Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview

Muscle or Heart? Functional Impact of Sarcopenia and Heart Failure in Geriatric Inpatients

Objectives: To evaluate the individual and combined impact of sarcopenia (SARC) and heart failure (HF) on functional performance, systemic biomarkers, and structural cardiac changes in hospitalized older adults. A total of 598 patients aged ≥65 years admitted to a geriatric unit between January 2023 and December 2024, stratified into four groups based on the presence or absence of sarcopenia and HF. Methods: Muscle strength (handgrip), gait speed, SPPB score, and calf circumference were assessed, along with inflammatory/nutritional markers and echocardiographic parameters. Sarcopenia was diagnosed according to EWGSOP2 criteria and HF was diagnosed according to ESC 2021 guidelines. Results: Functional impairment was the most severe in the SARC+/HF+ group, with significantly lower handgrip strength, gait speed, and SPPB scores (p < 0.001). Sarcopenia alone was associated with greater functional decline than HF alone. Serum hemoglobin and albumin levels were reduced in sarcopenic groups, while NT-proBNP and cardiac remodeling indices (IVS and LVEDD) were highest in patients with both conditions. Conclusions: Sarcopenia exerts a significant impact on physical performance in older adults, surpassing that of HF in isolation. The coexistence of sarcopenia and HF amplifies vulnerability and clinical decline, supporting the need for integrated assessment and early muscle-targeted interventions in geriatric cardiology.

Assessment of Sarcopenia Using Rectus Femoris Ultrasound in Emergency Patients-A Cross-Sectional Study

Background: Sarcopenia is a progressive muscle disorder commonly associated with aging and chronic diseases. It has been linked to worse clinical outcomes and increased vulnerability during acute illness. However, its prevalence in emergency department (ED) populations remains underexplored. This study aimed to evaluate the presence of sarcopenia among ED patients using ultrasound, determine its relationship with underlying comorbidities, and assess its association with in-hospital complications. Methods: We conducted a prospective, observational, cross-sectional study at the Infanta Cristina University Hospital (Madrid, Spain) from January to May 2024. A total of 150 patients aged 18 years and older who presented to the ED were assessed for sarcopenia using rectus femoris ultrasound. Sociodemographic, clinical, and laboratory variables were collected. A multivariate logistic regression model was used to identify independent predictors of in-hospital complications. Patients were followed for 30 days to evaluate outcomes. Comparisons were made between diagnostic groups and sarcopenia indices. Results: The mean age of the cohort was 70.7 years (SD 18.15), and 52% were male. Neurological diseases were associated with the highest degree of sarcopenia (mean Y-axis: 0.93 cm), followed by digestive (1.05 cm), hematological (1.05 cm), and cardiovascular diseases (1.08 cm). Patients who developed in-hospital complications had lower mean muscle thickness values compared to those without complications (1.08 cm vs. 1.24 cm; p < 0.05). Sarcopenia was significantly correlated with the presence of comorbidities and poor clinical outcomes. Conclusions: These findings support the integration of sarcopenia screening protocols into emergency care and highlight the need for studies exploring early nutritional or rehabilitation interventions targeted at high-risk patients.

Association between Skeletal Muscle Mass and Ocular Perfusion Pressure in Glaucoma

PURPOSE

This study aimed to investigate the relationship between body composition and glaucoma by analyzing the associations between anthropometric and ocular parameters.

METHODS

A total of 494 eyes from 247 patients were reviewed from a general health examination database at a tertiary hospital. Anthropometric parameters were assessed using a multifrequency bioelectrical impedance device. Mean ocular perfusion pressure (MOPP) was calculated based on systolic and diastolic blood pressures and intraocular pressure (IOP). Retinal thickness and other ocular parameters were analyzed for their association with body composition.

RESULTS

A total of 221 eyes from 221 patients, including 104 with glaucoma, were enrolled in the final analysis. The prevalence of sarcopenia was significantly higher in patients with glaucomatous damage than in those without (p = 0.025). Higher IOP showed significant associations with lower MOPP (p < 0.001), higher body mass index (BMI; p = 0.001), and higher waist to hip ratio (p = 0.001). Retinal thickness was not significantly associated with body composition parameters, including BMI and appendicular lean mass adjusted with squared height. Higher MOPP was significantly correlated with lower IOP (p < 0.001), higher BMI (p < 0.001), higher waist to hip ratio (p < 0.001), and higher appendicular lean mass divided by squared height (p = 0.009).

CONCLUSIONS

Skeletal muscle mass and BMI were significantly associated with MOPP. Since low MOPP is a known risk factor for glaucoma, its association with skeletal muscle mass may indicate a relationship between systemic muscle health, ocular blood perfusion, and glaucomatous damage. Further large-scale studies are needed to validate these associations between skeletal muscle mass and glaucoma and explore their clinical implications.

Subclinical atherosclerosis and sarcopenia: A prospective study

The relationship between subclinical carotid artery atherosclerosis and sarcopenia has not been clarified in many respects. In this study, the possible relationship between composite clinical sarcopenia indices and various levels of subclinical atherosclerosis parameters was revisited. The Ishii score (Ishii-max and Ishii-average) was used to determine sarcopenia in 257 prospectively recruited healthy controls and patients with neurological diseases (age: 65 ± 10 years, 50% female). Carotid artery distensibility indices (stress, strain, modulus, stiffness, and distensibility), intima-media thickness (IMT-max and IMT-mean), and 10 Kate plaque burden score were obtained for ultrasonographic subclinical atherosclerosis evaluation, together with detailed clinical and anthropometric, quality of life, and nutritional assessments. Sarcopenic subjects (n = 75) were older, slimmer, and at higher risk of malnutrition (Malnutrition Universal Screening Tool score > 0) than nonsarcopenic subjects (n = 182). IMT-mean and IMT-max were significantly higher in sarcopenic cases (mean difference: 45 microns and 60 microns, respectively, P < .05). Carotid plaque burden score was significantly higher in sarcopenic patients (average score: 2.2 vs 0.8 in sarcopenic and nonsarcopenic ones, P < .001). There was no difference in terms of carotid artery distensibility parameters. In various regression models, the Ishii score was always determined as an independent predictor of IMT-max and IMT-mean in the models (standardized beta, from 0.132-0.168; partial-r, from 0.156-0.201; p, from 0.019-0.001). Structural indices of subclinical atherosclerosis (carotid IMT and plaque burden), but not functional ones (carotid artery modulus and distensibility), are significantly abnormal in sarcopenic subjects. If future research validates these findings, employing ultrasonographic atherosclerosis indices as surrogate markers in sarcopenia treatments could address a crucial unmet need.

The Association Between Sarcopenia Index and Aortic Valve Sclerosis in Coronary Artery Disease Patients: Insights from a Retrospective Cross-Sectional Analysis and Animal Models

Background

The Sarcopenia Index (SI) is a recognized predictor of cardiovascular risk in patients with coronary artery disease (CAD), yet its association with aortic valve sclerosis (AVSc) remains insufficiently studied. This study aimed to examine the relationship between SI and AVSc in CAD patients.

Methods

In this retrospective study, 1056 CAD patients at Shanghai Ruijin Hospital underwent SI assessment and Doppler echocardiography. SI was calculated as [serum creatinine (mg/dL)/cystatin C (mg/L)] × 100. Logistic regression, subgroup analyses, and restricted cubic splines evaluated the SI-AVSc association. ROC curves determined SI's diagnostic value and its addition to traditional AVSc factors. In parallel with clinical observations, aortic valve changes were analyzed in mice via hematoxylin and eosin, AlizarinRed S, and Masson's trichrome to assess valve thickness, fibrosis and calcification.

Results

Patients with the lowest SI levels showed a higher prevalence of AVSc. Multivariate logistic regression revealed that SI was independently associated with AVSc (P<0.001). The C-statistic for SI in identifying AVSc was 0.708 (95% CI: 0.671, 0.744), and it improved risk stratification when SI was added to traditional clinical models (C-statistic increased from 0.840 to 0.866). In the subgroup analysis, the discriminatory power of SI was enhanced among elderly patients. Findings from animal models supported these results, and Spearman correlation analyses revealed negative correlation between SI and peak systolic aortic valve flow velocity (Spearman's rho=-0.578, P=0.006). Histological analysis demonstrated that aortic valve leaflets in the low SI group were thicker and more fibrotic than those in the high SI group, and this complementary approach provided mechanistic insights into how sarcopenia may promote valve degeneration in elder mice.

Conclusion

Lower Sarcopenia Index is associated with the presence of AVSc in CAD patients. SI improves risk stratification and acts as a valuable associated marker for AVSc, emphasizing its potential clinical utility in enhancing patient management.

Antioxidant Diets and Lifestyles Could Mitigate the Risk of Sarcopenia with Low Muscle Mass in Women: A Retrospective Study

Background: Sarcopenia is characterized by a loss of muscle mass, strength, and function. At present, there are no effective methods available for prevention or treatment. Oxidative Balance Score (OBS) has been shown to be significantly correlated with a decreased risk of sarcopenia. Nevertheless, gender-specific studies still exhibit certain limitations. Methods: Individuals who completed dual-energy X-ray absorptiometry and the diet and lifestyle questionnaires from the National Health and Nutrition Examination Survey were enrolled. OBSs were calculated according to dietary or lifestyle variables and physical activity. Sarcopenia with low muscle mass (SLM) was identified based on the ratio of appendicular skeletal muscle mass to body mass index. A logistic regression analysis investigated the association between OBS and the risk of SLM in different gender groups. Kaplan-Meier survival and subgroup analyses and Cox regression analyses were used to explore the relationship between OBS and mortality in individuals with SLM in each gender subgroup. Results: The level of OBS in the SLM group was lower (20.40 vs. 17.07, p < 0.05). A multivariate logistic regression analysis showed that the OR between individual dietary nutrients and lifestyle and the risk of SLM exhibition was gender-specific. Stratified analyses revealed that total OBS, as well as diet and lifestyle OBS were negatively associated with the risk of SLM within each gender subgroup (all p < 0.05, all trends p < 0.05). Furthermore, a restriction cubic spline regression analysis showed that diet and lifestyle OBSs were negatively correlated with the risk of SLM in females (nonlinear p = 0.0469, nonlinear p = 0.0254). The KM curve showed that OBS was not significantly associated with all-cause mortality in the male and female subgroups (female, p = 0.064, male, p = 0.53). Conclusions: This study establishes a significant negative correlation between OBS and the risk of SLM, particularly among females. Consequently, adopting an antioxidant diet and lifestyle may prove to be more advantageous for females.

Beyond body mass index: the role of muscle strength in reducing mortality risk in older adults with severe obesity - multi-country cohort study

BACKGROUND/OBJECTIVE

Since muscle strength is modifiable and handgrip strength is a reliable biomarker for strength and mortality, exploring its association with mortality in individuals with severe obesity could help identify protective thresholds. We aimed to examine the dose-response association between handgrip strength and mortality in adults with severe obesity.

SUBJECTS/METHODS

We retrieved data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Handgrip strength was measured in participants with a body mass index (BMI) higher than 40 kg/m2. We used time-varying Cox proportional hazards regression to assess the association between handgrip strength and all-cause mortality risk. To account for potential non-linearity, we employed restricted cubic splines. We examined a total of 2229 adults (67.9% women; BMI of 43.8 kg/m2).

RESULTS

We found an association between handgrip strength and mortality, showing a minimal and optimal dose for a reduced risk with 31 kg (HR 0.97, 95% CI, 0.96-0.99) and 36 kg (HR 0.90, 95% CI, 0.81-0.99), respectively. Additional sex-stratified analysis showed that lower than median levels of handgrip strength were gradually associated with increased risk in both men and women.

CONCLUSIONS

The association between handgrip strength and all-cause mortality in European adults with severe obesity highlights practical thresholds for risk reduction, with 31 kg as the minimum and 36 kg as the optimal strength level. In both men and women, handgrip strength below the median was linked to a gradual increase in mortality risk, emphasizing the importance of maintaining adequate muscle strength to improve health outcomes.

Endothelial IGF- 1R deficiency disrupts microvascular homeostasis, impairing skeletal muscle perfusion and endurance: implications for age-related sarcopenia

Aging is associated with a progressive decline in circulating insulin-like growth factor- 1 (IGF- 1) levels in humans, which has been implicated in the pathogenesis of sarcopenia. IGF- 1 is an anabolic hormone that plays a dual role in maintaining skeletal muscle health, acting both directly on muscle fibers to promote growth and indirectly by supporting the vascular network that sustains muscle perfusion. However, the microvascular consequences of IGF- 1 deficiency in aging muscle remain poorly understood. To elucidate how impaired IGF- 1 input affects skeletal muscle vasculature, we examined the effects of endothelial-specific IGF- 1 receptor (IGF- 1R) deficiency using a mouse model of endothelial IGF- 1R knockdown (VE-Cadherin-CreERT2/Igf1rf/f mice). These mice exhibited significantly reduced skeletal muscle endurance and attenuated hyperemic response to acetylcholine, an endothelium-dependent vasodilator. Additionally, they displayed microvascular rarefaction and impaired nitric oxide-dependent vasorelaxation, indicating a significant decline in microvascular health in skeletal muscle. These findings suggest that endothelial IGF- 1R signaling is critical for maintaining microvascular integrity, muscle perfusion, and function. Impaired IGF- 1 input to the microvascular endothelium may contribute to reduced muscle blood flow and exacerbate age-related sarcopenia. Enhancing vascular health by modulating IGF- 1 signaling could represent a potential therapeutic strategy to counteract age-related muscle decline.

Identifying semaphorin 3C as a biomarker for sarcopenia and coronary artery disease via bioinformatics and machine learning

OBJECTIVE

Sarcopenia not only affects patients' quality of life but also may exacerbate the pathological processes of coronary artery disease (CAD). This study aimed to identify potential biomarkers to improve the combined diagnosis and treatment of sarcopenia and CAD.

METHODS

Datasets for sarcopenia and CAD were sourced from the Gene Expression Omnibus (GEO). Weighted gene co-expression network analysis (WGCNA) was used to identify key module genes. Functional enrichment analysis was conducted to explore biological significance. Three machine learning algorithms were applied to further determine candidate hub genes, including SVM-RFE, LASSO regression, and random forest (RF). Then, we generated receiver operating characteristic (ROC) curves to evaluate the diagnostic efficacy of the candidate genes. Moreover, mendelian randomization (MR) analysis was conducted based on GWAS summary data, along with sensitivity analysis to explore causal relationships.

RESULTS

WGCNA analysis identified 278 genes associated with sarcopenia and CAD. The results of the enrichment analysis indicated a complex interplay between RNA metabolism, signaling pathways, and cellular stress responses. Through machine learning methods and ROC curves, we identified the key gene semaphorin 3C (SEMA3C). MR analysis revealed that higher plasma levels of SEMA3C are associated with an increased risk of CAD (OR = 1.068, 95 % CI 1.012-1.128, P = 0.016) and low hand grip strength (HGS) (OR = 1.059, 95 % CI 1.010-1.110, P = 0.018) .

CONCLUSION

SEMA3C has been identified as a key gene for sarcopenia and CAD. This insight suggests that targeting SEMA3C may offer new therapeutic opportunities in related conditions.

Changes in Mental and Physical Health Outcomes Following One Day a Week Cardiopulmonary Rehabilitation in Regional New South Wales

INTRODUCTION

Cardiopulmonary rehabilitation participation rates in regional Australia remain poor, with outcomes further worsened by the limited number of cardiopulmonary rehabilitation professionals in these settings.

OBJECTIVE

This study investigated the role of cardiopulmonary rehabilitation in improving physical and mental health outcomes of participants with heart or lung diseases in a regional NSW centre.

DESIGN

A retrospective study of adults who attended a 1-h session per week cardiac or pulmonary rehabilitation programme at Bathurst Hospital between January 2021 and December 2023.

MAIN OUTCOME MEASURES

Pre- and post-rehabilitation assessments were conducted, which included heart rate, blood pressure, oxygen saturation, waist circumference, rating of perceived exertion, 5-sit-to-stand test (5-STS), 6-min walk test (6MWT), and the patient health questionnaire-9 for assessment of depression (PHQ-9 score ≥ 10 = major depression).

FINDINGS

Data for eligible participants (n = 186, mostly males 57.5%), aged 69 ± 12 years, were analysed. There were statistically significant improvements (pre vs. post) in mean PHQ-9 scores (6.3 vs. 4.2, p < 0.001), 5-STS (15.8 vs. 12.5 s, p < 0.001), 6MWT (328.6 vs. 377.9 m, p < 0.001) and waist circumference (104.7 vs. 103.9 cm, p < 0.03) post-rehabilitation. Compared with pre-rehabilitation measures, the overall proportion with major depression was significantly lower by 50% (25.3% vs. 12.4%, p < 0.05) post-rehabilitation. This decrease was significant for the cardiac (11.6% decrease) and pulmonary (15.4% decrease) rehabilitation participants.

CONCLUSION

Despite the limiting structure of one session per week for the cardiopulmonary rehabilitation programme at this regional centre, participants showed significant improvements in their mental and physical health at the end of the programme. Funding such organic programmes will yield a greater positive impact on the health of people in this region.

Unveiling the Systemic Impact of Congestion in Heart Failure: A Narrative Review of Multisystem Pathophysiology and Clinical Implications

Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium retention, leading to maladaptive left ventricular remodeling. Hepatic congestion contributes to cholestatic liver injury, while metabolic disturbances drive anemia, muscle wasting, and systemic inflammation. Additionally, congestion disrupts the intestinal barrier and immune function, exacerbating HF progression. Given its widespread impact, effective congestion management requires a shift from a cardiovascular-centered approach to a comprehensive, multidisciplinary strategy. Targeted decongestive therapy, metabolic and nutritional optimization, and immune modulation are crucial in mitigating congestion-related organ dysfunction. Early recognition and intervention are essential to slow disease progression, preserve functional capacity, and improve survival. Addressing HF congestion through personalized, evidence-based strategies is vital for optimizing long-term care and advancing treatment paradigms.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Visceral Fat, Metabolic Health, and Lifestyle Factors in Obstructive Bronchial Diseases: Insights from Bioelectrical Impedance Analysis

Background/Objectives: This study examines the relationship between visceral fat (VF), metabolic health, and dietary patterns in patients with obstructive bronchial diseases (OBDs) using bioelectrical impedance analysis (BIA). Methods: A total of 75 patients diagnosed with OBD, including chronic obstructive pulmonary disease (COPD) and/or asthma, were assessed for VF levels via BIA. Dietary habits were evaluated using a structured questionnaire to explore their correlation with VF accumulation. Results: The study cohort comprised predominantly male participants (66.7%), with the majority aged between 61 and 70 years (46.7%). Significant gender differences in VF distribution were observed, with 60% of females maintaining normal VF levels (1-9) compared to only 28% of males, while 38% of males exhibited very high VF levels (15-30; p = 0.003). Body mass index (BMI) showed a strong correlation with VF (p < 0.0001), as overweight and obese individuals predominantly displayed elevated VF levels (≥10). Moreover, metabolic syndrome (MS) was present in 66.7% of participants, with these individuals exhibiting significantly higher VF levels compared to those without MS (p = 0.001). Dietary analysis revealed that frequent consumption of fast food (r = 0.717, p < 0.001), carbonated drinks (r = 0.366, p = 0.001), and refined carbohydrates (r = 0.438, p < 0.001) was significantly associated with increased VF accumulation. Conversely, higher intake of water (r = -0.551, p < 0.001), fruits (r = -0.581, p < 0.001), and vegetables (r = -0.482, p < 0.001) correlated with lower VF levels. Lack of physical activity was also strongly linked to VF accumulation (r = 0.481, p < 0.001), further reinforcing the role of lifestyle factors in metabolic health. Conclusions: The findings underscore the significant impact of dietary habits and physical activity on VF accumulation in OBD patients. BMI and MS emerged as critical predictors of VF, while unhealthy dietary patterns and sedentary lifestyles further exacerbated VF deposition. Elevated VF levels were linked to adverse lipid profiles, reinforcing the need for dietary and lifestyle modifications in managing metabolic health among OBD patients. Although no direct association was identified between VF and forced expiratory volume in one second (FEV1), the results highlight the necessity of integrated nutritional and metabolic interventions in the management of chronic respiratory diseases.

The influence of malnutrition-sarcopenia syndrome on chorioretinal microvasculature using optical coherence tomography angiography

PURPOSE

To probe into the effects of malnutrition-sarcopenia syndrome on the changes of retinal and choroidal microvasculature.

METHODS

To achieve our goals, we employed optical coherence tomography angiography (OCTA), a cutting-edge non-invasive imaging technique, to compare retinal and choroidal parameters in a controlled setting. A total of 22 participants diagnosed with Malnutrition-Sarcopenia Syndrome were enrolled alongside 22 healthy subjects matched for age and gender as controls. Parameters under scrutiny included inner retinal vessel flow density (VFD), total retinal thickness, and choroidal thickness, choroidal vascularity index (CVI). Linear regression analyses were performed to identify any significant variations of systemic profles associated with retinal and choroidal parameters.

RESULTS

Our data unveiled substantial discrepancies in the retinochoroidal microvascular health between the patient cohort and the control group. Specifically, the patients with malnutrition-sarcopenia syndrome showcased notably diminished values in inner retinal VFD, total retinal thickness, choroidal thickness and CVI, all with extreme statistical significance (p < 0.0001). Further, body mass index (BMI) exhibited a noteworthy positive association with retinal thickness (p = 0.026), whereas skeletal muscle index (SMI) showed a similar trend with choroidal thickness and CVI through both univariate and multiple linear regression analyses. Besides, pearson's correlation analysis also indicated that SMI was positively correlated with choroidal thickness and CVI in the sarcopenia patients.

CONCLUSIONS

The collective evidence suggests that malnutrition coupled with sarcopenia exerts deleterious effects on chorioretinal microvasculature, with potential repercussions on visual function. This research underscores the imperative of proactive monitoring and early intervention targeting chorioretinal microvasculature changes in patients battling malnutrition-sarcopenia syndrome.

The causal relationships between iron status and sarcopenia in Europeans: a bidirectional two-sample Mendelian randomization study

BACKGROUND

Previous studies have indicated potential associations between metals, lifestyle factors, and sarcopenia. However, the specific causal relationships between iron status, lifestyle factors, and sarcopenia remain unclear. Therefore, we conducted a bidirectional two-sample Mendelian Randomization (MR) approach to investigate these relationships.

METHODS

The exposure variables included iron status, living alone, coffee intake, alcohol taken with meals, and moderate physical activity, while the outcome variable was sarcopenia, assessed by grip strength in both hands and usual walking pace. We employed the Weighted Median (WM), the Inverse Variance-Weighted (IVW), and other MR methods to explore these problems for analysis. Simultaneously, we conducted a bidirectional MR analysis to assess whether sarcopenia has a reverse causal relationship with internal iron status.

RESULTS

In our present research, we found serum iron (P = 0.033), ferritin (P = 0.001), transferrin saturation (P = 0.029) and coffee intake (P = 0.002) revealed a negative trend for sarcopenia, living alone (P = 0.022) and alcohol taken with meal (P = 0.006) showed a opposite trend for sarcopenia. Whereas sarcopenia showed negative trend for ferritin (P = 0.041) and transferrin saturation (P = 0.043), showed the opposite trend for transferrin (P = 0.021).

CONCLUSION

Our study suggested that higher serum iron levels might reduce the risk of sarcopenia. Moreover, living alone and alcohol consumption might increase the sarcopenia risk, while coffee intake and moderate physical activity could reduce the sarcopenia risk.

Relationship Between Lifestyle and Physical Fitness Among Older Women with Sarcopenia

This cross-sectional study aimed to identify the interactions between lifestyle-related, diagnostic, and physical strength-related sarcopenia factors. The study included 512 female participants aged 60-100 years from Incheon, Republic of Korea, recruited from 12 institutions. Participants engaged in the study from June to August 2023. We administered questionnaires on demographic characteristics and health indicators and undertook physical measurements, including grip strength and body composition. Hierarchical regression analysis and two-way analysis of variance were conducted to examine the association between sarcopenia and the examined variables. Statistical significance was set at p < 0.05. Hierarchical regression analysis of the variables affecting sarcopenia showed each characteristic's effect: Model 1 (basic characteristic): R2, 0.391; p < 0.001; Model 2 (Model 1 + additional characteristics): R2, 0.427; p < 0.001. Hierarchical regression analysis of diagnostic and fitness factors affecting sarcopenia also showed an effect on sarcopenia (Model 1 (basic characteristics): R2, 0.318; p < 0.001; Model 2 (Model 1 + body composition): R2, 0.419; p < 0.001; Model 3 (Model 2 + fitness factors): R2, 0.664; p < 0.001). This study enhances the understanding of sarcopenia by investigating its connections with sociodemographic factors, lifestyle choices, and physical activity. The study underscores that lifestyle factors sustainably influence sarcopenia while confirming its correlation with fitness-related factors. Notably, this study highlights the results that muscle function is very important in preventing sarcopenia and that continuous physical activity and types of physical activity affect it.

FOXO regulation of TXNIP induces ferroptosis in satellite cells by inhibiting glutathione metabolism, promoting Sarcopenia

Aging-related sarcopenia represents a significant health concern due to its impact on the quality of life in the elderly. This study elucidates the molecular mechanisms underlying sarcopenia by employing single-cell sequencing and public transcriptome databases to compare young and aged mouse skeletal muscles. Cellular classification and pseudotime analyses differentiated cell types and their interrelationships, revealing a marked reduction in satellite cell numbers and a consistent upregulation of TXNIP (Thioredoxin interacting protein) across various muscle cell populations in aged mice. Further transcriptomic data integration and batch correction from the GEO (Gene Expression Omnibus) database highlighted key differentially expressed genes. The role of TXNIP and its transcriptional regulation by FOXO1 (Forkhead box O1) was confirmed through in vitro experiments, which demonstrated FOXO1's influence on TXNIP expression and its subsequent suppression of glutathione metabolism, leading to satellite cell ferroptosis. Additionally, in vivo studies showed that overexpression of TXNIP in young mice's muscle tissues significantly reduced muscle mass, suggesting its potential role in the initiation of sarcopenia. Our findings suggest that FOXO1-mediated regulation of TXNIP and the disruption of glutathione metabolism are central to the process of sarcopenia, offering new insights into its pathogenesis.

Personalised screening tool for early detection of sarcopenia in stroke patients: a machine learning-based comparative study

BACKGROUND

Sarcopenia is a common complication in patients with stroke, adversely affecting recovery and increasing mortality risk. However, no standardised tool exists for its screening in this population. This study aims to identify factors influencing sarcopenia in patients with stroke, develop a risk prediction model and evaluate its predictive performance.

METHODS

Data from 794 patients with stroke were analysed to assess demographic and clinical characteristics. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate regression analysis. Logistic regression (LR), random forest (RF) and XGBoost algorithms were used to construct prediction models, with the optimal model subjected to external validation. Internal validation was conducted via bootstrap resampling, and external validation involved an additional cohort of 159 patients with stroke. Model performance was assessed using the area under the curve (AUC), calibration curves and decision curve analysis (DCA).

RESULTS

Seven variables were identified through LASSO and multivariate regression analysis. The LR model achieved the highest AUC (0.805), outperforming the RF (0.796) and XGBoost (0.780) models. Additionally, the LR model exhibited superior accuracy, precision, recall, specificity and F1-score. External validation confirmed the LR model's robustness, with an AUC of 0.816. Calibration and DCA curves demonstrated their accuracy and clinical applicability.

CONCLUSIONS

A predictive model, presented as a nomogram and an online risk calculator, was developed to assess sarcopenia risk in patients with stroke. Early screening using this model may facilitate timely interventions and improve patient outcomes.

Time Allocation to Physical Activity and Sedentary Behaviour and Its Impact on Sarcopenia Risk: A Systematic Review and Meta-Analysis

AIM

To evaluate the relationship between time spent in sedentary behaviour and physical activity and sarcopenia in older adults, and to analyse the effect of reallocating time between different intensities of activities on sarcopenia.

DESIGN

Systematic review and meta-analysis.

METHODS

Following PRISMA guidelines, data were synthesised using a random-effects model, with heterogeneity assessed via Cochran's Q test and the I2 statistic. Study quality was evaluated using the Newcastle-Ottawa Scale by two independent reviewers.

DATA SOURCES

A comprehensive search was conducted in PubMed, Web of Science, Embase, CINAHL and Cochrane databases for studies published up to November 5, 2024, with no language or date restrictions. Relevant reference lists were also manually screened.

RESULTS

The present review included six studies involving 9914 older adults. Three studies suggested that older adults without sarcopenia spent more time performing light physical activities (SMD: 0.35; 95% CI: 0.24-0.45) and moderate to vigorous physical activity (SMD: 0.61; 95% CI: 0.49-0.74) and had less sedentary behaviour (SMD: -0.34; 95% CI: -0.51 to -0.16) than did older adults with sarcopenia. Replacing sedentary behaviour with an equivalent amount of moderate to vigorous physical activity (10, 30, or 60 min) each day can reduce the risk of sarcopenia, with 30 min showing the best preventive effect. However, research findings on the relationship between substituting sedentary behaviour time with light physical activities and sarcopenia are inconsistent.

IMPLICATIONS FOR THE PROFESSION

Encouraging older adults to engage in moderate to vigorous physical activity, even in short bouts of 10 min, can significantly reduce the risk of sarcopenia. Healthcare professionals should tailor activity recommendations to individual preferences and physical conditions to promote overall health and reduce sedentary behaviour.

PATIENT AND PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL REGISTRATION

CRD42023416166.

Impact of resistance training and chicken intake on vascular and muscle health in elderly women

BACKGROUND

Resistance training is a well-known exercise therapy for preventing and improving lacks of muscle mass, strength, and quality with advances in age; however, its effects on arterial stiffness are not beneficial. Additionally, a higher intake of protein, which is an effective nutrient for muscle health, results in lower arterial stiffness. Whether the combination of moderate to high-intensity resistance training and high-protein intake would improve muscle mass, strength, and quality and cancel the resistance training-induced increase in arterial stiffness in elderly women remains unclear.

METHODS

Ninety-three elderly women (67.2 ± 5.3 years) were randomly divided into four groups; sedentary control (CON), higher dietary animal protein intake (HP), resistance training (RT), and combination of RT and HP (RT + HP) groups. Participants in the RT and RT + HP groups completed 12 weeks of resistance training (exercise intensity at 70% of one-repetition maximum (1-RM), three sets with 10 repetitions of leg extension and curls, 3 days/week). In addition to the daily diet, the HP and RT + HP groups consumed steamed chicken breast as a high-protein diet.

RESULTS

Percent changes in thickness (indices of muscle mass) and echo intensity (index of muscle quality) in the quadriceps muscle, 1-RM of leg extension and curls (index of muscle strength), and circulating C1q levels (a potential biomarker of muscle fibrosis) in the RT and RT + HP groups significantly improved after both RT and RT + HP interventions (P < 0.05). Percent changes in carotid-femoral pulse wave velocity (cfPWV) and carotid β-stiffness (indices of arterial stiffness), and circulating angiotensin II (a vasoconstrictor peptide hormone) levels via each intervention were significantly higher in the RT group (4.9 ± 12.7%, 13.8 ± 13.5%, 94.9 ± 132.7%, respectively), as compared with the CON group (-2.5 ± 5.9%, 0.2 ± 8.1%, 21.2 ± 79.3%, respectively) (P < 0.05). Of note, no significant differences in the cfPWV, carotid β-stiffness, and circulating angiotensin II levels between the RT + HP (-2.4 ± 9.3%, 2.4 ± 10.3%, -5.7 ± 29.6%, respectively) and CON groups were observed. Furthermore, significant positive relationships between the percent changes in circulating angiotensin II levels, and cfPWV (r = 0.438, P < 0.01) and carotid β-stiffness (r = 0.328, P < 0.01) were observed.

CONCLUSIONS

The combination of moderate to high-intensity resistance training and regular intake of steamed chicken breast as a high-protein food could increase muscle mass, strength, and quality and could cancel resistance training-induced increases in arterial stiffness in elderly women.

A Natural Autophagy Activator Castanea crenata Flower Alleviates Skeletal Muscle Ageing

BACKGROUND

Sarcopenia, characterized by a gradual decline in skeletal muscle mass and function with age, significantly impacts both quality of life and mortality. Autophagy plays a crucial role in maintaining muscle health. There is growing interest in leveraging autophagy to mitigate muscle ageing effects. The impact of natural autophagy activators on skeletal muscle ageing remains elusive. This study aims to identify natural autophagy activators and assess their effects on skeletal muscle ageing.

METHODS

To discover novel autophagy activators, we screened 493 natural products and identified Castanea crenata flower extract (CCFE) as a promising candidate. We investigated the effect of CCFE on cellular senescence in C2C12 cells induced by etoposide. In animal experiments, aged mice (18 months old) were fed a diet supplemented with 0.1% and 0.2% CCFE for 3 months. We assessed exercise capacity, mitochondrial function and autophagic flux to determine the impact of CCFE on skeletal muscle ageing. The components present in CCFE were analysed using LC-MS/MS, and their functional properties were examined.

RESULTS

CCFE enhanced autophagic flux (LC3II 80% increase, p < 0.05) and reduced senescence-associated β-galactosidase activity (32.78% decrease, p < 0.001). In aged mice, a 3-month supplementation with CCFE improved muscle weight (18% increase, p < 0.05) and function (treadmill performance increased by 60%, p < 0.5; grip strength increased by 25%, p < 0.05). It alleviated mitochondrial dysfunction (basal oxygen consumption rate increased by 59%, p < 0.05) and restored autophagy. CCFE enhanced autophagy by activating AMPK (80% increase, p < 0.01) and inhibiting Atg5 protein acetylation (65% decrease, p < 0.001), with contributions from ellagic acid and polyamines. CCFE supplementation restored polyamine levels (serum spermidine increased from 0.98 ± 0.08 to 2.22 ± 0.05 μg/mL, p < 0.001) and increased urolithin levels (serum urolithin A increased from 0 to 18.79 ± 0.062 ng/mL, p < 0.001), metabolites produced by the gut microbiome from ellagic acid in aged mice.

CONCLUSIONS

CCFE effectively suppressed skeletal muscle ageing by preventing mitochondrial dysfunction and restoring autophagic flux in aged mice. It achieved this by modulating AMPK and EP300 acetyltransferase activity, with contributions from its constituents, ellagic acid and polyamines. These findings highlight the potential of CCFE as a therapeutic agent for extending healthspan and mitigating sarcopenia, providing a basis for future clinical trials.

The Association Between Low Muscle Mass and the Risk of Depressive Symptoms: A Cross-Sectional Study Based on the Chinese Longitudinal Health Longevity Survey (CLHLS)

BACKGROUND

Many studies have shown a strong link between sarcopenia and depression, and low muscle mass (LMM) is an important component in the diagnosis of sarcopenia; however, there have been no studies on the relationship between LMM and depressive symptoms in the Chinese elderly population. To estimate the potential relationship between LMM and depressive symptoms among older adults, a cross-sectional analysis was conducted utilizing data from the Chinese Longitudinal Health Longevity Survey (CLHLS).

METHOD

The study sample comprised 11,711 individuals aged 65 years or older (mean age 83.0 ± 10.9) from the CLHLS database in 2018. We used the corrected appendicular skeletal muscle mass (ASM) prediction formula to assess muscle mass and the 10-item Center for Epidemiological Studies-Depression Scale (CES-D-10) to assess depressive symptoms. A multivariate logistic regression model and restricted cubic spline (RCS) curves were employed to investigate the association between LMM and depressive symptoms.

RESULTS

The study findings revealed a 1.16-fold higher risk of depressive symptoms in the LMM group compared to the control group (adjusted odds ratio [aOR]: 1.16, 95% confidence intervals [95% CI]: 1.05-1.29, p < 0.001). Furthermore, for every one-point decrease in LMM score below 7.87, the risk of depressive symptoms increased by 8%, with statistical significance. However, when the LMM score was greater than or equal to 7.87, the decrease in the LMM score did not significantly increase the risk of depressive symptoms.

CONCLUSION

Our study suggests LMM is a risk factor for depressive symptoms in the elderly Chinese population, and within a certain range, the risk of depressive symptoms increases as the LMM score decreases. Physical exercise may be an effective strategy to maintain optimal muscle mass and help the mental health of the elderly.

Association between appendicular skeletal muscle mass and myocardial glucose uptake measured by 18F-FDG PET

BACKGROUND

Low muscle mass is associated with high insulin resistance and an increased risk of cardiovascular disease. This study aims to determine whether low muscle mass affects the alterations in myocardial substrate metabolism that are associated with the development of cardiovascular disease.

METHOD

The study included 299 individuals (182 men and 117 women) who underwent examination at the Severance Health Check-up Center between January 2018 and February 2019. Myocardial glucose uptake was assessed using [18F]-fluorodeoxyglucose-positron emission tomography (18F-FDG PET/CT) scanning. Direct segmental bioimpedance analysis was used to measure appendicular skeletal muscle mass (ASM).

RESULTS

We analysed men and women separately owing to sex-related body composition differences. ASM/Ht2 was significantly positively correlated with myocardial glucose uptake measured by 18F-FDG PET/CT [ln (SUVheart/liver)] only in men (r = 0.154, P = 0.038 in men; r = -0.042, P = 0.652 in women, respectively). In men, myocardial glucose uptake was significantly associated with ASM/Ht2 even after adjusting for multiple confounders in a multivariable linear regression model (standardized β = 0.397, P = 0.004, in men; β = - 0.051, P = 0.698, in women). In women, age (β = -0.424 P = 0.029) was independent determinants of myocardial glucose uptake.

CONCLUSIONS

In men, ASM was strongly associated with myocardial glucose uptake as measured by 18F-FDG PET/CT. In women, age was significantly correlated with myocardial substrate utilization, but not with ASM.

Age-Related Arterial Stiffening Is Associated with a Body Shape Index and Lean Body Mass Index: A Retrospective Cohort Study in Healthy Japanese Population

INTRODUCTION

Several anthropometric indices reflecting cardiometabolic risks have been developed, but the relationship of body composition with arterial stiffness remains unclear. We aimed to determine the interaction between age-related anthropometric changes and progression of arterial stiffness.

METHODS

This research analyzed cross-sectional data (N = 13,672) and 4-year longitudinal data (N = 5,118) obtained from a healthy Japanese population without metabolic disorders. The relationship of age with anthropometric indices comprising estimated lean body mass index (eLBMI), body mass index (BMI), waist circumference (WC), and a body shape index (ABSI) was examined. The mediating effects of the indices on the association between age and arterial stiffness assessed by cardio-ankle vascular index (CAVI) were analyzed.

RESULTS

Unlike BMI and WC, ABSI (Rs = 0.284) and CAVI (Rs = 0.733) showed a positive linear relationship with aging in stratified analyses. Especially in the middle-older age groups, eLBMI showed a declining trend with aging. An increase in ABSI was associated with a decrease in eLBMI, whereas increase in BMI or WC was related to increased eLBMI. In cross-sectional analyses, age was associated with CAVI, partially mediated by ABSI or eLBMI after adjusting confounders. Baseline CAVI correlated negatively with 4-year change in (Δ)eLBMI (Rs = -0.120 in men, -0.161 in women). ΔCAVI correlated negatively with ΔeLBMI (Rs = -0.031).

CONCLUSION

ABSI is a modifiable index that well reflects age-related changes in arterial stiffness and body composition including lean body mass. Since arterial stiffening may cause skeletal muscle loss, potentially creating a vicious cycle, prioritizing CAVI and anthropometric indices in clinical practice may be a useful strategy.

Investigating the Causal Effects of Exercise-Induced Genes on Sarcopenia

Exercise is increasingly recognized as an effective strategy to counteract skeletal muscle aging and conditions such as sarcopenia. However, the specific exercise-induced genes responsible for these protective effects remain unclear. To address this, we conducted an eight-week aerobic exercise regimen on late-middle-aged mice and developed an integrated approach that combines mouse exercise-induced genes with human GWAS datasets to identify causal genes for sarcopenia. This approach led to significant improvements in the skeletal muscle phenotype of the mice and the identification of exercise-induced genes and miRNAs. By constructing a miRNA regulatory network enriched with transcription factors and GWAS signals related to muscle function and traits, we focused on 896 exercise-induced genes. Using human skeletal muscle cis-eQTLs as instrumental variables, 250 of these exercise-induced genes underwent two-sample Mendelian randomization analysis, identifying 40, 68, and 62 causal genes associated with sarcopenia and its clinical indicators-appendicular lean mass (ALM) and hand grip strength (HGS), respectively. Sensitivity analyses and cross-phenotype validation confirmed the robustness of our findings. Consistently across the three outcomes, RXRA, MDM1, RBL2, KCNJ2, and ADHFE1 were identified as risk factors, while NMB, TECPR2, MGAT3, ECHDC2, and GINM1 were identified as protective factors, all with potential as biomarkers for sarcopenia progression. Biological activity and disease association analyses suggested that exercise exerts its anti-sarcopenia effects primarily through the regulation of fatty acid oxidation. Based on available drug-gene interaction data, 21 of the causal genes are druggable, offering potential therapeutic targets. Our findings highlight key genes and molecular pathways potentially responsible for the anti-sarcopenia benefits of exercise, offering insights into future therapeutic strategies that could mimic the safe and mild protective effects of exercise on age-related skeletal muscle degeneration.

Muscle quality and major adverse cardiovascular events in post-acute myocardial infarction: A prospective cohort study

BACKGROUND & AIMS

Functional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI.

METHODS AND RESULTS

This is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54-69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01-0.84).

CONCLUSION

Functional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI.

Vascular Impairment, Muscle Atrophy, and Cognitive Decline: Critical Age-Related Conditions

The triad of vascular impairment, muscle atrophy, and cognitive decline represents critical age-related conditions that significantly impact health. Vascular impairment disrupts blood flow, precipitating the muscle mass reduction seen in sarcopenia and the decline in neuronal function characteristic of neurodegeneration. Our limited understanding of the intricate relationships within this triad hinders accurate diagnosis and effective treatment strategies. This review analyzes the interrelated mechanisms that contribute to these conditions, with a specific focus on oxidative stress, chronic inflammation, and impaired nutrient delivery. The aim is to understand the common pathways involved and to suggest comprehensive therapeutic approaches. Vascular dysfunctions hinder the circulation of blood and the transportation of nutrients, resulting in sarcopenia characterized by muscle atrophy and weakness. Vascular dysfunction and sarcopenia have a negative impact on physical function and quality of life. Neurodegenerative diseases exhibit comparable pathophysiological mechanisms that affect cognitive and motor functions. Preventive and therapeutic approaches encompass lifestyle adjustments, addressing oxidative stress, inflammation, and integrated therapies that focus on improving vascular and muscular well-being. Better understanding of these links can refine therapeutic strategies and yield better patient outcomes. This study emphasizes the complex interplay between vascular dysfunction, muscle degeneration, and cognitive decline, highlighting the necessity for multidisciplinary treatment approaches. Advances in this domain promise improved diagnostic accuracy, more effective therapeutic options, and enhanced preventive measures, all contributing to a higher quality of life for the elderly population.

Association between SARC-F scores and risk of adverse outcomes in older patients with cardiovascular disease: a prospective study at a tertiary hospital in the south of Vietnam

Introduction

Older patients typically face elevated mortality rates and greater medical resource utilization during hospitalizations compared to their younger counterparts. Sarcopenia, serving as a prognostic indicator, is related to disability, diminished quality of life, and increased mortality. The SARC-F questionnaire, known for its cost-effectiveness, offers a valuable means of assessing sarcopenia. This study aims to explore the association between SARC-F scores and risk of adverse outcomes in elderly patients with cardiovascular disease at a Ho Chi Minh City hospital.

Method

Participants aged 60 and above, admitted to the Department of Cardiology - Interventional and Cardiovascular Emergency of Thong Nhat Hospital in Ho Chi Minh City from November 2021 to June 2022, were recruited for the prospective, single-center study. The prognostic outcomes included all-cause death and the initial occurrence of emergency re-hospitalization within 6 months' post-discharge. The Kaplan-Meier analysis compared the overall survival rates between different SARC-F score groups.

Results

The study enrolled 285 patients with a median age of 74 (67, 81). During a 6-month follow-up period, there were 14 cases of mortality. A SARC-F score of 4 or higher was significantly associated with an increased risk of all-cause mortality, with HR of 2.02 (95% CI: 1.39-2.92, p < 0.001), and higher incidence of re-hospitalization events with RR of 1.66 (95% CI: 1.06 to 2.59, p = 0.026). Kaplan-Meier survival analysis indicated a notably higher mortality rate in the patients with high SARC-F scores (p < 0.001).

Conclusion

In elderly patients with cardiovascular disease, the SARC-F questionnaire could serve as a simple and cost-effective method for detecting mortality and the risk of re-hospitalization.

Low dietary vitamin C intake is associated with low muscle strength among elderly Korean women

Although vitamin C is one of the most important antioxidants, its effect on muscle quality is not fully understood. Therefore, we hypothesized that low dietary vitamin C intake is associated with low muscle strength. To test the hypothesis, a single 24-h dietary recall and handgrip strength test of 10,883 younger adults 19-64 y and 3,961 older adults ≥65 y from the seventh Korea National Health and Examination Survey (KNHANES VII 2016-2018) was analyzed by multivariable linear and logistic regression models, and low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Approximately 15.5% of Korean adults met the recommended intake of dietary vitamin C, and those with higher dietary vitamin C intake had higher total energy and protein intake. After adjusting for confounding variables, including age, body mass index, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical condition, and dietary intake of protein, vitamin E, and β-carotene, dietary vitamin C was correlated with maximal handgrip strength in younger women 19-64 y (β = 0.002; SE = 0.001; P-value = .026) and older women ≥65 y (β = 0.005; SE = 0.002; P-value = .013). Among older women ≥65 y, those in the lowest quartile of dietary vitamin C intake had a higher risk of low muscle strength compared to those in the highest quartile after adjustment of confounding factors (odds ratio, 2.16; 95% confidence interval, 1.49-3.15). These results imply that adequate dietary vitamin C intake may reduce the risk of sarcopenia in older Korean women.

Association of the sarcopenia index with cognitive impairment in a middle-aged to older patients with acute ischemic stroke or transient ischemic attack: A multicenter cohort study

OBJECTIVES

The sarcopenia (SI) index, defined as the serum creatinine to cystatin C ratio, is considered a predictor of poor muscle health and malnutrition, which is related to major adverse cardiovascular events. However, the effect of the SI index on cognitive function in stroke patients remains unknown. In this study, we aimed to examine the association between the SI and longitudinal cognitive impairment in patients with acute ischemic stroke or transient ischemic attack.

RESEARCH DESIGN AND METHODS

Participants who met the inclusion criteria in this national, multicenter, prospective cohort study were enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were categorized into four groups according to the quartile of the SI index. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale. Multivariable-adjusted logistic regression models were performed to evaluate the association between the SI index and post-stroke cognitive impairment (PSCI) at the 3-month follow-up. Moreover, discrimination tests were used to evaluate the incremental predictive value of the SI index beyond the potential risk factors. Furthermore, we performed subgroup analyses to test interactions.

RESULTS

Among the enrolled participants, the lower the SI index was, the worse the cognitive performance. At the 3-month follow-up, participants in the lowest SI quartile group exhibited a 42% increase in the risk of cognitive impairment relative to the highest quartile group [OR 0.58 (95% CI 0.37-0.90)]. Moreover, after applying the discrimination test, adding the SI index into the potential risk factors resulted in a slight improvement in predicting the risk of cognitive impairment [NRI 14% (P = 0.01)].

CONCLUSION

This study demonstrated that a lower sarcopenia index was positively associated with a higher prevalence of PSCI. Monitoring the SI index in stroke patients and early identification and treatment of individuals with low SI level may be helpful to reduce the risk of cognitive impairment.

Reduced calf muscle pump function is not explained by handgrip strength measurements

OBJECTIVE

Reduced calf muscle pump function (CPF) is an independent risk factor for venous thromboembolism and mortality. We aimed to evaluate the relationship between handgrip strength (HGS) and CPF.

METHODS

Patients referred to the Gonda Vascular Laboratory for noninvasive venous studies were identified and consented. Patients underwent standard venous air plethysmography protocol. CPF (ejection fraction) was measured in each lower extremity of ambulatory patients by comparing refill volume after ankle flexes and passive refill volumes. The cutoff for reduced CPF (rCPF) was defined as an ejection fraction of <45%. Maximum HGS bilaterally was obtained (three trials per hand) using a dynamometer. HGS and CPF were compared (right hand to calf, left hand to calf) and the correlation between the measures was evaluated.

RESULTS

115 patients (mean age, 59.2 ± 17.4 years; 67 females, mean body mass index, 30.83 ± 6.46) were consented and assessed for HGS and CPF. rCPF was observed in 53 right legs (46%) and 67 left legs (58%). CPF was reduced bilaterally in 45 (39%) and unilaterally in 30 (26%) patients. HGS was reduced bilaterally in 74 (64.3%), unilaterally in 23 (20%), and normal in 18 (15.7%) patients. Comparing each hand/calf pair, no significant correlations were seen between HGS and CPF. The Spearman's rank correlation coefficients test yielded values of 0.16 for the right side and 0.10 for the left side.

CONCLUSIONS

There is no significant correlation between HGS and CPF, demonstrating that HGS measurements are not an acceptable surrogate for rCPF, indicating different pathophysiological mechanisms for each process.

Start Strong, Finish Strong: A Review of Prehabilitation in Cardiac Surgery

Cardiac surgery constitutes a significant surgical insult in a patient population that is often marred by significant comorbidities, including frailty and reduced physiological reserve. Prehabilitation programs seek to improve patient outcomes and recovery from surgery by implementing a number of preoperative optimization initiatives. Since the initial trial of cardiac prehabilitation twenty-four years ago, new data have emerged on how to best utilize this tool for the perioperative care of patients undergoing cardiac surgery. This review will explore recent cardiac prehabilitation investigations, provide clinical considerations for an effective cardiac prehabilitation program, and create a framework for future research studies.

Breast arterial calcification is associated with sarcopenia in peri- and post-menopausal women

PURPOSE

Breast arterial calcification (BAC) refers to medial calcium deposition in breast arteries and is detectable via mammography. Sarcopenia, which is characterised by low skeletal muscle mass and quality, is associated with several serious clinical conditions, increased morbidity, and mortality. Both BAC and sarcopenia share common pathologic pathways, including ageing, diabetes, and chronic kidney disease. Therefore, this study evaluated the relationship between BAC and sarcopenia as a potential indicator of sarcopenia.

METHODS

This study involved women aged >40. BAC was evaluated using digital mammography and was defined as vascular calcification. Sarcopenia was assessed using abdominal computed tomography. The cross-sectional skeletal mass area was measured at the third lumbar vertebra level. The skeletal mass index was obtained by dividing the skeletal mass area by height in square meters(m2). Sarcopenia was defined as a skeletal mass index of ≤38.5 cm2/m2. A multivariable model was used to evaluate the relationship between BAC and sarcopenia.

RESULTS

The study involved 240 participants. Of these, 36 (15 %) were patients with BAC and 204 (85 %) were without BAC. Sarcopenia was significantly higher among the patients with BAC than in those without BAC (72.2 % vs 17.2 %, P < 0.001). The multivariable model revealed that BAC and age were independently associated with sarcopenia (odds ratio[OR]: 7.719, 95 % confidence interval[CI]: 3.201-18.614, and P < 0.001 for BAC and OR: 1.039, 95 % CI: 1.007-1.073, P = 0.01 for age).

CONCLUSION

BAC is independently associated with sarcopenia. BAC might be used as an indicator of sarcopenia on screening mammography.

Stem cell secretome treatment improves whole-body metabolism, reduces adiposity, and promotes skeletal muscle function in aged mice

Aging coincides with the progressive loss of muscle mass and strength, increased adiposity, and diminished physical function. Accordingly, interventions aimed at improving muscle, metabolic, and/or physical health are of interest to mitigate the adverse effects of aging. In this study, we tested a stem cell secretome product, which contains extracellular vesicles and growth, cytoskeletal remodeling, and immunomodulatory factors. We examined the effects of 4 weeks of 2×/week unilateral intramuscular secretome injections (quadriceps) in ambulatory aged male C57BL/6 mice (22-24 months) compared to saline-injected aged-matched controls. Secretome delivery substantially increased whole-body lean mass and decreased fat mass, corresponding to higher myofiber cross-sectional area and smaller adipocyte size, respectively. Secretome-treated mice also had greater whole-body physical function (grip strength and rotarod performance) and had higher energy expenditure and physical activity levels compared to control mice. Furthermore, secretome-treated mice had greater skeletal muscle Pax7+ cell abundance, capillary density, collagen IV turnover, reduced intramuscular lipids, and greater Akt and hormone sensitive lipase phosphorylation in adipose tissue. Finally, secretome treatment in vitro directly enhanced muscle cell growth and IL-6 production, and in adipocytes, it reduced lipid content and improved insulin sensitivity. Moreover, indirect treatment with secretome-treated myotube culture media also enhanced muscle cell growth and adipocyte size reduction. Together, these data suggest that intramuscular treatment with a stem cell secretome improves whole-body metabolism, physical function, and remodels skeletal muscle and adipose tissue in aged mice.

Development and validation of a reliable method for automated measurements of psoas muscle volume in CT scans using deep learning-based segmentation: a cross-sectional study

OBJECTIVES

We aimed to develop an automated method for measuring the volume of the psoas muscle using CT to aid sarcopenia research efficiently.

METHODS

We used a data set comprising the CT scans of 520 participants who underwent health check-ups at a health promotion centre. We developed a psoas muscle segmentation model using deep learning in a three-step process based on the nnU-Net method. The automated segmentation method was evaluated for accuracy, reliability, and time required for the measurement.

RESULTS

The Dice similarity coefficient was used to compare the manual segmentation with automated segmentation; an average Dice score of 0.927 ± 0.019 was obtained, with no critical outliers. Our automated segmentation system had an average measurement time of 2 min 20 s ± 20 s, which was 48 times shorter than that of the manual measurement method (111 min 6 s ± 25 min 25 s).

CONCLUSION

We have successfully developed an automated segmentation method to measure the psoas muscle volume that ensures consistent and unbiased estimates across a wide range of CT images.

Association between non-alcoholic fatty liver disease and risk of sarcopenia: a systematic review and meta-analysis

OBJECTIVES

To determine the association of non-alcoholic fatty liver disease (NAFLD) with the incidence of sarcopenia.

DESIGN

Systematic review and meta-analysis of observational clinical studies.

SETTING AND PARTICIPANTS

Adults with NAFLD.

METHODS

Databases such as PubMed, Embase, Cochrane and Web of Science were searched for eligible studies published from the inception of each database up to 4 April 2023. All cross-sectional studies on the association between NAFLD and sarcopenia were included in this study. The quality of the included studies and risk of bias was assessed using the Agency for Healthcare Research and Quality checklist. STATA V.15.1 software was used for statistical analysis.

RESULTS

Of the 1524 retrieved articles, 24 were included in this review, involving 88 609 participants. Our findings showed that the prevalence of sarcopenia was higher in the NAFLD group than in the control group (pooled OR 1.74, 95% CI 1.39 to 2.17). In a subgroup analysis by region, patients with NAFLD showed an increased risk of sarcopenia (pooled OR 1.97, 95% CI 1.54 to 2.51) in the Asian group, whereas patients with NAFLD had no statistically significant association with the risk of sarcopenia in the American and European groups, with a pooled OR of 1.31 (95% CI 0.71 to 2.40) for the American group and a pooled OR of 0.99 (95% CI 0.21 to 4.69) for the European group. Similar results were observed in the sensitivity analysis, and no evidence of publication bias was observed.

CONCLUSIONS AND IMPLICATIONS

The current study indicated a significant positive correlation between NAFLD and sarcopenia, which may be affected by regional factors. This study provides the correlation basis for the relationship between NAFLD and sarcopenia and helps to find the quality strategy of sarcopenia targeting NAFLD.

Recent Update on the Prevalence of Sarcopenia in Koreans: Findings from the Korea National Health and Nutrition Examination Survey

BACKGROUND

As recognized by the World Health Organization in 2016 with its inclusion in the International Classification of Diseases, Tenth Revision as M62.84, and by South Korea in 2021 as M62.5, the diagnostic guidelines for sarcopenia vary globally. Despite its prevalence in older populations, data on sarcopenia in Koreans aged 60 and above is scarce, highlighting the need for research on its prevalence in this demographic.

METHODS

Utilizing the 2022 Korea National Health and Nutrition Examination Survey dataset, sarcopenia was assessed among 1,946 individuals aged 60 or older according to the Asian Working Group for Sarcopenia 2019 criteria, incorporating grip strength and bioelectrical impedance analysis measurements. Statistical analyses were performed to differentiate categorical and continuous variables using logistic regression and Student's t-tests, respectively.

RESULTS

The prevalence of sarcopenia was found to increase with age, with the highest prevalence observed in the oldest age group (80 years and older). The overall prevalence of sarcopenia in our study population was 6.8%. Among men, the prevalence of sarcopenia was 5.5% in the 60 or older age group, 9.6% in the 70 or older age group, and 21.5% in the 80 or older age group. Among women, the prevalence of sarcopenia was 7.9%, 10.5%, and 25.9%, respectively.

CONCLUSIONS

This study highlights the significant burden of sarcopenia in elderly Koreans, particularly among the oldest individuals. These findings call for targeted interventions to manage and prevent sarcopenia, along with further research on its risk factors, consequences, and effective mitigation strategies.

Effects of 12-week Circuit Exercise Intervention on Blood Pressure, Vascular Function, and Inflammatory Cytokines in Obese Older Women with Sarcopenia

Background

This study investigates the effects of a 12-week circuit exercise program on blood pressure, vascular function, and inflammatory cytokines in older obese women with sarcopenia.

Methods

Twenty-eight older obese women with sarcopenia (mean age: 78.2 ± 3.7 years) were randomly divided into an exercise group (EG, n = 14) and a control group (CG, n = 14). The EG participated in a 12-week circuit exercise training regimen, conducted three times weekly, with each session lasting between 45 to 75 minutes (progressively increased over time). The CG was advised to maintain their regular daily routines throughout the intervention period. All dependent variables, including blood pressure, vascular function, and inflammation cytokines, were evaluated pre- and post-intervention.

Results

Positive changes were observed in the EG in body composition (body fat mass; p < 0.001, body fat percentage; p < 0.01, free-fat mass; p < 0.01), blood pressure (heart rate; p < 0.05, rate pressure product; p < 0.01), vascular function (brachial-ankle pulse wave velocity; p < 0.05, flow-mediated dilation; p < 0.001), and inflammation cytokines (interleukin-6; p < 0.05). In the CG, there was an increase in body fat mass (p < 0.05) and body fat percentage (p < 0.05), while no changes were observed in other variables.

Conclusions

The 12-week circuit exercise program significantly reduced blood pressure, improved vascular function, and decreased inflammatory cytokines in obese older women with sarcopenia. However, individual variations in response highlight the need for personalized exercise regimens.

Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series

Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.

Associations between life's essential 8 and sarcopenia in US adults: a cross-sectional analysis

Cardiovascular disease (CVD) is closely associated with sarcopenia. We aimed to examine the relationship between Life's Essential 8 (LE8) and the incidence of sarcopenia among adults in the United States. In this study, a cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey from 2013 to 2018 and included 5999 adult participants. LE8 score was categorized into low (< 49), moderate (49-79), and high CVH (≥ 79) groups and consisted of health behavior score and health factor score based on American Heart Association definitions. Sarcopenia was defined according to The Foundation for the National Institutes of Health Sarcopenia Project. Multivariate logistic regressions, restricted cubic spline regressions, and subgroup analyses were used to assess the association between LE8 and sarcopenia. LE8 and its subscales score were negatively associated with the incidence of sarcopenia in US adults.

Prognostic role of sarcopenia on major adverse cardiac events among patients who underwent successful percutaneous coronary intervention: a retrospective cohort study

AIMS

We investigated the prevalence of sarcopenia and its influence on 1-year major adverse cardiac events (MACEs) in patients after successful percutaneous coronary intervention (PCI).

METHODS AND RESULTS

This retrospective medical record review using purposive sampling was conducted at a tertiary care university hospital in Korea. Medical records of a total of 303 patients (≥40 years) who underwent successful PCI between January 2014 and December 2020 were analysed. We retrospectively assessed sarcopenia at initial admission. Sarcopenia was assessed by a sarcopenia index based on a ratio of serum creatinine to serum cystatin C. MACE rates were evaluated within l year after PCI. A Kaplan-Meier analysis with a log-rank test was performed to compare the time with 1-year MACE event-free survival between groups with and without sarcopenia. Cox proportional hazards regression was conducted to assess sarcopenia's influence on MACE. The prevalence of sarcopenia and 1-year MACE after PCI were 24.8 and 8.6%, respectively. We found that sarcopenia at admission (hazard ratio, 3.01; 95% confidence interval, 1.22-7.38, P = 0.017) was significantly associated with 1-year MACE among patients after PCI.

CONCLUSION

Expanding knowledge of sarcopenia among cardiovascular nurses may aid in early recognition of patients at risk of sarcopenia. Our finding implies that the sarcopenia index based on serum creatinine and cystatin C may be available as a prognostic factor for MACE in patients undergoing PCI. Future studies should be conducted to prospectively validate the sarcopenia index with a multi-centre, large sample.

Effect of Sarcopenia on 10-Year Risk of Atherosclerotic Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus

Objective

To investigate the impact of sarcopenia on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among individuals with type 2 diabetes mellitus (T2DM).

Methods

This study included the clinical, laboratory, and body composition data of 1491 patients with T2DM who were admitted to the Department of Endocrinology and Metabolism at Tianjin Union Medical Center from July 2018 to July 2023. The China-PAR model was utilized to evaluate cardiovascular disease risk. Associations between ASCVD risk and various clinical parameters were analyzed, and the relationship between body composition parameters and ASCVD risk was assessed using logistic regression.

Results

The analysis revealed that T2DM patients with sarcopenia had a higher 10-year ASCVD risk compared to those without sarcopenia, with reduced muscle mass independently predicting an increased risk of cardiovascular disease. This association was significant among female T2DM patients, while male T2DM patients with sarcopenia showed a marginally higher median ASCVD risk compared to their non-sarcopenic counterparts. ASCVD risk inversely correlated with body muscle parameters and positively correlated with fat content parameters. Specifically, height- and weight-adjusted fat mass (FM, FM%, FMI) were identified as risk factors for ASCVD. Conversely, muscle parameters adjusted for weight and fat (ASM%, SMM%, FFM%, ASM/FM, SMM/FM, FMM/FM) were protective against ASCVD risk. These findings highlight the critical role of sarcopenia in influencing cardiovascular disease risk among Chinese patients with T2DM, as predicted by the China-PAR model.

Conclusion

This study highlights the importance of sarcopenia in T2DM patients, not only as an indicator of ASCVD risk, but possibly as an independent risk factor in this demographics.

Differential association between physical activity behaviours and dynapenia by comorbid diseases in community-dwelling Korean older adults

BACKGROUND

Physical activity (PA) behaviours and comorbid diseases are associated with muscle strength. However, the association between dynapenia and detailed PA behaviours, including participation in aerobic and resistance exercises and sedentary behaviour (SB), in relation to comorbid diseases has not yet been investigated. Using nationwide data, this study aimed to evaluate the independent association of dynapenia with detailed PA behaviour (participation in aerobic and resistance exercises and SB), and assess the differential associations of detailed PA behaviour with dynapenia according to comorbid diseases with prevalent sarcopenia.

METHODS

A total of 7,558 community-dwelling older adults aged ≥ 65 years who were included in the Korea National Health and Nutrition Examination Survey from 2014 to 2019 were included in the present study. Cross-sectional associations between PA behaviours (participation in aerobic exercise, participation in resistance exercise, and SB) and dynapenia were analysed using complex-sample multivariable-adjusted logistic regression models according to the type of comorbid disease (cardiovascular disease [CVD], diabetes mellitus [DM], and chronic lung disease [CLD]).

RESULTS

Sufficient aerobic exercise, sufficient resistance exercise, and low sedentary time of < 420 min/day showed independent negative associations with dynapenia (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.60-0.83; OR, 0.54; 95% CI, 0.42-0.69; and OR, 0.84; 95% CI, 0.72-0.97, respectively). Among the participants with CVD or CLD, the associations of sufficient resistance exercise (OR, 0.46; 95% CI, 0.26-0.82 and OR, 0.51; 95% CI, 0.35-0.75 for CVD and CLD, respectively) and low sedentary time (OR, 0.66; 95% CI, 0.45-0.98 and OR, 0.71; 95% CI, 0.55-0.93 for CVD and CLD, respectively) with dynapenia were significant, whereas the association of sufficient aerobic exercise with dynapenia was insignificant. Meanwhile, in participants with DM, sufficient aerobic exercise (OR, 0.70; 95% CI, 0.52-0.94) and sufficient resistance exercise (OR, 0.45; 95% CI, 0.29-0.70) were independently associated with dynapenia, whereas no association between SB and dynapenia was found.

CONCLUSION

We observed an independent inverse association between PA behaviours and dynapenia. Disease-specific associations between each PA behaviour (sufficient aerobic exercise, sufficient resistance exercise, and low sedentary time) and dynapenia differed in the older adults. Therefore, these differences should be acknowledged during interventions for this population.

Association between sarcopenia and risk of major adverse cardiac and cerebrovascular events-UK Biobank database

BACKGROUND

Few studies on the risk of incident major adverse cardiac and cerebrovascular events (MACCEs) in sarcopenia have been reported. The objective was to assess the association between presarcopenia and sarcopenia and a higher risk of MACCEs.

METHODS

This study on the UK Biobank prospective cohort, used data collected between 2006 and 2021. Community-dwelling Caucasian participants aged 37 to 73 years were included if values for Handgrip Strength (HGS) and Skeletal Muscle Index (SMI) were available and if no history of MACCEs was reported. Exposure was assessed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was measured using HGS, and muscle mass using the SMI. Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, whereas sarcopenia was defined as low HGS with low SMI. The main outcome was to determine whether presarcopenia and/or sarcopenia were predictors of MACCEs (composite events).

RESULTS

A total of 406,411 included participants (women: 55.7%) were included. At baseline, there were 18,257 (4.7%) presarcopenics-subgroup n°1 (low HGS only), 7940 (2.1%) presarcopenics-subgroup n°2 (low SMI only), and 1124 (0.3%) sarcopenics. Over a median follow-up of 12.1 years (IQR: [11.4; 12.8]), 28,300 participants (7.0%) were diagnosed with at least one event. Compared to NonSarc, presarcopenic (subgroups n°1 and n°2) and sarcopenic status were significantly associated with a higher risk of MACCEs (respectively fully adjusted HRs: HR = 1.25 [95% CI: 1.19; 1.31], HR = 1.33 [95% CI: 1.23; 1.45] and HR = 1.62 [95% CI: 1.34; 1.95]).

CONCLUSIONS

In a community-dwelling population, the risk of MACCEs was higher in both presarcopenic and sarcopenic participants.

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

The crosstalk of the heart with distant organs such as the lung, liver, gut, and kidney has been intensively approached lately. The kidney is involved in (1) the production of systemic relevant products, such as renin, as part of the most essential vasoregulatory system of the human body, and (2) in the clearance of metabolites with systemic and organ effects. Metabolic residue accumulation during kidney dysfunction is known to determine cardiovascular pathologies such as endothelial activation/dysfunction, atherosclerosis, cardiomyocyte apoptosis, cardiac fibrosis, and vascular and valvular calcification, leading to hypertension, arrhythmias, myocardial infarction, and cardiomyopathies. However, this review offers an overview of the uremic metabolites and details their signaling pathways involved in cardiorenal syndrome and the development of heart failure. A holistic view of the metabolites, but more importantly, an exhaustive crosstalk of their known signaling pathways, is important for depicting new therapeutic strategies in the cardiovascular field.

Mitochondrial involvement in sarcopenia

Sarcopenia lowers the quality-of-life for millions of people across the world, as accelerated loss of skeletal muscle mass and function contributes to both age- and disease-related frailty. Physical activity remains the only proven therapy for sarcopenia to date, but alternatives are much sought after to manage this progressive muscle disorder in individuals who are unable to exercise. Mitochondria have been widely implicated in the etiology of sarcopenia and are increasingly suggested as attractive therapeutic targets to help restore the perturbed balance between protein synthesis and breakdown that underpins skeletal muscle atrophy. Reviewing current literature, we note that mitochondrial bioenergetic changes in sarcopenia are generally interpreted as intrinsic dysfunction that renders muscle cells incapable of making sufficient ATP to fuel protein synthesis. Based on the reported mitochondrial effects of therapeutic interventions, however, we argue that the observed bioenergetic changes may instead reflect an adaptation to pathologically decreased energy expenditure in sarcopenic muscle. Discrimination between these mechanistic possibilities will be crucial for improving the management of sarcopenia.

In people with type 2 diabetes, sarcopenia is associated with the incidence of cardiovascular disease: A prospective cohort study from the UK Biobank

AIM

To investigate the association of sarcopenia with cardiovascular disease (CVD) incidence in people with type 2 diabetes.

MATERIALS AND METHODS

A prospective cohort study with 11 974 White European UK Biobank participants with type 2 diabetes, aged 40-70 years, included. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People as either non-sarcopenic or sarcopenic. Outcomes included CVD, stroke, heart failure (HF) and myocardial infarction (MI). The association between sarcopenia and the incidence of outcomes was investigated using Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. The rate advancement period was used to estimate the time period by which CVD is advanced because of sarcopenia.

RESULTS

Over a median follow-up of 10.7 years, 1957 participants developed CVDs: 373 had a stroke, 307 had an MI and 742 developed HF. Compared with non-sarcopenia, those with sarcopenia had higher risks of CVD (HR 1.89 [95% CI 1.61; 2.21]), HF (HR 2.59 [95% CI 2.12; 3.18]), stroke (HR 1.90 [95% CI 1.38; 2.63]), and MI (HR 1.56 [95% CI 1.04; 2.33]) after adjustment for all covariates. Those with sarcopenia had CVD incidence rates equivalent to those without sarcopenia who were 14.5 years older. Similar results were found for stroke, HF and MI.

CONCLUSIONS

In people with type 2 diabetes, sarcopenia increased the risk of developing CVD, which might occur earlier than in those without sarcopenia. Therefore, sarcopenia screening and prevention in patients with type 2 diabetes may be useful to prevent the complications of CVD.

Possible sarcopenia and risk of chronic kidney disease: a four-year follow-up study and Mendelian randomization analysis

INTRODUCTION

Chronic kidney disease (CKD) is a common risk factor for sarcopenia. However, whether sarcopenia increases the risk of CKD remains unclear. To investigate the longitudinal and causal associations between possible sarcopenia and CKD, this study was performed.

METHODS

Possible sarcopenia was defined according to the Asian Working Group for Sarcopenia in 2019. Participants aged ≥ 40 years were recruited from the baseline survey of the China Health and Retirement Longitudinal Study and followed up for four years. Binary logistic regression was used to evaluate the cross-sectional and longitudinal associations between possible sarcopenia, low muscle strength, low physical performance and CKD. Propensity score matching was used to balance the intergroup differences. Subgroup and interactive analyses were adopted to identify potential interactive effects. Mendelian Randomization analysis was used to assess the causal association between appendicular lean mass (ALM) and CKD.

RESULTS

After data cleansing, a total of 7296 participants were included in the baseline survey. In the cross-sectional analyses, the odds ratios (ORs) of prevalent CKD were 1.50 (95% CI = 1.23-1.84, p < 0.001) for possible sarcopenia, 1.37 (95% CI = 1.10-1.70, p < 0.01) for low muscle strength and 1.42 (95% CI = 1.16-1.74, p < 0.001) for low physical performance in the full models. No significant interaction effects of covariates were detected (all P for interaction > 0.05). After four years of follow-up, an increased risk of incident CKD was also observed in participants with possible sarcopenia (OR = 1.66, 95% CI = 1.13-2.44, p = 0.010) and low physical performance (OR = 1.69, 95% CI = 1.16-2.45, p = 0.006), but not in participants with low muscle strength (OR = 1.19, 95% CI = 0.75-1.88, p = 0.469). In the Mendelian Randomization analysis, the inverse variance weighted estimator showed that a 1-standard deviation increase of genetically predicted ALM was associated with a lower risk of CKD (OR = 0.92, 95% CI = 0.85-0.99, p = 0.035). All the sensitivity analyses supported the main findings.

CONCLUSIONS

Possible sarcopenia is an independent risk factor for CKD and may serve as a predictor of CKD for early identification and intervention.

Jakyak-gamcho-tang, a decoction of Paeoniae Radix and Glycyrrhizae Radix et Rhizoma, ameliorates dexamethasone-induced muscle atrophy and muscle dysfunction

BACKGROUND

Although chronic treatment with glucocorticoids, such as dexamethasone, is frequently associated with muscle atrophy, effective and safe therapeutics for treating muscle atrophy remain elusive. Jakyak-gamcho-tang (JGT), a decoction of Paeoniae Radix and Glycyrrhizae Radix et Rhizoma, has long been used to relieve muscle tension and control muscle cramp-related pain. However, the effects of JGT on glucocorticoid-induced muscle atrophy are yet to be comprehensively clarified.

PURPOSE

The objective of the current study was to validate the protective effect of JGT in dexamethasone-induced muscle atrophy models and elucidate its underlying mechanism through integrated in silico - in vitro - in vivo studies.

STUDY DESIGN AND METHODS

Differential gene expression was preliminarily analyzed using the RNA-seq data to determine the effects of JGT on C2C12 myotubes. The protective effects of JGT were further validated in dexamethasone-treated C2C12 myotubes by assessing cell viability, myotube integrity, and mitochondrial function or in C57BL/6 N male mice with dexamethasone-induced muscle atrophy by evaluating muscle mass and physical performance. Transcriptomic pathway analysis was also performed to elucidate the underlying mechanism.

RESULTS

Based on preliminary gene set enrichment analysis using the RNA-seq data, JGT regulated various pathways related to muscle differentiation and regeneration. Dexamethasone-treated C2C12 myotubes and muscle tissues of atrophic mice displayed substantial muscle protein degradation and muscle loss, respectively, which was efficiently alleviated by JGT treatment. Importantly, JGT-mediated protective effects were associated with observations such as preservation of mitochondrial function, upregulation of myogenic signaling pathways, including protein kinase B/mammalian target of rapamycin/forkhead box O3, inhibition of ubiquitin-mediated muscle protein breakdown, and downregulation of inflammatory and apoptotic pathways induced by dexamethasone.

CONCLUSION

To the best of our knowledge, this is the first report to demonstrate that JGT could be a potential pharmaceutical candidate to prevent muscle atrophy induced by chronic glucocorticoid treatment, highlighting its known effects for relieving muscle spasms and pain. Moreover, transcriptomic pathway analysis can be employed as an efficient in silico tool to predict novel pharmacological candidates and elucidate molecular mechanisms underlying the effects of herbal medications comprising diverse biologically active ingredients.

Association of high-sensitivity cardiac troponin T with all-cause and cardiovascular mortality in older adults with low lean mass: A 14.6-year longitudinal study

BACKGROUND

Current evidence on the association between high-sensitivity cardiac troponin T (hs-cTnT) levels and mortality in elderly sarcopenic patients is limited. This study aimed to investigate the association of serum hs-cTnT concentrations with all-cause and cardiovascular mortality in older adults with low lean mass (LLM) and without baseline cardiovascular disease.

METHODS

This prospective cohort study included 369 older adults (representing 3.2 million people) from the National Health and Nutrition Examination Survey 1999-2004. Individuals were linked to national death records until 31 December 2019. The weighted Kaplan-Meier analysis, Cox proportional hazards models, restricted cubic spline models, stratified analysis, interaction analysis, and sensitivity analysis were performed to examine the association between hs-cTnT levels and mortality in older adults with LLM.

RESULTS

During 4697 person-years of follow-up (median duration, 14.6 years), 228 (65.6%) deaths were documented, including 56 (15.8%) deaths from cardiovascular disease. Individuals with a hs-cTnT level of ≥14 ng/L had 2.1- and 4.4-fold higher risks of all-cause and cardiovascular mortality, respectively. Compared with the lowest quartile, the fourth quartile of hs-cTnT levels was significantly associated with 3.1- and 6.4-fold higher risks of all-cause and cardiovascular mortality, respectively. Each one standard deviation increase in natural log-transformed hs-cTnT levels significantly and linearly increased the risks of all-cause and cardiovascular mortality by 39% and 61%, respectively. Stratified and sensitivity analyses confirmed the robustness of the association.

CONCLUSIONS

In this nationally representative cohort of US older adults with LLM, higher serum hs-cTnT concentrations were significantly associated with increased risks of all-cause and cardiovascular mortality.