGROUND

Recent evidence suggests that frailty may be a more reliable measure than age to predict outcomes following trauma. Frailty leads to prolonged hospitalisation and increased burden on the hospital system in older patients. The aim of this study is to review the prevalence of frailty in our trauma patients and the association of frailty with hospital-based and twelve-month outcomes.

METHODS

Patient demographics, discharge destination, hospital length of stay (LOS), and functional status at 12 months were reviewed. Frailty was assessed using the Clinical Frailty Scale (score <4 non frail, 4 vulnerable, >4 frail). Factors associated with frailty and outcomes including discharge destination (home or inpatient care) and LOS (p value <0.2) were included in multivariate models.

RESULTS

There were 1230 patients admitted to the trauma ward between November 2020-August 2021 who had linked registry data. Of these, 217 (17.6 %) were deemed frail with 131 (10.7 %) being vulnerable. In the group over 65 years, 38.6 % were frail and 16.1 % were vulnerable. Accounting for confounding factors (including age), being frail was associated with discharge to further inpatient care (AOR 4.82 (3.02 - 7.68), p value <0.001). At 12 months post injury, the mortality rate of patients with frailty was 28 %, compared to 2 % for the rest of the population and patients reported significantly more problems with undertaking daily tasks such as mobility and self-care.

CONCLUSION

After adjusting for confounding factors, frailty is associated with nearly five times the increase in odds of a discharge to further inpatient care. Long term outcomes are also significantly poorer for patients with frailty. Identifying frailty on admission may help outcomes by targeting this patient group and optimising healthcare resource usage.

Associations Between Adherence to the Mediterranean Diet and Incident Sarcopenia in Prospective Cohort Studies

The loss of skeletal muscle mass and strength, known as sarcopenia, is prevalent in older adults and linked to an increased risk of disability, frailty, and early mortality. Muscle health is crucial for the functionality and independence of older adults. As the aging population continuously grows, finding cost-effective strategies for preventing and treating sarcopenia is an important public health priority. While nutrition is recognized as a key factor in the development of sarcopenia, its role in preventing and treating the condition is still under investigation. In recent decades, nutritional research has shifted from a focus on individual nutrients or healthy foods to examining the combination of nutrients and foods in dietary patterns, along with their potential synergistic and antagonistic effects. A balanced diet and regular participation in physical activity are essential for maintaining musculoskeletal health. One of the healthy eating patterns with the greatest evidence of multiple health benefits is the Mediterranean diet, which has also been linked to positive effects on muscle function in observational studies. However, there is a lack of intervention studies. This review explores the updated evidence from longitudinal prospective studies on associations between adherence to the Mediterranean diet and sarcopenia in order to promote preventive and intervention strategies for healthy muscle aging.

Application Value of STOP-Bang Questionnaire in Predicting Abnormal Metabolites

Objective

To evaluate the application value of STOP-Bang questionnaire (SBQ) in predicting abnormal metabolites.

Methods

Totally 121 patients were included into the study and filled the questionnaires, and their clinical data were collected at the same time. These patients were grouped according to the questionnaire scores. The clinical data of patients in various groups were compared using R4.3.1 statistical software.

Results

Based on the SBQ score, the patients were divided into the following groups: low-risk group (0-2 scores), mid-risk group (3-4 scores), and high-risk group (5-8 scores). SBQ score was related to several abnormal metabolites. A higher SBQ score indicated elevated uric acid (UA), waist circumference (WC), fasting blood glucose (FBG), hemoglobin A1c (HbA1c) and triacylglycerol (TG), but notably lower high density lipoprotein-cholesterol (HDL-C). In respect of liver function, alanine aminotransferase (ALT) and aspartate transaminase (AST) were both in low/mid-risk group than in high-risk group. With respect to renal function, there was a statistically significant difference in serum creatinine (SCr) (lowest in the low-risk group and highest in the high-risk group) but no such difference in estimated glomerular filtration rate (eGFR) among the three groups. The diagnosability analysis showed that the AUROC proved the good performance of SBQ in predicting metabolic syndrome (MetS) and hyperuricemia (HUA).

Conclusion

OSA frequently co-occurs with various metabolic disorders. SBQ, a widely used tool for assessing the risk of OSA, may also be a potential tool for predicting the presence of metabolic diseases. A higher SBQ score indicates a heightened susceptibility to more abnormal metabolites, but SBQ is poor in predicting liver and renal functions. The patients with SBQ score ≥3 are suggested to pay a visit to the Endocrine Department and Sleep Disorders Center for a comprehensive evaluation of comorbid Obstructive sleep apnea (OSA) and the management of systematic metabolism.

Development and validation of a nomogram to predict frailty risk in Chinese older adults combined with physical fitness test indicators

This study aimed to develop and validate a nomogram combined with the indicators of the physical fitness test to predict frailty risk in Chinese older adults. We recruited 344 participants from a community in Hebei Province, China. Data were collected on 57 candidate factor variables from sociodemographic factors, lifestyle factors, clinical factors, body composition test, and physical fitness test. Ultimately 6 factor variables were included in this predictive model: age, nutritional risk, hypertension, multimorbidity, depression and 2-Minute step test. The area under the curve (AUC) value in the training set and validation set is 0.866 and 0.854, which indicates that the model has a good ability to discriminate. The results of the H-L test indicate that the model is well calibrated. The calibration curves also indicate a good model fit. The model provides older adults with risk indicators to identify and prevent the onset of frailty as early as possible.

Effectiveness of low-load resistance training with blood flow restriction vs. conventional high-intensity resistance training in older people diagnosed with sarcopenia: a randomized controlled trial

Low-load resistance training with blood flow restriction (LRT-BFR) has shown potential to improve muscle strength and mass in different populations; however, there remains limited evidence in sarcopenic people diagnosed with sarcopenia criteria. This study systematically compared the effectiveness of LRT-BFR and conventional high-intensity resistance training (CRT) on clinical muscle outcomes (muscle mass, strength and performance), cardiovascular disease (CVD) risk factors and sarcopenia-related biomarkers of older people with sarcopenia. Twenty-one older individuals (aged 65 years and older) diagnosed with sarcopenia were randomly assigned to the LRT-BFR (20%-30% one-repetition maximum (1RM), n = 10) or CRT (60%-70% 1RM, n = 11) group. Both groups underwent a supervised exercise program three times a week for 12 weeks. The primary outcome was knee extensor strength (KES), and the secondary outcomes included body composition (body mass, body mass index and body fat percentage), muscle mass [appendicular skeletal muscle mass index (ASMI)], handgrip strength, physical performance [short physical performance battery (SPPB) and 6-m walk], CVD risk factors [hemodynamic parameters (systolic and diastolic blood pressure and heart rate (SBP, DBP and HR)) and lipid parameters (total cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein)], sarcopenia-related blood biomarkers [inflammatory biomarkers, hormones (growth hormone (GH) and insulin-like growth factor 1) and growth factors (myostatin and follistatin)] and quality of life [Short Form 36 Health Survey (SF-36)]. Both interventions remarkably improved the body composition, KES, 6-m walk, SBP, HDL, TG, GH, FST and SF-36 scores. CRT significantly improved the ASMI (p < 0.05) and SPPB (p < 0.05). A significant improvement in HR was observed only after LRT-BFR. No significant between-group differences were found before and after the interventions. This study suggested that LRT-BFR and CRT are beneficial to the clinical muscle outcomes, CVD risk factors and certain sarcopenia-related biomarkers of older people with sarcopenia. By comparison, CRT seems more effective in improving muscle mass, while LRT-BFR may be more beneficial for improving cardiovascular health in this population. Therefore, LRT-BFR is a potential alternative to CRT for aging sarcopenia.

Exploring frailty prevalence among adults in Indian healthcare settings: A systematic review and meta-analysis

Frailty is an age-associated state of increased vulnerability due to declines in physiologic systems, leading to compromised ability to withstand stressors. Given India's rapidly aging population, our study aims to estimate the pooled prevalence of frailty and its associated factors in hospital settings. An extensive search was conducted across four databases, up to January 2024. A random-effects model was utilized. To quantify heterogeneity, the I² statistic, prediction interval, and the Chi-square-based Q test were employed. Outliers were identified using a Baujat plot and influence analysis. Doi plot, luis furuya kanamori (LFK) index and funnel plot were used to assess publication bias. The current meta-analysis determined a pooled frailty prevalence of 42.3% (95%CI: 34.8%-50.1%) and prefrailty prevalence of 39.8% (95%CI: 30.4%-49.8%), both exhibiting high heterogeneity (I² values of 96.9% and 95.3%, respectively). A high degree of variability was indicated by a prediction interval ranging from 9% to 76%, while Egger's test suggested no evidence of publication bias. Our systematic review and meta-analysis, encompassing 6,856 individuals, revealed a considerable prevalence of frailty at 42.3%, underscoring its ubiquity across health spectra and demographics in India.

Long-chain n-3 polyunsaturated fatty acid supplementation and neuromuscular function in older adults

PURPOSE OF REVIEW

This review aims to explore the latest research investigating the effects of marine-derived long-chain n -3 polyunsaturated fatty acid (LC n -3 PUFA) supplementation on neuromuscular function in older adults.

RECENT FINDINGS

Ageing results in a decline in skeletal muscle strength and mass. There is growing evidence that LC n -3 PUFA supplementation increases muscle strength and mass in healthy older adults, yet the mechanisms underlying these effects remain elusive. Recent studies investigating LC n -3 PUFA supplementation have demonstrated effects on neuromuscular function such as increases in the compound muscle action potential (M-wave) amplitude and surface electromyography alongside increases in muscular strength. Therefore, evidence suggests that LC n -3 PUFA may elicit a beneficial effect at the neuromuscular junction and possess neuroprotective properties in older adults.

SUMMARY

LC n -3 PUFA supplementation may increase or maintain neuromuscular function throughout the ageing process. Further research is warranted to investigate the long-term effects LC n -3 PUFA supplementation on neuromuscular outcomes such as single motor unit properties and cortical/supraspinal networks, utilizing state-of-the-art techniques in neuromuscular physiology.

Intestinal barrier damage contributes to a higher prevalence of frailty in aging people living with HIV: a retrospective case control study in a Chinese cohort

Background

It has been previously demonstrated that intestinal barrier damage is one of the underlying mechanisms leading to frailty in non-HIV-infected aging populations. However, there is a paucity of direct evidence which demonstrates the association between intestinal barrier damage and frailty in people living with HIV (PLWH).

Methods

The present study is a retrospective case control study. Participants older than 50 years old were stratified into a frail/pre-frail group (case group) and non-frail group (control group) according to the Fried frailty phenotype. We collected and curated data concerning socio-demographic variables, psychological states and social functioning, and clinical information associated with the identification of biomarkers of intestinal barrier damage, microbial translocation, and levels of inflammatory cytokines of participants.

Results

The case group had significantly higher levels of Reg-3α (p=0.042) and I-FABP (p=0.045) compared to the control group. We further observed, after adjusting for confounding factors by logistic regression analysis, that I-FABP levels remained significantly higher in the case group compared to the control group (p=0.033). Also, Fried Phenotype scores positively correlated with I-FABP levels (rs=0.21, p=0.01), LPS levels (rs=0.20, p=0.02), and sCD14 levels (rs=0.18, p=0.04). Moreover, the study confirmed both the positive correlation between inflammatory cytokines (IL-6 and IP-10) with frailty in aging PLWH, and between inflammatory cytokines (IL-6, IL-8 and IP-10) with biomarkers of intestinal barrier dysfunction in older PLWH.

Conclusion

The present study indicates that the inflammation induced by intestinal barrier damage/dysfunction is likely to contribute to frailty in aging PLWH.

Effectiveness of digital health exercise interventions on muscle function and physical performance in older adults with possible, confirmed or severe sarcopenia: a protocol for a systematic review

INTRODUCTION

Sarcopenia is characterised by the progressive weakening of muscle function that occurs with age. This condition frequently leads to frailty, disability and even death. Research on sarcopenia prevention is growing. Digital health exercise interventions are increasingly gaining attention in this field, with the rapid advancement of the internet and the influence of the COVID-19. However, there is a lack of empirical support for their effectiveness. Our study aims to assess the effect of digital health exercise intervention on sarcopenia in older persons, specifically focusing on its ability to improve muscle strength, muscle mass and physical performance.

METHODS AND ANALYSIS

Searching will be performed in the following 11 databases (Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, WOS, Scopus, CBM, CNKI, WANFANG and VIP) for published trials and 2 trial registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) for unpublished trials. Google Scholar will be used to find grey literature. The criterion of inclusion will be clinical trials involving digital health exercise interventions in older adults (≥60 years) diagnosed with sarcopenia (possible, confirmed or severe sarcopenia). For data synthesis, we will use a summary table to show the major characteristics of selected trials and a summary graph to demonstrate the risk of bias for each outcome using RoB 2, which will be further discussed in a narrative synthesis. The possibility of meta-analysis for quantitative data will be assessed according to the homogeneity analysis of the trials, using the methods of fixed or random effects model. If meta-analysis is possible, subgroup analysis and sensitivity analysis will be performed as well. Publication bias will be assessed through the use of the funnel plot and Egger's linear regression test when an adequate number of trials are available. Finally, the Grading of Recommendations, Assessment, Development and Evaluation approach will be used to classify the certainty of evidence body into four categories (high, moderate, low and very low).

ETHICS AND DISSEMINATION

The findings of the systematic review will be shared through publishing in a peer-reviewed journal and presentation at appropriate conferences. Since we will not be using specific patient data, ethical approval is unnecessary.

PROSPERO REGISTRATION NUMBER

CRD42024516930.

Frailty Indicator over the Adult Life Cycle as a Predictor of Healthcare Expenditure and Mortality in the Short to Midterm

BACKGROUND

Assessing frailty from middle age onward offers valuable insights into predicting healthcare expenditures throughout the life cycle.

OBJECTIVES

This paper examines the use of physical frailty as an indicator of healthcare demand across all age groups. The originality of this work lies in extending the analysis of frailty indicators beyond the typical focus on individuals under 50 years old to include those in mid-life and older.

METHODS

For this study, we used a database where frailty was measured in 2012 in a sample of individuals aged 15 to over 90. These individuals were tracked for their healthcare expenditures from 2012 to 2016.

RESULTS

Among the sample of 6928 individuals, frailty in 2012 resulted in a statistically significant increase in costs at the 5% level for the population aged 15 to 65. We applied multilevel linear regression models with year fixed effects, controlling for demographic factors, education level, precarity, social dimensions, lifestyle factors (e.g., vegetable consumption), physical activity, emotional well-being, and medical history. A Hausman test was conducted to validate the model choice. For mortality rate analysis, Cox models were used.

CONCLUSIONS

Our findings demonstrate that physical frailty provides valuable information for understanding its impact on healthcare expenditure. The effect of frailty on mortality is particularly significant for the elderly population. Moreover, frailty is a predictor of healthcare costs not only in older adults but also across the entire life cycle.

Association of oral hypofunction with aspiration pneumonia, fractures, and mortality in older Japanese adults

AIM

In Japan's public health system, dentists can assess and intervene in oral hypofunction cases. However, the associations between oral hypofunction and health outcomes and costs remain unclear. This study aimed to identify these associations.

METHODS

This retrospective cohort study using a Japanese health insurance claims database included 45 916 individuals aged ≥65 years who underwent dental examinations for oral hypofunction. The primary outcomes were incidence rates of aspiration pneumonia, femoral or vertebral fractures and all-cause mortality. Secondary outcomes were annual medical and dental costs. We used competing risk regression and Cox models to estimate primary outcomes, and gamma regression models for secondary outcomes.

RESULTS

The adjusted hazard ratios were 0.84 (95% CI 0.74-0.96) for the incidence of aspiration pneumonia, 1.11 (1.02-1.21) for the incidence of femoral or vertebral fractures and 1.27 (1.07-1.50) for all-cause mortality in individuals with oral hypofunction compared with those without. The adjusted relative risk was 1.05 (1.01-1.10) for annual medical costs and 0.94 (0.81-1.09) for annual dental costs in individuals with oral hypofunction compared with those without.

CONCLUSIONS

Individuals with oral hypofunction were at increased risk of femoral or vertebral fractures and all-cause mortality, and they incurred significantly higher annual medical costs, compared with those without this condition. Notably, they showed a lower risk of aspiration pneumonia, suggesting potential benefits of dental intervention. Integrating dental care into medical strategies might be necessary to improve health outcomes and reduce healthcare costs for those with oral hypofunction. Geriatr Gerontol Int 2024; 24: 1053-1059.

Diagnostic and prognostic value of calf circumference for sarcopenia in community-dwelling older adults

BACKGROUND

An age-dependent normative values of calf circumference (CC) has been recently proposed as an accessible proxy for muscle mass. However, its usefulness to estimate sarcopenia has not been assessed. The objectives of the present study were to determine if the substitution of the classical way to assess muscle mass by these values have enough diagnostic accuracy and prognostic value among older adults living in the community.

METHODS

Data from the Toledo Study of Healthy Ageing (TSHA) were used. CC was measured using an anthropometric tape. We used two age-groups CC cut-off points: the TSHA CC median and the one proposed in the Longevity Check-up 7+ (Lookup 7+) project. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and FNIH criteria standardized for our population (sFNIH). Frailty (according to the Frailty Phenotype and the Frailty Trait Scale-5) and disability (Katz index) were assessed at baseline and follow-up. Mortality and first hospitalization were also recorded. Logistic (incident frailty and worsening disability) and Cox (mortality and hospitalization) regressions were performed. Diagnostic accuracy was assessed through Kappa index, AUCs, positive and negative predictive values. Predictive ability was assessed through AUCs and integrated AUCs (IAUCs).

RESULTS

1531 participants (74.8 ± 5.8 years; 45.6% men) were included in the analysis. Prevalence rates of sarcopenia were 22.7% (sFNIH), 15.0% (FNIH), and 13.9% (EWGSOP2). Using TSHA-based cut-points of CC, the prevalence of sarcopenia was 16.8% (sFNIH), 11.0% (FNIH), and 11.5% (EWGSOP2). According to LC7+-based CC cut-off points, sarcopenia prevalence was 17.6% (sFNIH), 11.9% (FNIH), and 12.4% (EWGSOP2). CC cut-off points showed low-to-moderate agreement (Kappa Index values between 0.49 and 0.69) with appendicular lean mass for the evaluation of sarcopenia. Sarcopenia identified by Lookup 7+ and TSHA CC cut-off points was associated with the adverse events examined, with similar AUCs and IAUCs than original sarcopenia definitions, and were lost after adjustment by baseline frailty, except when the original EWGSOP2 definition was used.

CONCLUSIONS

Using normalized values of CC as a criteria of muscle mass shows moderate agreement with classical criteria for diagnosing sarcopenia and offer similar predictive value in community-dwelling older adults.

Urban-rural differences in the prevalence and associated factors of sarcopenia: A systematic review and meta-analysis

BACKGROUND

Loss of muscle mass, muscle strength, and/or physical performance due to aging is known as sarcopenia. Regardless of how serious this illness is, no single diagnostic criteria have been established. Much research conducted recently has demonstrated differences between built environment characteristics (i.e., urban and rural) and the occurrence of sarcopenia; however, variations in sarcopenia prevalence in urban-rural areas around the world have been reported by fewer studies. This work sought to determine how sarcopenia prevalence varied between urban and rural areas and to explore the associated influencing factors.

METHODS

Using the pertinent MESH phrases and free words, PubMed, Web of Science, Embase, and China national knowledge infrastructure databases were scanned for core sarcopenia literature up to February 26, 2023. Observational studies involving urban-rural patients with sarcopenia published in Chinese and English, and assessing muscle mass via computed tomography, bioelectrical impedance, or dual-energy X-ray absorption techniques were considered as inclusion criteria. The meta-analysis involved analysis of the urban-rural prevalence in subgroups by diagnostic criteria, tools for assessing muscle mass and study type, as well as the factors related to urban-rural differences in the occurrence of sarcopenia. STATA version 11.0 was used to perform the statistical analysis.

RESULTS

Sixty-six articles involving 433,091 participants were included for analysis: of which 27 were analyzed for both prevalence and related factors whereas 39 were for only prevalence. The meta-analysis revealed the prevalence of sarcopenia to be 0.18 (95 % CI 0.14-0.22), with significant heterogeneity (P < 0.001; I2 = 99.9 %). Moreover, the prevalence of sarcopenia in urban group [0.16 (I2 = 99.9 %, 95 % CI 0.1-0.22)] was lower than in rural group [0.2 (I2 = 99.6 %, 95 % CI 0.16-0.25)] and urban-rural group [0.21 (I2 = 97.5 %, 95 % CI 0.16-0.25)]. Besides, the factors significantly associated with sarcopenia in urban-rural areas were age, gender, BMI, malnutrition, physical activity, and polypharmacy. There was significant heterogeneity between these factors and the association of sarcopenia.

CONCLUSIONS

Sarcopenia is associated with aspects of the built environment, and studies have revealed that sarcopenia is more common in rural than in urban populations with influencing factors including age, gender, BMI, poor nutrition, insufficient physical activity, and polypharmacy. The lack of uniform diagnostic criteria makes a robust and comprehensive assessment difficult. Therefore, the formation of certain universal and standardized diagnostic criteria will help future research on sarcopenia.

Medicare Fee-For-Service Spending for Fall Injury and Nonfall Events: The Health, Aging, and Body Composition Study

Background and Objectives

Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) and fracture is unknown. We examined whether incident fall injuries, including NFFI and fractures, were associated with higher Medicare spending in 12 months after incident events in older adults.

Research Design and Methods

The Health, Aging, and Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) with linked Medicare Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient and inpatient fall injuries (N = 448) from 2000/01 exam to December 31, 2008 were identified using the first claim with a nonfracture injury diagnosis code with a fall E-code, or a fracture diagnosis code with/without an E-code. Up to 3 participants without fall injuries (N = 1 147) were matched on nonfall events to 448 participants in the fall injury month. We calculated the change in monthly FFS spending in 12 months before versus after index events in both groups. Generalized linear regression with centered outcomes and gamma distributions examined the association of prepost expenditure changes with fall injuries (including NFFI and fractures) adjusting for related covariates.

Results

Monthly spending increased after versus before fall injuries (USD$2 261 vs $981), nonfracture (N = 105; USD$2 083 vs $1 277), and fracture (N = 343; USD$2 315 vs $890) injuries (all p < .0001). However, after adjusting for covariates in final models, fall injuries were not significantly associated with larger increases in spending/month versus nonfall events (differential increase: USD$399.58 [95% CI: -USD$44.95 to $844.11]). Fracture prepost change in monthly spending was similar versus NFFI (differential increase: USD$471.93 [95% CI: -USD$21.17 to $965.02]).

Discussion and Implications

Although substantial increases occurred after injuries, with fracture and NFFI increasing similarly, changes in monthly spending after fall injury were not different compared to nonfall events. Our results contribute to the understanding of subsequent spending after fall injury that may inform further research on fall injury-related health care spending.

Relationship of endogenous plasma concentrations of β-hydroxy β-methyl butyrate (HMB) with frailty in community dwelling older adults with type-2 diabetes mellitus

BACKGROUND

Supplementation with β-hydroxy β-methyl butyrate (HMB) appears to be effective in preserving muscle in older adults. However, the association between endogenously produced HMB with frailty has not been studied in people with chronic disease.

OBJECTIVES

The purpose of this study is to explore whether an association exists between endogenous HMB levels and frailty status in older adults with type-2 diabetes mellitus (T2DM).

METHODS

Data were taken from the Toledo Study of Healthy Ageing, a community-dwelling aged (65 years+) cohort. Frailty was assessed at baseline and at 2.99 median years according to the Frailty Phenotype (FP) standardized to our population and the Frailty Trait Scale 12 (FTS12). The associations between HMB levels and frailty were assessed using three nested multivariate logistic regressions and segmented by sex. Glucose, HMB and glucose interaction, age and body composition were used as covariables.

RESULTS

255 participants (mean age 75.3 years, 52.94% men) were included. HMB levels showed an inverse cross-sectional association with frailty, which was modified when the interaction term HMB*glucose was included, remaining significant only for FTS12 [OR (95% CI): 0.436 (0.253, 0.751), p-value 0.003]. The association between HMB endogenous levels and FTS12 appears to be independent of sex, in which the association was maintained after adjusting for the covariates. However, there appears to be threshold points for glucose levels, above which the protective effect of HMB is lost: 145.4 mg/dl adjusted by gender for the whole sample and 149.6 mg/dl and 138.9 mg/dl for men and women, respectively. Endogenous HMB levels were not found to be associated with incident frailty.

CONCLUSIONS

Cross-sectional analysis revealed that endogenous HMB levels were inversely associated with frailty as assessed by the FTS12 in older people with T2DM. This association was found to be dependent on circulating fasted glucose levels.

Decreased mitochondrial respiration associates with frailty in community-dwelling older adults

Aging population has led to an increased prevalence of chronic and degenerative pathologies. A manifestation of unhealthy aging is frailty, a geriatric syndrome that implies a non-specific state of greater vulnerability. Currently, methods for frailty diagnosis are based exclusively on clinical observation. The aim of this study is to determine whether the bioenergetic capacity defined as mitochondrial oxygen consumption rate (OCR) of peripheral circulation mononuclear cells (PBMC) associates with the frailty phenotype in older adults and with their nutritional status. This is a cross-sectional analytic study of 58 participants 70 years and older, 18 frail and 40 non-frail adults, from the ALEXANDROS cohort study, previously described. Participants were characterized through sociodemographic and anthropometric assessments. Frail individuals displayed a higher frequency of osteoporosis and depression. The mean age of the participants was 80.2 ± 5.2 years, similar in both groups of men and women. Regarding the nutritional status defined as the body mass index, most non-frail individuals were normal or overweight, while frail participants were mostly overweight or obese. We observed that OCR was significantly decreased in frail men (p < 0.01). Age was also associated with significant differences in oxygen consumption in frail patients, with lower oxygen consumption being observed in those over 80 years of age. Therefore, the use of PBMC can result in an accessible fingerprint that may identify initial stages of frailty in a minimally invasive way.

Myoprotective whole foods, muscle health and sarcopenia in older adults

PURPOSE OF REVIEW

Sarcopenia increases in prevalence at older ages and may be exacerbated by poor diet. Whole foods rich in specific nutrients may be myoprotective and mitigate the risk of sarcopenia. Here we review recent evidence published from observational and intervention studies regarding myoprotective foods and explore their benefit for the prevention and/or treatment of sarcopenia in older adults.

RECENT FINDINGS

We found limited new evidence for the role of whole foods in sarcopenia and sarcopenia components (muscle mass, strength, physical performance). There was some evidence for higher consumption of protein-rich foods (milk and dairy) being beneficial for muscle strength in observational and intervention studies. Higher consumption of antioxidant-rich foods (fruit and vegetables) was associated with better physical performance and lower odds of sarcopenia in observational studies. Evidence for other protein- and antioxidant-rich foods were inconsistent or lacking. There remains a clear need for intervention studies designed to identify the role of whole foods for the treatment of sarcopenia.

SUMMARY

Although evidence for myoprotective roles of dairy, fruit and vegetables is emerging from observational studies, higher level evidence from intervention studies is needed for these foods to be recommended in diets of older adults to prevent and/or treat sarcopenia.

Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study

BACKGROUND

Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia.

METHODS

This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05.

RESULTS

Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ2(2) = 101.05, p < 0.001) and depression scores (χ2(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ2(2) = 25.68, p < 0.001), activity of daily living (χ2(2) = 6.00, p = 0.05), and global quality of life (χ2(2) = 20.64, p < 0.001).

CONCLUSIONS

The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs).

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05754398 (03/03/2023).

Low physical activity is a risk factor for sarcopenia: a cross-sectional analysis of two exercise trials on community-dwelling older adults

BACKGROUND

Physical inactivity is an important factor in the development of sarcopenia. This cross-sectional study explores the prevalence of sarcopenia and associations of physical activity (PA) with sarcopenia in two exercise trial populations. These study groups are clinically meaningful community-dwelling populations at increased risk for sarcopenia: older adults not meeting the PA guidelines and those with a recent hip fracture (HF).

METHODS

Data from 313 older adults who did not meet the PA guidelines (60% women; age 74.5 ± 3.8, body mass index 27.9 ± 4.7) and 77 individuals with HF diagnosed on average 70 ± 28 days earlier (75% women; age 79.3 ± 7.1, body mass index 25.3 ± 3.6) were included in this study. Grip strength and muscle mass (Dual-energy X-ray absorptiometry [DXA] in older adults not meeting the PA guidelines and bioimpedance analysis in participants with HF) were used to assess sarcopenia according to the European Working Group in Older People 2019 (EWGSOP2) criteria. The current level of PA was self-reported using a question with seven response options in both study groups and was measured with a hip-worn accelerometer for seven consecutive days in older adults not meeting the PA guidelines.

RESULTS

The prevalence of sarcopenia and probable sarcopenia was 3% (n = 8) and 13% (n = 41) in the older adults not meeting the PA guidelines and 3% (n = 2) and 40% (n = 31) in the HF group, respectively. In the age- and sex-adjusted logistic regression model, the lowest levels of self-reported PA were associated with increased probable sarcopenia and sarcopenia risk in older adults not meeting the PA guidelines (OR 2.8, 95% CI, 1.3-6.1, p = 0.009) and in the HF group (OR 3.9, 95% CI, 1.4-11.3, p = 0.012). No significant associations between accelerometer-measured PA and probable sarcopenia or sarcopenia were found.

CONCLUSIONS

Probable sarcopenia is common among community-dwelling older adults not meeting the PA guidelines and very common among individuals recovering from HF who are able to be involved in exercise interventions. In addition, since low PA is associated with higher probable sarcopenia and sarcopenia risk, it is recommended to screen for sarcopenia and promote regular physical activity to prevent sarcopenia in these populations.

Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies

BACKGROUND

Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults.

METHODS

We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865.

FINDINGS

We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37-0·62) and longitudinally (four studies, n=7545; 0·51, 0·27-0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71-0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour).

INTERPRETATION

Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia.

FUNDING

None.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

Effects of the bio-psycho-social frailty dimensions on healthcare utilisation among elderly in Europe: A cross-country longitudinal analysis

Frailty represents an emerging challenge and has major implications for clinical practice, public health, and the sustainability of health systems. It is a geriatric condition, related to but distinct from disability and multimorbidity and characterized by a diminished physiological reserve of multiple organs. Despite limited consensus and evidence, it has been argued that cognitive and social aspects influence the condition. Therefore, we aim to provide evidence on the importance of taking a broader approach in defining frailty, by investigating the role of its physical, social, and psychological subdomains to predict healthcare utilisation in elderly Europeans. The study is based on the Survey of Health, Ageing and Retirement in Europe (SHARE), and uses 185,169 total observations from 12 European countries included in wave 4, 5, 6, and 8. The analysis investigates the influence of the physical frailty index (a proxy of the Frailty Phenotype definition), psychological and social frailty indexes (built to proxy the Tilburg Frailty Index) on the likelihood of hospitalisation and the number of doctor visits. We addressed missing values due to item non-response with fully conditional specification multivariate imputation and exploited the longitudinal structure of the data to control for time-fixed unobserved characteristics. In addition, our two multivariate models included regressors to correct for demand side factors (health status, socio-economic status, and behavioral risk) as well as for country-specific characteristics. Physical and psychological frailty positively influence the likelihood of hospitalisation (OR = 1.90 and OR = 1.31, respectively) and the number of doctor visits (IRR = 1.30 and IRR = 1.07), while social frailty reduces the two types of health services utilisation (OR = 0.53 and IRR = 0.90). The three frailty dimensions are relevant risk stratification factors in elderly Europeans, and health policies should focus more on the psycho-social aspects of this condition, as a strategy to both contain expenditures and avoid potential healthcare inequalities.

Association of diet quality with the risk of Sarcopenia based on the Chinese diet balance index 2016: a cross-sectional study among Chinese adults in Henan Province

BACKGROUND

Sarcopenia can lead to a series of unfavourable health outcomes. Diet is an important factor influencing sarcopenia. In this study, we aimed to evaluate the association of sarcopenia with diet quality assessed by the Chinese Diet Balance Index 2016 (DBI-16).

METHODS

A cross-sectional study was conducted to collect information on nutrition and health in Henan Province, China, and a total of 644 individuals were studied. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria updated in 2019. Diet quality was assessed by using the Chinese Diet Balance Index 2016 (DBI-16), which includes three indicators: the lower bound score (LBS), higher bound score (HBS) and diet quality distance (DQD). Binary logistic regression analysis was used to estimate the risk of sarcopenia associated with diet quality.

RESULTS

A total of 49 of the 644 participants were diagnosed with sarcopenia. Excessive intake (score > 0) of cereals, meat, eggs and salt, inadequate intake (score < 0) of vegetables, fruits, dairy products, soybeans and low diet variety were commonly seen in both groups of participants. The participants with sarcopenia had a more serious inadequate intake of fruit than those without sarcopenia (p < 0.05). The overall LBS, HBS and DQD in both groups were in the interval of low-level problems. Compared with participants with a suitable LBS, those with an unsuitable LBS were more likely to have a low gait speed (OR: 2.58; 95%CI: 1.13-7.04) after multiple adjustments. However, the other two DBI-16 indicators, the HBS and DQD, were not associated with sarcopenia or its related diagnostic variables.

CONCLUSION

Unfavourable diet quality, mainly referring to inadequate dietary intake in this study, may be a risk factor for low gait speed.

Long-term clinical outcomes in critically ill patients with sepsis and pre-existing low muscle mass: a retrospective cohort study

PURPOSE

Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Low muscle mass has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear.

METHODS

Retrospective cohort analysis of patients treated at a quaternary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with low muscle mass defined by [Formula: see text] 5th percentile skeletal muscle index, measured at the L3 lumbar level (L3SMI) on Computed-Tomography (CT) scan ([Formula: see text] 41.6 cm2/m2 for males and [Formula: see text] 32.0 cm2/m2 for females). L3SMI was calculated by normalizing the CT-measured skeletal muscle area to the square of the patient's height (in meters). Measurements were taken from abdominal/pelvic CT scan obtained within 7 days of sepsis onset. The prevalence of low muscle mass and its association with clinical outcomes, including in-hospital and one-year mortality, and post-hospitalization discharge disposition in survivors, was analyzed. Unfavorable post-hospitalization disposition was defined as discharge to a location other than the patient's home.

RESULTS

Low muscle mass was present in 34 (23%) of 150 patients, with mean skeletal muscle indices of 28.0 ± 2.9 cm2/m2 and 36.8 ± 3.3 cm2/m2 in females and males, respectively. While low muscle mass was not a significant risk factor for in-hospital mortality (hazard ratio 1.33; 95% CI 0.64 - 2.76; p = 0.437), it significantly increased one-year mortality after adjusting for age and illness severity using Cox multivariate regression (hazard ratio 1.9; 95% CI 1.1 - 3.2; p = 0.014). Unfavorable post-hospitalization discharge disposition was not associated with low muscle mass, after adjusting for age and illness severity in a single, multivariate model.

CONCLUSION

Low muscle mass independently predicts one-year mortality but is not associated with in-hospital mortality or unfavorable hospital discharge disposition in critically ill patients with sepsis.

Effectiveness of Whey Protein Supplementation during Resistance Exercise Training on Skeletal Muscle Mass and Strength in Older People with Sarcopenia: A Systematic Review and Meta-Analysis

OBJECTIVE

To determine the effectiveness of whey protein (WP) supplementation during resistance exercise training (RET) vs. RET with or without placebo supplementation on skeletal muscle mass, strength, and physical performance in older people with Sarcopenia.

METHODS

Electronic searches in the PubMed, Embase, Scopus, Web of Science, LILACS, SPORTDiscus, Epistemonikos, and CINAHL databases were performed until 20 January 2023. Randomized clinical trials conducted on sarcopenic adults aged 60 or older were included. The studies had to compare the effectiveness of the addition of supplements based on concentrated, isolated, or hydrolyzed whey protein during RET and compare it with RET with or without placebo supplementation on skeletal muscle mass and strength changes. The study selection process, data extraction, and risk of bias assessment were carried out by two independent reviewers.

RESULTS

Seven randomized clinical trials (591 participants) were included, and five of them provided data for quantitative synthesis. The overall pooled standardized mean difference (SMD) estimate showed a small effect size in favor of RET plus WP for skeletal muscle mass according to appendicular muscle index, with statistically significant differences compared with RET with or without the placebo group (SMD = 0.24; 95% CI, 0.05 to 0.42; p = 0.01; I2 = 0%, p = 0.42). The overall pooled mean difference (MD) estimate showed a significant difference of +2.31 kg (MD = 2.31 kg; 95% CI, 0.01 to 4.6; p = 0.05; I2 = 81%, p < 0.001) in handgrip strength in the RET plus WP group compared with the RET group with or without placebo. The narrative synthesis revealed discordance between the results of the studies on physical performance.

CONCLUSIONS

WP supplementation during RET is more effective in increasing handgrip strength and skeletal muscle mass in older people with Sarcopenia compared with RET with or without placebo supplementation. However, the effect sizes were small, and the MD did not exceed the minimally important clinical difference. The quality of the evidence was low to very low according, to the GRADE approach. Further research is needed in this field.

Long-Term Clinical Outcomes in Critically Ill Patients with Sepsis and Pre-existing Sarcopenia: A Retrospective Cohort Study

Purpose

Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Sarcopenia has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear.

Methods

Retrospective cohort analysis of patients treated at a tertiary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with sarcopenia defined by skeletal muscle index at the L3 lumbar area on abdominal Computed-Tomography scan. The prevalence of sarcopenia and its association with clinical outcomes was analyzed.

Results

Sarcopenia was present in 34 (23%) of 150 patients, with median skeletal muscle indices of 28.1 cm 2 /m 2 and 37.3 cm 2 /m 2 in sarcopenic females and males, respectively. In-hospital mortality was not associated with sarcopenia when adjusted for age and illness severity. One year mortality was increased in sarcopenic patients, after adjustment for illness severity (HR 1.9, p = 0.02) and age (HR 2.4, p = 0.001). However, it was not associated with increased likelihood for discharge to long-term rehabilitation or hospice care in adjusted analyses.

Conclusion

Sarcopenia independently predicts one year mortality but is not associated with unfavorable hospital discharge disposition in critically ill patients with sepsis.

Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study

BACKGROUND

Sarcopenia is a geriatric syndrome with progressive loss of skeletal muscle mass and function and has a negative impact on clinical outcomes associated with chronic obstructive pulmonary disease (COPD). Recently, the sarcopenia index (SI) was developed as a surrogate marker of sarcopenia based upon the serum creatinine to cystatin C ratio. We aimed to assess the value of SI for predicting clinically important outcomes among elderly patients with acute exacerbation of COPD (AECOPD).

METHODS

This cross-sectional study included elderly patients with AECOPD in China from 2017 to 2021. Clinical data were collected from medical records, and serum creatinine and cystatin C were measured. Outcomes included respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality. Binary logistic regression was used to analyze the association between SI and clinical outcomes.

RESULTS

A total of 306 patients (260 men, 46 women, age range 60-88 years) were enrolled in this study. Among the total patients, the incidence of respiratory failure and severe pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was still independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13-0.56, P < 0.05). In subgroup analysis, the incidence of respiratory failure was negatively associated with SI values in groups with both frequent exacerbation and non-frequent exacerbation. After adjustment for potential confounders, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06-0.64 and OR: 0.31, 95% CI: 0.11-0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, invasive mechanical ventilation, and mortality in all groups.

CONCLUSION

The SI based on serum creatinine and cystatin C can predict respiratory failure in patients with AECOPD and either frequent or infrequent exacerbations. This indicator provides a convenient tool for clinicians when managing patients with AECOPD in daily clinical practice.

Effect of Familial Longevity on Frailty and Sarcopenia: A Case-Control Study

Familial longevity confers advantages in terms of health, functionality, and longevity. We sought to assess potential differences in frailty and sarcopenia in older adults according to a parental history of extraordinary longevity. A total of 176 community-dwelling subjects aged 65-80 years were recruited in this observational case-control study, pair-matched 1:1 for gender, age, and place of birth and residence: 88 centenarians' offspring (case group) and 88 non-centenarians' offspring (control group). The main variables were frailty and sarcopenia based on Fried's phenotype and the European Working Group on Sarcopenia in Older People (EWGSOP) definitions, respectively. Sociodemographics, comorbidities, clinical and functional variables, the presence of geriatric syndromes, and laboratory parameters were also collected. Related sample tests were applied, and conditional logistic regression was performed. Cases had a higher percentage of robust patients (31.8% vs. 15.9%), lower percentages of frailty (9.1% vs. 21.6%) and pre-frailty (59.1% vs. 62.5%) (p = 0.001), and lower levels of IL-6 (p = 0.044) than controls. The robust adjusted OR for cases was 3.00 (95% CI = 1.06-8.47, p = 0.038). No significant differences in muscle mass were found. Familial longevity was also associated with less obesity, insomnia, pain, and polypharmacy and a higher education level and total and low-density lipoprotein cholesterol. The results suggest an inherited genetic component in the frailty phenotype, while the sarcopenia association with familial longevity remains challenging.

A systematic review and meta-analysis of the association between sarcopenia and myocardial infarction

BACKGROUND

Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction.

METHODS

PubMed, Cochrane Library, and Embase were searched for studies on the association between sarcopenia and myocardial infarction from their inception until November 26, 2022. The fixed-effects model was used to calculate the combined risk ratio (RR) of sarcopenia in patients with myocardial infarction. Sensitivity analysis was used to test the robust of the combined result, and funnel plot were used to test publication bias.

RESULTS

Five studies were included finally. There was no significant association between sarcopenia and risk of developing myocardial infarction [RR = 1.01; 95% CI = 0.94, 1.08; P = 0.317]. The sensitivity analysis showed robust of the combined result. The funnel plot showed no significant publication bias.

CONCLUSION

Limited evidence suggests no definitive association between sarcopenia and risk of myocardial infarction.