Skeletal muscle mass adjusted by height correlated better with muscular functions than that adjusted by body weight in defining sarcopenia

Association of different bioimpedanciometry estimations of muscle mass with functional measures

AIM

To investigate the muscle mass adjustment technique that best correlates with functional measures.

METHODS

A cross-sectional study was designed. Community-dwelling older adults aged ≥60 years were assessed for body composition and functional measures between November 2012 and July 2017 in the geriatric outpatient clinic of a university hospital. Body composition was assessed with bioimpedance analysis. Skeletal muscle mass (SMM) was adjusted by height² , weight or body mass index (BMI). Functional and disability measures included handgrip strength assessed by a Jamar hydraulic hand dynamometer, gait speed by 4-m usual gait speed, frailty by the Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight scale score, activities of daily living (ADL) and instrumental ADL scores. Nutrition was evaluated by the Mini Nutritional Assessment - Short Form.

RESULTS

A total of 1437 older adults (458 men, 979 women) with a mean age of 74.6 ± 7.0 years were included. The prevalences of low muscle mass were 2.4%, 47.8% and 20.3% when SMM was adjusted by height² , weight and BMI, respectively. Multivariate analyses adjusted for age, number of diseases, drugs and the Mini Nutritional Assessment - Short Form score revealed that when the SMM was adjusted by BMI, low muscle mass showed better associations with grip strength, gait speed, ADL, instrumental ADL and frailty than the height² or the weight-adjusted SMM.

CONCLUSIONS

SMM adjustment by BMI to designate low muscle mass was better associated with functional and disability measures than adjustment by height² and weight. The present results put forward the SMM index (by BMI) as the best adjustment method for SMM. These findings might be relevant for defining both sarcopenia and malnutrition. Geriatr Gerontol Int 2019; 19: 593-597.

Predictors of Discordance in the Assessment of Skeletal Muscle Mass between Computed Tomography and Bioimpedance Analysis

Computed tomography (CT) and bioimpedance analysis (BIA) can assess skeletal muscle mass (SMM). Our objective was to identify the predictors of discordance between CT and BIA in assessing SMM. Participants who received a comprehensive medical health check-up between 2010 and 2018 were recruited. The CT and BIA-based diagnostic criteria for low SMM are as follows: Defined CT cutoff values (lumbar skeletal muscle index (LSMI) <1 standard deviation (SD) and means of 46.12 cm²/m² for men and 34.18 cm²/m² for women) and defined BIA cutoff values (appendicular skeletal muscle/height² <7.0 kg/m² for men and <5.7 kg/m² for women). A total of 1163 subjects were selected. The crude and body mass index (BMI)-adjusted SMM assessed by CT were significantly associated with those assessed by BIA (correlation coefficient = 0.78 and 0.68, respectively; p < 0.001). The prevalence of low SMM was 15.1% by CT and 16.4% by BIA. Low SMM diagnosed by CT was significantly associated with advanced age, female gender, and lower serum albumin level, whereas low SMM diagnosed by BIA was significantly associated with advanced age, female gender, and lower BMI (all p < 0.05). Upon multivariate analysis, age >65 years, female and BMI <25 kg/m² had significantly higher risks of discordance than their counterparts (all p < 0.05). We found a significant association between SMM assessed by CT and BIA. SMM assessment using CT and BIA should be interpreted cautiously in older adults (>65 years of age), female and BMI <25 kg/m².

Association of loss of muscle mass with mortality in liver cirrhosis without or before liver transplantation: A systematic review and meta-analysis

BACKGROUND

Liver cirrhosis is a risk factor for the loss of muscle mass, which is associated with numerous adverse health outcomes. This meta-analysis aimed to examine whether loss of muscle mass was a predictor of increased mortality in cirrhotic patients without or before liver transplantation.

METHODS

Without language restriction, PubMed and Embase were searched for articles published from the earliest records to December 2018 investigating the influence of loss of muscle mass on survival of cirrhotic patients. Those who had undergone liver transplantation and had hepatocellular carcinoma were excluded. The main outcome was the hazard ratio (HR) for the association of mortality with loss of muscle mass, and the secondary outcome was the association of loss of muscle mass with Child-Pugh class and death caused by severe infection.

RESULTS

The meta-analysis included 16 observational studies, comprising 4070 participants. The pooled crude and adjusted HRs for the association of mortality with loss of muscle mass were 2.05 (95% confidence interval [CI], 1.51-2.78) and 2.36 (95% CI, 1.61-3.46). Using Child-Pugh Class A as reference, the odds ratios (ORs) for the association of loss of muscle mass with Child-Pugh Class B and Class C were 1.68 (95% CI, 0.96-2.92) and 1.94 (95% CI, 0.66-5.65). Patients with loss of muscle mass were likely to have infection-related mortality (OR = 3.38, 95% CI, 0.61-18.88) but the association did not reach statistical significance.

CONCLUSIONS

Loss of muscle mass is associated with mortality in cirrhotic patients without or before liver transplantation. Future studies should be conducted to explore whether exercise and nutritional supplementation can reverse muscle mass loss and improve long-term survival.

Association between metabolic syndrome and limb muscle quantity and quality in older adults: a pilot ultrasound study

PURPOSE

Limited imaging studies have investigated whether limb muscle quantity and quality change after metabolic syndrome (MetS) development. This pilot study examined MetS influence on limb muscle characteristics in older adults.

METHODS

Participants were recruited from annual health examinations; their right biceps brachii, triceps brachii, rectus femoris, and gastrocnemius muscles were measured by ultrasound. Anthropometric parameters, blood biochemistry, and physical performance (handgrip strength and gait speed) were also examined.

RESULTS

Overall, 129 participants were enrolled, including 26 with MetS. Although handgrip strength was lower in MetS patients, there were no significant between-group differences considering thickness and mean echogenicity of the four muscles. Handgrip strength was positively correlated with the thickness of biceps brachii, triceps brachii, and rectus femoris but was negatively associated with their echogenicity. On multivariate analysis, triceps muscle echogenicity was trivially associated (odds ratio, 0.93; 95% confidence interval, 0.86-0.99) with MetS, possibly due to multicollinearity with grip strength.

CONCLUSION

No significant difference was recognized in limb muscle thickness and echogenicity in the geriatric population with MetS compared with healthy controls by ultrasound imaging. However, the finding might be caused by the small sample size of our participants. Future large-scale studies should explore the influence of separated risk factors of MetS on limb muscle echotexture and examine whether manifestation differs in different age populations.

Implications of low muscle mass across the continuum of care: a narrative review

Abnormalities in body composition can occur at any body weight. Low muscle mass is a predictor of poor morbidity and mortality and occurs in several populations. This narrative review provides an overview of the importance of low muscle mass on health outcomes for patients in inpatient, outpatient and long-term care clinical settings. A one-year glimpse at publications that showcases the rapidly growing research of body composition in clinical settings is included. Low muscle mass is associated with outcomes such as higher surgical and post-operative complications, longer length of hospital stay, lower physical function, poorer quality of life and shorter survival. As such, the potential clinical benefits of preventing and reversing this condition are likely to impact patient outcomes and resource utilization/health care costs. Clinically viable tools to measure body composition are needed for routine screening and intervention. Future research studies should elucidate the effectiveness of multimodal interventions to counteract low muscle mass for optimal patient outcomes across the healthcare continuum. Key messages Low muscle mass is associated with several negative outcomes across the healthcare continuum. Techniques to identify and counteract low muscle mass in clinical settings are needed.

The Association Between the Number of Natural Remaining Teeth and Appendicular Skeletal Muscle Mass in Korean Older Adults

Background

The aim of this study was to examine the correlation between the number of remaining natural teeth (NRT) and the appendicular skeletal muscle mass index (SMI) in older adults.

Methods

This study was based on data from the 2008–2010 Korea National Health and Nutritional Examination Surveys. The participants were 2,378 older participants (984 men and 1,394 women) aged over 65 years. Survey dentists conducted oral health examinations, and ASM was measured using dual-energy X-ray absorptiometry.

Results

The participants with NRT≥20 had more ASM and SMI than those with NRT<20 in both sexes. SMI was correlated with NRT in men (r=0.018, p<0.001) and in women (r=−0.007, p<0.001). The positive correlation between the NRT and SMI remained significant in men even after adjusting for age, marital status, income, smoking, drinking, physical activity, protein intake, energy intake, calcium intake, body mass index, fasting blood glucose level, medications, and prostheses (β=0.011, p=0.001). In women, the correlation disappeared after adjustment for smoking, alcohol, physical activity, protein intake, energy intake, calcium intake, marital status, income, fasting basal glucose, medication administration, and prostheses.

Conclusion

This study showed a correlation between NRT and SMI in those ≥65 years of age in Korea. The relationship persisted in men, but not in women, even after adjusting for confounders.

High correlation of temporal muscle thickness with lumbar skeletal muscle cross-sectional area in patients with brain metastases

Objectives

This study aimed to assess the correlation of temporal muscle thickness (TMT), measured on routine cranial magnetic resonance (MR) images, with lumbar skeletal muscles obtained on computed tomography (CT) images in brain metastasis patients to establish a new parameter estimating skeletal muscle mass on brain MR images.

Methods

We retrospectively analyzed the cross-sectional area (CSA) of skeletal muscles at the level of the third lumbar vertebra on computed tomography scans and correlated these values with TMT on MR images of the brain in two independent cohorts of 93 lung cancer and 61 melanoma patients (overall: 154 patients) with brain metastases.

Results

Pearson correlation revealed a strong association between mean TMT and CSA in lung cancer and melanoma patients with brain metastases (0.733; p<0.001). The two study cohorts did not differ significantly in patient characteristics, including age (p = 0.661), weight (p = 0.787), and height (p = 0.123). However, TMT and CSA measures differed significantly between male and female patients in both lung cancer and melanoma patients with brain metastases (p<0.001).

Conclusion

Our data indicate that TMT, measured on routine cranial MR images, is a useful surrogate parameter for the estimation of skeletal muscle mass in patients with brain metastases. Thus, TMT may be useful for prognostic assessment, treatment considerations, and stratification or a selection factor for clinical trials in patients with brain metastases. Further studies are needed to assess the association between TMT and clinical frailty parameters, and the usefulness of TMT in patients with primary brain tumors.

Increased Serum Dihomo-γ-linolenic Acid Levels Are Associated with Obesity, Body Fat Accumulation, and Insulin Resistance in Japanese Patients with Type 2 Diabetes

Objective To clarify the associations between serum omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acid (PUFA) levels and obesity-related metabolic abnormalities in patients with type 2 diabetes. Methods and Materials Data from 225 Japanese patients with type 2 diabetes were cross-sectionally analyzed. The serum levels of n-6 PUFAs [dihomo-γ-linolenic acid (DGLA) and arachidonic acid (AA)] and n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) were measured, and the estimated Δ-5 desaturase (D5D) activity was calculated based on the AA to DGLA ratio. The associations between the composition of PUFAs and obesity-related parameters, including the body mass index (BMI), waist circumference, alanine amino transferase (ALT) level, homeostatic model assessment of insulin resistance (HOMA-IR), and body fat percentage, as measured by a bioelectrical impedance analysis, were analyzed. Results Among the PUFAs, the DGLA level had the strongest correlations with BMI (p<0.001), waist circumference (p<0.001), ALT level (p<0.001), HOMA-IR (p<0.001), and body fat percentage (p<0.01). AA was positively correlated and D5D was negatively correlated with several obesity-related parameters, while n-3 PUFAs did not have a constant correlation. A multivariate regression analysis revealed that the DGLA level was an independent determinant for HOMA-IR (β=0.195, p=0.0066) after adjusting for sex, age, BMI, and the ALT, triglyceride, and HbA1c levels. Conclusion A high serum DGLA level was associated with obesity, body fat accumulation, a high ALT level, and insulin resistance in patients with type 2 diabetes. The measurement of the serum PUFA levels may be useful for evaluating metabolic abnormalities and estimating the dietary habits of patients.

Association between Geriatric Nutrition Risk Index and low muscle mass in Chinese elderly people

BACKGROUND/OBJECTIVES

The aim of the study was to evaluate the relationship between Geriatric Nutrition Risk Index (GNRI) and low muscle mass (LMM) in elderly people.

SUBJECTS/METHODS

A cross-sectional study was carried out in Chinese PLA General Hospital with 3240 participants who underwent a health check-up examination between February 2016 and February 2017. Linear regression and logistic regression were used to examine the relationship between GNRI and LMM.

RESULTS

The mean age of the participants in the study was 64.6 years. The mean appendicular skeletal muscle mass index (ASMI) was 8.92 ± 0.93 kg/m² in men and 7.62 ± 0.73 kg/m² in women. The incidences of LMM were 7.9% in men and 3.7% in women. Linear regression demonstrated that GNRIs were positively correlated with ASMIs in both men and women (β = 0.055 for men and 0.039 for women, all P < 0.001). The cut-off point of the GNRI in elderly people for LMM was 104.0 in men and 107.0 in women and were identified by Classification and Regression Trees (CART). Logistic regression showed that both men and women with decreased GNRIs had higher ratios of LMM [odds ratio (OR) = 3.904 for men and 4.486 for women, P < 0.001 and P = 0.001, respectively].

CONCLUSIONS

Elderly people with a low GNRI had a higher incidence of LMM, which suggested that GNRI had a close relationship with LMM and that it could be a good indicator in identifying senior people who need further nutritional support and physical activity.

Is sarcopenia associated with hepatic encephalopathy in liver cirrhosis? A systematic review and meta-analysis

BACKGROUND/PURPOSE

Hepatic encephalopathy (HE), a major neuropsychiatric complication in advanced liver disease, is associated with poor prognosis. Sarcopenia, characterized by a decline in muscle mass, strength, and physical performance, is prevalent in liver cirrhosis. This study aims to explore whether sarcopenia is associated with HE in cirrhotic patients.

METHODS

PubMed and EMBASE were searched for relevant cohort and case-control studies investigating the association between sarcopenia and HE up to July 2018. Data of patients' characteristics, definition of low muscle mass, and protocols of grading/diagnosing HE were retrieved. The primary outcome was estimated by a pooled odds ratio (OR) and its 95% confidence interval (CI), using a random effect model.

RESULTS

The meta-analysis enrolled 6 studies, comprising 1795 patients. Sarcopenia was positively associated with the presence of HE (OR 2.74 with a 95% CI, 1.87 to 4.01). The association was less likely to be influenced by differences in research designs, focused study outcomes, muscle mass measurements, and protocols of grading/diagnosing HE. There was lack of evidence supporting higher serum ammonia levels in patients with sarcopenia.

CONCLUSION

In patients with liver cirrhosis, there is a significant association between sarcopenia and HE. A greater number of prospective studies are necessary to clarify whether the association remains even after adjusting relevant confounders and to suggest effective prevention of HE in patients with coexisting sarcopenia.

Association of Anthropometric and Nutrition Status Indicators with Hand Grip Strength and Gait Speed in Older Adults

BACKGROUND

How nutrition status indicators relate to function in older adults is an issue that needs to be explored. This study aimed to quantify the associations of anthropometric parameters and nutrition status indicators with hand grip strength (HGS) and gait speed (GS) in older adults.

METHODS

A cross-sectional observational study was conducted in a population-based sample of 1500 older adults ≥65 years old. Logistic regression models were used to explore the associations between anthropometric, nutrition, and functional measures.

RESULTS

Lower values of height, mid-arm muscle circumference, and calf circumference, as well as higher values of waist circumference, were associated with both low GS and HGS. The adjusted odds ratio (OR) for low GS was around 2-fold higher in participants presenting risk for undernutrition or undernutrition. The adjusted OR (95% confidence interval) for low HGS was 1.54 (1.01-2.36) in women and 1.57 (0.91-2.72) in men at risk for undernutrition/undernutrition.

CONCLUSIONS

In older adults, lower values of height and calf circumference, as well as higher waist circumference, were associated with both low GS and HGS. Lower values of mid-arm muscle circumference were also associated with low values of both functional parameters only in men. The risk for undernutrition/undernutrition was more strongly associated with low GS than with low HGS in both women and men.

Hand grip strength measurement in different epidemiologic studies using various methods for diagnosis of sarcopenia: a systematic review

BACKGROUND

The purpose of this systematic review was to compare various methods for measuring hand grip strength to provide data for the development of a standardized protocol for such a measurement based on epidemiologic studies of sarcopenia in older population.

METHODS

Systematic review and meta-analysis were performed using 34 available epidemiologic studies.

RESULTS

The choice of hand dynamometer and measurement protocols for measuring hand grip strength was not consistent among studies. Mean values of hand grip strength in older population were also different by study area (Europe, America, and Asia) and gender.

CONCLUSION

This systematic review demonstrated that various grip strength measurement methods were used in different epidemiologic studies. A standardized method is needed to enable more consistent measurement of grip strength and better assessment of sarcopenia.

Reference values for hand grip strength in the South Korean population

Objective

To establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS.

Methods

Based on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People.

Results

The mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m², respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35–39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively.

Conclusion

These results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population.

Limb muscle quality and quantity in elderly adults with dynapenia but not sarcopenia: An ultrasound imaging study

BACKGROUND

Dynapenia is prevalent in people with reduced skeletal muscle mass, i.e. sarcopenia, but a certain population develops muscle strength loss despite having normal skeletal muscle volume. To date, studies investigating muscle quality and quantity in groups with dynapenia but not sarcopenia are limited.

METHODS

Echogenicity and thickness of the biceps brachii, triceps brachii, rectus femoris, and medial gastrocnemius muscles were measured using high-resolution ultrasonography in 140 community-dwelling elderly adults. Participants with decreased handgrip strength but normal muscular volume were diagnosed as having dynapenia without sarcopenia. A multivariate regression model was used to analyze the association between dynapenia and ultrasound indicators of the sampled muscle expressed as odds ratio (OR) and 95% confidence interval (CI).

RESULTS

A total of 140 participants were recruited for the study, 12.6% (n = 18) of whom had dynapenia. The dynapenia group had a higher mean age, higher proportion of women, slower fast gait speed, reduced handgrip strength, and decreased thicknesses of the biceps brachii, rectus femoris, and medial gastrocnemius muscles. On multivariate logistic regression analysis, dynapenia was associated with older age (OR, 1.18; 95% CI, 1.05 to 1.33), higher body mass index (OR, 1.28; 95% CI, 1.05 to 1.64), and decreased thicknesses of the rectus femoris (OR, 0.01; 95% CI, <0.01 to 0.24) and medial gastrocnemius muscles (OR, 0.03; 95% CI, <0.01 to 0.61).

CONCLUSION

Dynapenia without sarcopenia is associated with decreased thicknesses of the rectus femoris and medial gastrocnemius muscles, an association that remains significant after adjustment for demographics, body composition, and physical performance. Ultrasound measurements of lower-limb muscle thickness can be considered an auxiliary criterion for evaluating dynapenia.

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

BACKGROUND

Hepatocellular carcinoma (HCC) has multiple prognostic factors, and there is an increase in knowledge about the body composition and physical status of patients with HCC. The present meta-analysis aimed to explore whether loss of skeletal muscle mass is associated with mortality and tumor recurrence in patients with HCC.

METHOD

A systematic search was conducted for published literature using PubMed, Embase, and Scopus. We included cohort or case-control studies investigating patients with HCC. The primary and secondary outcomes were the associations of loss of skeletal muscle mass with overall survival and tumor recurrence, respectively, expressed by a summary hazard ratio (HR) and 95% confidence interval (CI).

RESULT

A total of 13 studies comprising 3,111 patients were included. The summary HRs calculated by either univariate or multivariate analysis both suggested a significant association between sarcopenia and all-cause mortality (crude HR = 2.04, 95% CI: 1.74-2.38; adjusted HR = 1.95, 95% CI: 1.60-2.37). Similarly, loss of skeletal muscle mass was associated with tumor recurrence (crude HR = 1.85, 95% CI: 1.44-2.37; adjusted HR = 1.76, 95% CI: 1.27-2.45). The stratified analysis showed that treatment types and inclusion of body mass index or body weight in the Cox regression model did not modify both clinical outcomes. With an increase in cut-off values of muscle mass on computed tomography images (especially for male patients), there was an insignificant trend of stronger associations between loss of skeletal muscle mass and all-cause mortality.

CONCLUSION

Loss of skeletal muscle mass is associated with increased all-cause mortality and tumor recurrence in patients with HCC. Further prospective studies incorporating measurements of muscle strength and physical function are warranted to see whether inclusion of both parameters better predicts the outcome than use of muscle mass only.

Impact of a motivational resistance-training programme on adherence and body composition in the elderly

Lack of physical activity is one of the major causes for obesity and functional disability in the elderly. Including regular exercise in the elderly's lifestyle is not an easy task. The main objective was to analyse the effect of a motivational resistance-training programme on satisfying the individual's psychological needs, level of self-determination and body composition. A quasi-experimental study was performed with 47 volunteers (29 females, 18 males) of 67-75 years of age, divided into two groups: experimental (n = 27) and control (n = 20). A 12-week intervention programme was performed, with a total of 36 sessions. The results of the inter-group analysis indicated significant differences in the post-test measurement between the experimental group and the control group (in favour of the experimental group) regarding basic psychological needs. The experimental group, in comparison to the control group, significantly decreased their percentage of fat mass and increased muscle mass. Body weight and BMI values increased in the control group, while significantly decreasing in the experimental group. In conclusion, the motivational resistance-training programme in the elderly gave rise to positive significant changes at the physical, psychological and social levels, according to the definition of health by the World Health Organization.

Nonalcoholic fatty liver disease and sarcopenia in a Western population (NHANES III): The importance of sarcopenia definition

BACKGROUND

Recent epidemiological studies have shown that sarcopenia is associated with non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis in an Asian population. We investigated whether NAFLD is associated with a higher risk of sarcopenia using a different definition in elderly patients.

METHODS

A population-based cross-sectional survey of US patients was conducted, involving 2551 participants aged 60-75 years. NAFLD was measured by ultrasound. Sarcopenia was defined by both a low muscle mass and poor muscle function. In addition, the skeletal muscle index (SMI) was calculated as the absolute muscle mass (kilograms) divided by height² (meters) or total body mass (kilograms). A multivariable logistic regression was conducted to estimate the relationship between sarcopenia and NAFLD in the elderly.

RESULTS

After adjusting for age, sex, and race/ethnicity, severe hepatic steatosis was associated with a decreased risk of sarcopenia as defined by the height-adjusted SMI (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.46-0.87). In contrast, severe hepatic steatosis was associated with an increased risk of sarcopenia as defined by the weight-adjusted SMI (OR 1.73; 95% CI 1.31-2.28). These significant associations remained after further adjustments for other potential confounding variables.

CONCLUSIONS

NAFLD is associated with a lower risk of sarcopenia when using the height-adjusted SMI. In contrast, it showed the opposite result when using the weight-adjusted SMI. The definition of sarcopenia may be an important factor when examining its relationship with NAFLD.

Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review

Background

Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. The aim of this systematic review is to gather all the relevant studies that measured HGS to diagnose sarcopenia and frailty and to identify the differences between the protocols used.

Methods

A systematic review was carried out following the recommendations of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed and Web of Science were systematically searched, until August 16, 2016. The evidence regarding HGS measurement protocols used to diagnose sarcopenia and frailty was summarised and the most recent protocols regarding the procedure were compared.

Results

From the described search 4393 articles were identified. Seventy-two studies were included in this systematic review, in which 37 referred to sarcopenia articles, 33 to frailty and two evaluated both conditions. Most studies presented limited information regarding the protocols used.

Conclusions

The majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.

Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies

Objectives

to explore whether sarcopenia is associated with depression.

Design

electronic literature databases from PubMed, Scopus, Embase and Google Scholar were searched. A systematic review and meta-analysis of observational studies was conducted.

Setting

community and outpatient clinic.

Participants

people with and without diagnoses of sarcopenia.

Measurements

outcome measures of depression.

Results

about 15 articles were included, 5 of which were retrieved for narrative review. The crude odds ratios (ORs) between sarcopenia and depression were extracted from the remaining 10 studies, 6 of which also included adjusted ORs. Sarcopenia was associated with depression without adjusting covariates (crude OR, 1.640; 95% confidence interval (CI), 1.247-2.155). After adjusting for potential confounders such as age, gender, cognitive performance and physical activity, sarcopenia still demonstrated a significant positive association with depression (adjusted OR, 1.821; 95% CI, 1.160-2.859). A stratified analysis showed that the studies that used bioelectrical impedance analysis for measurement of body composition tended to have an elevated association between sarcopenia and depression compared with those that used dual-energy X-ray absorptiometry or equation estimation.

Conclusion

sarcopenia was independently associated with depression. The causal relationship between the two clinical conditions requires future validation with cohort studies.

Handgrip strength values of Portuguese older adults: a population based study

Background

Handgrip strength is used to identify sarcopenia and frailty phenotypes, being a potential predictor of mortality in older adults. However, uniformity is lacking in the reference values. This study aimed to describe handgrip strength values of older population aged ≥65 years in Portugal, considering the possible influence of anthropometric parameters.

Methods

A cross-sectional study was conducted in Portugal, among 1500 older adults aged ≥65 years old, according to “The Nutrition UP 65 Study Protocol”. Demographic data were collected and cognitive performance, subjective general health, physical activity, anthropometric parameters and nutritional status were assessed and analysed. Handgrip strength data was obtained with a Jamar dynamometer. A Pubmed/Medline search was carried out to compare handgrip strength data between Portuguese older adults and other older populations.

Results

Handgrip strength was higher among men than among women (30.3 ± 9.2 Kgf vs 18 ± 5.4 Kgf, p < 0.001, respectively). In general, handgrip strength values of Portuguese older adults were lower than other older populations. In our sample, age, cognitive and nutritional status, self-reported sitting time and practice of physical activity were significantly correlated with handgrip strength in both sexes. Concerning anthropometric parameters, height was the most significantly correlated with handgrip strength (r = 0.34, p < 0.001, in women and r = 0.40, p < 0.001, in men).

Conclusion

This study described, for the first time, handgrip strength values of Portuguese population aged ≥65 years, according to age and to sex-specific tertiles of height. The definition of handgrip strength reference values in this age group merits further reflection.

Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies

BACKGROUND

Sarcopenia, an age-related decline in muscle mass and function, is one of the most important health problems in elderly with a high rate of adverse outcomes. However, several studies have investigated the prevalence of sarcopenia in the world, the results have been inconsistent. The current systematic review and meta- analysis study was conducted to estimate the overall prevalence of sarcopenia in both genders in different regions of the world.

METHODS

Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched between January 2009 and December 2016. The population- based studies that reported the prevalence of sarcopenia in healthy adults aged ≥ 60 years using the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and Asian Working Group for Sarcopenia (AWGS) definitions, were selected. According to these consensual definitions, sarcopenia was defined by presence of low muscle mass (adjusted appendicular muscle mass for height) and muscle strength (handgrip strength) or physical performance (the usual gait speed). The random effect model was used for estimation the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia and 95% confidence interval (CI) were calculated using the Binomial Exact Method. Heterogeneity was assessed by subgroup analysis.

RESULTS

Thirty- five articles met our inclusion criteria, with a total of 58404 individuals. The overall estimates of prevalence was 10% (95% CI: 8-12%) in men and 10% (95% CI: 8-13%) in women, respectively. The prevalence was higher among non- Asian than Asian individuals in both genders especially, when the Bio-electrical Impedance Analysis (BIA) was used to measure muscle mass (19% vs 10% in men; 20% vs 11% in women).

CONCLUSION

Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass and different regions of the world for estimating parameters of sarcopenia, present systematic review revealed that a substantial proportion of the old people has sarcopenia, even in healthy populations. However, sarcopenia is as a consequence of the aging progress, early diagnosis can prevent some adverse outcomes.

Presarcopenia and its Impact on Disability in Female Patients With Rheumatoid Arthritis

Objectives

This cross-sectional pilot study aims to investigate presarcopenia in female patients with rheumatoid arthritis (RA) and to evaluate its relationship to the disability assessment.

Patients and methods

Forty female patients with RA (mean age 48.29±8.34; range 31 to 66 years) and 40 healthy controls (mean age 46.21±6.90; range 31 to 58 years) matched for age, sex, and body mass index were included. Pain, morning stiffness duration, disease activity score, erythrocyte sedimentation rate, C-reactive protein, and Health Assessment Questionnaire (HAQ) were evaluated. Body compositions were assessed with whole body dual energy X-ray absorptiometry. The appendicular skeletal muscle mass and skeletal muscle mass index (SMI) of RA patients were compared to the controls and possible correlations between SMI, disease characteristics, and HAQ score were investigated.

Results

The body mass index values and percentages of obese, overweight, and healthy weight subjects were similar in the patient and control groups. However, appendicular skeletal muscle mass and SMI calculations were significantly lower, and the percentage of presarcopenia was significantly higher in patients with RA (20%) than controls (7%) (p<0.05). Although there was no significant correlation between SMI and other parameters, a significant negative correlation was determined between SMI and HAQ score in patients with RA (p<0.05).

Conclusion

We demonstrated lower SMI values and higher presarcopenia ratios in patients with RA than healthy controls. Independent from other disease characteristics, the inverse correlation between SMI and HAQ scores may contribute to understanding of the impact of the process on patient disability.