Association between the mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia with the risk of pneumonia in stable patients diagnosed with schizophrenia

Association between muscular strength and sleep quality in older adults undergoing hemodialysis: a cross-sectional study

PURPOSE

Older adults undergoing hemodialysis experience improved survival rates but often suffer from sleep disorders, resulting in adverse health outcomes. This study aims to assess the association between handgrip strength (HGS), a key indicator of muscular strength, and sleep quality in older adults undergoing hemodialysis.

METHODS

This cross-sectional and analytical study assessed 150 older adults undergoing hemodialysis selected by simple randomization. Data on demographics, clinical parameters, HGS, and sleep quality (PSQI) were collected and analyzed using descriptive and inferential statistics with SPSS version 20.

RESULTS

The mean age of the participants was 65.61 ± 4.07 years. Mean mid-upper arm circumference (MUAC) and calf circumference (CC) were 29.59 cm and 36.96 cm, respectively. The mean HGS was 28.7 ± 8.55 kg, with males exhibiting higher HGS (37.72 ± 6.17 kg) than females (23.55 ± 5.38 kg). The mean PSQI score was 6.71, with 54.1% reporting poor sleep quality. Sleep quality was significantly associated with income source, underlying diseases, Charlson Comorbidity Index (CCI), BMI, MUAC, CC, HGS, and blood levels of potassium and creatinine. A moderate negative correlation (r = - 0.438, p < 0.001) was observed between HGS and PSQI scores, indicating better sleep quality with greater muscular strength. Elevated potassium levels increase the risk of poor sleep.

CONCLUSIONS

Older adults undergoing hemodialysis frequently experience poor sleep quality, which is associated with lower muscular strength. These findings highlight the importance of implementing targeted interventions, such as strength-training programs, to improve muscular strength and, consequently, sleep quality in this vulnerable population.

Nomogram to screen older adult patients attending the radiology department for sarcopenia

BACKGROUND

Sarcopenia is an age-related syndrome that can impact the physical and mental health of older adults. However, it is often overlooked in clinical practice. Therefore, we aim to construct a nomogram based on simplified discriminant parameters for screening older adult patients for sarcopenia risk.

METHODS

This cross-sectional study included 654 patients aged ≥ 60 years who underwent an examination in the radiology department between October 2023 and June 2024. Patients were diagnosed with sarcopenia according to the method and cutoff value criteria proposed the Asian Working Group on Sarcopenia (AWGS) 2019 criteria. Calf circumference (CC), SARC-F score, mid-upper arm circumference (MUAC), and SARC-CalF score were used as simplified discriminant parameters for sarcopenia. The discriminative ability of these parameters for sarcopenia was assessed using receiver operating characteristic analysis. Additionally, we included each screening parameter and evaluated it's important for screening for the presence of sarcopenia via univariate and multivariate logistic regression analysis to develop a new screening nomogram model. The performance of the nomogram was evaluated using receiver operating characteristic curves, and the performance of the nomogram model was compared to that of CC, SARC-F, MUAC, and the SARC-CalF using the Delong test.

RESULTS

Of the 654 subjects, 120 (18.3%) were diagnosed with sarcopenia, and the areas under the curve (AUCs) of the CC, SARC-F, MUAC, and SARC-CalF were 0.73, 0.61, 0.66, and 0.70, respectively. The multivariate analysis results revealed that older age, male sex, low CC, low MUAC, and low strength were related to sarcopenia. A nomogram model constructed with these five variables had an AUC of 0.84. The DeLong test showed that the diagnostic efficacy of the joint model was significantly higher than that of CC, SARC-F, MUAC, and SARC-CalF.

CONCLUSIONS

Our simple nomogram based on simplified discriminant parameters offers personalized sarcopenia screening for older adult patients attending the radiology department.

IS CALF CIRCUMFERENCE ASSOCIATED WITH CLINICAL AND NUTRITIONAL OUTCOME IN OLDER PATIENTS?

BACKGROUND

Previous studies have shown a relationship between calf circumference (CC) and outcomes in hospitalized patients.

AIMS

To investigate the relationship between CC and clinical and nutritional outcomes in older in-patients (OiP) in a surgery ward.

METHODS

This was a cross-sectional study with 417 OiP in a surgery ward. Clinical variables, anthropometry, and nutritional screening instruments such as subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening (NRS) were used in the investigation. The tests Pearson's chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman's coefficient, and multiple linear regression analyses were used to review the factors associated with CC.

RESULTS

Lower CC values were found in the age group 80 years and over (p<0.0001), presence of complications (p=0.0269), NRS (p<0.0001), SGA (p<0.0001), and MNA (p<0.0001). Gender (p=0.0011; partial R2=0.01151), age (p=0.0002; partial R2=0.06032), body mass index (p≤0.0001; partial R2=0.40820), and arm circumference (p≤0.0001; partial R2=0.11890) are variables that together were associated with CC. There was also a relationship between SGA (p=0.0166; partial R2=0.00605) and absence of complications during hospitalization (p=0.0047; R2=0.01154) with CC.

CONCLUSIONS

Gender, age, body mass index, and arm circumference were jointly associated with CC, in addition to SGA and absence of complications. The CC is a relevant indicator for OiP in the clinical practice.

Pre-existing sarcopenia and swallowing outcomes in acute stroke patients

BACKGROUND & AIMS

This study aimed to investigate the associations of pre-existing sarcopenia with swallowing function, oral intake level, and aspiration pneumonia in patients with acute stroke.

METHODS

This observational study included patients (≥60 years of age) with acute ischemic stroke or intracerebral hemorrhage within 7 days of onset who were screened for sarcopenia, malnutrition, and swallowing difficulties in a stroke-care unit within 48 h of admission. Sarcopenia was defined by the Asian Working Group on Sarcopenia 2019 as having a low calf circumference, handgrip strength, and appendicular muscle mass index. The primary outcome was impaired oral intake (functional oral intake scale <5 points) at 3, 7, and 14 days after admission, and the secondary outcome was aspiration pneumonia during hospitalization.

RESULTS

We enrolled 350 patients (median age of 77 years; 63% males) who underwent the aforementioned screening. Sarcopenia was diagnosed in 34% of patients, and malnutrition was found in 66% of patients with sarcopenia. When compared with the comparison group (defined as patients with either or both normal calf circumference and handgrip strength), the sarcopenia group had significantly lower tongue pressure and a higher prevalence of dysphagia. Sarcopenia was associated with functional oral intake scale <5 at 7 days (adjusted odds ratio [OR], 4.72; 95% confidence interval [CI], 1.91-11.71); p = 0.002) and 14 days (adjusted OR, 3.93; 95% CI, 1.47-10.53; p = 0.006) and with aspiration pneumonia during hospitalization (adjusted OR, 6.12; 95% CI, 1.63-22.94; p = 0.007).

CONCLUSION

Acute stroke patients with sarcopenia may have weakness of the swallowing-related muscles which may lead to impaired oral intake and aspiration pneumonia.

Association of Ishii test scores with pneumonia in stable schizophrenic subjects

AIM

We investigated the relationship between the sarcopenia-indicating Ishii test scores and pneumonia risk in stable schizophrenia patients.

METHODS

This prospective investigation involves schizophrenic inpatients from two mental health centers in western China. Patient baseline information was gathered over 1 month from September 1 to 30 in 2020. All pneumonia-related patient information, including diagnosis and treatment, was acquired over 1 year between October 2020 and October 2021. Patients with schizophrenia were screened for sarcopenia utilizing a threshold value established by Ishii et al. Using regression analysis, the link between Ishii test scores and pneumonia risk in schizophrenia patients was investigated.

RESULT

This study recruited 232 males and 107 females with schizophrenia over the age of 50 and older. During a 1-year follow-up period, four patients (3 males and 1 female) acquired pneumonia within 1 week of relapse in schizophrenia; therefore, these patients were excluded from the study. Finally, data were collected for 335 patients. The pneumonia incidences were 29.3% in males and 14.2% in females. Our analysis confirmed that compared to the male schizophrenia patients with Ishii test scores < 105 (non-sarcopenia), those with Ishii test scores ≥ 105 (sarcopenia) exhibited an elevated pneumonia risk (OR = 2.739, 95%CI: 1.406-5.333). Following confounders adjustment, Ishii test scores ≥ 105 remained a risk factor for pneumonia (OR = 2.064, 95%CI: 1.029-4.143). Among females with schizophrenia, the Ishii test scores were not associated with pneumonia risk.

CONCLUSION

In conclusion, our results demonstrated that the Ishii test scores ≥ 105 were strongly associated with pneumonia risk in stable schizophrenic male patients.