Software for the Diagnosis of Sarcopenia in Community-Dwelling Older Adults: Design and Validation Study

Abdominal obesity as a risk factor for sarcopenia among the community-dwelling older adults: data from baseline phase of Birjand longitudinal aging study

Objectives

Sarcopenia could be linked to abdominal obesity through various mechanisms. The aim of the current study was to evaluate the association between sarcopenia and abdominal obesity among community-dwelling aged population.

Methods

Data were collected from 1356 eligible older adults (≥ 60 years) who participated in the baseline phase of Birjand Longitudinal Aging Study (BLAS) in 2019. Body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), a body shape index (ABSI), body roundness index (BRI), and body adiposity index (BAI) were measured. Sarcopenia was assessed based on hand grip strength, appendicular skeletal muscle mass (ASMM) and gait speed.

Results

In the studied population, 834 individuals were sarcopenic. The best predictors of sarcopenia and low gait speed were BAI and WHtR (AUC = 0.61 to 0.65). All abdominal obesity indices were risk factors for sarcopenia, except for WHR. ABSI was significantly and directly associated with sarcopenia, only in the crude model (OR (95%CI): 1.14 (1.02; 1.28), P = 0.02). WHR, WHtR, BMI, and WC increased and ABSI decreased the odds of low handgrip strength.

Conclusions

Most abdominal obesity indices were identified as risk factors for sarcopenia except for WHR. Anthropometric indices can be considered for evaluating the risk of sarcopenia in the elderly.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01616-6.

Neck Circumference Cut-Off Points for Identifying Adiposity: Association with Chronic Metabolic Diseases in Older People

BACKGROUND

The leading cause of death in older people is cardiovascular diseases. Several studies have found that neck circumference (NC) is a simple anthropometric marker associated with adiposity. The aim of this study is to estimate and validate NC cut-off points as adiposity markers and analyze their association with cardiovascular and chronic metabolic diseases in older people.

METHODS

A cross-sectional study in 358 non-disabled, community-dwelling older people (71.7 ± 3.9 years) living in Santiago de Chile and participating in the HTSMayor study was conducted. Measurements of body composition and cardiovascular risks were evaluated. Receiver operating characteristic (ROC) curves and multiple logistic regression models were used to evaluate the association of NC with cardiovascular and chronic metabolic diseases. NC cut-off points were obtained to predict obesity, abdominal obesity, and adiposity.

RESULTS

The best performance values of neck circumference relative to obesity and adiposity were obtained with respect to abdominal obesity (40.6 cm in men and 34.2 cm in women). Higher NC values were associated with a higher area under the curve (AUC) for men and women (men: AUC = 0.84; women: AUC = 0.86). NC was significantly associated with a higher risk for diabetes mellitus (OR = 1.95), hypertension (OR = 2.42), acute myocardial infarction (OR = 4.36), and comorbidities (OR = 2.01), and a lower risk for sarcopenia (OR = 0.35).

CONCLUSIONS

This study shows that NC is a useful tool for detecting abdominal obesity, obesity, and adiposity in older people and that a higher NC increases the risk of chronic diseases.

Machine Learning Applications in Sarcopenia Detection and Management: A Comprehensive Survey

This extensive review examines sarcopenia, a condition characterized by a loss of muscle mass, stamina, and physical performance, with a particular emphasis on its detection and management using contemporary technologies. It highlights the lack of global agreement or standardization regarding the definition of sarcopenia and the various techniques used to measure muscle mass, stamina, and physical performance. The distinctive criteria employed by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGSOP) for diagnosing sarcopenia are examined, emphasizing potential obstacles in comparing research results across studies. The paper delves into the use of machine learning techniques in sarcopenia detection and diagnosis, noting challenges such as data accessibility, data imbalance, and feature selection. It suggests that wearable devices, like activity trackers and smartwatches, could offer valuable insights into sarcopenia progression and aid individuals in monitoring and managing their condition. Additionally, the paper investigates the potential of blockchain technology and edge computing in healthcare data storage, discussing models and systems that leverage these technologies to secure patient data privacy and enhance personal health information management. However, it acknowledges the limitations of these models and systems, including inefficiencies in handling large volumes of medical data and the lack of dynamic selection capability. In conclusion, the paper provides a comprehensive summary of current sarcopenia research, emphasizing the potential of modern technologies in enhancing the detection and management of the condition while also highlighting the need for further research to address challenges in standardization, data management, and effective technology use.

Anthropometric equations to estimate appendicular muscle mass from dual-energy X-ray absorptiometry (DXA): A scoping review

BACKGROUND

Appendicular skeletal muscle mass (ASM) obtained from dual-energy x-ray absorptiometry (DXA) is recommended to quantify sarcopenia, but has limited availability in disadvantaged-income countries, moreover in an epidemiological context. Predictive equations are easier and less costly to apply, but a review of all available models is still lacking in the scientific literature. The objective of this work is to map, with a scoping review, the different proposed anthropometric equations to predict ASM measured by DXA.

METHODS

Six databases were searched without restriction on publication date, idiom, and study type. A total of 2,958 studies were found, of which 39 were included. Eligibility criteria involved ASM measured by DXA, and equations proposed to predict ASM.

RESULTS

predictive equations (n = 122) were gathered for 18 countries. The development phase involves sample size, coefficient of determination (r2), and a standard error of estimative (SEE) varying between 15 and 15,239 persons, 0.39 and 0.98, 0.07 and 3.38 kg, respectively. The validation phase involves a sample size, accuracy, and a SEE between 15 and 3,003 persons, 0.61 and 0.98, 0.09 and 3.65 kg, respectively.

CONCLUSIONS

The different proposed predictive anthropometric equations of ASM DXA were mapped, including validated pre-existing equations, offering an easy-to-use referential article for clinical and research applications. It is necessary to propose more equations for other continents (Africa and Antarctica) and specific health-related conditions (e.g., diseases), once the equations can only have sufficient validity and accuracy to predict ASM generally when applied to the same population.

Innovation in Digital Health Interventions for Frailty and Sarcopenia

Today, the challenges of an aging society are primarily seen in frailty, sarcopenia, and impaired functionality [...]

Challenges in the Management of Sarcopenia in the Primary Care Setting: A Scoping Review

BACKGROUND

Sarcopenia is a disease associated with the loss of muscle mass, strength, and function. It affects the elderly in various ways, such as reduced mobility, compromising their daily activities, and even deteriorating metabolic health. Primary care serves as the first point of contact for patients and plays an important role in health promotion and disease prevention. Hence, this review is conducted to identify the challenges in the management of sarcopenia in the primary care setting.

METHOD

In December 2022, a scoping review was conducted using PubMed, SCOPUS, Web of Science, and a manual search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We used articles that have been written in English, and relevant articles were then screened, duplicates were removed, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords challenges, management, sarcopenia, and primary care were included.

RESULT

The initial search generated 280 publications, and 11 articles were included after inclusion and exclusion criteria for this review. In this review, challenges in the management of sarcopenia in a primary care setting are reviewed based on the screening and diagnosis.

CONCLUSIONS

With an increasing aging population, it is important to understand the challenges in the management of sarcopenia in a primary care setting. Identification of elderly at risk of sarcopenia, followed by referring the affected elderly for confirmation of the diagnosis, is essential to preventing the adverse health effects. The initiation of treatment that comprises resistance exercise training and nutrition should not be delayed, as they are salient in the management of sarcopenia.

Association between Sarcopenia and Nutritional Status in Chilean Older People Aged 65 Years and Older

In 2018 the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the definition of sarcopenia, with loss of muscle strength being the primary feature. The objective is to describe and associate sarcopenia and nutritional status in a group of Chilean older adults aged 65 years and older.

METHODS

Descriptive, associative and comparative study, with a cross-sectional design and a quanti-qualitative approach. A number of 155 institutionalized and community-dwelling Chilean older people aged 65 years and older participated in the study (year 2018). Sarcopenia was diagnosed using the algorithm proposed by the EWGSOP2. Muscle strength, muscle quantity and physical performance were assessed; Body Mass Index (BMI) and Mini Nutritional Assessment (MNA) were used. Variables were described according to sex and age groups (65-69; 70-79; and ≥80 years). The association between sarcopenia and nutritional status was studied by the application of multivariate logistic regression analysis with adjustments for age and sex.

RESULTS

49.7% and 5.2% of older adults had probable sarcopenia and severe sarcopenia, respectively; 52.9% and 7% had malnutrition by excess and by deficit, respectively, according to their BMI; and 33.5% had malnutrition according to the MNA. Participants with obesity had 3.2 times more risk of presenting sarcopenia, versus subjects with normal nutritional status (OR: 3.2; 95% CI; 1.24; 8.26).

CONCLUSION

Sarcopenia, as defined by the criteria of the EWGSOP2, depends on the nutritional status according to BMI in older people, with obese individuals being at greater risk of suffering from sarcopenia. Nearly 50% had probable sarcopenia, a condition that could be detected early with the purpose of taking preventive measures, such a nutritional approach.

A pooled analysis of the association between sarcopenia and osteoporosis

BACKGROUND

Sarcopenia is a progressive generalized skeletal muscle disorder that causes the accelerated loss of muscle mass and function. Osteoporosis is a systemic condition of the skeleton that results in low bone mass and quality. Several studies have suggested that osteoporosis and sarcopenia are interrelated; however, a few studies indicate the lack of a significant association between sarcopenia and osteoporosis. We aimed to evaluate the association between sarcopenia and osteoporosis via a systematic review and pooled analysis.

METHODS

From the inception of the PubMed and Embase databases until September 2022, we conducted a systematic search for studies evaluating the relationship between sarcopenia and osteoporosis. Study appraisal and synthesis methods: We included observational studies that provided 95% confidence intervals (CIs) and risk estimates. Two reviewers independently extracted data and assessed the quality of the research. The random-effects model was applied to the pool analysis, and the odds ratios (ORs) and 95% CIs were finally calculated.

RESULTS

The primary statistic was the mutual risk between sarcopenia and osteoporosis. According to the inclusion criteria, 56 studies (796,914 participants) were finally included. Sarcopenia was significantly correlative to the risk of osteoporosis (OR, 3.06; 95% CI, 2.30-4.08), and each standard deviation increase in relative appendicular skeletal muscle mass was significantly related to a decreased risk of osteoporosis (OR, 0.65; 95% CI, 0.56-0.75). Osteoporosis observably referred to a higher risk of sarcopenia (OR, 2.63; 95% CI, 1.98-3.49).

CONCLUSION

Our research indicated that sarcopenia and osteoporosis are highly positively correlated. Osteoporosis is closely associated with the risk of sarcopenia. Our finding highlights the importance of sarcopenia screening for those at risk of osteoporosis, and vice versa. However, heterogeneity was noted among the studies, and this might have influenced the accuracy of the results. Therefore, the results of our study should be interpreted with caution.

Fetal muscle extract improves muscle function and performance in aged mice

Background: Loss of skeletal muscle mass and function is one of the major musculoskeletal health problems in the aging population. Recent studies have demonstrated differential proteomic profiles at different fetal stages, which might be associated with muscle growth and development. We hypothesized that extract derived from fetal muscle tissues at the stage of hypertrophy could ameliorate the loss of muscle mass and strength in aged mice.

Methods: To allow sufficient raw materials for investigation, skeletal muscle extract from fetal sheep at week 16 of gestation and maternal tissue were used in the present study. iTRAQ (isobaric tags for relative and absolute quantitation) and KEGG pathway analyses identified differentially expressed proteins in fetal sheep muscle extract vs. adult sheep muscle extract. Effects of FSME and ASME on human myoblast proliferation were studied. To examine the effect of FSME in vivo, C57BL/6 male mice at 20 months of age were subjected to intramuscular administration of FSME or vehicle control for 8 weeks. A grip strength test and ex vivo muscle force frequency test were conducted. Finally, serum samples were collected for multiplex analysis to determine potential changes in immunological cytokines upon FSME injection.

Results: Compared with ASME, 697 and 412 peptides were upregulated and downregulated, respectively, in FSME, as indicated by iTRAQ analysis. These peptides were highly related to muscle development, function, and differentiation from GO enrichment analysis. FSME promoted cell proliferation of myoblast cells (+300%, p < 0.01) without causing significant cytotoxicity at the tested concentration range compared with ASME. After 8 weeks of FSME treatment, the percentage of lean mass (+10%, p < 0.05), grip strength (+50%, p < 0.01), and ability in fatigue resistance were significantly higher than those of the control group. Isometric forces stimulated by different frequencies were higher in the control group. Histologically, the control group showed a larger cross-sectional area (+20%, p < 0.01) than the FSME group. The multiplex assay indicated that FSME treatment did not lead to an elevated circulatory level of inflammatory cytokines. Of note, after FSME treatment, we observed a significant drop in the circulating level of IL-12 (p40) from 90.8 ± 48.3 pg/ml to 82.65 ± 4.4 pg/ml, G-CSF from 23476 ± 8341.9 pg/ml to 28.35 ± 24.2 pg/ml, KC from 97.09 ± 21.2 pg/ml to 29.2 ± 7.2 pg/ml, and RANTES from 325.4 ± 17.3 pg/ml to 49.96 ± 32.1 pg/ml.

Conclusion: This is the first study demonstrating the beneficial effect of fetal muscle extract on muscle health in aged mice. Further analysis of the active ingredients of the extract will shed light on the development of a novel treatment for sarcopenia.

Forecasting Healthy Life Expectancy Among Chilean Community-Dwelling Older Adults With and Without Sarcopenia

BACKGROUND

Sarcopenia is an important risk factor for disability and dependency at old age. The prevalence of sarcopenia among the Chilean older population is high.

OBJECTIVE

To estimate life expectancy, healthy life expectancy and unhealthy life expectancy among sarcopenic and non-sarcopenic older adults from Santiago, Chile.

METHODS

A sample of 1,897 community-dwelling older adults aged 60 years or more, living in Santiago, was observed between 5-15 years. Disability was defined as the unhealthy state, assessed through self-reported difficulties in activities of daily living. Sarcopenia was determined via HTSMayor software. Total and marginal life expectancies were estimated using the Interpolated Markov Chain method "IMaCh".

RESULTS

At 60 years, estimated life expectancy for sarcopenic and non-sarcopenic older adults was similar (22.7 and 22.5 years, respectively). The proportion of years to be lived with disability was three times greater in sarcopenic adults, compared to non-sarcopenic people. This difference was observed up to 80 years. Non-sarcopenic women had a higher proportion of years to be lived with disabilities compared to non-sarcopenic men of the same age, but this proportion was higher among sarcopenic men, compared to sarcopenic women until 70 years of age.

DISCUSSION

People with sarcopenia expect to live a higher proportion of years with disabilities. Sarcopenic men until 70 years expected to live a higher proportion of years with disability, compared to sarcopenic women. Monitoring sarcopenia among older people may help to identify individuals with higher risk of disability onset. Future research should focus on disentangling the mechanisms explaining sex differences.

Besides Sarcopenia, Pre-Sarcopenia Also Predicts All-Cause Mortality in Older Chileans

PURPOSE

Many studies have demonstrated that Sarcopenia causes a serious impact on health, including death in older adults. The objective of this study was to determine the association of sarcopenia and pre-sarcopenia with all-cause mortality in older Chileans.

SUBJECTS AND METHODS

Follow-up of 2311 community-dwelling people ≥ 60y from the Alexandros cohort. Anthropometric measurements, handgrip strength, mobility, and physical performance tests were performed. Sarcopenia, pre-sarcopenia, and severe sarcopenia were defined using the 2010 European Working Group on Sarcopenia in Older People (EWGSOP1) algorithm. Muscle mass was estimated using a prediction model with cut-off points validated for the Chilean population. Physical performance was determined by 3 m walking speed or five chair-stands or time up go test (TUG). Mortality data were obtained from death certificates of the National Civil Registry. Life tables for survival data, Kaplan Meier estimations, and Cox regression were calculated.

RESULTS

The prevalence of sarcopenia was 20.2% (95% CI:18.6% to 21.9%) and similar in both sexes; pre-sarcopenia was identified in 20.4% (95% CI:18.8% to 22.1%) of the sample. Kaplan Meier survival estimates demonstrated lower survival rates for the people with sarcopenia and pre-sarcopenia (Log rank test for equality of survivor functions: p<0.0001). A dose-response was observed in the survival rates according to the stages of sarcopenia, showing the lowest survival rates for the people with severe sarcopenia, followed by older adults with sarcopenia, pre-sarcopenia, and without sarcopenia (Log rank test for equality of survivor functions: p<0.0001). After adjusting for age, sex, nutritional status, and number of chronic diseases, hazard ratios for death showed higher risk for subjects with sarcopenia (HR=1.47, 95% CI:1.17-1.83) and pre-sarcopenia (HR=1.35, 95% CI:1.03-1.78) in comparison with people without sarcopenia.

CONCLUSION

The results confirm a dose-response increase in the risk of all-cause death in older adults with sarcopenia and pre-sarcopenia compared to non-sarcopenic individuals.