Energy and nutrient intake by people with and without sarcopenia diagnosed by the European Working Group on Sarcopenia in Older People: a systematic review and meta-analysis

CONTEXT

There is growing evidence that insufficient dietary intake is associated with sarcopenia.

OBJECTIVE

In this systematic review and meta-analysis, the energy and nutrient intakes by people with and without sarcopenia were compared using only the European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) consensus diagnostic criteria.

DATA SOURCES

Only observational studies that compared energy and nutrient intake from food alone by individuals with and without sarcopenia were included. Studies were searched in the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus. The review followed the PRISMA checklist and submitted the protocol to PROSPERO.

DATA EXTRACTION

Data were extracted by 2 authors independently. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale.

DATA ANALYSIS

A total of 8648 articles were identified and 12 were selected. Among individuals with sarcopenia, lower intakes of energy and some nutrients, mainly with antioxidant properties, were observed compared with those without sarcopenia. Meta-analyses showed that individuals with sarcopenia consume fewer calories/day than individuals without sarcopenia (n = 10 studies; standardized mean difference (SMD) -0.15; 95% confidence interval: -0.29, -0.01) diagnosed by EWGSOP1 and EWGSOP2. Individuals with sarcopenia consume less omega-3, folate, magnesium, phosphorus, selenium, zinc, and vitamins C, D, and E when compared with those without sarcopenia.

CONCLUSION

The results of the present study suggest that insufficient intake of energy and nutrients with antioxidant potential may be associated with sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020195698.

Prevalence of sarcopenia using different methods in patients with non-alcoholic fatty liver disease

BACKGROUND

Sarcopenia is a clinical condition associated with several liver diseases and it includes non-alcoholic fatty liver disease (NAFLD) in its broad spectrum as steatosis, steatohepatitis and fibrosis. However, the criteria to define sarcopenia are diverse, and even those established in consensus have been discussed regarding their performance in making an accurate diagnosis.

AIM

To evaluate the prevalence of sarcopenia, using different methods, in patients with NAFLD, and its association with clinical-anthropometric parameters.

METHODS

This was an observational study of outpatients with NAFLD. Sarcopenia was defined by the European Working Group Consensus on Sarcopenia in Older People of 2010 (EWGSOP1) and 2018 (EWGSOP2). The skeletal muscle index was used to estimate muscle mass, handgrip strength was assessed using the dynamometer and physical performance by walking a distance of four meters at usual walking speed. The non-invasive fibrosis scores, fibrosis-4 (FIB-4) index and Aspartate aminotransferase to platelet ratio index (APRI), were used to assess the absence and presence of fibrosis.

RESULTS

Fifty-seven individuals with NAFLD were evaluated, the mean age (SD) was 52.7 (11.3) years and 75.4% were female. Fibrosis assessed by FIB-4 and APRI was observed in 3.7% and 16.6% of patients with NAFLD, respectively. The diagnosis of sarcopenia was identified only by EWGSOP1 in 3.5% of NAFLD patients, and the prevalence of probable/pre-sarcopenia was higher using the EWGSOP2 consensus at 26.3%, when compared to 1.8% with EWGSOP1. Sarcopenia defined by EWGSOP1, was associated with grade I steatosis, but without overweight (P < 0.05). An association between sarcopenia and fibrosis was not observed (P > 0.05). EWGSOP2 showed a greater number of patients with probable sarcopenia, and who were overweight (12 (80.0%)), with a higher degree of steatosis [11 (73.3%) and presence of fibrosis (1 (6.7%), FIB-4 and 3 (20.0%), APRI] compared to EWGSOP1 [1 (100%), 0 (0.0%), 0 (0.0%), FIB-4 and 0 (0.0%), APRI, respectively].

CONCLUSION

The present study showed that sarcopenia in NAFLD was not predominant in patients without fibrosis, by both diagnostic methods. In addition, the prevalence of probable sarcopenia also depends on the method applied.

Anthropometric clinical indicators of visceral adiposity as predictors of nonalcoholic fatty liver disease

OBJECTIVE

This study aims to evaluate the role of anthropometric clinical indicators of visceral adiposity as predictors of NAFLD, identifying the cutoff points based on gender.

METHODS

This was a cross-sectional study conducted in patients with or without NAFLD. Waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), Conicity Index (C Index), and lipid accumulation product (LAP) were evaluated.

RESULTS

A total of 107 individuals were evaluated, of which 46.7% were diagnosed with NAFLD. Individuals with NAFLD presented higher values of WC, BMI, C Index, LAP, and WHtR when compared with those without NAFLD (p<0.05). For the total sample, the indicators WC, BMI, WHtR, LAP, and C Index had an area under the receiver operator characteristic curve (AUC) above 0.87, with no difference in the prediction of NAFLD in both sexes. WHtR (AUC=0.934) was the indicator of visceral adiposity with the best discriminatory power for NAFLD, followed by LAP (0.919), WC (0.912), C Index (0.907), and BMI (0.877).

CONCLUSIONS

The anthropometric clinical indicators of visceral adiposity showed high performance, especially the WHtR indicator, as NAFLD predictors.