Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures

An integrated view of the pathophysiological crosstalk between adipose tissue, bone and cardiovascular system in men and women

BACKGROUND

Obesity, bone-related and cardiovascular diseases (CVD) are among the leading global health concerns. Growing evidence suggests that these conditions share common pathophysiological pathways and disease outcomes. PATHOGENETIC INTERACTIONS OF OBESITY, CVD AND BONE-RELATED DISEASES: Obesity is a well-established risk factor for atherosclerotic CVD (ASCVD), as dysfunctional ectopic adipose tissue may produce endocrine/paracrine hormones modulating metabolic processes and inflammation, predisposing to ASCVD. Although obesityhas been considered a protective factor for bone loss, it may lead to osteoporosis development and increased fracture risk at specific sites. Biological and epidemiological evidence has demonstrated the existence of a dynamic relationship between ASCVD and osteoporosis, since atherosclerotic calcification and bone mineralization share common pathophysiological mechanisms. Therefore, addressing ASCVD, obesity, and bone-related diseases requires multiple-level approach, which involve accurate screening, lifestyle modifications and pharmacological interventions.The current evidence about the pathophysiological relationships between obesity, bone-related diseases and ASCVD is discussed herein, highlighting common risk factors, proposed biomolecular mechanisms, clinical outcomes, lifestyle changes and pharmacological treatments.

CONCLUSIONS

As populations become increasingly older and obese, understanding the correlation within this triad highlights an unmet clinical need. Applying this knowledge would help to reduce both societal and individual costs, while supporting the development of novel preventive, diagnostic and therapeutic strategies to reduce morbidity and disability associated with cardio-metabolic and bone-related diseases.

Handgrip strength assessment in geriatric populations: digital dynamometers comparative study

BACKGROUND/OBJECTIVES

Handgrip strength is a critical indicator of overall health, particularly in older adults, and is associated with frailty, sarcopenia and risk of adverse health outcomes. Precise and reliable measurement instruments are necessary to ensure accuracy in personalised diagnostic evaluations. This study aimed to assess the inter-instrument reliability and agreement between the Jamar Plus+ digital and Jamar hydraulic dynamometers in measuring handgrip strength.

METHODS

A cross-sectional study was conducted to assess the handgrip strength of older individuals in the community aged more than 60, using the Jamar Plus+ digital and Jamar hydraulic dynamometers. The inter-instrument reliability and agreement between the devices were evaluated using Intraclass Correlation Coefficients (ICCs) and Bland-Altman analysis.

RESULTS

A total of 109 participants with a mean age of 66±5.3 years were included in this study. The Jamar Plus+ digital dynamometer recorded significantly higher handgrip strength measurements (27.0±7.1 kg) compared with the Jamar hydraulic dynamometer (21.0±6.7 kg). The ICCs between the two devices ranged from 0.67 to 0.70, indicating moderate reliability. Bland-Altman analysis revealed a consistent overestimation of handgrip strength by the Jamar Plus+ digital dynamometer, with systematic biases of 4.8 kg in men and 6.26 kg in women compared with the Jamar hydraulic dynamometer.

CONCLUSION

The Jamar Plus+ digital dynamometer consistently overestimated handgrip strength compared with the Jamar hydraulic dynamometer, but both devices demonstrated moderate reliability. The Jamar Plus+ showed greater responsiveness to variations in strength. Selecting appropriate diagnostic tools is crucial for optimising individualised health assessments in older adults.

Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients

INTRODUCTION

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors.

METHODS

The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression.

RESULTS

Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height.

CONCLUSION

A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia

Mobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.

No cost difference between single or dual implants for distal femur fractures in the perioperative period

PURPOSE

This study uses a value-driven outcome model to assess the cost-effectiveness of single versus dual implants used in the fixation of distal femur fractures (DFF).

METHODS

A retrospective review identified all DFF treated at a level I trauma center between 2013 and 2023. Patients with open fractures, bilateral fractures, multiple injuries, and less than six months of cost-data or follow-up were excluded. DFF were divided into fixation by an intramedullary nail (IMN), lateral plate (LP), or dual construct (DC) including IMN and plate or dual plating. Cost data included all costs, including implant, facility, and operative costs associated with initial surgery and subsequent admissions associated with the injury. Actual cost data were analyzed via an inverse Gaussian regression model.

RESULTS

Of 293 cases, 123 were treated by IMN, 133 by LP, and 37 by DC. There was no demographic, BMI, Charlson Comorbidity Index (CCI), or Injury Severity score (ISS) differences between groups. DC DFF tended to be AO Type C (27%) or periprosthetic fractures (35%) (p < 0.001). DC was 47% more expensive than IMN and 43% more expensive than LP at initial surgery (p < 0.001) and 46% more expensive than IMN and 40% more costly than LP downstream (p < 0.001). However, when controlling for age, BMI, fracture classification, and ISS, there was no difference in total cost across fixation types.

CONCLUSION

The total cost for dual construct fixation of distal femur fractures was similar to intramedullary nailing or lateral plating despite higher initial costs and use in more complex fracture patterns.

Impact of frailty on outcomes of elderly patients with atrial fibrillation: A systematic review and meta-analysis

Objective

Atrial fibrillation (AF) prevalences have risen globally due to the increasing aging populations posing significant health challenges. Frailty, a state characterized by weak physiological reserves, has emerged as a crucial factor influencing cardiovascular disease outcomes, including those in patients with AF. With this systematic review and meta-analysis, we aimed to elucidate the impact of frailty on mortality, and the incidences of stroke, major bleeding events, and other outcomes in elderly patients with AF.

Method

A comprehensive search of PubMed, EMBASE, and Scopus databases yielded 1302 relevant records from inception until January 2024. We screened them to assess their eligibility for our study. We included data from 23 studies into our analysis, covering a diverse global population. We also assessed the quality of the included studies by assigning Newcastle- Ottawa Scale scores.

Results

Frailty demonstrated a consistent association with increased all-cause mortality (Hazards ratio [HR] 2.46 in frail individuals). Frailty also correlated with elevated risks of stroke (HR, 1.46) and major bleeding events (HR, 1.34). Our analysis also revealed non-significant associations with cardiovascular death and intra-cranial hemorrhage.

Conclusion

Frailty significantly increases the frequency of adverse outcomes in elderly patients with AF; thus, these patients should be managed with tailored risk stratification tools. Integrating frailty assessments into clinical decision-making should aid in optimizing care strategies and enhance outcomes in this vulnerable population.

Low Skeletal Muscle Radiodensity Predicts Response to CDK4/6 Inhibitors Plus Aromatase Inhibitors in Advanced Breast Cancer

BACKGROUND

Recent evidence indicates that a dysregulated host metabolism influences treatment outcomes in patients with breast cancer. We investigated the association of computed tomography (CT)-derived body composition indices with therapeutic responses in patients with hormone receptor-positive, HER2-negative advanced breast cancer (ABC) on endocrine plus CDK4/6 inhibitor (CDK4/6i) treatment.

METHODS

The study involved a retrospective cohort of patients with ABC at the Yonsei Cancer Center who received CDK4/6i and aromatase inhibitors as first-line therapy between January 2017 and October 2020. Body composition parameters were estimated from the non-enhanced CT images of the third lumbar spine by commercialized deep learning software. Patients with low skeletal muscle radiodensity (SMD) were defined as patients with SMD of low tertile (≤ 28.7 Hounsfield Units). The primary outcome was progression-free survival (PFS).

RESULTS

Among the 247 female participants (median age, 53 years; mean body mass index [BMI], 23.7 kg/m2), 45.7% had disease progression or death during a median follow-up of 36.4 months. After adjusting for age and visceral metastasis, SMD was the only independent predictor among body composition parameters for worse PFS (adjusted hazard ratio [HR] = 1.20 per standard deviation decrement, 95% CI: 1.01-1.42, p = 0.041), whereas BMI, muscle area, and fat area were not. Participants with low SMD had a higher risk of progression than those without (PFS, 27.2 vs. 51.1 months, p = 0.009; adjusted HR 1.84, 95% CI: 1.22-2.76, p = 0.003). Strong associations between low SMD and poor PFS were observed in groups with pre-menopause status (HR, 3.04 vs. 1.19 in post-menopause; 95% CI: 1.54-5.99, p for interaction < 0.05) and without visceral metastases (HR, 2.95 vs. 1.19 in with visceral metastases; 95% CI: 1.59-5.49, p for interaction < 0.05).

CONCLUSIONS

CT-defined low SMD predicts poor treatment outcomes in patients with ABC undergoing first-line treatment with aromatase inhibitors and CDK4/6i.

Prevalence and risk factors of cognitive frailty in patients with cardiovascular disease: A hospital-based cross-sectional study

The prevalence of the cognitive frailty is increasing in China. Screening for this condition is crucial for its early detection, prevention, and treatment. This study was designed to explore the incidence of cognitive frailty among hospitalized elderly patients suffering from cardiovascular disease. It also aimed to analyze the factors influencing its occurrence, thereby providing substantial evidence for the development of early prevention and intervention strategies. From March 2022 to October 2023, under cardiovascular care program, the cardiovascular patients (n = 1190) were subjected to standardized questionnaires to collect demographical characteristics. Also, nutritional and psychosocial assessments tests were performed for the enrolled patients. Multivariate logistic regression analysis was used to evaluate factors associated with cognitive frailty. A total of 1190 (755 males and 435 females) were included. The mean age was 73.36 ± 7.37 years. The prevalence of cognitive frailty in the study population was 33.9% (404/1190). The prevalence of cognitive frailty was 40.7% in men, 22.3% in women. In terms of specific cardiovascular diseases, the prevalence of cognitive frailty was 28.5% in coronary heart disease, 20.5% in arrhythmia, 36.8% in valvular disease, 53% in heart failure, and 13.7% in hypertension. The multivariable analysis showed that age (OR = 1.13, 95% CI: 1.10-1.15, P < .001), anxiety (OR = 1.01, 95% CI: 1.03-1.11, P = .001), female sex (OR = 1.83, 95% CI: 1.10-1.16, P < .001), education level (college and above, OR = 0.27, OR = 0.12-0.64, P = .003), polypharmacy (OR = 2.29, 95% CI: 1.62-3.23, P < .001), comorbidity (OR = 1.93 95% CI: 1.37-2.71, P < .010), region (rural, OR = 1.77, 95% CI: 1.36-2.30, P < .001), sarcopenia (OR = 1.60, 95% CI: 1.16-2.19, P = .004), and nutritional status (risk of malnutrition, OR = 1.66, 95% CI: 1.17-2.35, P = .004; malnutrition exists, OR = 3.24, 95% CI: 1.85-5.83, P < .001) were independently associated with cognitive frailty. The prevalence of cognitive frailty was 33.9% in hospitalized elderly cardiovascular patients in Guangzhou. heart failure, hypertension, age, anxiety, female sex, education level, polypharmacy, comorbidity, region, sarcopenia, and nutritional status were independent risk factors for cognitive frailty.

Osteoporosis: a problem still faulty addressed by the Romanian healthcare system. Results of a questionnaire survey of people aged 40 years and over

Purpose

We aimed to investigate the knowledge and awareness level of osteoporosis, its risk factors, the possible causes of underdiagnosis, as well as the preventive measures and lifestyle behavior of the Romanian population.

Patients and methods

A non-interventional, cross-sectional study was performed, consisting of an in-person survey, in 10 pharmacies located in both urban and rural settings in Romania. The survey was distributed to patients ≥40 years old.

Results

Of 189 respondents, 78.8% were women, the majority age group being 60-69 (31.7%) and 50-59 (30.7%) years old and coming from urban areas (69.3%). Although 75.1% of participants declared knowing about osteoporosis, having a moderate level of knowledge, and women being more aware of the pathology, 77.3% have never performed a DXA test. Moreover, participants already diagnosed with osteoporosis did not show a better disease knowledge than those without a diagnosis. Nearly half of the respondents did not know that a family history of the disease increases the risk of developing it and 60% of them thought that symptoms may develop before a fracture occurs. The preventive strategies tend to be disregarded and thus, underused. Moreover, 42.9% of participants reported being diagnosed with osteoporosis, do not undergo treatment, although they are aware of the existence of effective strategies. The dataset was used to build a participant compatibility network. The network's clustering revealed six relevant communities, which are not correlated with questionnaire results but reflect the patterns of feature associations.

Conclusion

Preventive and therapeutic osteoporosis education programs are urgently needed in the Romanian population to decrease disability and high mortality risks and thus, to improve the quality of life.

Understanding the Role of Oxidative Stress in Platelet Alterations and Thrombosis Risk among Frail Older Adults

Frailty and cardiovascular diseases are increasingly prevalent in aging populations, sharing common pathological mechanisms, such as oxidative stress. The evidence shows that these factors predispose frail individuals to cardiovascular diseases but also increase the risk of thrombosis. Considering this background, this review aims to explore advances regarding the relationship between oxidative stress, platelet alterations, and cardiovascular diseases in frailty, examining the role of reactive oxygen species overproduction in platelet activation and thrombosis. The current evidence shows a bidirectional relationship between frailty and cardiovascular diseases, emphasizing how frailty not only predisposes individuals to cardiovascular diseases but also accelerates disease progression through oxidative damage and increased platelet function. Thus, oxidative stress is the central axis in the increase in platelet activation and secretion and the inadequate response to acetylsalicylic acid observed in frail people by mitochondrial mechanisms. Also, key biomarkers of oxidative stress, such as isoprostanes and derivate reactive oxygen metabolites, can be optimal predictors of cardiovascular risk and potential targets for therapeutic intervention. The potential of antioxidant therapies in mitigating oxidative stress and improving cardiovascular clinical outcomes such as platelet function is promising in frailty, although further research is necessary to establish the efficacy of these therapies. Understanding these mechanisms could prove essential in improving the health and quality of life of an aging population faced with the dual burden of frailty and cardiovascular diseases.

Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study

BACKGROUND

Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults.

METHODS

We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs).

RESULTS

At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%.

CONCLUSION

Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.

Physical frailty and oral health as risk factors for low bone density in community-dwelling residents

This study aimed to explore the association between bone mineral density and physical frailty including nutrition, muscle mass, and oral function. We included participants aged 35-80 years and examined their bone mineral density, serum albumin level, body composition, and variance of hue (VOH) of two-colored gum. We also used the geriatric oral health assessment index (GOHAI). These data were used to calculate the geriatric nutritional risk index (GNRI) and skeletal muscle index (SMI). Multinomial logistic regression was performed to assess the relationship between GNRI, SMI, VOH, GOHAI, and bone mineral density after adjusting for comorbidities, including hypertension, diabetes mellitus, and previous bone fracture. We included 228 participants and classified their bone mineral density as normal, osteopenic, or osteoporotic. Older age (odds ratio (OR) 1.15, 95% confidence interval (CI) [1.08, 1.23]), low GNRI (OR 0.90, 95% CI [0.83, 0.98]), low SMI (OR 0.43, 95% CI [0.27, 0.68]), and high VOH (OR 1.08, 95% CI [1.01, 1.17]) were significantly associated with osteoporosis. Older age (OR 1.08, 95% CI [1.04, 1.11]) and low GNRI (OR 0.93, 95% CI [0.87, 0.99]) were significantly associated with osteopenia. GNRI, SMI, and VOH were significantly associated with osteoporosis among male participants. Although the multinomial logistic regression analysis indicated that GNRI, SMI, VOH, and GOHAI were not significantly associated with osteoporosis or osteopenia among female participants, the demographic distribution showed that older age, low GNRI, and low SMI were significantly associated with bone mineral density decline. Physical frailty, including nutritional decline, muscle mass loss, and poor oral status, is associated with low bone density. This easy-to-use tool can be used to detect osteoporosis early and to prevent osteoporosis and osteoporosis-related fractures.

Performance in a Balance Test and Prediction of All-Cause Mortality in Community-Dwelling Elderly Ambulatory Individuals: A Systematic Review and Meta-analysis

Objective: This systematic review and meta-analysis was performed to evaluate the association between an inability to perform a static balance test and mortality in community-dwelling older ambulatory individuals. Methods: PubMed, Embase, and Scopus were searched for relevant cohort studies. Hazard ratios (HR) were pooled (random-effect model). Meta-regression was performed with independent demographic variables (PROSPERO ID: CRD42022381137). Results: A total of 11,713 articles were screened and 15 were included. An inability to perform a static balance test was significantly associated with a higher risk of mortality irrespective of whether confounding variables were considered [HR, 1.14 (95% CI: 1.07-1.21); p < .001; i2, 87.96% (p < .01)] or not [HR, 1.11 (95% CI: 1.03-1.20); p = .01; i2, 95.28% (p < .01)] (both moderate GRADE evidence). Also, this association was correlated with progressive age. Conclusion: An inability to successfully complete a static balance test was significantly associated with a higher risk of mortality among community-dwelling older ambulatory individuals.

Sustainability of exercise-induced benefits on circulating MicroRNAs and physical fitness in community-dwelling older adults: a randomized controlled trial with follow up

BACKGROUND

Circulating miRNAs (c-miR) have been shown to be potential biomarkers in sarcopenia, but the miRNAs response to aerobic exercise in older people remains inconclusive. We sought to examine the exercise benefits on physical fitness and miRNAs, and to explore the mediating effect of miRNAs on training-induced fitness changes.

METHODS

This controlled trial recruited 58 community-dwelling older adults and randomized them into exercise group (EX) and control group (CON). EX received 8-week supervised moderate intensity cycling training 3x/week. C-miR expression (c-miR-21, c-miR-126, c-miR-146a, c-miR-222), physical fitness (body composition, cardiorespiratory fitness, muscular fitness) and physical activity level (PAL, measured as in daily step counts) were evaluated at baseline, post-training, and post-16-week follow-up. The mediating effect of miRNA expression onto exercise-induced physical fitness change was determined by causal mediation analysis (CMA).

RESULTS

Exercise significantly improved body fat and cardiorespiratory fitness in older people while maintaining muscle mass and strength, and augmented expression of c-miR-126, c-miR-146a, and c-miR-222 for up to 16 weeks post-training. Notably, older people in EX had substantially higher daily step counts than CON throughout the study even after the active training period. However, CMA revealed no significant indirect effect but a potential mediating effect of c-miR-21, but not the rest, onto the body composition, cardiorespiratory fitness, and lower limb strength.

CONCLUSION

An eight-week supervised MICT program promoted a higher level of physical activity up to 16 weeks post-training, which induces better cardiorespiratory fitness and resists decline in muscular measures. C-miRNA, especially c-miR-21, potentially mediates the training effect upon fitness.

The Impact of an Outdoor Motor-Cognitive Exercise Programme on the Health Outcomes of Older Adults in Community Settings: A Pilot and Feasibility Study

Physical and cognitive exercises can prevent or at least mitigate the symptoms of certain diseases and help older adults perform a range of daily functions. Yet, most seniors do not meet the World Health Organisation's recommended guidelines for physical activity. The objective of this study is to promote and maintain the physical and cognitive capacity of older adults by implementing a feasible and effective low-threshold, age-appropriate, motor-cognitive training outdoors. In the German city of Chemnitz, citizens aged 60 years and older participated in a quasi-randomised intervention trial. Exercises to train coordination, strength, endurance, and cognition were integrated into a 12-week outdoor motor-cognitive exercise programme. Both the physical (e.g., 6MWT) and cognitive skills (e.g., TMT B) of the intervention group (n = 41) and control group (no intervention, n = 58) were measured before (T1) and after (T2) completion of the exercise programme. Some of the participants' physical and all their cognitive measures improved. Neurocognitive performance (DSST) showed a significant time × group interaction effect (F(1,95) = 6.943, p = 0.010, ηp2 = 0.068). Sex and age were found to be influencing factors. We consider our exercise programme to be successfully implemented, well received by the participants, and feasible and useful to promote the continued exercise of daily functions as part of healthy aging in community-dwelling older adults.

Contribution of reduced skeletal muscle perfusion reserve to exercise intolerance in heart failure with preserved ejection fraction

BACKGROUND

Skeletal muscle (SM)-associated mechanisms of exercise intolerance in HFpEF are insufficiently defined, and inadequate augmentation of SM blood flow during physical effort may be one of the contributors. Therefore, we sought to investigate the association of SM perfusion response to exertion with exercise capacity in this clinical condition.

METHODS

Echocardiography and SM microvascular perfusion by contrast-enhanced ultrasound were performed at rest and immediately post-exercise test in 77 HFpEF patients in NYHA class II and III, and in 25 subjects with normal exercise tolerance (stage B). Exercise reserve of cardiac function and SM perfusion was calculated by subtracting resting value from exercise value.

RESULTS

In addition to decreased cardiac functional reserve, HFpEF patients demonstrated significantly reduced SM perfusion reserve as compared to HF stage B, with the degree of impairment being greater in the subgroup with more profound left ventricular (LV) diastolic abnormalities (E/e' > 15 and TRV > 2.8 m/s). SM perfusion reserve was significantly associated with exercise capacity (beta = 0.33; SE 0.11; p = 0.003), cardiac output reserve (beta = 0.24; SE 0.12; p = 0.039), resting E/e' (beta = -0.33; SE 0.11; p = 0.006), and patient frailty expressed by the PRISMA 7 score (beta = -0.30; SE 0.11; p = 0.008). In multivariable analysis including clinical, demographic and cardiac functional variables, SM perfusion reserve was in addition to patient frailty, sex and LV longitudinal strain reserve among the independent correlates of exercise capacity.

CONCLUSIONS

SM perfusion reserve is impaired in HFpEF, and is associated with reduced exercise capacity independent of clinical, demographic and "central" cardiac factors. This supports the need to consider the SM domain in patient management strategies in HFpEF.

Sarcopenia in long-term survivors of cancer in childhood and adolescence: A cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle-bone unit

BACKGROUND

Sarcopenia, a loss of systemic skeletal muscle mass (SMM), is prevalent in childhood cancer survivors and often accompanied by increased fat mass (sarcopenic obesity [SO]). We examined whether calf muscle cross-sectional area (CSA), measured by peripheral quantitative computed tomography (pQCT), can identify sarcopenia and SO in long-term survivors of pediatric acute lymphoblastic leukemia (ALL), and explored its relationship with adjacent bone geometry.

PROCEDURES

Calf muscle CSA and CSA Z scores at the 38% tibia in 70 subjects (median survival 15 years) were compared between sexes and ALL risk group, and their association with sarcopenia and SO evaluated. Relationships between bone strength and muscle mass were assessed further using linear regression and methods described by Schoenau et al. for evaluation of a functional muscle-bone unit.

RESULTS

A calf muscle CSA Z score of less than or equal to zero is 73.81% sensitive and 84.62% specific for detecting sarcopenia defined by height-adjusted appendicular lean mass measured by dual-energy x-ray absorptiometry. No significant difference in CSA Z scores was noted between sexes or ALL risk groups; however, Z scores were markedly higher in those without SO (adjusted odds ratio 0.529, 95% confidence interval [CI]: 0.340-0.824). Ratios of calf muscle mass to height and total bone mineral content at the 38% tibia are "sufficient" and consistent with estimated reference ranges for a healthy population.

CONCLUSIONS

CSA Z scores may represent a useful clinical measure of SMM and are predictive of SO in this population. Our results are supportive of a functional muscle-bone unit in long-term survivors of pediatric ALL.

Vitamin D Deficiency and Cardiovascular Mortality: Retrospective Analysis "Siena Osteoporosis" Cohort

Vitamin D is a fat-soluble vitamin that plays a key role in bone metabolism, particularly concerning the regulation of calcium and phosphate homeostasis. Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Western countries. Knowledge of the role of vitamin D in CVD arose from evidence of the vitamin D receptor (VDR) inside the cardiovascular system. In this retrospective analysis, we investigated the relationships between vitamin D status and hospitalization for heart failure (HF), overall mortality and cardiovascular mortality. Between 2004 and 2009, age-stratified, random sampling of elderly men and postmenopausal women in the primary care registers of Siena residents was performed. In total, 174 males (mean ± SD, 65.9 ± 6 years) and 975 females (62.5 ± 6 years) were enrolled in the study. We investigated the association between 25OHD status and hospitalization for HF or causes of mortality. A total of 51 subjects (12 males and 39 females) had been hospitalized for acute HF. At the end of the survey, 931 individuals were alive, while 187 had died (43 males and 144 females). A greater proportion of deceased patients showed low 25OHD (particularly patients with levels below 20 ng/mL). A similar trend was observed concerning the prevalence of patients with 25OHD levels below 20 ng/mL who died from stroke (RR = 2.15; 95% CIs 0.98-4.69; p = 0.06). Low 25OHD levels may be predictive of cardiovascular mortality. Whether vitamin deficiency represents a primitive cause or is a simple bystander in increased cardiovascular mortality should be further investigated in prospective large cohort studies specifically designed to assess CVD risk, including a detailed assessment of cardiac dysfunction and the characterization of atherosclerotic lesions.

The Association between Dietary Protein Diversity and Protein Patterns with Frailty in Older Chinese Adults: A Population-Based Cohort Study

OBJECTIVES

Frailty is a pervasive condition among older people worldwide. Despite the association between higher protein intake and lower frailty risk has been well documented, older individuals encounter barriers to enhancing their protein consumption due to reduced appetite and impaired digestive capacity. This study aims to delve into the potential correlation between dietary protein diversity, protein patterns, and the risk of frailty among older Chinese individuals.

DESIGN

Prospective cohort study.

SETTING

Community-based.

PARTICIPANTS

2,216 participants aged 65 and above and not frail at the baseline were recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset spanning from 2014 to 2018.

MEASUREMENTS

Dietary protein diversity was evaluated utilizing a protein diversity score (PDS), calculated based on the results of a food frequency questionnaire. Dietary protein patterns were identified by employing principal component analysis (PCA). Frailty was ascertained using a 40-item frailty index (FI) where FI > 0.21 indicated frailty. Logistic analysis was employed to investigate the association between dietary variables and frailty.

RESULTS

541 participants were identified as frail after a 4-year follow-up. After adjusting for confounders, each 1-unit increase in PDS was linked to a 10% decrease in frailty risk. Compared to individuals with PDS ≤ 1, those with PDS scores of 2-3, 4-5, and 6 had lower risks of frailty, with OR (95% CI) of 0.78 (0.58-1.06), 0.58 (0.38-0.87), 0.42 (0.20-0.81), respectively (P trend = 0.038). Individuals who consistently maintained high PDS demonstrated a lower frailty risk in contrast to those who maintained low PDS (OR = 0.60, 95% CI, 0.41-0.87). Additionally, the "meat-fish" pattern exhibited a protective association with frailty, with OR Q4 versus Q1 (95% CI) of 0.54 (0.40-0.74), P trend < 0.001.

CONCLUSION

Maintaining a variety of dietary protein sources and following a "meat-fish" protein pattern might decrease the likelihood of frailty among the older Chinese population.