Associations between Sarcopenia and Metabolic Risk Factors: A Systematic Review and Meta-Analysis

Sarcopenia: an Aging Perspective and Management Options

There is no doubt that sarcopenia is one of the most defining characteristics of aging that negatively impacts the people's health and quality of life. The condition is characterized by the progressive and generalized loss of muscle mass and strength, affecting physical performance. It is part of aging but can be exacerbated by pathophysiological conditions like cancer and several factors such as a sedentary lifestyle, poor nutrition, chronic diseases, falls and immobilization. Numerous cellular mechanisms have been implicated in its pathogenesis, including hormonal changes, mitochondrial dysfunctions, altered apoptotic and autophagic signaling, muscle fiber composition, and inflammatory pathways. To prevent sarcopenia, exercise is one of the most effective strategies as it has a strong influence on both anabolic and catabolic muscle pathways and helps improve skeletal muscle function. A well-rounded, multicomponent exercise program that targets muscle strength, aerobic capacity, and balance is recommended for optimal results. While nutrition is essential for muscle maintenance, relying solely on dietary interventions is unlikely to fully address sarcopenia. Therefore, a combination of adequate nutrition and regular exercise is recommended to promote muscle health and function. The purpose of this study is to review sarcopenia from an aging viewpoint and discuss the role of exercise and nutrition as prevention and management options.

Association of the cardiometabolic index with sarcopenia among U.S. adults: NHANES 2011-2018 findings

BACKGROUND

The cardiometabolic index (CMI), initially devised as a diagnostic tool for diabetes mellitus, has evolved into a composite biomarker for evaluating metabolic syndrome and cardiovascular disease risk. In order to shed light on any possible interactions between sarcopenia and CMI, this study will look at the relationship between the two.

METHODS AND RESULTS

Data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed to investigate the possible link between sarcopenia and CMI. Among 3,185 eligible participants, the weighted prevalence of sarcopenia was 7.84%. A significant positive association emerged between CMI and sarcopenia risk, with each unit increase in CMI was linked with a 12% greater risk of sarcopenia in the fully adjusted model (OR: 1.12; 95% CI: 1.01-1.26). Moreover, dose-response relationships were evident across CMI tertiles (P for trend < 0.05). Subgroup analyses and interaction tests indicated that the positive correlation between CMI and the risk of sarcopenia differs significantly across subgroups defined by education level, sedentary time and CVD status (all P for interaction < 0.05).

CONCLUSIONS

Our findings demonstrate a robust association between elevated CMI levels and increased sarcopenia risk, suggesting CMI's potential utility as a clinical biomarker for sarcopenia risk surveillance. To confirm these results and demonstrate causality, more research is required.

Association of possible Sarcopenia, Sarcopenia and sarcopenic obesity with multimorbidity among middle-aged and older adults: findings from the China health and retirement longitudinal study

BACKGROUND AND OBJECTIVES

The association between possible sarcopenia, sarcopenia and sarcopenic obesity on multimorbidity risk remains poorly investigating. We aimed to evaluate the associations between possible sarcopenia, sarcopenia and sarcopenic obesity on multimorbidity prevalence and incidence among middle-aged and older Chinese population.

METHODS

A total of 13,036 participants from the China Health and Retirement Longitudinal Study 2011 were included in cross-sectional analyses. 5771 participants were including in longitudinal analyses and were followed up in 2018. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Obesity was defined according to body mass index.

RESULTS

In cross-sectional analyses, possible sarcopenia, sarcopenia and sarcopenic obesity were significantly associated with higher multimorbidity prevalence. During the 7 years of follow-up, 2295(39.77%) participants with new-onset multimorbidity were identified. Compared with participants without sarcopenia or obesity, a greater increase in the risk of multimorbidity incidence was found among participants with obesity only (OR = 1.39, 1.21-1.59), sarcopenia only (OR = 1.45, 1.35-1.58) and sarcopenic obesity (OR = 2.42, 2.03-2.89). Both pre-sarcopenia, sarcopenia and sarcopenic obesity were positively related to an increased number of morbidities.

CONCLUSION

Pre-sarcopenia, sarcopenia and sarcopenic obesity were associated with higher multimorbidity prevalence and incidence. Our findings provide important implications for screening and preventing possible sarcopenia, sarcopenia and obesity, which may be beneficial in reducing chronic disease burden.

Cystatin-c / total cholesterol ratio as a predictor of probable sarcopenia in geriatric population from 12 European countries

BACKGROUND

A low handgrip strength (HGS) is associated with several diseases in older adults. However, predictive biomarkers of future low HGS are poorly known. We investigated the prognostic efficacy of the ratio of plasma cystatin-c and total cholesterol (CT ratio) levels for predicting future low HGS in Europe.

METHODS

The data was collected from the Survey of Health, Ageing, and Retirement in Europe (SHARE) between 2015 and 2021-22. The study participants were geriatric adults aged 50 or above (n = 17,698) from 12 European countries. The baseline data in 2015 included the measurements of CT ratio from participants with normal HGS. The participants who developed low HGS in subsequent years were included. We also investigated the quality of life, difficulties performing daily activities, and several comorbidities in the study population.

RESULTS

In a multivariate-adjusted model, male gender, advancing age, poor quality of life, difficulties performing daily activities, and the presence of depression, high blood pressure, diabetes mellitus, Alzheimer's disease, and osteoarthritis were associated with a higher risk of developing low HGS. CT ratio exhibited significant prognostic accuracy for low HGS among men and women aged 60-79, irrespective of the quality of life, degree of depression, difficulties performing daily activities, and the presence of comorbidities, including depression, high blood pressure, diabetes mellitus, Alzheimer's disease, and osteoarthritis.

CONCLUSION

Collectively, the CT ratio exhibits adequate prognostic accuracy for low HGS, which is not significantly affected by comorbidities and functional limitations. Our findings have clinical and policy implications in timely identifying older adults at risk of developing low HGS.

An explainable machine learning-based prediction model for sarcopenia in elderly Chinese people with knee osteoarthritis

BACKGROUND

Sarcopenia is an age-related progressive skeletal muscle disease that leads to loss of muscle mass and function, resulting in adverse health outcomes such as falls, functional decline, and death. Knee osteoarthritis (KOA) is a common chronic degenerative joint disease among elderly individuals who causes joint pain and functional impairment. These two conditions often coexist in elderly individuals and are closely related. Early identification of the risk of sarcopenia in KOA patients is crucial for developing intervention strategies and improving patient health.

METHODS

This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), selecting symptomatic KOA patients aged 65 years and above and analyzing a total of 95 variables. Predictive factors were screened via least absolute shrinkage and selection operator (LASSO) regression and logistic regression. Eight machine learning algorithms were employed to construct predictive models, with internal cross-validation and independent test validation performed. The final selected model was analyzed via the SHapley Additive exPlanations (SHAP) method to enhance interpretability and clinical applicability. To facilitate clinical use, we developed a web application based on this model ( http://106.54.231.169/ ).

RESULTS

The results indicate that six predictive factors-body mass index, upper arm length, marital status, total cholesterol, cystatin C, and shoulder pain-are closely associated with the risk of sarcopenia in KOA patients. CatBoost demonstrated excellent overall performance in both calibration analyses and probability estimates, reflecting accurate and dependable predictions. The final results on the independent test set (accuracy = 0.8902; F1 = 0.8627; AUC = 0.9697; Brier score = 0.0691) indicate that the model possesses strong predictive performance and excellent generalization ability, with predicted probabilities closely aligning with actual occurrence rates and thereby underscoring its reliability.

CONCLUSION

From the perspective of public health and aging, this study constructed an interpretable sarcopenia risk prediction model on the basis of routine clinical data. This model can be used for early screening and risk assessment of symptomatic KOA patients, assisting health departments and clinicians in the early detection and follow-up of relevant populations, thereby improving the quality of life and health outcomes of elderly individuals.

Association between lipid ratios and sarcopenia and the mediating roles of inflammatory biomarkers in a cross-sectional study from NHANES 2011-2018

Sarcopenia, which leads to reduced quality of life and increased medical burden, is challenging to diagnose in a timely manner. Lipid metabolism plays a role in sarcopenia, and this study explored the associations between blood lipid profile parameters and sarcopenia. Using data from the National Health and Nutrition Examination Survey 2011-2018, we conducted weighted multivariate logistic regression to investigate the associations between lipid ratios and sarcopenia, including non-high-density lipoprotein cholesterol (non-HDL-C) to HDL-C, triglyceride (TG) to HDL-C, low-density lipoprotein cholesterol (LDL-C) to HDL-C, and remnant cholesterol (RC) to HDL-C ratios. We performed subgroup analyses to assess interactions with other covariates and used mediation models to evaluate the mediating roles of inflammatory biomarkers. We included a total of 9500 non-sarcopenic and 849 sarcopenic participants aged 18-59 years. While we observed modest correlations between individual lipid components and sarcopenia, we obtained significant positive associations for lipid ratios. Specifically, non-HDL/HDL-C (OR = 1.09; 95% CI 1.03-1.15; P = 0.003), TG/HDL-C (OR = 1.02; 95% CI 1.02-1.04; P = 0.014), LDL/HDL-C (OR = 1.27; 95% CI 1.11-1.45; P < 0.001), and RC/HDL-C ratios (OR = 1.55; 95% CI 1.16-2.07; P = 0.004) showed strong associations with sarcopenia. These associations were more pronounced in younger participants, those with lower family economic status, and those without self-reported diabetes. Furthermore, there were significant mediation effects of inflammatory biomarkers on the association between non-HDL/HDL-C, LDL/HDL-C, and RC/HDL-C and sarcopenia risk, with proportions ranging from 2.90 to 6.36%. In conclusion, our study demonstrated the positive associations between lipid ratios and sarcopenia in middle-aged adults, suggesting the potential of these lipid ratios for improving sarcopenia case identification. Further research is required to explore the underlying mechanisms.

Effects of digital-based interventions on the outcomes of the eligibility criteria for sarcopenia in healthy older adults: A systematic review and meta-analysis

BACKGROUND

While the digital-based interventions targeting older adults to prevent age-related health problems such as sarcopenia have grown rapidly in recent years, there are no meta-analyses indicating synthesized pooled estimates.

OBJECTIVE

To examine the effects of digital-based interventions on sarcopenia-related measures, including physical performance and muscle mass, in healthy community-dwelling older adults.

METHODS

Systematic searches were performed on MEDLINE, Web of Science, and Cochrane Library for eligible studies published up to 31 March 2023. The mean difference with a 95 % confidence interval was calculated. Methodological quality was assessed using Cochrane RoB 2.0. The GRADE criteria were used to assess evidence certainty.

RESULTS

Thirteen randomized controlled trials with 742 participants were included in the meta-analysis. Handgrip strength, usual walking speed, five times sit-to-stand performance, and 30-second chair stand test showed significant enhancements with the digital-based interventions. However, there were no significant effects of digital-based interventions in appendicular muscle mass. The overall evidence certainty was low.

CONCLUSIONS

Although digital-based interventions for healthy older adults are effective in improving physical functions, evidence certainty is low. Additional randomized controlled trials are thus required to further validate the findings.

A lower atherogenic index of plasma was associated with a higher incidence of sarcopenia

Sarcopenia is an age-related muscle senescence disease that leads to functional limitations, physical disability and premature death in older adults. Atherogenic index of plasma (AIP) is a novel indicator of atherosclerotic status based on triglycerides and high-density lipoprotein cholesterol. The aim of this study was to investigate the association between AIP and new-onset sarcopenia and its components among middle-aged and older adults in a Chinese community. This cohort study included 7,992 participants who were free of sarcopenia in 2011 in the China Health and Retirement Longitudinal Study and were followed up in 2013 and 2015. Sarcopenia was assessed using the recommendations of the Asian Working Group for Sarcopenia 2019. Longitudinal associations between AIP and sarcopenia and its components were assessed using Cox proportional risk regression modeling. The results showed that AIP was negatively associated with sarcopenia [HR and 95% CI: 0.73 (0.62-0.86)]; with muscle mass [β and 95%CI: 0.49 (0.4-0.57)], skeletal muscle mass index [β and 95%CI: 0.17 (0.15-0.2)], and grip strength [β and 95% CI: 0.17 (0.15-0.2)] being positively correlated. A lower AIP was associated with a lower muscle mass and handgrip strength and higher incidence of sarcopenia. Regular measurement of AIP in the middle-aged and older population in the community can help in the early diagnosis and intervention of sarcopenia.

Higher triglyceride-glucose index and triglyceride glucose-body mass index protect against sarcopenia in Chinese middle-aged and older non-diabetic women: a cross-sectional study

Purpose

Sarcopenia, an age-related complication, constitutes a major public health problem given the aging of the population. However, it is frequently overlooked and undertreated in mainstream practice. The study aimed to investigate the correlations between triglyceride-glucose (TyG) index and TyG-body mass index (BMI) and sarcopenia in non-diabetic middle-aged and older women and whether they would be helpful indicators of sarcopenia.

Patients and methods

This cross-sectional study was conducted in the Department of Endocrinology, Hebei Medical University Third Hospital. This study prospectively enrolled 460 non-diabetic postmenopausal women aged ≥50 years.

Results

As TyG and TyG-BMI increased, the prevalence of sarcopenia decreased. In multivariate analysis, the TyG index and TyG-BMI index were inversely associated with sarcopenia (OR: 0.492; 95% CI: 0.256-0.944 and OR: 0.948; 95% CI: 0.934-0.962). Women in the fourth TyG-BMI quartiles showed decreased OR of 0.009 (95% CI: 0.001-0.072) for sarcopenia with respect to first quartiles after adjusting confounding factors. The area under the curve (AUC) for TyG index in the diagnosis of sarcopenia was 0.598 (95% CI: 0.529-0.666), while the AUC for TyG-BMI index was 0.858 (95% CI: 0.816-0.899).

Conclusion

Higher TyG index and TyG-BMI index protected against sarcopenia in non-diabetic middle-aged and older females. Moreover, the TyG-BMI index was a reliable and cost-efficient biomarker to predict sarcopenia.

Association of sarcopenia, ambient air pollution and cognitive function in a community-dwelling middle-aged and elderly Korean population: a community-based cohort study

OBJECTIVES

To investigate the association of sarcopenia, exposure to medium-term to long-term ambient particulate matter 2.5 µm and 10 µm (PM2.5 and PM10) pollution and cognitive function in a community-dwelling cohort of middle-aged and older adults in South Korea.

DESIGN

A community-based prospective cohort study.

SETTING

In the Korean Genome and Epidemiology Study (KoGES).

PARTICIPANTS

The participants were drawn from the seventh follow-up visit conducted between 2015 and 2016 in the KoGES community-based Ansung cohort who had participated in an ageing substudy.

OUTCOME MEASURES

Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination (K-MMSE) and decreased cognitive function was defined as a K-MMSE score of 23 or less.

RESULTS

Of the 2274 participants (mean age 70.1 years, 58.3% women and mean annual PM2.5 and PM10 levels of 30.7 and 52.2 μg/m3, respectively), 8.7% (n=197) were sarcopenic, 35.8% (n=814) were possible sarcopenic and 55.5% (n=1263) were non-sarcopenic. The predictors of sarcopenia included body mass index, cognitive function, age, marital status, hypertension and physical activity. Exposure to PM2.5 and PM10 for an average duration of 1 month to 3 years was not selected as a predictor of sarcopenia. Participants with sarcopenia were associated with lower cognitive scores (β=-1.51, p<0.0001) and decreased cognitive function compared with those without sarcopenia (OR 2.34, 95% CI 1.56 to 3.52). Exposure to medium-term and long-term PM2.5 or PM10 was not associated with sarcopenia. The effect modification of PM exposure on the association between sarcopenia and cognitive function was generally not detected.

CONCLUSIONS

In this community-based observational cohort study of KoGES participants aged 50 years and older, sarcopenia was associated with decreased cognitive function. However, medium-term to long-term exposure to PM2.5 or PM10 was not associated with sarcopenia and did not modify the relationship between sarcopenia and cognitive function.

A framework of biomarkers for skeletal muscle aging: a consensus statement by the Aging Biomarker Consortium

The skeletal muscle is an important organ for movement and metabolism in human body, and its physiological aging underlies the occurrence of muscle atrophy and sarcopenia. China has the largest aging population in the world and is facing a grand challenge with how to prevent and treat skeletal muscle aging-related diseases. To address this difficult problem, the Aging Biomarker Consortium (ABC) of China has reached an expert consensus on biomarkers of skeletal muscle aging by synthesizing literatures and insights from scientists and clinicians. This consensus attempts to provide a comprehensive assessment of biomarkers associated with skeletal muscle aging, and proposes a systematic framework to classify them into three dimensions: functional, structural, and humoral. Within each dimension, the experts recommend clinically relevant biomarkers for skeletal muscle aging. This consensus aims to lay the foundation for future research on skeletal muscle aging, facilitating precise prediction, diagnosis, and treatment of skeletal muscle aging and sarcopenia. It is anticipated to make significant contributions to healthy aging of skeletal muscle in the elderly population in China and around the world as well.

Indoor air pollution by solid fuel usages for cooking is longitudinally associated with possible sarcopenia in middle-aged Chinese population

Objectives

The Asia Working Group of Sarcopenia (AWGS) 2019 consensus proposed a new concept named "possible sarcopenia". The present study was to estimate the association between indoor air pollution by solid fuel usages for cooking and possible sarcopenia among middle-aged and older Chinese population.

Methods

A longitudinal cohort analysis was carried out using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 17,708 participants were recruited and followed up in the CHARLS. Cox proportional hazards models were used to estimate the effects of cooking fuel usages on the new onset of possible sarcopenia. Stratified analyses were performed according to gender and age, and sensitivity analyses were performed using the complete dataset.

Results

A total of 4,653 participants were included in the final cohort analysis. During the follow-up of 4 years (2011-2015), a total of 1,532 (32.92%) participants developed new-onset possible sarcopenia. Compared with clean fuel usages for cooking, solid fuel usages were associated with a higher risk of possible sarcopenia (HR = 1.37, 95% CI = 1.23-1.52, p-value < 0.001). After adjusting for potential confounders, there was a trend for association between solid fuel usages and an increased risk of possible sarcopenia. Stratified analyses by gender and age demonstrated a stronger association of the solid fuel usages with possible sarcopenia in the middle-aged female participants (Model 1: HR = 1.83, 95% CI = 1.24-2.69, p-value = 0.002; Model 2: HR = 1.65, 95% CI = 1.10-2.47, p-value = 0.016). Sensitivity analyses indicated that the results were robust.

Conclusion

Indoor air pollution from solid fuel usages for cooking was a modifiable risk factor for sarcopenia, especially in middle-aged female population. These findings provide a new prevention strategy to reduce the growing burden of sarcopenia, especially for middle-aged female individuals using solid fuels for cooking.

The ZJU index is associated with the risk of sarcopenia in American adults aged 20-59: a cross-sectional study

BACKGROUND

The ZJU index is an innovative computational method which integrates BMI, FBG, TG, and ALT to AST ratio. It strongly correlates with measures of lipid metabolism and glucose intolerance. No researches have yet explored the relationship between the ZJU index and sarcopenia.

METHODS

We analyzed NHANES data from 2011 to 2018, dividing the ZJU index into quartiles. The association was investigated by adjusting for confounders using multivariable linear and logistic regression analysis. Results were visualized through RCS regression and threshold effect analyses. We conducted various subgroup and sensitivity analyses and plotted ROC curves to assess prediction efficacy, with the AUC as the measure of accuracy.

RESULTS

As the ZJU index increases, the prevalence of sarcopenia also rises. Following the control of potential confounders via logistic regression analysis, our research identified a distinct relationship between the ZJU index and sarcopenia, which was statistically significant (P < 0.001), with higher ZJU index values associated with increased risk (OR = 12.40, 95% CI: 8.46-18.17). Interaction analysis suggests that the relationship between the ZJU index and the risk of developing sarcopenia varies significantly between males and females across different ZJU index levels. ROC analysis for the ZJU index shows an AUC of 0.749.

CONCLUSIONS

The ZJU index significantly correlates with a heightened risk of sarcopenia in Americans, suggesting its potential as a predictive marker for sarcopenia.

The relationship between serum lipid with sarcopenia: Results from the NHANES 2011-2018 and bidirectional Mendelian randomization study

BACKGROUND

The relationship between serum lipids and sarcopenia remains unclear due to conflicting results in previous studies.

OBJECTIVE

To explore the associations and potential causality between serum lipids, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC), and sarcopenia.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) were analysed using multivariable regression and restricted cubic splines (RCSs) to assess the associations between serum lipids and sarcopenia. Bidirectional Mendelian randomization (MR) was employed to investigate the causal relationships with sarcopenia-related traits such as appendicular lean mass (ALM), hand grip strength, and usual walking pace.

RESULTS

Serum HDL-C and TG levels were inversely associated with ALMBMI, with each 1-unit increase linked to a 0.13 % and 1.32 % decrease, respectively. Elevated TG, but not HDL-C, LDL-C, or TC levels, was significantly associated with an increased risk of sarcopenia (P for trend = 0.001). RCS analysis revealed a log-shaped dose-response relationship between TG and sarcopenia risk (P overall <0.001, P non-linear <0.001), with a cutoff value of 92.75 mg/dL. Genetically predicted HDL-C, LDL-C, and TG were associated with ALM. Conversely, ALM showed an inverse causal relationship with all four serum lipids. Additionally, genetically predicted usual walking pace influenced HDL-C and TG levels (P < 0.001).

CONCLUSION

The study reveals a nonlinear association between TG levels and sarcopenia risk, and a bidirectional association between lipid profiles and muscle mass, underscoring the need for further research to elucidate these mechanisms.

High-density lipoprotein cholesterol level and risk of muscle strength decline and sarcopenia in older adults

BACKGROUND

Recent studies have demonstrated that very high high-density lipoprotein cholesterol (HDL-C) level was paradoxically linked with higher risk of cardiovascular mortality, all-cause mortality, and several age-related diseases. However, whether very high HDL-C level is associated with a higher risk of sarcopenia in older adults remains unclear. We aimed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength over time in older adults.

METHODS

Participants were from the ongoing China Health and Retirement Longitudinal Study (CHARLS), which includes a nationally representative sample of adults aged ≥45 years and was performed from 2011 to 2020 with follow-ups every two to three years. The current study included 4031 participants aged ≥60 years. Muscle health-related data were collected in waves 2011, 2013, and 2015. Based on HDL-C level at baseline, participants were categorized into five groups: <35 mg/dl, 35-40 mg/dl, 40-60 mg/dl, 60-70 mg/dl and >70 mg/dl. The main outcomes were incident sarcopenia and incident low grip strength over follow-up. Low grip strength and sarcopenia were defined according to the 2019 Consensus by the Asian Working Group for Sarcopenia. Cox proportional-hazard regression was performed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength in older adults.

RESULTS

The mean age of study sample was 67.3 (SD 6.1) years, and 49.6% were male. During an average 3.7-year follow-up, 409 (10.1%) participants developed sarcopenia and 771 (21.1%) developed low grip strength. Non-linear association was observed between HDL-C level and the hazard of developing sarcopenia and low grip strength. The multivariable model showed that compared to the reference group (40-60 mg/dl), older adults with very high HDL-C level (>70 mg/dl) had a significantly higher risk of developing sarcopenia (HR 1.69, 95% CI 1.28-2.23) and low grip strength (HR 1.23 95% CI 1.00-1.51). Stratified analyses by sex revealed similar association.

CONCLUSIONS

We present the first longitudinal evidence that very high HDL-C level was associated with a significantly higher risk of muscle strength decline and developing sarcopenia in older adults. It is essential to monitor the muscle health of older adults with very high HDL-C level in clinical practice.

Sarcopenic Obesity and Cardiovascular Disease: An Overlooked but High-Risk Syndrome

PURPOSE OF REVIEW

Sarcopenic obesity (SO), defined as the coexistence of excess fat mass and reduced skeletal muscle mass and strength, has emerged as an important cardiovascular risk factor, particularly in older adults. This review summarizes recent findings on the diagnosis, prevalence, health impacts, and treatment of SO.

RECENT FINDINGS

Growing evidence suggests SO exacerbates cardiometabolic risk and adverse health outcomes beyond either condition alone; however, the heterogeneity in diagnostic criteria and the observational nature of most studies prohibit the evaluation of a causal relationship. This is concerning given that SO is increasing with the aging population, although that is also difficult to assess accurately given wide-ranging prevalence estimates. A recent consensus definition proposed by the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity provides a framework of standardized criteria to diagnose SO. Adopting uniform diagnostic criteria for SO will enable more accurate characterization of prevalence and cardiometabolic risk moving forward. Although current management revolves around diet for weight loss coupled with resistance training to mitigate further muscle loss, emerging pharmacologic therapies have shown promising results. As the global population ages, diagnosing and managing SO will become imperative to alleviate the cardiovascular burden.

Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies

Background

Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.

Methods

UPF intake was assessed through food frequency questionnaires in the Nurses' Health Study (NHS; n = 75,735), Nurses' Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle-Ottawa Scale, funnel plots, and Egger's tests, and meta-evidence was evaluated using NutriGrade.

Findings

The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06-1.16), 1.16 (1.09-1.24), and 1.04 (0.96-1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%-24%), 23% (12%-34%), and 9% (3%-15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.

Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.

Funding

National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

The association between non‑high‑density lipoprotein cholesterol to high‑density lipoprotein cholesterol ratio (NHHR) and low muscle mass in adults aged 20-59: a population-based study in the United States

BACKGROUND

The ratio between non-high-density lipoprotein cholesterol and high-density lipoprotein cholesterol (NHHR) is a reliable marker for assessing the risk linked to lipid metabolism disorders. Sarcopenia, characterized by age-related loss of muscle mass and strength/function, includes the assessment of muscle mass, muscle strength, and muscle-specific strength. However, research into NHHR's relationship with low muscle mass risk remains unexplored.

METHODS

Our study utilized a cross-sectional approach, examining data derived from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Through multivariable linear and logistic regression, we investigated the relationships of the NHHR with muscle mass and low muscle mass. We visualized the results using smoothing curves and assessed threshold effects. We also performed various subgroup and sensitivity analyses.

RESULTS

This research encompassed 9,012 participants and demonstrated significant nonlinear associations between NHHR and ALMBMI or low muscle mass risk in a generalized additive model (GAM), pinpointing critical NHHR values (3.328 and 3.367) where changes in NHHR significantly impacted ALMBMI and low muscle mass risk.

CONCLUSIONS

The NHHR demonstrates a significant association with an increased risk of low muscle mass among middle-aged Americans. This ratio has potential as a predictive marker for low muscle mass. Further exploration of NHHR is expected to aid in advancing preventive and therapeutic measures for this condition.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and sarcopenia in individuals with cancer: a cross-sectional study

BACKGROUND

Cancer and sarcopenia are both closely related to lipid metabolism, but the relationship between lipid metabolism and patients with cancer and sarcopenia has not been thoroughly studied. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a reliable measure of lipid metabolism. The purpose of this study was to determine the possible relationship between the NHHR and sarcopenia in individuals with cancer.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) database for individuals with cancer, with and without sarcopenia was analyzed using weighted multiple regression equations, weighted regression cubic spline (RCS) analysis, and weighted subgroup analysis.

RESULTS

In total, 1,602 individuals with cancer were included, of whom 17.1% had sarcopenia. In Adjusted Model 2, the occurrence of sarcopenia was found to be significantly associated with a higher NHHR in cancer (95% confidence interval [CI]:1.01-1.39, P = 0.036). Individuals with high a NHHR had a 2.09-fold higher risk of developing sarcopenia in comparison to those with a low NHHR (95% CI:1.12-3.92, P = 0.022). RCS analysis further identified a U-shaped non-linear relationship between females with cancer and the muscle index. Subgroup analysis indicated that sex was a significant stratifying factor, whereas age, race, marital status, smoking and drinking habits, and history of cardiovascular disease, arthritis, hypertension, and diabetes had no significant impact.

CONCLUSION

From the perspective of lipid metabolism, the NHHR may serve as an indicator for monitoring and preventing the occurrence of sarcopenia in individuals with cancer, particularly for females with cancer who appear to have greater sensitivity.

Relationships of Fat Mass Index and Fat-Free Mass Index with Low-Density Lipoprotein Cholesterol Levels in the Tohoku Medical Megabank Community-Based Cohort Study

AIMS

Although fat mass (FM) and fat-free mass (FFM) have an impact on lipid metabolism, the relationship between different body composition phenotypes and lipid profiles is still unclear. By dividing the FM and FFM by the square of the height, respectively, the fat mass index (FMI) and fat-free mass index (FFMI) can be used to determine the variations in body composition. This study aimed to investigate the relationship of combined FMI and FFMI with low-density lipoprotein cholesterol (LDL-C) levels.

METHODS

This cross-sectional study comprised 5,116 men and 13,630 women without cardiovascular disease and without treatment for hypertension, and diabetes. Following sex-specific quartile classification, FMI and FFMI were combined into 16 groups. Elevated LDL-C levels were defined as LDL-C ≥ 140 mg/dL and/or dyslipidemia treatment. Multivariable logistic regression models were used to examine the relationships between combined FMI and FFMI and elevated LDL-C levels.

RESULTS

Overall, elevated LDL-C levels were found in 1,538 (30.1%) men and 5,434 (39.9%) women. In all FFMI subgroups, a higher FMI was associated with elevated LDL-C levels. Conversely, FFMI was inversely associated with elevated LDL-C levels in most FMI subgroups. Furthermore, the groups with the highest FMI and lowest FFMI had higher odds ratios for elevated LDL-C levels than those with the lowest FMI and highest FFMI.

CONCLUSIONS

Regardless of FFMI, FMI was positively associated with elevated LDL-C levels. Conversely, in the majority of FMI subgroups, FFMI was inversely associated with elevated LDL-C levels.

A Cross-Sectional Study on Metabolic Syndrome Parameters, the Nutritional Index, and Physical Status Associated with or Without the Possible Diagnosed Sarcopenia in Older Women Using A Propensity Score Matching Method

Objectives

To develop strategies against sarcopenia, physiological and biochemical data in older women were analyzed using propensity score matching.

Methods

Fifty-six women aged ≥75 years with the AWGS calf circumference <33 cm were included in the sarcopenia risk group. Low muscle strength (handgrip strength <18kg) or low physical performance (five-times-sit-to-stand test ≥12s) were used the possible-sarcopenia group. Propensity score matching adjusted for age and BMI was performed between the possible-sarcopenia group with low muscle strength (or physical performance) and the sarcopenia risk group without low muscle strength (or physical performance). The comparison included nutritional index, metabolic syndrome parameters, BMD, and skeletal muscle mass index score between both groups.

Results

The possible-sarcopenia group with low muscle strength exhibited significantly lower BMD (p=0.014) and skeletal muscle mass index score (p=0.002) compared to the sarcopenia risk group without low muscle strength. The possible-sarcopenia group with low physical performance exhibited significantly lower AST (p=0.034) compared to the sarcopenia risk group without low physical performance.

Conclusion

These results suggest that older women with possible sarcopenia and low muscle strength may have reduced BMD and skeletal muscle mass index.

Relationships Between the Apolipoprotein Levels and Sarcopenia in Inpatients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Background

Apolipoprotein (Apo) may be associated with sarcopenia in elderly inpatients with type 2 diabetes mellitus (T2DM), but fewer studies are available. In this study, we explored the association of ApoA1, ApoB, and ApoB/ApoA1 with sarcopenia and compared the predictive role of Apo indicators for sarcopenia in an elderly T2DM.

Objective

To investigate the relationships between the Apo and sarcopenia in elderly inpatients with T2DM.

Methods

This study included 253 inpatients with T2DM (mean age of 70.11±5.44 years, 32.8% male). The inpatients were divided into the sarcopenic group (n = 100) and non-sarcopenic group (n = 153). The associations among the Apo and sarcopenia were assessed using multivariate analyses.

Results

Inpatients in the sarcopenia group showed lower ApoA1 levels than those in the non-sarcopenia group (1.25±0.21 vs 1.36±0.20 g/L, P < 0.05) and showed higher ApoB/ApoA1 and ApoB levels than those in the non-sarcopenia group (0.82±0.27 vs 0.69±0.19 g/L, P < 0.05;1.00±0.32 vs 0.93±0.24 g/L, P < 0.05, respectively). After adjusting for age and BMI, the logistic regression model indicated that ApoA1 was a protective factor for elderly inpatients with T2DM sarcopenia.(OR =0.079,95% CI: 0.021~0.306, P < 0.05);ApoB and AopB/AopA1 were risk factors for elderly inpatients with T2DM sarcopenia.(OR =3.578,95% CI:1.318~9.715, P < 0.05;OR =16.440,95% CI:4.437~60.427, P < 0.05, respectively). AopB/AopA1 provided an AUC value of 0.765 in elderly men.(95% CI: 0.665~0.866, P<0.05).

Conclusion

ApoA1, AopB, and AopB/AopA1 are associated with sarcopenia in elderly inpatients with T2DM, and AopB/AopA1 may be a potential predictor of sarcopenia in elderly men with T2DM.

Development and validation of a predictive model for the risk of sarcopenia in the older adults in China

BACKGROUND

Sarcopenia is a progressive age-related disease that can cause a range of adverse health outcomes in older adults, and older adults with severe sarcopenia are also at increased short-term mortality risk. The aim of this study was to construct and validate a risk prediction model for sarcopenia in Chinese older adults.

METHODS

This study used data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), a high-quality micro-level data representative of households and individuals aged 45 years and older adults in China. The study analyzed 65 indicators, including sociodemographic indicators, health-related indicators, and biochemical indicators.

RESULTS

3454 older adults enrolled in the CHARLS database in 2015 were included in the final analysis. A total of 997 (28.8%) had phenotypes of sarcopenia. Multivariate logistic regression analysis showed that sex, Body Mass Index (BMI), Mean Systolic Blood Pressure (MSBP), Mean Diastolic Blood Pressure (MDBP) and pain were predictive factors for sarcopenia in older adults. These factors were used to construct a nomogram model, which showed good consistency and accuracy. The AUC value of the prediction model in the training set was 0.77 (95% CI = 0.75-0.79); the AUC value in the validation set was 0.76 (95% CI = 0.73-0.79). Hosmer-Lemeshow test values were P = 0.5041 and P = 0.2668 (both P > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. ROC and DCA showed that the nomograms had good predictive properties.

CONCLUSIONS

The constructed sarcopenia risk prediction model, incorporating factors such as sex, BMI, MSBP, MDBP, and pain, demonstrates promising predictive capabilities. This model offers valuable insights for clinical practitioners, aiding in early screening and targeted interventions for sarcopenia in Chinese older adults.

The relationship between sarcopenia and metabolic dysfunction-associated fatty liver disease among the young and middle-aged populations

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new term for diagnosing fatty liver disease, which is considered to be a multi-systemic disease with multiple extrahepatic manifestations, including sarcopenia. The link between sarcopenia and MAFLD remains uncertain, especially among young and middle-aged adults. Thus, we examined the relationship between MAFLD and sarcopenia in young and middle-aged individuals in this study.

METHODS

A total of 2214 individuals with laboratory tests, dual-energy X-ray absorptiometry and ultrasound transient elastography from NHANES 2017-2018 were selected for this study. MAFLD was diagnosed as fatty liver disease with any one of the situations: overweight/obesity, diabetes mellitus, presence of metabolic dysregulation. Sarcopenia was defined by appendicular lean mass adjusted for body mass index (BMI). Multivariable logistic regression and restricted cubic spline (RCS) model were applied to explore the relationship between MAFLD and sarcopenia, and the mediation analyses were also conducted. Moreover, subgroup analyses stratified by BMI and lifestyles were done.

RESULTS

The prevalence of MAFLD was 47.85%, and nearly 8.05% of participants had sarcopenia. The prevalence of sarcopenia was higher in participants with MAFLD (12.75%; 95% CI 10.18-15.31%) than in the non-MAFLD (3.73%; 95% CI 2.16-5.31%). MAFLD was significantly positively associated with sarcopenia after adjustments [OR = 2.87 (95% CI: 1.62-5.09)]. Moreover, significant positive associations were observed between liver fibrosis and sarcopenia prevalence in MAFLD patients (OR = 2.16; 95% CI 1.13-4.15). The RCS curve revealed that MAFLD was linearly associated with sarcopenia. The relationship between the MAFLD and sarcopenia were mediated by C-reactive protein (mediation proportion: 15.9%) and high-density lipoprotein cholesterol (mediation proportion: 18.9%). Subgroup analyses confirmed the association between MAFLD and sarcopenia differed in different lifestyle groups.

CONCLUSIONS

Both MAFLD prevalence and severity was significantly associated with sarcopenia. Thus, clinicians should advise comorbidity screening and lifestyle changes to young and middle-aged patients.

5'-Cytimidine Monophosphate Ameliorates H2O2-Induced Muscular Atrophy in C2C12 Myotubes by Activating IRS-1/Akt/S6K Pathway

Age-related muscle atrophy (sarcopenia), characterized by reduced skeletal muscle mass and muscle strength, is becoming increasingly prevalent worldwide, which is especially true for older people, and can seriously damage health and quality of life in older adults. This study aims to investigate the beneficial effects of 5'-cytimidine monophosphate (CMP) on H2O2-induced muscular atrophy in C2C12 myotubes. C2C12 myotubes were treated with H2O2 in the presence and absence of CMP and the changes in the anti-oxidation, mitochondrial functions, and expression of sarcopenia-related proteins were observed. Immunofluorescence analysis showed that CMP significantly increased the diameter of myotubes. We found that CMP could increase the activity of antioxidant enzymes and improve mitochondrial dysfunction, as well as reduce inflammatory cytokine levels associated with sarcopenia. RNA-seq analysis showed that CMP could relieve insulin resistance and promote protein digestion and absorption. Western blot analysis further confirmed that CMP could promote the activation of the IRS-1/Akt/S6K signaling pathway and decrease the expression of MuRF1 and Atrogin-1, which are important markers of muscle atrophy. The above results suggest that CMP protects myotubes from H2O2-induced atrophy and that its potential mechanism is associated with activating the IRS-1/Akt/S6K pathway to promote protein synthesis by improving mitochondrial dysfunction and insulin resistance. These results indicate that CMP can improve aging-related sarcopenia.

Association between the triglyceride glucose index and low skeletal muscle mass: a cross-sectional study

OBJECTIVES

Triglyceride glucose (TyG) represents a consistent surrogate biomarker and index of insulin resistance (IR), IR has also been linked to skeletal muscle mass loss (SMM-L). Here, we evaluated the association between SMM-L and the TyG index (TyGi).

DESIGN

An analytical cross-sectional study.

SETTING

Tertiary care hospitals.

PARTICIPANTS

36 275 participants who underwent health checks between 1 January 2013 and 31 December 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

A bioelectrical impedance analysis was used to assess the body composition, SMM-L was defined as low ASMI (total limb lean mass/height2) and TyGi was calculated as ln(triglycerides (mg/dL)×fasting blood glucose (mg/dL)/2).

RESULTS

A total of 36 275 subjects were included in the study, of which 58.46% were male, with a mean age of 43.74±12.33 years. The prevalence of low skeletal muscle mass (SMM) was 17.7% and the mean TyGi was 8.56±0.64. TyGi was found to be significantly correlated with low SMM in all subjects (OR 1.87, 95% CI 1.75 to 2.00, p<0.001), with higher correlations seen in younger subjects (OR 1.97, 95% CI 1.77 to 2.20, p<0.001), and remaining significant in middle age (OR 1.95, 95% CI 1.77 to 2.14, p<0.001), old age (OR 1.73, 95% CI 1.38 to 1.16, p<0.001), men (OR 1.60, 95% CI 1.46 to 1.76, p<0.001) and women (OR 2.59, 95% CI 2.39 to 2.87, p<0.001).

CONCLUSIONS

These data demonstrated a significant independent interaction between TyGi and low SMM in all subjects regardless of sex and age subgroups in the general population.

The association of lipid metabolism with bone metabolism and the role of human traits: a Mendelian randomization study

Background

The impact of lipid metabolism on bone metabolism remains controversial, and the extent to which human traits mediate the effects of lipid metabolism on bone metabolism remains unclear.

Objective

This study utilized mendelian randomization to investigate the effects of blood lipids on bone mineral density (BMD) at various skeletal sites and examined the mediating role of human traits in this process.

Methods

We leveraged genetic data from large-scale genome-wide association studies on blood lipids (n=1,320,016), forearm bone mineral density (FA-BMD) (n=10,805), lumbar spine bone mineral density (LS-BMD) (n=44,731), and femoral neck bone mineral density (FN-BMD) (n=49,988) to infer causal relationships between lipid and bone metabolism. The coefficient product method was employed to calculate the indirect effects of human traits and the proportion of mediating effects.

Results

The results showed that a 1 standard deviation(SD) increase in HDL-C, LDL-C and TC was associated with a decrease in LS-BMD of 0.039 g/cm2, 0.045 g/cm2 and 0.054 g/cm2, respectively. The proportion of mediating effects of systolic blood pressure (SBP) on HDL-C to LS-BMD was 3.17%, but suppression effects occurred in the causal relationship of LDL-C and TC to LS-BMD. Additionally, the proportion of mediating effects of hand grip strength (HGS) on the TC to LS-BMD pathway were 6.90% and 4.60% for the left and right hands, respectively.

Conclusion

In conclusion, a negative causal relationship was established between lipid metabolism and bone metabolism. Our results indicated that SBP and HGS served as mediators for the effects of lipid metabolism on bone metabolism.

The levels and trends of metabolic risk factors in the elderly population at the national and sub-national scale in Iran from 1990 to 2016

Purpose

Describing the trends of metabolic risk factors (MRFs) in the elderly population.

Methods

We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016.

Results

Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1-70.4) in women and to 51.1% (47.5-54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016.

Conclusion

The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01297-z.

A Korean Nationwide Cross-Sectional Study Investigating Risk Factors, Prevalence, and Characteristics of Sarcopenia in Men in Early Old Age

The present study investigated the risk factors, prevalence, and characteristics of sarcopenia among men aged 50-64 years. A total of 2868 participants were enrolled in this study. Of these, 328 individuals were classified into a sarcopenia group; the remaining 2540 were assigned to a control group. This study examined several variables, including skeletal muscle mass index, age, height, weight, body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, triglyceride and total cholesterol levels, alcohol consumption, and tobacco use. It employed a stratified, clustered, and multistage probability sampling design. Complex sampling was used for the data analysis. The prevalence of sarcopenia was 10.25% (95% CI: 8.98-11.69). All anthropometric measures, including height, weight, BMI, and waist circumference, were significantly different between the two groups (p < 0.05). In terms of blood pressure, only systolic blood pressure (SBP) was significant (p < 0.05), and fasting glucose and triglyceride levels were risk factors for sarcopenia (p < 0.05). Tobacco use differed significantly between the two groups (p < 0.05). This study reported the specific prevalence of sarcopenia and identified its risk factors among men in early old age.

Geriatric sarcopenia is associated with hypertension: A systematic review and meta-analysis

This meta-analysis aimed to explore the potential relationship between senile sarcopenia and hypertension in older people. A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, up to November 2022. Ten studies comprising 14 804 participants were enrolled. The odds ratio (OR) and 95% confidence interval (CI) was pooled to evaluate the correlation between sarcopenia and hypertension in older people utilizing a random-effects model. Subgroup and sensitivity analyses were then carried out to explore the potential sources of heterogeneity. The results revealed a substantial correlation between sarcopenia and hypertension among older people (OR = 1.39, 95% CI: 1.15-1.67, p < .01). Further subgroup analysis revealed an association between sarcopenic obesity and hypertension (OR = 1.49, 95% CI: 1.37-1.62, p < .01). In conclusions, our findings highlighted a significant relationship between sarcopenia and hypertension among older people, with sarcopenic obesity amplifying this risk.

Association between serum triglyceride to high-density lipoprotein cholesterol ratio and sarcopenia among elderly patients with diabetes: a secondary data analysis of the China Health and Retirement Longitudinal Study

OBJECTIVE

Previous studies investigating the association between the serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and the occurrence of sarcopenia in different populations have yielded inconsistent results. This study aimed to investigate the potential association between TG/HDL-C ratio and sarcopenia among elderly Chinese patients with diabetes.

DESIGN

A secondary data analysis.

SETTING

This was a secondary analysis of data from the China Health and Retirement Longitudinal Study.

PARTICIPANTS

In this study, 752 elderly individuals with diabetes were included after excluding individuals aged <60 years old, those with missing data for the assessment of sarcopenia and missing measurements for plasma glucose or glycated haemoglobin.

OUTCOME MEASURES

The primary information included TG/HDL-C ratio, muscle strength, physical performance, muscle mass and covariables. The association between TG/HDL-C ratio and sarcopenia was assessed using ordinal logistic regression and linear regression analysis.

RESULTS

On multivariate ordinal logistic regression, among male patients, compared with those with the lowest quartile of TG/HDL-C ratio (≤1.41), those with the highest quartile (>4.71) had a significantly lower risk of more severe sarcopenia (OR 0.24, 95% CI 0.10 to 0.54). Similarly, among female patients, compared with those with the lowest quartile of TG/HDL-C ratio (≤2.07), those with the highest quartile (>5.61) had a significantly lower risk of more severe sarcopenia (OR 0.17, 95% CI 0.07 to 0.44). In multivariate linear regression, male patients with the highest quartile of TG/HDL-C ratio (β=0.36, 95% CI 0.20 to 0.51) had higher muscle mass than those with the lowest quartile. Similarly, female patients with the highest quartile of TG/HDL-C ratio (β=0.31, 95% CI 0.10 to 0.51) had higher muscle mass than those with the lowest quartile.

CONCLUSIONS

There was a negative association between TG/HDL-C ratio categorised by quartile and sarcopenia, which indicates that a higher TG/HDL-C ratio may be related to better muscle status.

Epidemiology of sarcopenia: Prevalence, risk factors, and consequences

Sarcopenia is a geriatric condition featured by a progressive loss of muscle mass and function and associated with various adverse health outcomes. In this review, we aimed to summarize the epidemiological features of sarcopenia as well as consequences and risk factors of the disease. We performed a systematic review of meta-analysis on sarcopenia to collect data. The prevalence of sarcopenia varied between studies and depending on definition used. Sarcopenia was estimated to influence 10 %-16 % of the elderly worldwide. The prevalence of sarcopenia was higher among patients compared to general populations. The prevalence of sarcopenia ranged from 18 % in diabetic patients to 66 % in patients with unresectable esophageal cancer. Sarcopenia is associated with a high risk of a wide range of adverse health outcomes, including poor overall and disease-progression free survival rate, postoperative complications, and longer hospitalization in patients with different medical situations as well as falls and fracture, metabolic disorders, cognitive impairment, and mortality in general populations. Physical inactivity, malnutrition, smoking, extreme sleep duration, and diabetes were associated with an increased risk of sarcopenia. However, these associations were mainly based on non-cohort observational studies and need confirmation. High-quality cohort, omics, and Mendelian randomization studies are needed to deeply understand the etiological basis of sarcopenia.

The correlation between serum creatine kinase with low muscle mass in type 2 diabetes patients

Creatine kinase (CK), the key enzyme in regulating energy metabolism, is demonstrated to be correlated with insulin resistance. Type 2 diabetes mellitus (T2DM) is considered as a risk factor for developing low muscle mass. The purpose of this investigation was to evaluate whether serum CK is associated with low muscle mass in T2DM patients. This cross-sectional study enrolled a consecutive population of 1086 T2DM patients recruited from the inpatients in our department. Dual-energy X-ray absorptiometry was utilized to detect the skeletal muscle index (SMI). In all, 117 males (20.24%) and 72 females (16.51%) showed low muscle mass in T2DM patients. CK was associated with a reduced risk of low muscle mass in male and female T2DM patients. SMI was correlated with age, duration of diabetes, body mass index (BMI), diastolic blood pressure (DBP), triglyceride, high-density lipoprotein cholesterol, and CK in male subjects analyzed using linear regression. Linear regression analysis showed that SMI was correlated with age, BMI, DBP, and CK in female subjects. In addition, CK was correlated with BMI and fasting plasma glucose in male and female T2DM groups. CK is inversely correlated with low muscle mass in T2DM patients.

Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand

BACKGROUND

Sarcopenia is an age-associated skeletal muscle condition characterized by low muscle mass, strength, and physical performance. There is no international consensus on a sarcopenia definition and no contemporaneous clinical and research guidelines specific to Australia and New Zealand. The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force aimed to develop consensus guidelines for sarcopenia prevention, assessment, management and research, informed by evidence, consumer opinion, and expert consensus, for use by health professionals and researchers in Australia and New Zealand.

METHODS

A four-phase modified Delphi process involving topic experts and informed by consumers, was undertaken between July 2020 and August 2021. Phase 1 involved a structured meeting of 29 Task Force members and a systematic literature search from which the Phase 2 online survey was developed (Qualtrics). Topic experts responded to 18 statements, using 11-point Likert scales with agreement threshold set a priori at >80%, and five multiple-choice questions. Statements with moderate agreement (70%-80%) were revised and re-introduced in Phase 3, and statements with low agreement (<70%) were rejected. In Phase 3, topic experts responded to six revised statements and three additional questions, incorporating results from a parallel Consumer Expert Delphi study. Phase 4 involved finalization of consensus statements.

RESULTS

Topic experts from Australia (n = 62, 92.5%) and New Zealand (n = 5, 7.5%) with a mean ± SD age of 45.7 ± 11.8 years participated in Phase 2; 38 (56.7%) were women, 38 (56.7%) were health professionals and 27 (40.3%) were researchers/academics. In Phase 2, 15 of 18 (83.3%) statements on sarcopenia prevention, screening, assessment, management and future research were accepted with strong agreement. The strongest agreement related to encouraging a healthy lifestyle (100%) and offering tailored resistance training to people with sarcopenia (92.5%). Forty-seven experts participated in Phase 3; 5/6 (83.3%) revised statements on prevention, assessment and management were accepted with strong agreement. A majority of experts (87.9%) preferred the revised European Working Group for Sarcopenia in Older Persons (EWGSOP2) definition. Seventeen statements with strong agreement (>80%) were confirmed by the Task Force in Phase 4.

CONCLUSIONS

The ANZSSFR Task Force present 17 sarcopenia management and research recommendations for use by health professionals and researchers which includes the recommendation to adopt the EWGSOP2 sarcopenia definition in Australia and New Zealand. This rigorous Delphi process that combined evidence, consumer expert opinion and topic expert consensus can inform similar initiatives in countries/regions lacking consensus on sarcopenia.

Body mass index, waist circumference and cardiovascular diseases in transitional ages (40 and 66 years)

BACKGROUND

There is lack of data on effect modification by age on the association between body mass index (BMI) or waist circumference (WC) and cardiovascular diseases (CVDs). We aimed to investigate the impact of BMI and WC on incident CVDs in individuals aged 40 and 66 years.

METHODS

Overall, 2 430 510 participants who underwent a national health screening for transitional ages provided by the Korean National Health Insurance Service between 2009 and 2012 were included. The adjusted hazard ratios and 95% confidence intervals for myocardial infarction (MI), ischaemic stroke and CVDs as a composite outcome of MI and ischaemic stroke were calculated using multivariable Cox proportional hazard regression analysis.

RESULTS

During a mean follow-up of 7.7 years, 24 884 MI and 29 415 ischaemic stroke events occurred. Among participants aged 40 years, there was a J-shaped association of BMI with incident CVDs, MI and ischaemic stroke with nadir at BMI 18.5-22.9 kg/m2 (P for trend < 0.001 for all). Among those aged 66 years, there were significant U-shaped associations of BMI with CVDs and MI with nadir at a BMI of 23.0-24.9 kg/m2 (P for trend 0.013 and 0.017, respectively). WC was linearly associated with all study outcomes in both age groups (P for trend < 0.001). The impact of general and abdominal obesity on both study outcomes was more prominent in those aged 40 years than in those aged 66 years (P for interaction < 0.001).

CONCLUSIONS

To prevent cardiovascular risk, weight loss intervention should be cautiously implemented and individualized according to age. The maintenance of muscle mass may be essential in managing weight loss particularly in older population.

Determination of skeletal muscle mass by aspartate aminotransferase / alanine aminotransferase ratio, insulin and FSH in Chinese women with sarcopenia

BACKGROUND

Sarcopenia is an age-related skeletal muscle disorder that involves a loss of muscle mass or strength and physiological function. Skeletal muscle deteriorates in both quantity and quality. The endocrine system is an important regulator of muscle metabolism. Therefore, we aimed to explore the relationship between biochemical markers and muscle mass in sarcopenia.

METHODS

We used the AWGS 2014 as the diagnostic criteria for sarcopenia, considering both the loss in muscle mass, muscle strength and physical performance. A total of 2837 elderly female participants over 50 years of age from the West China Health and Aging Trend (WCHAT) study were included. Insulin, glucose, 25(OH)VD, procalcitonin, alanine aminotransferase, aspartate aminotransferase, total protein, prealbumin, albumin, thyroid-stimulating hormone, free triiodothyronine, free tetraiodothyronine, triglycerides, cholesterol, high-density lipoprotein, very low-density lipoprotein, cortisol, and follicle-stimulating hormone were measured. Based on the findings of univariate analysis, multivariate regression and receiver operating characteristic (ROC) curves were established.

RESULTS

Participants with sarcopenia had significantly lower free triiodothyronine, insulin, total protein, albumin, prealbumin, albumin/prealbumin ratio (A/G), alanine aminotransferase, triglycerides, and very low-density lipoprotein concentrations (P < 0.05). Compared with those without sarcopenia, those with sarcopenia had significantly higher free tetraiodothyronine, cortisol, follicle-stimulating hormone (FSH), aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT), and high-density lipoprotein concentrations (P < 0.05). Insulin (OR = 0.854), FSH (OR = 1.016), and the AST/ALT ratio (OR = 1.819) were independent risk factors for low muscle mass (P < 0.001). The AUC of insulin was the highest, followed by the AST/ALT ratio and FSH (0.691, 0.671, and 0.634, respectively), and the AUC of the mixture of the above three reached 0.736.

CONCLUSION

In this cross-sectional study of elderly Chinese females aged over 50 years from the WCHAT, FSH, insulin, and AST/ALT ratio were associated with sarcopenia and risk factors for low muscle mass.

Association between ALT/AST and Muscle Mass in Patients with Type 2 Diabetes Mellitus

Objective

The alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio is thought to be related to metabolic disorders and insulin resistance. Type 2 diabetes mellitus (T2DM) is a high-risk population for low muscle mass. This study was performed to evaluate the association between ALT/AST and muscle mass in subjects with T2DM.

Method

This cross-sectional study enrolled 1068 subjects (566 males and 502 females) with T2DM. General information, medical history, and blood samples were collected. Skeletal muscle index (SMI) was detected using dual-energy X-ray absorptiometry. Logistic regression analysis was utilized to determine the correlation of ALT/AST and low muscle mass in subjects with T2DM. Multiple linear regression analysis was utilized to evaluate the association between ALT/AST, SMI and other metabolic characteristics.

Result

Of all subjects, 115 men (20.3%) and 71 women (14.1%) presented low muscle mass. ALT/AST was related to an increased risk for low muscle mass in both genders. Multiple linear regression analysis displayed that SMI was negatively associated with ALT/AST, age, glycosylated hemoglobin (HbA1c), and high-density lipoprotein cholesterol (HDL) in male group. While in female group, SMI was positively associated with systolic blood pressure (SBP) and negatively associated with ALT/AST and age. Furthermore, ALT/AST was associated with age and BMI in both genders.

Conclusion

ALT/AST was negatively associated with muscle mass in subjects with T2DM.

Sex Differences of Sarcopenia in an Elderly Asian Population: The Prevalence and Risk Factors

The loss of muscle mass is widespread in age-related health phenomena in the elderly population. This study examined the prevalence of sarcopenia in a community-dwelling elderly population according to gender. The study also identified gender-specific risk factors in older people aged 75-84 years old. One thousand two hundred and ninety-three participants aged between 75 and 84 years from the National Health and Nutrition Examination Surveys in Korea were investigated. The prevalence of sarcopenia in males and females in the weighted-value sample was 41.2% (95%CI: 35.8-46.8) and 37.2% (32.7-41.9), respectively. Gender-specific clinical risk factors in males were height, weight, body mass index, waist circumference, skeletal muscle mass index, fasting glucose, and triglyceride levels. Height, weight, body mass index, waist circumference, skeletal muscle mass index, and total cholesterols were clinical risk factors for females. These outcomes would be crucial to primary care clinicians and health care professionals when patients require a referral for early detection and treatment. Health care professionals and clinicians can quickly identify potential sarcopenic patients by acknowledging the gender-specific prevalence and risk factors.

Diagnostic significance of calf circumference in sarcopenia of healthy korean adult males

This study aimed to determine the relationship between sarcopenia and physical function, and the best method of diagnosing sarcopenia in healthy adults. Early prevention of sarcopenia is important; however, no studies have been conducted in healthy and relatively young adults. In addition, it remains unclear whether calf circumference is associated with sarcopenia-defined variables. A total of 85 healthy male participants were enrolled, and the mean standard deviation age of the participants was 59.76 (8.12) years. Abdominal computed tomography (CT) was performed to measure muscle areas. All subjects were divided into sarcopenia and non-sarcopenia groups based on skeletal muscle mass index using computed tomography. Sarcopenia showed a tendency to be related to lower grip strength, five times sit-to-stand and timed up and go tests for physical function. This result shows that overweight and obesity in the sarcopenia group had fully adjusted odds ratios of 0.026 (95% CI: 0.002–0.317) and 0.008 (95% CI: 0.001–0.096), respectively. Calf circumference was higher specificity (71.43 and 64.86) better than bioelectrical impedance analysis-based skeletal mass index and had a similar sensitivity (72.09 and 82.35). In conclusion, calf circumference suggests the need to consider its use as a tool for assessing muscle mass in the diagnosis of sarcopenia.

The relationship between body mass index and stroke: a systemic review and meta-analysis

BACKGROUND

Stroke is an acute cerebrovascular event closely related to brain tissue damage, and is one of the major causes of death and disability in worldwide. Various studies have reported the effects of body mass index (BMI) on the risk of stroke, but the results remain varied and these results have not been synthesized. Therefore, a meta-analysis was performed to evaluate the relationship between BMI and the risk of stroke.

OBJECTIVES

This systematic review was conducted to explore the relationship between BMI and the risk of stroke.

METHODS

PubMed, EMBASE, Web of Science and Cochrane Library, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Chinese Biomedical Database (CBM), and CQVIP were comprehensively searched for studies exploring the relationship between BMI and stroke from inception to December 1, 2021.

RESULTS

This review included 24 studies involving 5,798,826 subjects. The results of meta-analysis showed that the pooled RR of stroke risk was 0.93 (95% confidence interval [CI] 0.82-1.06, I² = 88.8%, P = 0.29) for the underweight group. Higher BMI (overweight or obese group) was associated with an increased overall risk of stroke, with pooled RR values of 1.25 (95% CI 1.16-1.34, I² = 84.8%, P = 0.00) and 1.47 (95% CI: 1.02-2.11, I² = 99.4%, P = 0.04).

CONCLUSION

The risk of stroke was positively correlated with BMI, and the association was stronger in male and ischemic stroke. Lowering BMI can be used as a way to prevent stroke, and for people who are overweight or obese, lowering body weight can reduce the risk of stroke.

[Mibefradil improves skeletal muscle mass, function and structure in obese mice]

OBJECTIVE

To observe the effect of mibefradil on skeletal muscle mass, function and structure in obese mice.

METHODS

Fifteen 6-week-old C57BL/6 mice were randomized equally into normal diet group (control group), high-fat diet (HFD) group and high-fat diet +mibefradil intervention group (HFD +Mibe group). The grip strength of the mice was measured using an electronic grip strength meter, and the muscle content of the hindlimb was analyzed by X-ray absorptiometry (DXA). Triglyceride (TG) and total cholesterol (TC) levels of the mice were measured with GPO-PAP method. The cross-sectional area of the muscle fibers was observed with HE staining. The changes in the level of autophagy in the muscles were detected by Western blotting and immunofluorescence assay, and the activation of the Akt/mTOR signaling pathway was detected with Western blotting.

RESULTS

Compared with those in the control group, the mice in HFD group had a significantly greater body weight, lower relative grip strength, smaller average cross sectional area of the muscle fibers, and a lower hindlimb muscle ratio (P < 0.05). Immunofluorescence assay revealed a homogenous distribution of LC3 emitting light red fluorescence in the cytoplasm in the muscle cells in HFD group and HFD+Mibe group, while bright spots of red fluorescence were detected in HFD group. In HFD group, the muscular tissues of the mice showed an increased expression level of LC3 II protein with lowered expressions of p62 protein and phosphorylated AKT and mTOR (P < 0.05). Mibefradil treatment significantly reduced body weight of the mice, lowered the expression level of p62 protein, and increased forelimb grip strength, hindlimb muscle ratio, cross-sectional area of the muscle fibers, and the expression levels of LC3 II protein and phosphorylated AKT and mTOR (P < 0.05).

CONCLUSION

Mibefradil treatment can moderate high-fat diet-induced weight gain and improve muscle mass and function in obese mice possibly by activating AKT/mTOR signal pathway to improve lipid metabolism and inhibit obesityinduced autophagy.

Gender-Specific Risk Factors and Prevalence for Sarcopenia among Community-Dwelling Young-Old Adults

Sarcopenia in the elderly is a serious global public health problem. Numerous sarcopenia studies classified their subjects into a single group, but health conditions and body composition vary according to age. This study examined the prevalence of sarcopenia according to gender and assessed the gender-specific risk factors in young-old adults. In this study, 2697 participants in Korea aged from 65 to 74 years were analyzed from Korea National Health and Nutrition Examination Surveys. The prevalence of sarcopenia in males and females was 19.2% (CI 95%: 16.4–22.3) and 26.4% (23.7–29.4), respectively. The risk factors in men were age, body mass index (BMI), waist circumference (WC), skeletal muscle index (SMI), fasting glucose (FG), triglyceride, and systolic blood pressure (SBP). Their odd ratios were 1.447, 0.102, 1.494, 0.211, 0.877, 1.012, and 1.347. The risk factors in women were age, height, weight, BMI, WC, SMI, and fasting glucose with values of 1.489, 0.096, 0.079, 0.158, 0.042, and 1.071, respectively. The prevalence of sarcopenia was higher in females than in males. Overall, the clinical risk factors in males were age, height, BMI, WC, SMI, FG, triglyceride, and SBP. Age, height, weight, BMI, WC, SMI, and FG were the risk factors for women.

Protein Hydrolysate from Spirulina platensis Prevents Dexamethasone-Induced Muscle Atrophy via Akt/Foxo3 Signaling in C2C12 Myotubes

Loss of muscle mass is the primary symptom of sarcopenia. Protein intake is recommended to prevent muscle mass loss, and Spirulina platensis, a microalga with high protein content, is a potential protein supplement. Here, we evaluated the differentiation ability of C2C12 cells and the inhibitory effect of Spirulina hydrolysates (SPH) prepared by Collupulin on dexamethasone (DEX)-treated C2C12 cells. SPH contained 578.27 mg/g protein and 92.30 mg/g branched-chain amino acids. SPH increased C2C12 myotube length and diameter, likely owing to increased MyoD1 and Myf5 expression. Inhibition of increased Atrogin-1, MuRF-1, and FoxO3 expression by SPH in DEX-treated C2C12 cells suppressed DEX-induced muscle atrophy. Moreover, SPH inhibited the DEX-induced increase in cytosolic p-Akt protein expression and suppressed the increase in nuclear FoxO3a protein expression, thereby suppressing the increase in the protein expression of the ubiquitin-proteasome-related factors Atrogin-1 and MuRF-1, which are involved in muscle atrophy. SPH suppressed DEX-induced muscle atrophy by activating the Akt/FoxO3a pathway. SPH promoted C2C12 myoblast differentiation into myotubes and inhibited DEX-induced myotube atrophy by suppressing Atrogin-1 and MuRF-1 expression and regulating the FoxO3a transcription factor. Collectively, SPH can be used as a functional food to inhibit muscle atrophy and promote muscle regeneration.

Association of triglyceride-glucose index and the presence of low muscle mass in type 2 diabetes patients

Triglyceride-glucose index (TyG index) has been used in healthy individuals as a marker of insulin resistance. Type 2 diabetes mellitus (T2DM) showed an increased risk of developing low muscle mass compared to control subjects. This study is performed to determine the association of TyG index with the presence of low muscle mass in T2DM patients. This study included 1098 T2DM patients who were recruited from the inpatients in Qilu Hospital (Qingdao). Skeletal muscle index (SMI) was measured using dual energy X-ray absorptiometry. Serum triglyceride and fasting plasma glucose were measured and used to calculate TyG index. 119 male subjects (20.2%) had low muscle mass, while 72 female subjects (14.1%) had low muscle mass in T2DM patients. TyG index was correlated with a decreased risk of low muscle mass in both male and female T2DM groups. TyG index was found to be positively correlated with SMI after multivariate adjustment in male subjects. When TyG index was ≤ 9.5, TyG index was positively correlated with SMI. However, when TyG index was > 9.5, there was not a significant association between TyG index and SMI. Moreover, TyG index was not correlated with SMI after multivariate analysis in female subjects. However, TyG index was positively correlated with SMI when TyG index was ≤ 9. When TyG index was > 9, TyG index was negatively correlated with SMI, however, the correlation was not statistically significant. TyG index is inversely correlated with the presence of low muscle mass in T2DM patients.

Cardiovascular protection associated with cilostazol, colchicine and target of rapamycin inhibitors

ABSTRACT

An alteration in extracellular matrix production by vascular smooth muscle cells is a crucial event in the pathogenesis of vascular diseases such as aging-related, atherosclerosis and allograft vasculopathy. The human target of rapamycin (TOR) is involved in the synthesis of extracellular matrix by vascular smooth muscle cells. TOR inhibitors reduce arterial stiffness, blood pressure, and left ventricle hypertrophy and decrease cardiovascular risk in kidney graft recipients and patients with coronary artery disease and heart allograft vasculopathy. Other drugs that modulate extracellular matrix production such as cilostazol and colchicine have also demonstrated a beneficial cardiovascular effect. Clinical studies have consistently shown that cilostazol confers cardiovascular protection in peripheral vascular disease, coronary artery disease, and cerebrovascular disease. In patients with type 2 diabetes, cilostazol prevents the progression of subclinical coronary atherosclerosis. Colchicine reduces arterial stiffness in patients with Familial Mediterranean Fever and patients with coronary artery disease. Pathophysiological mechanisms underlying the cardioprotective effect of these drugs may be related to interactions between the cytoskeleton, TOR signaling and cyclic AMP synthesis that remain to be fully elucidated. Adult vascular smooth muscle cells exhibit a contractile phenotype and produce little extracellular matrix. Conditions that upregulate extracellular matrix synthesis induce a phenotypic switch toward a synthetic phenotype. TOR inhibition with rapamycin reduces extracellular matrix production by promoting the change to the contractile phenotype. Cilostazol increases the cytosolic level of cyclic AMP, which in turn leads to a reduction in extracellular matrix synthesis. Colchicine is a microtubule-destabilizing agent that may enhance the synthesis of cyclic AMP.

Food Security Moderates the Relationships of Muscle Mass with Metabolic Syndrome and Insulin Resistance

Background

This study aimed to determine whether food security moderates the relationship of skeletal muscle mass with metabolic syndrome (MetS) and insulin resistance (IR).

Methods

This study analyzed the data of 10,680 adults using the Korea National Health and Nutrition Examination Survey from 2008 to 2011. The food security reported by households, appendicular skeletal muscle mass (ASM) divided by body mass index (BMI) (ASM/BMI), weight (ASM/weight), or height squared (ASM/height²) as muscle mass indicators, MetS (defined as presence of at least 3 components of MetS), and IR (defined as sex-specific highest quintile of homeostatic model assessment for IR) were assessed. The association between the muscle mass indicators and food security as well as their interaction with MetS and IR was analyzed for all participants and each sex using complex sample logistic regression and general linear model analyses.

Results

When the ASM/BMI increased by 0.1 kg/BMI, the odds for MetS and IR decreased by 36% and 29%, respectively, after adjusting for age, sex, education, economic level, smoking, alcohol consumption, physical activity, chronic diseases, and intake of fats and protein. There was a significant interaction between ASM/BMI and food security in their relationship with MetS and its components. In the low food security group, the inverse relationship of ASM/BMI with MetS and IR was stronger than in the food security group. These findings were more pronounced in men than in women, and similar findings were observed in the association with ASM/weight.

Conclusions

The associations of skeletal muscle mass with MetS and IR may be influenced by household food security in Korean adults.

The association of cardio-metabolic risk factors and history of falling in men with osteosarcopenia: a cross-sectional analysis of Bushehr Elderly Health (BEH) program

Background

Osteosarcopenia, defined as sarcopenia plus osteopenia/osteoporosis, may increase the risk of fractures and affects morbidity and mortality in the older population. Falling is also common in the elderly and increases the risk of fractures and mortality. We examined the association of cardio-metabolic risk factors with a history of falling in osteosarcopenic men.

Methods

We used the baseline data of the Bushehr Elderly Health (BEH) program. Osteosarcopenia was defined as having both sarcopenia (reduced skeletal muscle mass plus low physical performance and/or low muscle strength) and osteopenia/osteoporosis (T-score ≤ − 1.0). Falling was defined as a self-reported history of an unintentional down on the ground during the previous year before the study. We used logistic regression analysis to estimate the adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) to quantify the associations.

Results

All elderly men diagnosed with osteosarcopenia (n = 341), with a mean age of 73.3(±7.4) years, were included. Almost 50(14.7%) participants reported falling. Age showed a positive association with falling (AOR: 1.09, 95%CI: 1.04–1.14). An increase of 10 mmHg in systolic blood pressure(SBP), reduces the odds of falling by 26%(AOR:0.74, 95%CI:0.62–0.89), while a positive association was detected for fasting plasma glucose (FPG), as 10 mg/dl increase in the FPG, raises the chance of falling by 14%(AOR = 1.14, 95%CI:1.06,1.23). Hypertriglyceridemia was inversely associated with falling (AOR = 0.33, 95% CI: 0.12, 0.89).

Conclusions

Falling is a major public health problem in rapidly aging countries, especially in individuals with a higher risk of fragility fractures. Older age-raised fasting plasma glucose and low SBP are associated with falling in osteosarcopenic patients. 

Considering the higher risk of fracture in osteosarcopenic men, comprehensive strategies are needed to prevent fall-related injuries in this high-risk population.

Impact of Different Operational Definitions of Sarcopenia on Prevalence in a Population-Based Sample: The Salus in Apulia Study

Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP1) issued its first operational definition to diagnose sarcopenia. This was updated in 2019 with a revised sequence of muscle mass and muscle strength (EWGSOP2). The aim of the study was to investigate the impact of these different operational definitions on sarcopenia prevalence in a representative population-based sample. Methods: For each algorithm, the prevalence of sarcopenia-related categories was calculated and related to sociodemographic and lifestyle variables, anthropometric parameters, and laboratory biomarkers. The present analysis used data from the Salus in Apulia Study (Italy, 740 subjects, mean age 75.5 ± 5.9 years, 54% women). Results: The application of the EWGSOP1 adapted algorithm resulted in 85% [95% confidence intervals (CI): 82–88%] non-sarcopenic subjects, 10% (95% CI: 8–12%) pre-sarcopenic subjects, and 5% (95% CI: 3–7%) sarcopenic/severe sarcopenic subjects. The sarcopenia-related categories were inversely related to weight and body mass index (BMI), particularly in overweight/obese subjects, and these categories showed favorable metabolic biomarkers. The EWGSOP2 algorithm yielded 73% (95% CI: 69–76%) non-sarcopenic subjects, 24% (95% CI: 21–27%) probably sarcopenic subjects, and 4% (95% CI: 2–5%) sarcopenic subjects. Conclusions: The present study identified BMI as a potential confounder of the prevalence estimates of sarcopenia-related categories in population-based settings with different EWGSOP operational definitions.

Association among the Prevalence of Sarcopenia without Obesity, Nonsarcopenic Obesity, Sarcopenic Obesity, and Metabolic Syndrome in Cancer Survivors: Based on Korea National Health and Nutrition Examination Survey

Objective:

In this study, we aimed to investigate the association among the prevalence of sarcopenia without obesity, nonsarcopenic obesity, sarcopenic obesity, and metabolic syndrome in cancer survivors using data from the 4^th and 6^th Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative data source.

Methods:

The 4^th and 6^th KNHANES was conducted in 2008–2011. Data from cancer survivors were obtained including 133 obese patients without sarcopenia, 98 obese patients with sarcopenia, and 87 patients with sarcopenia but without obesity. SPSS 22.0 was used for statistical analysis with complex sample survey modules and commands.

Results:

The prevalence of metabolic syndrome was 25.3% in the sarcopenia without obesity group, 61.7% in the nonsarcopenic obesity group, and 67.3% in the sarcopenic obesity group, showing the highest rate in the sarcopenic obesity group, with a significant difference among the three groups (P < 0.001).

Conclusions:

In this study, the prevalence of metabolic syndrome was 25.3%, 61.7%, and 67.3% in the sarcopenia without obesity, nonsarcopenic obesity, and sarcopenic obesity groups, respectively, showing that the sarcopenic obesity group had the highest metabolic syndrome rate. Based on these results, various education programs for the prevention and treatment of metabolic syndrome should be developed for cancer patients.