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Yoshimura Y, Wakabayashi H, Yamada M, Kim H, Harada A, Arai H. Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Am Med Dir Assoc 2018; 18:553.e1-553.e16. [PMID: 28549707 DOI: 10.1016/j.jamda.2017.03.019] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Much interest has been focused on interventions for treating sarcopenia; however, the effects have gained little evidence. OBJECTIVE To analyze the effectiveness of exercise, nutritional, drug, and combinational interventions for treating sarcopenia in older people. METHOD We systematically searched MEDLINE via PubMed, the Cochrane Library of Cochrane Reviews and Cochrane Central Register of Controlled Trials, and Ichushi-Web for randomized controlled trials (RCTs) from January 2000 to December 2016. We have assessed the type of intervention, the cohort used, the way sarcopenia was diagnosed, the outcomes, and the quality of evidence. We meta-analyzed the outcomes with the net difference between-group treatment from baseline to the end of the study. RESULTS We screened a total of 2668 records and included seven RCTs that investigated the effects of exercise (4 RCTs), nutrition (5 RCTs), drug (1 RCT), and combination (4 RCTs) on muscle mass, strength, and function in older people with sarcopenia. Very low to low-quality evidence suggests that (1) exercise interventions may play a role in improving muscle mass, muscle strength, and walking speed in 3 months of intervention; (2) nutritional interventions may be effective in improving muscle strength in 3 months of intervention; (3) as drug intervention, selective androgen receptor modulator had no clear effect on muscle mass, strength, and physical function; and (4) a combined intervention of exercise and nutrition may have positive effects in improving the walking speed in 3 months of intervention. CONCLUSION Our systematic review and meta-analysis showed some positive effects of exercise and nutritional interventions for treating sarcopenia in older people, although the quality of the evidence was low. Future high-quality RCTs should be implemented to strengthen the results.
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Affiliation(s)
- Yoshihiro Yoshimura
- Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Yokohama City University Medical Center, Kanagawa, Japan
| | - Minoru Yamada
- Department of Lifespan Developmental Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Atsushi Harada
- Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidenori Arai
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichinosawa Y, Harada M, Nakamura T, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease. JCSM CLINICAL REPORTS 2018. [DOI: 10.17987/jcsm-cr.v3i1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A simple and inexpensive sarcopenia screening tool would be beneficial in clinical practice. This study was performed to determine whether SARC-F questionnaire can be used to identify physical limitations and poor prognosis in elderly cardiovascular disease (CVD) patients.Methods The study population consisted of 257 Japanese patients ≥65 years old admitted to our hospital for CVD. Prior to discharge from hospital, SARC-F, handgrip strength, usual gait speed, short physical performance battery score, and 6-minute walking distance were measured in all patients. The patients were divided into two groups according to SARC-F score: SARC-F <4 and SARC-F ≥4. The study endpoint was the first occurrence of all-cause emergency readmission or all-cause mortality.Results The prevalence rate of SARC-F ≥4 was 26.8%, and increased with age and number of comorbidities. Even after adjusting for covariates, physical function was significantly poorer and the risks of physical function measurements below the critical cut-off values were higher in the SARC-F ≥4 group compared to the SARC-F <4 group. Sixty (23.3%) patients were readmitted and 17 (6.6%) died over a median follow-up period of 11 months (interquartile range: 6–13 months). SARC-F score was a significant predictor of adverse events after discharge. Patients with SARC-F ≥4 showed higher event risk than those with SARC-F <4 (adjusted hazard ratio: 1.78; 95% confidence interval: 1.03–3.07; P = 0.040).Conclusions SARC-F questionnaire is useful to identify patients at high risk of physical limitations and to predict post-discharge outcomes in elderly CVD patients.
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Distefano G, Standley RA, Zhang X, Carnero EA, Yi F, Cornnell HH, Coen PM. Physical activity unveils the relationship between mitochondrial energetics, muscle quality, and physical function in older adults. J Cachexia Sarcopenia Muscle 2018; 9:279-294. [PMID: 29368427 PMCID: PMC5879963 DOI: 10.1002/jcsm.12272] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/01/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The concept of mitochondrial dysfunction in ageing muscle is highly controversial. In addition, emerging evidence suggests that reduced muscle oxidative capacity and efficiency underlie the aetiology of mobility loss in older adults. Here, we hypothesized that studying well-phenotyped older cohorts across a wide range of physical activity would unveil a range of mitochondrial function in skeletal muscle and in turn allow us to more clearly examine the impact of age per se on mitochondrial energetics. This also enabled us to more clearly define the relationships between mitochondrial energetics and muscle lipid content with clinically relevant assessments of muscle and physical function. METHODS Thirty-nine volunteers were recruited to the following study groups: young active (YA, n = 2 women/8 men, age = 31.2 ± 5.4 years), older active (OA, n = 2 women/8 men, age = 67.5 ± 2.7 years), and older sedentary (OS, n = 8 women/11 men, age = 70.7 ± 4.7 years). Participants completed a graded exercise test to determine fitness (VO2 peak), a submaximal exercise test to determine exercise efficiency, and daily physical activity was recorded using a tri-axial armband accelerometer. Mitochondrial energetics were determined by (i) 31 P magnetic resonance spectroscopy and (ii) respirometry of fibre bundles from vastus lateralis biopsies. Quadriceps function was assessed by isokinetic dynamometry and physical function by the short physical performance battery and stair climb test. RESULTS Daily physical activity energy expenditure was significantly lower in OS, compared with YA and OA groups. Despite fitness being higher in YA compared with OA and OS, mitochondrial respiration, maximum mitochondrial capacity, Maximal ATP production/Oxygen consumption (P/O) ratio, and exercise efficiency were similar in YA and OA groups and were significantly lower in OS. P/O ratio was correlated with exercise efficiency. Time to complete the stair climb and repeated chair stand tests were significantly greater for OS. Interestingly, maximum mitochondrial capacity was related to muscle contractile performance and physical function. CONCLUSIONS Older adults who maintain a high amount of physical activity have better mitochondrial capacity, similar to highly active younger adults, and this is related to their better muscle quality, exercise efficiency, and physical performance. This suggests that mitochondria could be an important therapeutic target for sedentary ageing associated conditions including sarcopenia, dynapenia, and loss of physical function.
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Affiliation(s)
- Giovanna Distefano
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Robert A Standley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Xiaolei Zhang
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Elvis A Carnero
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Fanchao Yi
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Heather H Cornnell
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Paul M Coen
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, 301 East Princeton Street, Orlando, FL, 32804, USA.,Sanford Burnham Prebys Medical Discovery Institute at Lake Nona, 6400 Sanger Rd, Orlando, FL, 32827, USA
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What Is Important Besides Getting the Bone to Heal? Impact on Tissue Injury Other Than the Fracture. J Orthop Trauma 2018; 32 Suppl 1:S21-S24. [PMID: 29461398 DOI: 10.1097/bot.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fracture surgeons do a great job of managing bone issues, but they may overlook the associated soft tissue injuries that play a significant role in the final outcome after musculoskeletal injury. The soft tissue reconstruction ladder can help guide reconstructive procedures based on the least complex procedure that allows the best chance of fracture healing. Muscle injury, volume loss, and deconditioning occur with traumatic injury and during the recovery phase. Neuromuscular stimulation, nutrition, and strength training are potential ways to aid in recovery. Complex periarticular knee injuries have a high rate of associated soft tissue injuries that may affect outcome if associated with knee instability. Identifying and addressing these injuries can increase the likelihood of a good outcome. Articular cartilage loss can make articular reconstruction impossible. Large fresh osteoarticular allografts can be a reconstructive option. Addressing all the damaged structures involved with a fracture may be the next step in improving patient outcomes.
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Band MM, Sumukadas D, Struthers AD, Avenell A, Donnan PT, Kemp PR, Smith KT, Hume CL, Hapca A, Witham MD. Leucine and ACE inhibitors as therapies for sarcopenia (LACE trial): study protocol for a randomised controlled trial. Trials 2018; 19:6. [PMID: 29301558 PMCID: PMC5753568 DOI: 10.1186/s13063-017-2390-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sarcopenia (the age-related loss of muscle mass and function) is a major contributor to loss of mobility, falls, loss of independence, morbidity and mortality in older people. Although resistance training is effective in preventing and reversing sarcopenia, many older people are sedentary and either cannot or do not want to exercise. This trial examines the efficacy of supplementation with the amino acid leucine and/or angiotensin converting enzyme inhibition to potentially improve muscle mass and function in people with sarcopenia. Promising preliminary data exist from small studies for both interventions, but neither has yet been tested in adequately powered randomised trials in patients with sarcopenia. METHODS Leucine and ACE inhibitors in sarcopenia (LACE) is a multicentre, masked, placebo-controlled, 2 × 2 factorial randomised trial evaluating the efficacy of leucine and perindopril (angiotensin converting enzyme inhibitor (ACEi)) in patients with sarcopenia. The trial will recruit 440 patients from primary and secondary care services across the UK. Male and female patients aged 70 years and over with sarcopenia as defined by the European Working Group on Sarcopenia (based on low total skeletal muscle mass on bioimpedance analysis and either low gait speed or low handgrip strength) will be eligible for participation. Participants will be excluded if they have a contraindication to, or are already taking, an ACEi, angiotensin receptor blocker or leucine. The primary clinical outcome for the trial is the between-group difference in the Short Physical Performance Battery score at all points between baseline and 12 months. Secondary outcomes include appendicular muscle mass measured using dual-energy X-ray absorptiometry, muscle strength, activities of daily living, quality of life, activity using pedometer step counts and falls. Participants, clinical teams, outcomes assessors and trial analysts are masked to treatment allocation. A panel of biomarkers including microRNAs, neurohormones, genetic polymorphisms and markers of inflammation relevant to muscle pathophysiology will be measured to explore predictors of response and further elucidate mechanisms underlying sarcopenia. Participants will receive a total of 12 months of either perindopril or placebo and either leucine or placebo. DISCUSSION The results will provide the first robust test of the overall clinical and cost-effectiveness of these novel therapies for older patients with sarcopenia. TRIAL REGISTRATION ISRCTN, ISRCTN90094835 . Registered on 18 February 2015.
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Affiliation(s)
- Margaret M. Band
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
| | - Deepa Sumukadas
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Allan D. Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Peter T. Donnan
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
- Population Health Sciences Division, University of Dundee, Dundee, UK
| | - Paul R. Kemp
- Molecular Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Karen T. Smith
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
| | - Cheryl L. Hume
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
- Population Health Sciences Division, University of Dundee, Dundee, UK
| | - Miles D. Witham
- Tayside Clinical Trials Unit, University of Dundee/NHS Tayside, Dundee, UK
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY UK
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Sanford AM, Morley JE, McKee A. Editorial: Orthogeriatrics and Hip Fractures. J Nutr Health Aging 2018; 22:457-462. [PMID: 29582883 DOI: 10.1007/s12603-018-1007-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A M Sanford
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Charbek E, Espiritu JR, Nayak R, Morley JE. Editorial: Frailty, Comorbidity, and COPD. J Nutr Health Aging 2018; 22:876-879. [PMID: 30272086 DOI: 10.1007/s12603-018-1068-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- E Charbek
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO, USA 63104,
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Sakuma K, Yamaguchi A. Drugs of Muscle Wasting and Their Therapeutic Targets. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:463-481. [PMID: 30390265 DOI: 10.1007/978-981-13-1435-3_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Muscle wasting and weakness such as cachexia, atrophy, and sarcopenia are characterized by marked decreases in the protein content, myonuclear number, muscle fiber size, and muscle strength. This chapter focuses on the recent advances of pharmacological approach for attenuating muscle wasting.A myostatin-inhibiting approach is very intriguing to prevent sarcopenia but not muscular dystrophy in humans. Supplementation with ghrelin is also an important candidate to combat sarcopenia as well as cachexia. Treatment with soy isoflavone, trichostatin A (TSA), and cyclooxygenase 2 (Cox2) inhibitors seems to be effective modulators attenuating muscle wasting, although further systematic research is needed on this treatment in particular concerning side effects.
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Affiliation(s)
- Kunihiro Sakuma
- Institute for Liberal Arts, Environment and Society, Tokyo Institute of Technology, Tokyo, Japan.
| | - Akihiko Yamaguchi
- Department of Physical Therapy, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan
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Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 2018; 22:1148-1161. [PMID: 30498820 DOI: 10.1007/s12603-018-1139-9] [Citation(s) in RCA: 480] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.
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Affiliation(s)
- E Dent
- Dr. Elsa Dent, , Torrens University Australia, Wakefield Street, Adelaide, SA, Australia
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Bahat G, Yilmaz O, Oren MM, Karan MA, Reginster JY, Bruyère O, Beaudart C. Cross-cultural adaptation and validation of the SARC-F to assess sarcopenia: methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. Eur Geriatr Med 2017; 9:23-28. [DOI: 10.1007/s41999-017-0003-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/23/2017] [Indexed: 01/06/2023]
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Abstract
Precision (P4) medicine represents a new medical paradigm that focuses on Personalized, Predictive, Preventive and Participatory approaches. The P4 paradigm is particularly appropriate for moving the care of persons with myopenia forward. Muscular dystrophies are clearly a set of genetically different diseases where genomics are the basis of diagnosis, and genetic modulation via DNA, oligonucleotides and clustered regularly interspaced short palendronic repeats hold great potential for a cure. The utility of personalized genomics for sarcopenia coupled with utilizing a predictive approach for the diagnosis with early preventive strategies is a key to improving sarcopenic outcomes. The importance of understanding different levels of patient enthusiasm and different responses to exercise should guide the participatory phase of sarcopenic treatment. In the case of cachexia, understanding the effects of the different therapies now available through the P4 approach on muscle wasting is a key to management strategies.
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Affiliation(s)
- John E. Morley
- Division of Geriatric MedicineSaint Louis University School of Medicine1402 S. Grand Blvd., M238St. LouisMO63104USA
| | - Stefan D. Anker
- Division of Innovative Clinical Trials, Department of Cardiology and PneumologyUniversity Medical Centre GöttingenRobert‐Koch‐Straße 40, D‐37075GöttingenGermany
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Associations of obesity and weight change with physical and mental impairments in elderly Chinese people. Maturitas 2017; 108:77-83. [PMID: 29290219 DOI: 10.1016/j.maturitas.2017.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/26/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the associations between anthropometric measurements and functional impairments in a sample of urban elderly Chinese people. METHODS In two population-based cohort studies, the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS), 11,505 men and 17,166 women aged 70-88 years at the time of the functional assessment were studied. Weight history was collected and anthropometric data were taken at study enrollment (from 1996 to 2000 for the SWHS, 2002-2006 for the SMHS). Information on functional status and current weight was collected at the most recent follow-up survey (from 2011 to 2015). Logistic regression analyses were applied to estimate the associations of body mass index (BMI), waist-hip-ratio (WHR), and weight changes with functional decline. RESULTS After a median follow-up of 14.4 years (range 5.4-18.2 years), we found that BMI/WHR at or after middle age, and weight gain during adulthood were significantly associated with impaired walking ability and mental functioning. Being underweight after age 70 was associated with poorer hearing and/or vision as well as poorer memory. The associations between obesity and functional impairment were generally not modified by sex, comorbidity or exercise. CONCLUSION Weight gain, obesity at or after middle age, and underweight after age 70 were associated with physical and mental functional impairments among elderly Chinese people. These findings highlight the importance of maintaining healthy weight to reduce age-related functional decline.
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Reconsideration of frailty in relation to surgical indication. Gen Thorac Cardiovasc Surg 2017; 66:201-213. [PMID: 29170898 DOI: 10.1007/s11748-017-0869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Given that an increasing number of elderly patients are undergoing surgical procedures for a diversity of indications, the concept of frailty is currently being examined in more depth in clinical medicine. Established surgical risk scores designed to predict mortality are mainly focused on general demographic information and clinical factors; however, these do not account for the frailty condition. With vulnerability and low resiliency in the frail elderly, these conventional scores are unable to accurately predict postoperative outcomes including adverse complications, disability, the need for additional rehabilitation, and prolonged length of hospitalization. Over the last decade, it has been demonstrated that frailty is an independent risk factor of surgery and strongly associated with adverse postoperative outcomes and mortality. It is essential today that surgeons assimilate the concept of frailty and the relationship between frailty and surgical outcomes. A preoperative frailty assessment can assist in determining surgical indication and optimal perioperative management, ultimately impacting the postoperative functional state and quality of life. Here we review the validity of preoperative frailty assessments for surgical intervention, possible treatments for frailty, and indicate future directions in this field.
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Fuggle N, Shaw S, Dennison E, Cooper C. Sarcopenia. Best Pract Res Clin Rheumatol 2017; 31:218-242. [PMID: 29224698 DOI: 10.1016/j.berh.2017.11.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Sarcopenia is a condition that is characterized by loss of muscle mass, muscle strength and muscle functional impairment with ageing. The definition of sarcopenia has been through various permutations; however, an enormous recent breakthrough is the inclusion of the condition in the ICD-10 classification of diseases. This chapter covers the background issues regarding definition before describing the epidemiology of the disease according to human and environmental factors. It then provides a practical guide for the assessment of sarcopenia in a clinical setting and finishes with advice on present treatment and the exciting frontiers of future therapies.
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Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Unit, Tremona Road, Southampton, UK.
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Tremona Road, Southampton, UK.
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Tremona Road, Southampton, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Tremona Road, Southampton, UK.
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Kotlarczyk MP, Perera S, Nace DA, Resnick NM, Greenspan SL. Identifying Sarcopenia in Female Long-Term Care Residents: A Comparison of Current Guidelines. J Am Geriatr Soc 2017; 66:316-320. [PMID: 29155456 DOI: 10.1111/jgs.15213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To establish the prevalence of sarcopenia in a long-term care population, assess agreement among different consensus sarcopenia diagnostic criteria, and examine agreement of a self-reported questionnaire with consensus guidelines. DESIGN Cross-sectional secondary analysis. SETTING Long-term care communities in the greater Pittsburgh, Pennsylvania, area. PARTICIPANTS Women aged 65 and older (mean 83.6) undergoing eligibility screening for a fracture reduction trial (N = 141). MEASUREMENTS We measured appendicular lean muscle mass using dual-energy X-ray absorptiometry. Hand grip strength and usual gait speed were also evaluated. Sarcopenia status was determined according to European Working Group on Sarcopenia in Older People (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and the SARC-F questionnaire. RESULTS Eleven participants were sarcopenic (7.8%) according to the EWGSOP criteria, six (4.3%) according to FNIH conservative cut-point guidelines, and 32.6% (n = 46) according to FNIH intermediate cut-points. Only 2 of 141 participants met criteria for sarcopenia according to all three guidelines. Sarcopenia was identified in 30 (21.3%) participants according to the SARC-F questionnaire. Sensitivity of the SARC-F with consensus panel definitions ranged from 18.2% to 33.3%. Specificity ranged from 78.7% to 81.1%. CONCLUSION Current consensus criteria from the EWGSOP and FNIH Sarcopenia Project do not agree and have little overlap in older female long-term care residents. The SARC-F questionnaire is a simple tool that could be implemented in long-term care, but it has low sensitivity compared with current consensus guidelines in the identification of sarcopenic individuals.
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Affiliation(s)
- Mary P Kotlarczyk
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Nace
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neil M Resnick
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Greenspan
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Morley JE, Sanford A, Bourey R. Sleep Apnea: A Geriatric Syndrome. J Am Med Dir Assoc 2017; 18:899-904. [DOI: 10.1016/j.jamda.2017.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022]
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Kostka J, Sikora J, Kostka T. Relationship of quadriceps muscle power and optimal shortening velocity with angiotensin-converting enzyme activity in older women. Clin Interv Aging 2017; 12:1753-1760. [PMID: 29089749 PMCID: PMC5656348 DOI: 10.2147/cia.s146494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The goal of this study was to assess whether angiotensin-converting enzyme (ACE) activity is related to muscle function (strength, power and velocity), as well as to assess if ACE inhibitors (ACEIs) and other angiotensin system blocking medications (ASBMs) influence muscle performance in elderly women. SUBJECTS AND METHODS Ninety-five community-dwelling elderly women took part in this study. Anthropometric data, blood ACE activity analysis, maximum power (Pmax) and optimal shortening velocity (υopt) of the knee extensor muscles, handgrip strength, physical activity (PA) and functional performance were measured. RESULTS Women taking ACEI were on average almost 2 years older than the women who did not take ACEI. They took more medicines and were also characterized by significantly lower level of ACE, but they did not differ in terms of PA level, results of functional performance and parameters characterizing muscle functions. No correlations of ACE activity with Pmax and handgrip strength, as well as with PA or functional performance were found. Higher ACE activity was connected with lower υopt for women who did not take any ASBMs (rho =-0.37; p=0.01). CONCLUSION Serum ACE activity was not associated with muscle strength, power and functional performance in both ASBM users and nonusers, but was associated with optimal shortening velocity of quadriceps muscles in older women. Further prospective studies are needed to assess if ACEIs or other ASBMs may slow down the decline in muscle function and performance.
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Affiliation(s)
- Joanna Kostka
- Department of Geriatrics, Healthy Ageing Research Centre
- Department of Physical Medicine
| | - Joanna Sikora
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre
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Gomes MJ, Martinez PF, Pagan LU, Damatto RL, Cezar MDM, Lima ARR, Okoshi K, Okoshi MP. Skeletal muscle aging: influence of oxidative stress and physical exercise. Oncotarget 2017; 8:20428-20440. [PMID: 28099900 PMCID: PMC5386774 DOI: 10.18632/oncotarget.14670] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/09/2017] [Indexed: 12/13/2022] Open
Abstract
Skeletal muscle abnormalities are responsible for significant disability in the elderly. Sarcopenia is the main alteration occurring during senescence and a key public health issue as it predicts frailty, poor quality of life, and mortality. Several factors such as reduced physical activity, hormonal changes, insulin resistance, genetic susceptibility, appetite loss, and nutritional deficiencies are involved in the physiopathology of muscle changes. Sarcopenia is characterized by structural, biochemical, molecular and functional muscle changes. An imbalance between anabolic and catabolic intracellular signaling pathways and an increase in oxidative stress both play important roles in muscle abnormalities. Currently, despite the discovery of new targets and development of new drugs, nonpharmacological therapies such as physical exercise and nutritional support are considered the basis for prevention and treatment of age-associated muscle abnormalities. There has been an increase in information on signaling pathways beneficially modulated by exercise; nonetheless, studies are needed to establish the best type, intensity, and frequency of exercise to prevent or treat age-induced skeletal muscle alterations.
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Affiliation(s)
- Mariana Janini Gomes
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Paula Felippe Martinez
- School of Physical Therapy, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Luana Urbano Pagan
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Ricardo Luiz Damatto
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | | | - Aline Regina Ruiz Lima
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Katashi Okoshi
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
| | - Marina Politi Okoshi
- Botucatu Medical School, Internal Medicine Departament, Sao Paulo State University, UNESP, Botucatu, SP, Brazil
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Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L. Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complications 2017; 31:1465-1473. [PMID: 28669464 DOI: 10.1016/j.jdiacomp.2017.05.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 12/14/2022]
Abstract
Diabetes increases the risk of physical dysfunction and disability. Diabetes-related complications and coexisting morbidities partially explain the deterioration in physical function. The decline in muscle mass, strength and function associated with diabetes leads to sarcopenia, frailty and eventually disability. Frailty acts as a mediator in the pathogenesis of disability in older people with diabetes and its measurement in routine daily practice is recommended. Frailty is a dynamic process which progresses from a robust condition to a pre-frail stage then frailty and eventually disability. Therefore, a multimodal intervention which includes adequate nutrition, exercise training, good glycaemic control and the use of appropriate hypoglycemic medications may help delay or prevent the progression to disability.
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Affiliation(s)
- Alan J Sinclair
- University of Aston and Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK.
| | - Ahmed H Abdelhafiz
- Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK
| | - Leocadio Rodríguez-Mañas
- Hospital Universitario de Getafe, Department of Geriatrics and School of Health Sciences, Universidad Europea de Madrid, Spain
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120
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
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121
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Morley JE. Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia. J Cachexia Sarcopenia Muscle 2017; 8:523-526. [PMID: 28452130 PMCID: PMC5566640 DOI: 10.1002/jcsm.12192] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/16/2017] [Accepted: 01/21/2017] [Indexed: 01/22/2023] Open
Abstract
The anorexia of aging was first recognized as a physiological syndrome 30 years ago. Its major causes are an alteration in fundal compliance with an increase in antral stretch and enhanced cholecystokinin activity leading to increased satiation.This anorexia leads to weight loss in aging persons and is one of the component causes of the aging related sarcopenia. This physiological anorexia also increases the risk of more severe anorexia when an older person has an increase in inflammatory cytokines such as occurs when they have an illness. This results in an increase in the anorexia due to cachexia in older persons.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO, 63104, USA
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122
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Abstract
Sarcopenia is defined as low muscle function (walking speed or grip strength) in the presence of low muscle mass. A simple screening test-the SARC-F-is available to identify persons with sarcopenia. The major endocrine causes of sarcopenia are diabetes mellitus and male hypogonadism. Other causes are decreased physical activity, loss of motor neuron units, weight loss, inflammatory cytokines, reduced blood flow to muscles, very low 25(OH) vitamin D levels, and decreased growth hormone and insulin-like growth factor 1. Treatment for sarcopenia includes resistance and aerobic exercise, leucine-enriched essential amino acids, and vitamin D. In hypogonadal males, testosterone improves muscle mass, strength, and function. Selective androgen receptor molecules and anti-myostatin activin II receptor molecules are under development as possible treatments for sarcopenia. ABBREVIATIONS COPD = chronic obstructive pulmonary disease DHEA = dehydroepiandrosterone IGF-1 = insulin-like growth factor 1 GH = growth hormone mTOR = mammalian target of rapamycin SARM = selective androgen receptor molecule.
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Abstract
Sarcopenia refers to the loss of muscle mass and strength seen with advancing age. The pathophysiology is multifactorial, with loss of muscle satellite cells, changes in hormonal systems, chronic inflammation, oxidative stress and anabolic resistance to protein utilisation all implicated. Older age, female sex and immobility are important risk factors. Sarcopenia is clinically important as it is a major risk factor for physical frailty, falls, prolonged hospitalisation, dependency and earlier death. Diagnosis requires evidence of reduced muscle mass measured by handgrip strength or walk speed, together with evidence of low muscle mass, measured by one of a variety of techniques such as bioimpedance analysis or dual X-ray absorptiometry. Resistance training is the only intervention of proven efficacy to treat sarcopenia, but a range of nutritional and pharmacological interventions are under test, including myostatin inhibitors, leucine and protein supplementation, angiotensin-converting enzyme inhibitors and allopurinol.
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Affiliation(s)
- Natalie J Offord
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Landi F, Calvani R, Ortolani E, Salini S, Martone AM, Santoro L, Santoliquido A, Sisto A, Picca A, Marzetti E. The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation. Osteoporos Int 2017; 28:1569-1576. [PMID: 28154941 DOI: 10.1007/s00198-017-3929-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED This study evaluates the prevalence of sarcopenia among older people admitted to a rehabilitation unit after hip fracture and the association between sarcopenia and functional outcomes. The results show that sarcopenia had a negative impact on functional recovery. The assessment of sarcopenia among older adults receiving rehabilitation programs is crucial. INTRODUCTION Sarcopenia is a highly prevalent geriatric syndrome associated with adverse outcomes, including falls, disability, institutionalization, and mortality. Few studies assessed sarcopenia among older adults receiving rehabilitation programs. METHODS Patients aged 70 years or more consecutively admitted to in-hospital rehabilitation programs that had suffered from hip fracture entered the study. Sarcopenia was defined according to the Foundation for National Institutes of Health (FNIH) criteria. Multivariable linear regression models were used to analyze the association between the sarcopenia and functional recovery. RESULTS The recruited population was composed of 127 patients, with a mean age of 81.3 ± 4.8 years, predominantly females (64.6%). Using the criteria proposed by the FNIH, patients with a diagnosis of sarcopenia were 43 (33.9%). After adjustment for potential confounders, participants with sarcopenia had a significant increased risk of incomplete functional recovery compared with non-sarcopenic patients (OR 3.07, 95% CI 1.07-8.75). Compared with participants without sarcopenia, those with sarcopenia showed lower Barthel index scores at the time of discharge from the rehabilitation unit (69.2 versus 58.9, respectively; p < 0.001) and after 3 months of follow-up (90.9 versus 80.5, respectively; p = 0.02). CONCLUSIONS These findings support the systematic assessment of sarcopenia among older adults receiving rehabilitation programs to assist in the development of personalized treatment plans aimed at improving functional outcomes.
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Affiliation(s)
- F Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.
- Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, L.go F. Vito 8, 00168, Rome, Italy.
| | - R Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - E Ortolani
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - S Salini
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - A M Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - L Santoro
- Department of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - A Santoliquido
- Department of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - A Sisto
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - A Picca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - E Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
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CT of Patients With Hip Fracture: Muscle Size and Attenuation Help Predict Mortality. AJR Am J Roentgenol 2017; 208:W208-W215. [PMID: 28267356 DOI: 10.2214/ajr.16.17226] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our objective was to determine the association between muscle cross-sectional area and attenuation, as measured on routine CT scans, and mortality in older patients with hip fracture. MATERIALS AND METHODS A retrospective 10-year study of patients with hip fracture was conducted with the following inclusion criteria: age 65 years or older, first-time hip fracture treated with surgery, and CT of the chest, abdomen, or pelvis. This yielded 274 patients (70.4% women; mean [± SD] age, 81.3 ± 8.3 years). On each CT scan, two readers independently measured the size (cross-sectional area, indexed for patient height) and attenuation of the paravertebral muscle at T12 and the psoas muscle at L4. We then determined the association between overall mortality and the muscle size and muscle attenuation, while adjusting for demographic variables (age, sex, ethnicity, and body mass index), American Society of Anesthesiologists (ASA) classification, and Charlson comorbidity index (CCI). RESULTS The overall mortality rate increased from 28.3% at 1 year to 79.5% at 5 years. Mortality was associated with decreased thoracic muscle size (odds ratio [OR], 0.66; 95% CI, 0.49-0.87). This association persisted after adjusting for demographic variables (OR, 0.69; 95% CI, 0.50-0.95), the ASA classification (OR, 0.70; CI, 0.51-0.97), and the CCI (OR, 0.72; 95% CI, 0.52-1.00). Similarly, decreased survival was associated with decreased thoracic muscle attenuation after adjusting for all of these combinations of covariates (OR, 0.67-0.72; 95% CI, 0.49-0.99). Decreased lumbar muscle size and attenuation trended with decreased survival but did not reach statistical significance. CONCLUSION In older adults with hip fractures, CT findings of decreased thoracic paravertebral muscle size and attenuation are associated with decreased overall survival.
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Ethgen O, Beaudart C, Buckinx F, Bruyère O, Reginster JY. The Future Prevalence of Sarcopenia in Europe: A Claim for Public Health Action. Calcif Tissue Int 2017; 100:229-234. [PMID: 28012107 PMCID: PMC5313588 DOI: 10.1007/s00223-016-0220-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022]
Abstract
Sarcopenia is a major public health issue. To convince health policy makers of the emergency to invest in the sarcopenia field, it is of critical importance to produce reliable figures of the expected burden of sarcopenia in the coming years. Age- and gender-specific population projections were retrieved until 2045 from the Eurostat online database (28 European countries). Age- and gender-specific prevalences of sarcopenia were interpolated from a study that compared prevalence estimates according to the different diagnostic cutoffs of the EWGSOP proposed definition. The reported prevalence estimates were interpolated between 65 and 100 years. Interpolated age- and gender-specific estimates of sarcopenia prevalence were then applied to population projections until 2045. Using the definition providing the lowest prevalence estimates, the number of individuals with sarcopenia would rise in Europe from 10,869,527 in 2016 to 18,735,173 in 2045 (a 72.4% increase). This corresponds to an overall prevalence of sarcopenia in the elderly rising from 11.1% in 2016 to 12.9% in 2045. With the definition providing the highest prevalence estimates, the number of individuals with sarcopenia would rise from 19,740,527 in 2016 to 32,338,990 in 2045 (a 63.8% increase), corresponding to overall prevalence rates in the elderly of 20.2% and 22.3% for 2016 and 2045, respectively. We showed that the number of sarcopenic patients will dramatically increase in the next 30 years, making consequences of muscle wasting a major public health issue.
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Affiliation(s)
- O Ethgen
- Department of Public Health, Epidemiology and Health Economics, Liège State University, Quartier Hôpital, CHU B23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - C Beaudart
- Department of Public Health, Epidemiology and Health Economics, Liège State University, Quartier Hôpital, CHU B23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - F Buckinx
- Department of Public Health, Epidemiology and Health Economics, Liège State University, Quartier Hôpital, CHU B23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, Liège State University, Quartier Hôpital, CHU B23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - J Y Reginster
- Department of Public Health, Epidemiology and Health Economics, Liège State University, Quartier Hôpital, CHU B23, Avenue Hippocrate, 13, 4000, Liège, Belgium.
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127
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Affiliation(s)
- John E Morley
- aDivisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA bCenter for Geriatric Medicine, University Heidelberg, AGAPLESION Bethanien Hospital, Heidelberg, Germany
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128
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Abstract
With aging and other muscle wasting diseases, men and women undergo similar pathological changes in skeletal muscle: increased inflammation, enhanced oxidative stress, mitochondrial dysfunction, satellite cell senescence, elevated apoptosis and proteasome activity, and suppressed protein synthesis and myocyte regeneration. Decreased food intake and physical activity also indirectly contribute to muscle wasting. Sex hormones also play important roles in maintaining skeletal muscle homeostasis. Testosterone is a potent anabolic factor promoting muscle protein synthesis and muscular regeneration. Estrogens have a protective effect on skeletal muscle by attenuating inflammation; however, the mechanisms of estrogen action in skeletal muscle are less well characterized than those of testosterone. Age- and/or disease-induced alterations in sex hormones are major contributors to muscle wasting. Hence, men and women may respond differently to catabolic conditions because of their hormonal profiles. Here we review the similarities and differences between men and women with common wasting conditions including sarcopenia and cachexia due to cancer, end-stage renal disease/chronic kidney disease, liver disease, chronic heart failure, and chronic obstructive pulmonary disease based on the literature in clinical studies. In addition, the responses in men and women to the commonly used therapeutic agents and their efficacy to improve muscle mass and function are also reviewed.
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129
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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130
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the concept of anorexia of aging, including its complex pathophysiology and the multifaceted interventions required to prevent adverse health consequences from this geriatric syndrome. RECENT FINDINGS Anorexia of aging is extremely common, occurring in up to 30% of elderly individuals; however, this diagnosis is frequently missed or erroneously attributed to a normal part of the aging process. With aging, impairments in smell and taste can limit the desire to eat. Alterations in stress hormones and inflammatory mediators can lead to excess catabolism, cachexia, and reduced appetite. In addition, mood disorders, such as anxiety and depression, are powerful inhibitors of appetite. Anorexia of aging, with its negative consequences on weight and muscle mass, is a risk factor for the development of frailty and is important to screen for, as early intervention is key to reversing this debilitating condition. SUMMARY Anorexia of aging is a complex geriatric syndrome and a direct risk factor for frailty and thus should not be accepted as normal consequence of aging. Early diagnosis and formulating a plan for targeted interventions is critical to prevent disability and preserve function in elderly patients.
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Affiliation(s)
- Angela M Sanford
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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131
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease. J Am Med Dir Assoc 2016; 18:176-181. [PMID: 28043805 DOI: 10.1016/j.jamda.2016.10.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES A simple and inexpensive tool for screening of sarcopenia would be helpful for clinicians. The present study was performed to determine whether the SARC-F questionnaire is useful in screening of patients with cardiovascular disease (CVD) for impaired physical function. DESIGN Cross-sectional study. SETTING Single university hospital. PARTICIPANTS A total of 235 Japanese patients ≥65 years old admitted to our hospital for CVD. MEASUREMENTS SARC-F, handgrip strength, leg strength, respiratory muscle strength, standing balance, usual gait speed, Short Physical Performance Battery (SPPB) score, and 6-minute walking distance were measured before discharge from hospital. The patients were divided into 2 groups according to SARC-F score: SARC-F < 4 (nonsarcopenia group) and SARC-F ≥ 4 (sarcopenia group). RESULTS The sarcopenia prevalence rate was 25.5% and increased with age (P trend < .001). The sarcopenia group (SARC-F score ≥ 4) had significantly lower handgrip strength, leg strength, and respiratory muscle strength, poorer standing balance, slower usual gait speed, lower SPPB score, and shorter 6-minute walking distance compared to the nonsarcopenia group (SARC-F score < 4). Patients in the sarcopenia group had consistently poorer physical function even after adjusting for covariates. CONCLUSION The SARC-F questionnaire is a useful screening tool for impaired physical function in elderly CVD patients. These findings support the use of the SARC-F for screening in hospital settings.
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Affiliation(s)
- Shinya Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takashi Masuda
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Peterson SJ, Mozer M. Differentiating Sarcopenia and Cachexia Among Patients With Cancer. Nutr Clin Pract 2016; 32:30-39. [PMID: 28124947 DOI: 10.1177/0884533616680354] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with cancer are at an increased risk for muscle loss via 2 distinct mechanisms: sarcopenia, defined as the age-associated decrease in muscle mass related to changes in muscle synthesis signaling pathways, and/or cachexia, defined as cytokine-mediated degradation of muscle and adipose depots. Both wasting disorders are prevalent; among patients with cancer, 15%-50% are sarcopenic and 25%-80% are cachectic. Muscle mass may be difficult to quantify in overweight/obese individuals. Often, overweight/obese patients with cancer are assumed to be normally nourished when in fact severe muscle depletion may be present. No universally accepted treatment exists for preventing or reversing sarcopenia or cachexia in patients with cancer. Current treatment options are limited to nutrition therapy and exercise, which may lead to difficulties in adherence during cancer treatment. Future treatments may provide pharmaceutical therapy that targets muscle degradation and synthesis pathways. There is a need to determine a multimodal treatment plan for muscle depletion to improve quality of life, survival, and therapy complications in patients with cancer.
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Affiliation(s)
- Sarah J Peterson
- 1 Department of Clinical Nutrition/Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Marisa Mozer
- 1 Department of Clinical Nutrition/Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
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Wu TY, Liaw CK, Chen FC, Kuo KL, Chie WC, Yang RS. Sarcopenia Screened With SARC-F Questionnaire Is Associated With Quality of Life and 4-Year Mortality. J Am Med Dir Assoc 2016; 17:1129-1135. [DOI: 10.1016/j.jamda.2016.07.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/27/2022]
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134
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Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7:512-514. [PMID: 27891296 PMCID: PMC5114626 DOI: 10.1002/jcsm.12147] [Citation(s) in RCA: 507] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
The new ICD-10-CM (M62.84) code for sarcopenia represents a major step forward in recognizing sarcopenia as a disease. This should lead to an increase in availability of diagnostic tools and the enthusiasm for pharmacological companies to develop drugs for sarcopenia.
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Affiliation(s)
- Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and PneumologyUniversity of Göttingen Medical Centre, Georg‐August‐UniversityGöttingenGermany
| | - John E. Morley
- Divisions of Geriatric Medicine and EndocrinologySaint Louis University School of MedicineSt. LouisMOUSA
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and PneumologyUniversity of Göttingen Medical Centre, Georg‐August‐UniversityGöttingenGermany
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135
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Traish A. Testosterone therapy in men with testosterone deficiency: Are we beyond the point of no return? Investig Clin Urol 2016; 57:384-400. [PMID: 27847912 PMCID: PMC5109795 DOI: 10.4111/icu.2016.57.6.384] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Although testosterone therapy in men with testosterone deficiency was introduced in the early 1940s, utilization of this effective treatment approach in hypogonadal men is met with considerable skepticism and resistance. Indeed, for decades, the fear that testosterone may cause prostate cancer has hampered clinical progress in this field. Nevertheless, even after considerable knowledge was acquired that this fear is unsubstantiated, many in the medical community remain hesitant to utilize this therapeutic approach to treat men with hypogonadism. As the fears concerning prostate cancer have subsided, a new controversy regarding use of testosterone therapy and increase in cardiovascular disease was introduced. Although the new controversy was based on one ill-fated clinical trial, one meta-analysis with studies that utilized unapproved formulation in men with liver cirrhosis, and two retrospective studies with suspect or nonvalidated statistical methodologies and database contaminations, the flames of such controversy were fanned by the lay press and academics alike. In this review we discuss the adverse effect of testosterone deficiency and highlight the numerous proven benefits of testosterone therapy on men's health and debunk the myth that testosterone therapy increases cardiovascular risk. Ultimately, we believe that there is considerable scientific and clinical evidence to suggest that testosterone therapy is safe and effective with restoration of physiological levels in men with testosterone deficiency, irrespective of its etiology.
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Affiliation(s)
- Abdulmaged Traish
- Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, MA, USA
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136
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Sugiyama T, Watarai K, Oda T, Kim YT, Oda H. Possible different roles of exercise in preventing vertebral and hip fractures. Osteoporos Int 2016; 27:3135-6. [PMID: 27166681 DOI: 10.1007/s00198-016-3628-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- T Sugiyama
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan.
| | - K Watarai
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - T Oda
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - Y T Kim
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
| | - H Oda
- Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama, Saitama, 350-0495, Japan
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137
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Anastasilakis AD, Polyzos SA, Skouvaklidou EC, Kynigopoulos G, Saridakis ZG, Apostolou A, Triantafyllou GA, Karagiozoglou-Lampoudi T, Mantzoros CS. Circulating follistatin displays a day-night rhythm and is associated with muscle mass and circulating leptin levels in healthy, young humans. Metabolism 2016; 65:1459-65. [PMID: 27621181 PMCID: PMC5022793 DOI: 10.1016/j.metabol.2016.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Follistatin may affect lean and fat mass and be implicated in metabolic diseases. We aimed to elucidate physiological predictors of circulating follistatin variation in healthy young humans. PROCEDURES This was an observational, cross-sectional study with two additional prospective observational arms (circadian, seasonal sub-studies) and one prospective interventional arm (mixed meal sub-study). Healthy, young individuals of both sexes (n=122) were subjected to anthropometric and body composition measurements and their eating and exercise behavior profiles were assessed by validated questionnaires. Sub-groups were subjected to standardized meal ingestion (n=36), day-night rhythm (n=20) and seasonal variation (n=20) studies. Main outcome of the study were circulating follistatin levels. RESULTS At baseline follistatin levels were correlated with creatinine (r=0.24; p=0.01), creatine phosphokinase (rs=0.22; p=0.02), and with lean body mass (rs=0.19; p=0.04) and were higher in males than females (p=0.004) after adjustment for leptin, which was its major predictor. Follistatin levels showed a circadian (p<0.001), but not a seasonal, variation, and were also affected by the phase of menstrual cycle in females (p=0.034). Follistatin levels were not affected by dietary or exercise habits but levels increased after a standardized meal ingestion (250kcal) (p=0.002). CONCLUSIONS In healthy young individuals circulating follistatin levels are correlated with muscle mass. Follistatin levels are associated with circulating leptin levels and display a day-night rhythm and a menstrual cycle, but not a seasonal, variation.
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Affiliation(s)
| | - Stergios A Polyzos
- Department of Medicine, Aristotle University of Thessaloniki, Ippokration General Hospital, Thessaloniki, Greece
| | | | | | | | - Aggeliki Apostolou
- Nutrition-Dietetics Department, Alexander Technological Education Institute of Thessaloniki, Central Macedonia, Greece
| | - Georgios A Triantafyllou
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomai Karagiozoglou-Lampoudi
- Nutrition-Dietetics Department, Alexander Technological Education Institute of Thessaloniki, Central Macedonia, Greece
| | - Christos S Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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138
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Morley JE. Frailty and sarcopenia in elderly. Wien Klin Wochenschr 2016; 128:439-445. [PMID: 27670855 DOI: 10.1007/s00508-016-1087-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022]
Abstract
Frailty is a pre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized. Two major frailty definitions exist. The physical phenotype of frailty and the multiple deficit model. A simple frailty screening tool-FRAIL-has been validated. Treatment of frailty involves resistance exercise, optimization of nutrition, and treatment of fatigue (sleep apnea, depression), treatable causes of weight loss and adjustment of polypharmacy. Sarcopenia (decline in function with low muscle mass) is a major cause of frailty. A simple sarcopenia screening tool-SARC-F-has been validated. The multiple causes of sarcopenia are reviewed. Optimal treatment is resistance exercise, leucine-enriched essential amino acids and vitamin D replacement.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, 63104, St. Louis, MO, USA.
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139
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Abstract
Chronic heart failure (CHF) is a highly prevalent condition among the elderly and is associated with considerable morbidity, institutionalization and mortality. In its advanced stages, CHF is often accompanied by the loss of muscle mass and strength. Sarcopenia is a geriatric syndrome that has been actively studied in recent years due to its association with a wide range of adverse health outcomes. The goal of this review is to discuss the relationship between CHF and sarcopenia, with a focus on shared pathophysiological pathways and treatments. Malnutrition, systemic inflammation, endocrine imbalances, and oxidative stress appear to connect sarcopenia and CHF. At the muscular level, alterations of the ubiquitin proteasome system, myostatin signaling, and apoptosis have been described in both sarcopenia and CHF and could play a role in the loss of muscle mass and function. Possible therapeutic strategies to impede the progression of muscle wasting in CHF patients include protein and vitamin D supplementation, structured physical exercise, and the administration of angiotensin-converting enzyme inhibitors and β-blockers. Hormonal supplementation with growth hormone, testosterone, and ghrelin is also discussed as a potential treatment.
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140
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Argilés JM, Campos N, Lopez-Pedrosa JM, Rueda R, Rodriguez-Mañas L. Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. J Am Med Dir Assoc 2016; 17:789-96. [DOI: 10.1016/j.jamda.2016.04.019] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 12/17/2022]
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Hesse E. Muscle and Bone: Combating the Evil Side of the Connection. J Bone Miner Res 2016; 31:1647-51. [PMID: 27429170 DOI: 10.1002/jbmr.2912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/10/2016] [Accepted: 07/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Eric Hesse
- Heisenberg-Group for Molecular Skeletal Biology, Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
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142
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Morley JE. The Complexities of Diabetes in Older Persons. J Am Med Dir Assoc 2016; 17:872-4. [PMID: 27590405 DOI: 10.1016/j.jamda.2016.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO.
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143
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Morley JE, Cao L. Rapid screening for sarcopenia. J Cachexia Sarcopenia Muscle 2015; 6:312-4. [PMID: 26676168 PMCID: PMC4670738 DOI: 10.1002/jcsm.12079] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 02/05/2023] Open
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine St. Louis, MO, USA
| | - Li Cao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University Sichuan, China
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144
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Sarcopenia in cases of chronic and acute illness. Z Gerontol Geriatr 2015; 49:100-6. [DOI: 10.1007/s00391-015-0986-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/02/2015] [Accepted: 11/04/2015] [Indexed: 01/06/2023]
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Preoperative Cognitive and Frailty Screening in the Geriatric Surgical Patient: A Narrative Review. Clin Ther 2015; 37:2666-75. [PMID: 26626609 DOI: 10.1016/j.clinthera.2015.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE The identification of older patients who may have deficits in cognitive or functional domains will become more pressing as increasing numbers of these patients present for preoperative evaluations. The number of older adults with deficiencies in these areas is projected to grow, and more of these patients will present for assessment in preoperative clinics with the expectation that surgeries will be performed. METHODS We review current outcomes data for preoperative cognitive impairment and frailty. FINDINGS We point to a number of directions research is taking as systems for the prevention of postoperative cognitive and functional decline are being developed. We also discuss the current status of screening and examine potential instruments that can be used in the setting of the preanesthesia clinic. IMPLICATIONS Clinicians may anticipate that geriatric screening tools focused on cognitive and functional domains will play a direct role in the ongoing evolution of presurgical assessment and triage.
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