Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia

Predictors of dropout from cohort study due to deterioration in health status, with focus on sarcopenia, locomotive syndrome, and frailty: From the Shiraniwa Elderly Cohort (Shiraniwa) study

BACKGROUND

Conditions of the elderly like sarcopenia, locomotive syndrome, and frailty have been attracting attention recently. However, the relationship of these 3 conditions and the difference in the magnitude of influence each has on deterioration in health status remain unclear. The purpose of this study was to investigate the prevalence and relationship of sarcopenia, locomotive syndrome, and frailty, and to clarify their influence on the dropout from cohort study due to deterioration in health status.

METHODS

The 1st survey of the Shiraniwa Elderly Cohort (Shiraniwa) study was conducted in 2016. We examined 409 participants (aged ≥ 65 years; 164 males, 245 females) and assessed sarcopenia, locomotive syndrome, and frailty. Those who could not attend the 2nd survey (2017) due to deterioration in health status were defined as the Dropout group. We investigated the predictors of Dropout using multiple logistic regression analysis.

RESULTS

The prevalence of sarcopenia, locomotive syndrome stage 2, and frailty were 4.4%, 40.1%, and 14.2%, respectively; 89.7% of participants with frailty were also diagnosed with locomotive syndrome stage 2. From the results of the 2nd survey, 46 people were classified into the Dropout group. Independent predictors of the Dropout were locomotive syndrome stage 2 (adjusted odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.11-5.31) and frailty (adjusted OR: 3.37, 95%CI: 1.56-7.30).

CONCLUSIONS

Locomotive syndrome stage 2 was the most common condition in the elderly, and most people with frailty also had locomotive syndrome stage 2. Locomotive syndrome stage 2 and frailty independently influenced the dropout from cohort study due to deterioration in health status. These results suggest that screening for locomotive syndrome is useful for early detection of the elderly with a risk of deterioration in health status, and screening for frailty may contribute to detecting the elderly with higher risk of deterioration in health status.

Analysis of the Prevalence of Sarcopenia and Its Risk Factors in the Elderly in the Chengdu Community

OBJECTIVE

To understand the prevalence of sarcopenia in the Chengdu community, analyze the risk factors of sarcopenia, and provide a theoretical basis for further development of strategies for sarcopenia prevention and treatment.

METHODS

A total of 938 individuals aged 60 years and above were recruited from the community of Chengdu. Skeletal muscle mass was measured by the bioelectrical impedance analysis (BIA), and sarcopenia was diagnosed according to the Asian Sarcopenia Working Group (AWGS) 2019 diagnostic criteria. A scale was generated to determine the age, living habits, and chronic diseases of enrolled subjects. The Mini Mental Examination Scale (MMSE) was used to assess their cognitive function, and the Geriatric Depression Scale (GDS-15) was used to identify depression.

RESULTS

Among the 938 residents enrolled in the study, 172 (18.34%) had sarcopenia, including 48 (5.12%) with severe sarcopenia. The prevalence of sarcopenia in males was 19.91% and 16.81% in females. According to the binary logistic regression, older age (OR = 1.104, 95%CI: 1.059-1.151) and impaired cognitive function (OR = 2.251, 95%CI: 1.145-4.424) were independent risk factors for sarcopenia in females. Among the males, older age (OR = 1.079, 95%CI: 1.037-1.124) was the independent risk factor for sarcopenia. A moderate increase in BMI reduced the prevalence of sarcopenia in both females and males. Multi-category logistic regression analysis documented that females of older age were more likely to develop severe sarcopenia (χ2 = 16.769, P < 0.01 vs. no sarcopenia), females with lower BMI were more likely to develop severe sarcopenia (χ2 = 13.654, P < 0.01 vs. no sarcopenia), females with heart disease were more likely to develop severe sarcopenia (χ2 = 5.786, P = 0.016 vs. no sarcopenia; χ2 = 5.791, P = 0.016 vs. non-severe sarcopenia), and females with impaired cognitive function were more likely to develop severe sarcopenia (χ2 = 13.381, P < 0.01 vs. no sarcopenia; χ2 = 7.529, P = 0.006 vs. non-severe sarcopenia). Males were more likely to develop severe sarcopenia with older age (χ2 = 18.435, P < 0.01 vs. no sarcopenia; χ2 = 9.8011, P=0.002 vs. non-severe sarcopenia), lower BMI (χ2 = 12.736, P < 0.01 vs. no sarcopenia), smoking (χ2 = 4.68, P = 0.031 vs. no sarcopenia; χ2 = 5.652, P = 0.017 vs. non-severe sarcopenia), and chronic obstructive pulmonary disease (COPD) (χ2 = 5.517, P = 0.019 vs. no sarcopenia).

CONCLUSION

In the Chengdu community, the prevalence of sarcopenia among individuals 60 years of age or older was higher in males than in females. In elderly females, older age and impaired cognitive function were independent risk factors for sarcopenia. Women with more advanced age, decreased BMI, heart disease, and impaired cognitive function were more likely to develop severe sarcopenia. In elderly males, increased age was an independent risk factor for sarcopenia, and older age, decreased BMI, smoking, and COPD increased the probability of developing severe sarcopenia.

Extreme skeletal muscle loss during induction chemotherapy is an independent predictor of poor survival in advanced epithelial ovarian cancer patients

AIM

Skeletal muscle loss is often observed in advanced cancer patients. This study investigates whether skeletal muscle loss is associated with survival outcomes of advanced epithelial ovarian cancer (EOC) patients after induction chemotherapy (IC) in a Japanese cohort. Whether serum inflammatory markers are associated with skeletal muscle changes is also addressed.

METHODS

We retrospectively reviewed 60 patients with stage III/IV EOC who underwent IC between 2010 and 2017. Skeletal muscle area (SMA) was measured at the third lumbar vertebrae level on a single axial computed tomography-scan image. Receiver operating curve analysis was used to determine cut-off values of pre- and post-IC SMA and SMA ratio (SMAR). Univariate and multivariate analyses of overall survival (OS) were conducted using the log-rank test and Cox proportional hazards regression model, respectively.

RESULTS

The SMA decreased significantly after IC (P = 0.019). The cut-off value between low and high SMAR was 0.96. High or low SMAR was observed in 34 (57%) and 26 (43%) patients, respectively. Univariate analysis revealed that low SMAR was associated with poor OS (P = 0.025). Multivariate analysis showed that incomplete resection during interval debulking surgery (hazard ratio, 0.30; 95% CI, 0.11-0.80; P = 0.016) and a low SMAR (hazard ratio, 3.17; 95% CI, 1.18-9.06; P = 0.022) were independent predictors of poor OS. Of the serum inflammatory markers investigated, only post-IC absolute neutrophil count correlated significantly with SMAR (P = 0.012).

CONCLUSION

Low SMAR can be used to predict poor prognosis in advanced EOC patients who have undergone IC.

The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer

BACKGROUND

Recently, several studies have reported that sarcopenia and sarcopenic obesity (SO) could worsen postoperative complications after PD. This study aims to evaluate the effects of preoperative sarcopenia and SO following PD in pancreatic head cancer (PHD).

METHODS

Preoperative sarcopenia and SO were assessed in 548 patients undergoing PD for PHC at Samsung Medical Centre between 2007 and 2016. The visceral adipose tissue-to-skeletal muscle ratio was calculated from cross-sectional visceral fat and muscle areas on preoperative CT images. The overall survival (OS) and rate of clinically relevant postoperative pancreatic fistula (CR-POPF) among postoperative complications were extracted from prospectively maintained databases.

RESULTS

Preoperative sarcopenia was present in 252 patients (45.9%). The 5-year survival rates of patients with non-sarcopenia and sarcopenia were 28.4% and 23.4% (p = 0.046). Preoperative SO was present in 202 patients (36.9%). After multivariable analysis, the presence of SO was the only independent risk factor for CR-POPF (p = 0.018).

CONCLUSION

Sarcopenia can be a risk factor affecting decreased OS after PD in patients with PHC. SO is the only predictive factor for CR-POPF after PD in patients with PHC. More observational studies are needed to evaluate the effects of sarcopenia and SO on survival after PD.

Inflammatory potential of the diet and risk of sarcopenia and its components

BACKGROUND

Despite a large body of evidence on the link between dietary inflammatory index (DII) and several chronic conditions, limited data are available about the association of DII and sarcopenia. This study aimed to examine the relationship between inflammatory potential of the diet (as measured by DII) and sarcopenia and its components among community-dwelling elderly population.

METHODS

This population-based cross-sectional study was performed in 2011 among 300 elderly people (150 men and 150 women) aged ≥55 years, who were selected using cluster random sampling method. Dietary assessment was done using a pre-tested food frequency questionnaire. Energy-adjusted DII was calculated based on earlier studies. Sarcopenia and its components were determined based on the European Working Group on Sarcopenia (EWGSOP) definition.

RESULTS

Mean age of study participants was 66.7 ± 7.7 y. Subjects in the highest tertile of DII score (i.e. those with a more pro-inflammatory diet) were more likely to be older (P = 0.02). The prevalence of sarcopenia (P = 0.016) and low muscle mass (P = 0.041) was significantly higher among subjects in the top tertile compared with those in the bottom tertile of DII. After adjustment for potential confounders, those with the highest DII were 2.18 times (95% CI: 1.01-4.74) more likely to have sarcopenia than those with the lowest DII. With regard to components of sarcopenia, subjects in the top tertile of DII had not significantly greater odds of low muscle mass (OR: 1.38; 95% CI: 0.72-2.63), abnormal handgrip strength (OR: 0.97; 95% CI: 0.49-1.89), and abnormal gait speed (OR: 1.61; 95% CI: 0.84-3.08) than those in the bottom tertile.

CONCLUSIONS

In conclusion, a diet with more pro-inflammatory potential was associated with a greater odds of sarcopenia. Further studies are required to confirm these findings.

Cerebellar-limbic neurocircuit is the novel biosignature of physio-cognitive decline syndrome

Both physical and cognitive deficits occur in the aging process. We operationally defined the phenomenon as physio-cognitive decline syndrome (PCDS) and aimed to decipher its corresponding neuroanatomy patterns and neurocircuit. High resolution 3T brain magnetic resonance imaging (MRI) images from a community-dwelling longitudinal aging cohort were analysed. PCDS was defined as weakness (handgrip strength) and/or slowness (gait speed) concomitant with impairment in any cognitive domain (defined by 1.5 standard deviation below age, sex-matched norms), but without dementia or disability. Among 1196 eligible ≥ 50-year-old (62±9 years, 47.6%men) subjects, 15.9% had PCDS. Compared to the other participants, individuals with PCDS had significantly lower gray-matter volume (GMV) in the bilateral amygdala and thalamus, right hippocampus, right temporo-occipital cortex, and left cerebellum VI and V regions. The regions of reduced GMV in people with PCDS were similar between the middle-aged and older adults; whereas larger clusters with more extensive GMV-depleted regions were observed in ≥65-year-olds with PCDS. Diffusion-weighted tractography showed disrupted hippocampus-amygdala-cerebellum connections in subjects with PCDS. The neuroanatomic characteristics revealed by this study provide evidence for pathophysiological processes associated with concomitant physio-cognitive decline in the elderly. This neurocircuit might constitute a target for future preventive interventions.

Association of Ultrasound-Derived Metrics of the Quadriceps Muscle with Protein Energy Wasting in Hemodialysis Patients: A Multicenter Cross-Sectional Study

This study aimed to assess muscle wasting and risk of protein energy wasting (PEW) in hemodialysis (HD) patients using an ultrasound (US) imaging method. PEW was identified using the ISRNM criteria in 351 HD patients. Quadriceps muscle thickness of rectus femoris (RF) and vastus intermedius (VI) muscles and cross-sectional area (CSA) of the RF muscle (RF_CSA) were measured using US and compared with other physical measures. Associations of US indices with PEW were determined by logistic regression. Irrespective of gender, PEW vs. non-PEW patients had smaller RF, VI muscles, and RF_CSA (all p < 0.001). US muscle sites (all p < 0.001) discriminated PEW from non-PEW patients, but the RF_CSA compared to bio-impedance spectroscopy had a greater area under the curve (AUC, 0.686 vs. 0.581), sensitivity (72.8% vs. 65.8%), and specificity (55.6% vs. 53.9%). AUC of the RF_CSA was greatest for PEW risk in men (0.74, 95% CI: 0.66–0.82) and women (0.80, 95% CI: 0.70–0.90) (both p < 0.001). Gender-specific RF_CSA values (men < 6.00 cm²; women < 4.47 cm²) indicated HD patients with smaller RF_CSA were 8 times more likely to have PEW (AOR = 8.63, 95% CI: 4.80–15.50, p < 0.001). The US approach enabled discrimination of muscle wasting in HD patients with PEW. The RF_CSA was identified as the best US site with gender-specific RF_CSA values to associate with PEW risk, suggesting potential diagnostic criteria for muscle wasting.

The Anthropometric Assessment With the Bioimpedance Method Is Associated With the Prognosis of Cirrhotic Patients

BACKGROUND/AIM

The bioimpedance analysis (BIA) can provide anthropometric data on patients. The aim of the study is to evaluate the clinical relevance of these automatically obtained values.

PATIENTS AND METHODS

We studied the arm circumference (AC) and arm muscle circumference (AMC) of 197 histologically proven cirrhotic patients. The BIA-based anthropometric data were compared to the manually measured data. In addition, we evaluated whether or not the BIA-based anthropometric data were associated with the prognosis of the patients.

RESULTS

The data of %AC and %AMC obtained using the two methods were well correlated (p<0.001) with relatively inconspicuous differences (approximately 6.0% for %AC and 16.0% for %AMC). The data of %AC and %AMC obtained from the BIA method were significantly associated with the prognosis of the patients.

CONCLUSION

The BIA-based anthropometric data were associated with the direct measurement data and related to the prognosis of cirrhotic patients.

The Association between Major Dietary Pattern and Low Muscle Mass in Korean Middle-Aged and Elderly Populations: Based on the Korea National Health and Nutrition Examination Survey

Reduced skeletal muscle mass in older populations is independently associated with functional impairment and disability, resulting in increased risk of mortality and various comorbidities. This study aimed to examine the association between major dietary pattern and low muscle mass among Korean middle-aged and elderly populations. A total of 8136 participants aged ≥50 years were included from a cross-sectional study based on the 2008–2011 Korea National Health and Nutrition Examination Survey. The following four distinct dietary patterns were derived using factor analysis: “Condiment, vegetables, and meats”; “wheat flour, bread, fruits, milk, and dairy products”; “white rice, fish, and seaweeds”; and “whole grain, bean products, and kimchi”. A higher “white rice, fish, and seaweeds” pattern score was associated with a lower prevalence of low muscle mass in both men and women, whereas a higher “condiment, vegetables, and meats” pattern score was associated with a higher prevalence of low muscle mass in men. A dietary pattern based on white rice, fish, and seaweeds can be helpful in protecting against loss of skeletal muscle mass in Korean middle-aged and elderly populations. Future research is paramount to confirm the causal association between dietary pattern and the risk of low muscle mass.

Respiratory strength and pectoralis muscle mass as measures of sarcopenia: Relation to outcomes in resected non-small cell lung cancer

OBJECTIVES

Physical biomarkers to stratify patients with lung cancer into subtypes predictive of outcome beyond tumor-related characteristics are underexplored. This study was designed to investigate the clinical utility of preoperative sarcopenia based on respiratory strength and pectoralis muscle mass to predict the risk of death.

METHODS

This retrospective study included 346 consecutive patients undergoing curative-intent resection of non-small cell lung cancer from 2009 to 2013. Respiratory strength and muscle mass were assessed by peak expiratory flow rate and pectoralis muscle index (pectoralis muscle area/body mass index) using preoperative spirometry and chest axial images, respectively. Sarcopenia cutoff points were defined by gender-specific medians of peak expiratory flow rates and pectoralis muscle indices. Survival was compared between patients with sarcopenia and patients without.

RESULTS

Sarcopenia was present in 98 patients (28.3%) and was significantly associated with advancing age (P < .001). Patients with sarcopenia exhibited worse 5-year overall survival compared with patients without sarcopenia (69.9% vs 87.2%, P < .001). Multivariate analysis revealed that sarcopenia was an independent adverse prognostic factor (hazard ratio, 1.88; 95% confidence interval, 1.09-3.24; P = .023) after adjustment for gender, age, smoking status, coronary heart disease, diffusing capacity for carbon monoxide, neutrophil-to-lymphocyte ratio, albumin, histologic type, and pathologic stage.

CONCLUSIONS

Preoperative sarcopenia as identified by the criteria of low respiratory strength and reduced pectoralis muscle mass is significantly associated with poor overall survival. This may help to develop more individualized management strategies and optimize longitudinal care for patients.

Examining the association between muscle mass, muscle function, and fat indexes in an elderly population

OBJECTIVES

Skeletal muscle mass with function decline indicated as sarcopenia, which may cause disability in elderly adults. Studies regarding fat composition in sarcopenia have gained attraction recently; however, different fat indexes have yielded different findings. It is necessary to explore the association between muscle mass, muscle function, and fat indexes among elderly adults.

METHODS

Community-dwelling elderly adults ages 65 and older who received annual health examination or outpatient services were enrolled. Hand grip strength and gait speed were measured. Muscle and fat mass were estimated by bioelectrical impedance analyzer. Presarcopenia was defined as loss of muscle mass only; sarcopenia was loss of muscle mass accompanied by low grip strength or/and slow gait speed. The relationships between sarcopenia parameters and different fat indexes among elderly adults were analyzed.

RESULTS

There were 295 participants recruited. The presarcopenia group showed lower fat indexes compared to the sarcopenia group. Negative correlations existed between sarcopenia parameters (skeletal muscle mass index, grip strength, gait speed) and fat indexes (body-fat percentage, fat-to-muscle ratio). In the multiple hierarchical regression model, gait speed was negatively associated with body-fat percentage (β = -0.255, P = 0.009) and fat-to-muscle ratio (β = -0.272, P = 0.005) in the male group. In the female group, grip strength was inversely associated with body-fat percentage (β = -0.232, P = 0.009) and fat-to-muscle ratio (β = -0.195, P = 0.031).

CONCLUSIONS

Individuals in the presarcopenia group had lower fat indexes than those in the sarcopenia group. Gait speed in men and hand grip strength in women-but not muscle mass for either- were negatively associated with body-fat percentage and fat-to-muscle ratio.

Submental Muscle Activity and Its Role in Diagnosing Sarcopenic Dysphagia

PURPOSE

The objectives of this study were two-fold: 1) to investigate differences in activity duration and amplitude of the submental muscles during swallowing measured with surface electromyography (sEMG) in older patients with sarcopenic dysphagia compared to those without dysphagia and 2) to examine the diagnostic accuracy of submental sEMG signals for sarcopenic dysphagia.

PATIENTS AND METHODS

Patients (n = 60) aged ≥65 years participated in this cross-sectional study. The submental muscle activity duration parameters were the duration from the onset of swallowing to the maximum amplitude (duration A), duration from the maximum amplitude to the end of the swallowing activity (duration B), and total duration. The amplitude parameters were mean and maximum amplitude. Maximum lingual pressures were also measured for comparison with sEMG parameters.

RESULTS

Duration A was not significantly different between the groups (p = 0.15), but duration B (p < 0.001) and total duration (p < 0.001) were significantly different between the non-dysphagic and sarcopenic dysphagic groups. The mean (p = 0.014) and maximum (p < 0.001) amplitudes were significantly different between the groups. The area under the receiver operating characteristic curve (AUC) was 0.94 (95% confidence interval (CI) 0.87-0.98) for duration B, 0.95 (95% CI 0.89-0.99) for total duration, 0.76 (95% CI 0.63-0.87) for maximum amplitude, and 0.61 (95% CI 0.47-0.75) for mean amplitude. The AUC of the total duration was significantly greater than that of lingual pressure (p = 0.02).

CONCLUSION

Patients with sarcopenic dysphagia had longer submental muscle activity duration and higher amplitude during swallowing as assessed using sEMG. The findings of this study can be useful in elucidating the underlying pathophysiology of sarcopenic dysphagia and in diagnosing sarcopenic dysphagia.

The association between systemic inflammatory markers and sarcopenia: Results from the West China Health and Aging Trend Study (WCHAT)

BACKGROUND

Increased evidence suggests chronic inflammation is significant in the progression of sarcopenia in older adults. In this study, we aimed to compare the level of systemic inflammation markers (White blood cells, neutrophils, lymphocytes, platelets and their derived ratios) between sarcopenic and non-sarcopenic individuals and investigate the association of these inflammatory markers with sarcopenia.

METHODS

This cross-sectional study included 4224 adults (1514 men and 2710 women) from the West China Health and Aging Trend (WCHAT) study. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). The value of systemic inflammatory markers was based on laboratory data. Multiple logistic regression analysis was used to explore the association between inflammatory markers and sarcopenia after adjusting for covariates.

RESULTS

Among 4224 participants (mean age 62.3 ± 8.2 years, 64.2 % women), 814 (19.3 %) were diagnosed as sarcopenia. After adjusting for potential confounders, logistic regression analysis indicated that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were significantly associated with sarcopenia. Participants in the highest NLR, PLR and SII value group had higher odds for sarcopenia than those in the lowest value group (OR [95 %CI]: 1.233 [1.002,1.517], 1.455 [1.177,1.799] and 1.268 [1.029,1.561], respectively).

CONCLUSIONS

Higher NLR, PLR, and SII level are associated with an increased prevalence of sarcopenia in middle-aged and older adults. Since these systemic inflammatory markers are inexpensive and can be obtained easily from routine blood tests, regular follow-up of NLR, PLR and SII may be an effective strategy in sarcopenia screening and management.

Effects of vibration therapy on muscle mass, muscle strength and physical function in older adults with sarcopenia: a systematic review and meta-analysis

Background

Sarcopenia, a progressive loss of muscle mass and function with advancing age, is a prevalent condition among older adults. As most older people are too frail to do intensive exercise and vibration therapy has low risk and ease of participation, it may be more readily accepted by elderly individuals. However, it remains unclear whether vibration therapy would be effective among older adults with sarcopenia. This systematic review and meta-analysis examined the effect of vibration therapy including local vibration therapy and whole-body vibration therapy, for enhancing muscle mass, muscle strength and physical function in older people with sarcopenia.

Methods

A systematic literature search was conducted in March 2019 in the following 5 electronic databases: PubMed, CINAHL, Embase, PEDro, and the Cochrane Central Register of Controlled Trials, with no restriction of language or the year of publication. Randomized controlled trials and quasi-experimental studies examining effects of vibration therapy on muscle mass, muscle strength or physical function in older adults with sarcopenia were included in this systematic review. Two reviewers independently assessed the methodological quality of the selected studies.

Results

Of the 1972 identified studies, seven publications from six studies involving 223 participants were included in this systematic review. Five of them conducted whole-body vibration therapy, while two conducted local vibration therapy. A meta-analysis of randomized controlled studies indicated that muscle strength significantly increased after whole-body vibration therapy (SMD 0.69, 95% CI 0.28 to 1.11, I² = 0%, P = 0.001) and local vibration therapy (SMD 3.78, 95% CI 2.29 to 5.28, P < 0.001). Physical performance measured by the sit-to-stand test and the timed-up-and-go test were significantly improved after the intervention (SMD -0.79, 95% CI − 1.21 to − 0.37, I² = 0%, P < 0.001) and SMD -0.83, 95% CI − 1.56 to − 0.11, I² = 64%, P = 0.02, respectively).

Conclusion

Vibration therapy could be a prospective strategy for improving muscle strength and physical performance in older adults with sarcopenia. However, due to the limited number of the included studies, caution is needed when interpreting these results. More well-designed, large sample size studies should be conducted to further explore and validate the benefits of vibration therapy for this population.

Stroke and sarcopenia

Purpose of review

to evaluate recent scientific research studies related to the changes in skeletal muscle after stroke and the presence of sarcopenia in stroke survivors to establish its incidence and effects on function.

Recent Findings

Recently published findings on stroke-related sarcopenia are limited. This might be due to changes in the consensus definition of sarcopenia. Sarcopenia in stroke patients is estimated at 14 to 54%. The presence of sarcopenia at the time of a stroke can lead to worse recovery and functional outcomes.

Summary

Presence of sarcopenia prior to a stroke may be more common than suspected and can lead to worse functional recovery. Clinicians should be aware of this to better identify and treat stroke-related sarcopenia. Future research should focus on larger population studies to more accurately establish correlation between stroke and sarcopenia.

Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults

BACKGROUND

Despite differences between the studies regarding methods for estimating low muscle mass, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends use of two standard deviations (SDs) below the reference sex-specific means of healthy young adults.

AIMS

The aim of this study was to determine the cutoff points of skeletal muscle mass index (SMI) and handgrip strength (HS) in Turkish population and to compare the power of different cutoff points to predict comprehensive geriatric assessment (CGA) parameters.

METHODS

Two hundred and eight young healthy volunteers (104 women, 104 men) were included in the study to define SMI, HS cutoff values. 1150 older adults (784 women, 366 men) underwent CGA, including physical performance, activities of daily living (ADL), HS and frailty. Body composition was obtained from every participant by bioimpedance analysis (BIA). CGA parameters of sarcopenic patients according to EWGSOP and new Turkish cutoff points were compared.

RESULTS

SMI cutoff points were defined 5.70 kg/m² for women, 8.33 kg/m² for men. HS thresholds were calculated as 14 kg for women, 28 kg for men using measurements of healthy young adult reference. Considering the new threshold values, the prevalence of sarcopenia was 10% (7% women, 17% men). When new sarcopenia criteria were applied and covariates were adjusted, sarcopenia was found to be more closely related to ADL impairment, balance, frailty in men, and balance, slow walking speed, ADL impairment, frailty in women (p < 0.05).

DISCUSSION

Muscle mass and strength may vary between populations because of ethnicity and other related discrepancies. The evaluation of sarcopenia according to the present guidelines may cause overdiagnosis in some populations.

CONCLUSION

Cutoff points specific to populations should be determined.

Early Rehabilitation after Surgical Repair of Medial and Lateral Collateral Elbow Ligaments: A Report of Three Cases

Elbow ligament injuries are commonly caused by overuse; degeneration; and trauma; such as from a fall or collision. The purpose of this study was to present the results of three cases involving patients undergoing early rehabilitation after surgical treatment for complex injury of the elbow medial collateral ligament (MCL) and lateral collateral ligament (LCL). Two patients were non-athlete middle-aged women and one was a recreational judo player. Surgery was performed through open incision or arthroscopically. Rehabilitation consisted of range of motion (ROM) exercise; muscle strength restoration; and neuromuscular training. Passive ROM exercise and isometric strength exercise began at 7 days; isotonic strength training at 6 weeks; and neuromuscular training at 3 months after operation. Center- and home-based methods of exercise participation were combined. Center-based exercises were performed 1–2 times per week for the first 6 months and 1–2 times per month for the next 6 months. Patients also performed home-based and self-monitoring exercise. Examinations included ROM using a goniometer; muscle strength test using isokinetic equipment; and Oxford elbow score. In the six months after surgery; flexion ROM was 130° for Case A (health side 145°), 110° for Case B (health side 145°), and 135° for Case C (health side 135°); grip strength was restored to 13 kg (health side 28 kg), 16 kg (health side 25 kg), and 38 kg (health side 52 kg); and isokinetic flexion strength was improved to 30 Nm (health side 58 Nm), 21 Nm (health side 50 Nm), and 72 Nm (health side 80 Nm), respectively. In conclusion; patients who underwent early rehabilitation recovered ROM and muscle strength and returned to daily activity without any side effects. This study showed that patients with elbow MCL and LCL injuries took approximately 3 months to recover meaningful ROM; approximately 6 months to recover muscle strength; and 4–8 months to play light recreational sports. In addition; it took patients 6 weeks to return to their daily activities and 6 months to improve questionnaire scores in their function and pain during daily activity. In follow-up two years after surgery; all three patients had full ROM and muscle strength within 10% of the healthy side

Prediction Equations of the Multifrequency Standing and Supine Bioimpedance for Appendicular Skeletal Muscle Mass in Korean Older People

Bioimpedance analysis (BIA) has been demanded for the assessment of appendicular skeletal muscle mass (ASM) in clinical and epidemiological settings. This study aimed to validate BIA equations for predicting ASM in the standing and supine positions; externally to cross-validate the new and published and built-in BIA equations for group and individual predictive accuracy; and to assess the overall agreement between the measured and predicted ASM index as sarcopenia diagnosis. In total, 199 healthy older adults completed the measurements of multifrequency BIA (InBody770 and InBodyS10) and dual-energy X-ray absorptiometry (DXA). Multiple regression analysis was used to validate the new multifrequency bioelectrical impedance analysis (MF-BIA) prediction equations. Each MF-BIA equation in the standing and supine position developed in the entire group included height²/resistance, sex, and reactance as predictors (R² = 92.7% and 92.8%, SEE = 1.02 kg and 1.01 kg ASM for the standing and supine MF-BIA). The new MF-BIA equations had a specificity positive predictive value and negative predictive value of 85% or more except for a sensitivity of about 60.0%. The new standing and supine MF-BIA prediction equation are useful for epidemiological and field settings as well as a clinical diagnosis of sarcopenia. Future research is needed to improve the sensitivity of diagnosis of sarcopenia using MF-BIA.

Biomarkers of Physical Frailty and Sarcopenia: Coming up to the Place?

Physical frailty and sarcopenia (PF&S) recapitulates all the hallmarks of aging and has become a focus in geroscience. Factors spanning muscle-specific processes (e.g., mitochondrial dysfunction in skeletal myocytes) to systemic changes (e.g., inflammation and amino acid dysmetabolism) have been pinpointed as possible contributors to PF&S pathophysiology. However, the search for PF&S biomarkers allowing the early identification and tracking of the condition over time is ongoing. This is mainly due to the phenotypic heterogeneity of PF&S, its unclear pathophysiology, and the frequent superimposition of other age-related conditions. Hence, presently, the identification of PF&S relies upon clinical, functional, and imaging parameters. The adoption of multi-marker approaches (combined with multivariate modeling) has shown great potential for addressing the complexity of PF&S pathophysiology and identifying candidate biological markers. Well-designed longitudinal studies are necessary for the incorporation of reliable biomarkers into clinical practice and for unveiling novel targets that are amenable to interventions.

Selecting Appropriate Sarcopenia Screening Methods for Asian Populations

We aimed to determine the most appropriate sarcopenia screening method for Asian populations. We retrospectively studied the physiological differences between the sexes in healthy individuals and prospectively compared using skeletal muscle mass versus handgrip strength (HS) to screen for sarcopenia in a community-based population. Skeletal muscle mass was determined using dual-energy X-ray absorptiometry. Of 5881 healthy individuals recruited, 101 were from urban populations and 349 from a community-based population. The sexes were comparable in total lean muscle mass declines after peaking around 20 years of age. An age-dependent decline in total fat mass was found only among men;a persistent increase in total fat mass was observed only among women. The prevalence of low skeletal muscle mass significantly increased with age in both sexes only when applying the weight-adjusted skeletal muscle index (wSMI); it was significant only among men when applying the height-adjusted skeletal muscle index (hSMI). Using HS resulted in a much higher prevalence of sarcopenia in both sexes. A significant age-dependent increase in fat mass in women showed that the most appropriate adjustment method is wSMI for women and hSMI for men. Nevertheless, a primary HS survey is recommended for both sexes in Asian populations.

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults-The Yishun Study

OBJECTIVES

To describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia.

DESIGN

Participants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition.

SETTING AND PARTICIPANTS

In total, 542 community-dwelling Singaporeans were recruited (21‒90 years old, 57.9% women).

METHODS

We assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression.

RESULTS

According to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05).

CONCLUSIONS AND IMPLICATIONS

This is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.

Sarcopenia and Hip-Structure Analysis Variables in Korean Elderly Population

The purpose of this study is comparing the hip-structure analysis (HSA) variables with the skeletal muscle index (SMI) in elderly patients with sarcopenia using nationwide representative data on the Republic of Korea (ROK). The survey data were collected from household interviews and direct standardized physical examinations conducted in specially equipped mobile examination centers. The data were collected in 2008 from 9744 participants. Patients under 65 years of age who were without data on the skeletal-muscle-mass and HSA variables were excluded. After these exclusions, a total of 744 participants (293 men and 451 women) were ultimately analyzed. The HSA measurements of the hip-bone geometry were analyzed using dual-energy X-ray absorptiometry. The appendicular SMI is defined as the sum of the arm and leg SMIs. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia as SMIs of less than 5.4 kg/m² and 7.0 kg/m² for women and men, respectively. In the entire population, SMI was found to be positively correlated to HSA variables. After adjusting for age, body mass index, and energy intake in both the women and men groups, a statistically significant difference became evident in all variables between the SMI and the HSA. The present study suggests that skeletal-muscle loss negatively affects hip-bone-strength indices in elderly sarcopenia patients. Implementing strategies to increase SMI in the elderly population may be useful for reducing the vulnerability to hip fracture.

Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults

This study aimed to assess the effects of a multicomponent exercise program on physical function and muscle mass in older adults with sarcopenia or pre-sarcopenia. Moreover, we aim to standardize the exercise program for easy incorporation in the daily life of community-dwelling older adults as a secondary outcome. A single-blind randomized controlled trial was conducted with individuals (≥60 years) who had sarcopenia or pre-sarcopenia (n = 72). Participants were randomly assigned to the exercise and control groups. The exercise program consisted of 12 weekly 60-min sessions that included resistance, balance, flexibility, and aerobic training. Outcome measures were physical function and muscle mass. Assessments were conducted before and immediately after the intervention. Among the 72 participants (mean age: 75.0 ± 6.9 years; 70.8% women), 67 (93.1%) completed the trial. Group-by-time interactions on the chair stand (p = 0.02) and timed “up and go” (p = 0.01) tests increased significantly in the exercise group. Although the exercise group showed a tendency to prevent loss of muscle mass, no significant interaction effects were observed for cross-sectional muscle area and muscle volume. The 12-week exercise program improved physical function in the intervention group. Although it is unclear whether the program is effective in increasing muscle mass, a multicomponent exercise program would be an effective treatment for physical function among older adults with sarcopenia.

Relationship Between Low Handgrip Strength and Chronic Kidney Disease: KNHANES 2014-2017

OBJECTIVE

Accelerated loss of muscle mass is common in patients with chronic kidney disease (CKD). Various factors associated with CKD, such as nutritional deficiencies, metabolic acidosis, and chronic inflammation, contribute to muscle wasting. This study aimed to investigate the relationship between CKD and handgrip strength (HGS) in the Korean population.

DESIGN AND METHODS

This is a population-based, cross-sectional study of a nationally representative sample of 18,765 patients aged ≥19 years from the Korea National Health and Nutrition Examination Survey in 2014-2017. We measured HGS using a digital hand dynamometer and determined the cutoff for low HGS by deriving -2 standard deviation values of sex-matched healthy young adults (19-39 years old). We defined CKD as eGFR <60 mL/min/1.73 m² or the presence of CKD based on a self-reported questionnaire.

RESULTS

The prevalence of CKD was 4.0% in the total population. The cutoff values for the low HGS were 29.5 kg for men and 16.8 kg for women. The prevalence of low HGS was 6.2% in patients without CKD, and 25.2% in patients with CKD. There was a significant correlation between HGS and eGFR in both men and women. In multivariate logistic regression adjusted by age group, diabetes, hypertension, and obesity, CKD showed an independent relationship with low HGS in both men (odds ratio [OR] 1.910, 95% confidence interval [CI] 1.468-2.485) and women (OR 1.570, 95% CI 1.202-2.052).

CONCLUSIONS

The prevalence of low HGS was higher in patients with CKD. We suggest that the sarcopenia should be evaluated in patients with CKD.

Development of Taiwan Risk Score for Sarcopenia (TRSS) for Sarcopenia Screening among Community-Dwelling Older Adults

The SARC-F questionnaire has been suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as a first-step screening tool for sarcopenia. However, the sensitivity to SARC-F is low among community-dwelling older adults. Therefore, this study aimed to develop a new prediction model for sarcopenia screening in the community setting. We conducted a cross-sectional analysis of data from the Taiwan Integration of Health and Welfare (TIHW) study. Covariates including comorbidities, socioeconomic status, social support, health behaviors, body composition, and serum biomarkers were collected for analysis. Sarcopenia was defined using handgrip strength and gait speed cut-off values suggested by the Asian Working Group for Sarcopenia. Risk scores for sarcopenia were estimated by stepwise logistic regression. Among 1025 participants (mean age, 71.95 ± 6.89 years), 179 (17.5%) had sarcopenia. Seven items, including age, female sex, receiving social assistance pension, absence of exercise, being underweight, abnormal fasting glucose levels, and abnormal creatinine levels were selected for the Taiwan Risk Scores for Sarcopenia (TRSS) with a cutoff value of 76 (sensitivity, 71.8%; specificity, 71.1%) and area under the curve (AUC) of 0.757. Our results suggested that the TRSS model could be applied cost-effectively in the community for early detection of sarcopenia.

Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly

Background

Age-related sarcopenia is a serious global health issue in elderly individuals and for the community as it induces disability and significant economic burden. The purpose of the study is to understand the factors associated with sarcopenia and the role of growth hormone (GH) and insulin-like growth factor (IGF-1) in the occurrence of sarcopenia.

Methods

Elderly patients (n = 3276) were included in this cross-sectional study. Survey and measurement of body composition (bioelectrical impedance), grip strength, and step speed were performed according to the Asian Working Group on Sarcopenia (AWGS) diagnostic criteria. Hematological and hormonal indicators were compared between patients with and without sarcopenia in order to identify the associated factors.

Results

There were significant differences in the demographic parameters between the sarcopenia and non-sarcopenia groups (all P < 0.05). There were significant differences between the two groups regarding the blood levels of GH, IGF-1, testosterone (T), and mechanical growth factor (MGF) (all P < 0.001). Correlation analyses showed that the appendicular skeletal muscle mass (ASMI) was positively associated with gender and BMI, and with GH, T, IGF-1, MGF, BUN, Cr, and Hb levels, but negatively associated with HDL-C (all P < 0.05). Logistic multivariable regression analysis showed that IGF-1, MGF, BMI, and gender were independently associated with appendicular skeletal muscle mass (ASMI) (all P < 0.05).

Conclusions

GH and IGF-1 are associated with sarcopenia in the elderly. IGF-1 and MGF are independently associated with the reduction of skeletal muscle mass, along with BMI and gender.

Sarcopenia in patients with colorectal cancer: A comprehensive review

Colorectal cancer (CRC) is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality. The prevalence of sarcopenia in patients with CRC ranges between 12%-60%. Sarcopenia comes from the Greek "sarx" for flesh, and "penia" for loss. Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty (primary sarcopenia), but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia. Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality. Three parameters need to be measured: muscle strength, muscle quantity and physical performance. The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra. Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection. It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care and physical disability. Sarcopenia may also negatively impact on overall survival, disease-free survival, recurrence-free survival, and cancer-specific survival in patients with non-metastatic and metastatic colorectal cancer. Furthermore, patients with sarcopenia seem prone to toxic effects during chemotherapy, requiring dose deescalations or treatment delays, which seems to reduce treatment efficacy. A multimodal approach including nutritional support (dietary intake, high energy, high protein, and omega-3 fatty acids), exercise programs and anabolic-orexigenic agents (ghrelin, anamorelin), could contribute to muscle mass preservation. Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment (chemotherapy, radiotherapy or surgery) seems to be the next step for the best of care of CRC patients.

Quantification of skeletal muscle mass: sarcopenia as a marker of overall health in children and adults

Sarcopenia is defined as the loss of muscle mass or function and has been associated with increased morbidity and mortality in a variety of diseased populations. Sarcopenia results from a higher rate of muscle protein degradation compared to protein synthesis and is an important marker of metabolic status related to nutrition and physical activity. The diagnosis of sarcopenia is accomplished by clinical assessment demonstrating decreased muscle function and radiographic confirmation of decreased muscle mass, via dual X-ray absorptiometry, bioelectric impedance or cross-sectional imaging with CT or MRI. However, normative data for skeletal muscle mass are lacking, especially for children and young adults. Additionally, studies of skeletal muscle mass by cross-sectional imaging in children are scarce. Here, we review the concept of sarcopenia with an emphasis on its relevance in the pediatric population.

The mechanisms and treatments for sarcopenia: could exosomes be a perspective research strategy in the future?

The age-related loss of muscle mass and muscle function known as sarcopenia is a primary contributor to the problems faced by the old people. Sarcopenia has been a major public health problem with high prevalence in many countries. The related underlying molecular mechanisms of sarcopenia are not completely understood. This review is focused on the potential mechanisms and current research strategies for sarcopenia with the aim of facilitating the recognition and treatment of age-related sarcopenia. Previous studies suggested that protein synthesis and degradation, autophagy, impaired satellite cell activation, mitochondria dysfunction, and other factors associated with muscle weakness and muscle degeneration may be potential molecular pathophysiology of sarcopenia. Importantly, we also prospectively highlight that exosomes (small vesicles) as carriers can regulate muscle regeneration and protein synthesis according to recent researches. Dietary strategies and exercise represent the interventions that can also alleviate the progression of sarcopenia. At last, building on recent studies pointing to exosomes with the roles in increasing muscle regeneration, mediating the beneficial effects of exercise, and serving as messengers of intercellular communication and as carriers for research strategies of many diseases, we propose that exosomes could be a potential research direction or strategies of sarcopenia in the future.

Reference Values for Skeletal Muscle Mass - Current Concepts and Methodological Considerations

Assessment of a low skeletal muscle mass (SM) is important for diagnosis of ageing and disease-associated sarcopenia and is hindered by heterogeneous methods and terminologies that lead to differences in diagnostic criteria among studies and even among consensus definitions. The aim of this review was to analyze and summarize previously published cut-offs for SM applied in clinical and research settings and to facilitate comparison of results between studies. Multiple published reference values for discrepant parameters of SM were identified from 64 studies and the underlying methodological assumptions and limitations are compared including different concepts for normalization of SM for body size and fat mass (FM). Single computed tomography or magnetic resonance imaging images and appendicular lean soft tissue by dual X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) are taken as a valid substitute of total SM because they show a high correlation with results from whole body imaging in cross-sectional and longitudinal analyses. However, the random error of these methods limits the applicability of these substitutes in the assessment of individual cases and together with the systematic error limits the accurate detection of changes in SM. Adverse effects of obesity on muscle quality and function may lead to an underestimation of sarcopenia in obesity and may justify normalization of SM for FM. In conclusion, results for SM can only be compared with reference values using the same method, BIA- or DXA-device and an appropriate reference population. Limitations of proxies for total SM as well as normalization of SM for FM are important content-related issues that need to be considered in longitudinal studies, populations with obesity or older subjects.

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.

Hyperlipidemia and Statins Use for the Risk of New Diagnosed Sarcopenia in Patients with Chronic Kidney: A Population-Based Study

Background: Previous research found that statins, in addition to its efficiency in treating hyperlipidemia, may also incur adverse drug reactions, which mainly include myopathies and abnormalities in liver function. Aim: This study aims to assess the risk for newly onset sarcopenia among patients with chronic kidney disease using statins. Material and Method: In a nationwide retrospective population-based cohort study, 75,637 clinically confirmed cases of chronic kidney disease between 1997 and 2011were selected from the National Health Insurance Research Database of Taiwan. The selection of the chronic kidney disease cohort included a discharge diagnosis with chronic kidney disease or more than 3 outpatient visits with the diagnosis of chronic kidney disease found within 1 year. After consideration of patient exclusions, we finally got a total number of 67,001 cases of chronic kidney disease in the study. The Cox proportional hazards model was used to perform preliminary analysis on the effect of statins usage on the occurrence of newly diagnosed sarcopenia; the Cox proportional hazards model with time-dependent covariates was conducted to take into consideration the individual temporal differences in medication usage, and calculated the hazard ratio (HR) and 95% confidence interval after controlling for gender, age, income, and urbanization. Results: Our main findings indicated that patients with chronic kidney disease who use statins seem to effectively prevent patients from occurrences of sarcopenia, high dosage of statins seem to show more significant protective effects, and the results are similar over long-term follow-up. In addition, the risk for newly diagnosed sarcopenia among patients with lipophilic statins treatment was lower than that among patients with hydrophilic statins treatment. Conclusion: It seems that patients with chronic kidney disease could receive statin treatment to reduce the occurrence of newly diagnosed sarcopenia. Additionally, a higher dosage of statins could reduce the incidence of newly diagnosed sarcopenia in patients with chronic kidney disease.

Multidisciplinary team management for prevention of pneumonia and long-term weight loss after esophagectomy: a single-center retrospective study

BACKGROUND

In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We herein report the outcomes of the HOPE at 2 years after commencement.

METHODS

A total 125 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2014 and December 2018 at the Department of Surgery in Hamamatsu University School of Medicine. The patients were divided into the pre-HOPE group including 62 patients who underwent esophagectomy before the introduction of the HOPE and the HOPE group including 63 patients who underwent esophagectomy after the introduction of the HOPE. The outcomes of surgery were compared between the two groups.

RESULTS

There were no significant differences in the clinicopathological characteristics between the two groups. The incidence rates of atrial fibrillation and pneumonia were significantly lower in the HOPE group than in the pre-HOPE group (6% vs. 19%, p = 0.027 and 14% vs. 29%, p = 0.037, respectively). The estimated calorie doses at the time of discharge were approximately 750 and 1500 kcal/day in the pre-HOPE group and the HOPE group, respectively. The body weight loss was significantly less in the HOPE group than the pre-HOPE group at 1, 3, 6, and 12 months postoperatively than that before the surgery (p < 0.001).

CONCLUSIONS

The introduction of the multidisciplinary HOPE was associated with a significant reduction in the incidence of postoperative pneumonia and significantly less weight loss.

Ethnic Groups Differences in the Prevalence of Sarcopenia Using the AWGS Criteria

OBJECTIVES

To estimate the prevalence of sarcopenia in different ethnic groups and the association with cultural life styles in west China.

DESIGN

A cross-sectional study.

SETTINGS

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

4500 participants aged 50 years or older in west China were enrolled in this study. Sarcopenia was defined according to the diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS).

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants. Life-style information were collected by reviewers. Relationships between sarcopenia and ethnic groups were analyzed using univariate and multivariate analyses.

RESULTS

We found 869 (19.31%) adults aged 50 years old or older were sarcopenia. The mean age is 62.4±8.3 years. The main ethnic groups enrolled in this study is Han, Tibetan, Qiang, Yi and Hui. The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Compared to Han, after adjusting sex and age, Qiang has a lower prevalence of sarcopenia (odds ratio [OR]: 0.44, 95% CI 0.35-0.55), Yi has a higher prevalence of sarcopenia (OR: 1.78, 95% CI 1.29-2.43). While adding adjusting other potential cofounders, sarcopenia is still less prevalent in Qiang (OR: 0.44, 95% CI 0.34-0.57).

CONCLUSIONS

The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Sarcopenia was less prevalent in Qiang compared with Han. Further studies to determine related factors of sarcopenia among different ethnic groups are recommended.

Relationship of Peripheral Lymphocyte Subsets and Skeletal Muscle Mass Index in Sarcopenia: A Cross-Sectional Study

OBJECTIVES

Lymphocytes can affect the proliferation and migration of muscle satellite cells, which may be associated with reduced muscle mass in patients with sarcopenia. The present study aimed to further enrich understandings of the changes of blood lymphocytes and explore the relationship between peripheral lymphocyte subsets and muscle mass in patients with sarcopenia.

DESIGN

A cross-sectional study.

SETTING

Geriatrics department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

METHODS

Eighty-five subjects were enrolled in this study, and were divided into two groups: the sarcopenia group (n=60) and the non-sarcopenia group (n=25). The diagnosis of sarcopenia was based on the diagnostic criteria updated by the Asian Working Group for Sarcopenia (AWGS) in 2014. Complete blood count, peripheral lymphocyte subsets, and body composition of all patients were measured.

RESULTS

Skeletal muscle mass index (SMI) was negatively correlated with CD4+CD28null T lymphocytes in peripheral blood in patients with sarcopenia.

CONCLUSION

The result of our study may point out the role of CD4+CD28null T lymphocytes in the pathogenesis of sarcopenia.

Prevalence and clinical impact of sarcopenia in osteoporotic hip fracture: Single center retrospective cohort study

OBJECTIVE

The study aimed to identify the prevalence of sarcopenia in patients with osteoporotic hip fractures, investigate the anthropometric differences between sarcopenic and non-sarcopenic patients, and evaluate and compare the surgical outcomes between the two groups.

METHODS

The study included 135 patients (35 men and 100 women; mean age: 74.1 years (range; 25-96)) who received surgical treatment for hip fracture between March 2014 and October 2016 and underwent whole-body dual-energy X-ray absorptiometry (DEXA). The skeletal muscle mass index (SMI) for diagnosis of sarcopenia was measured using whole-body DEXA. The following data were collected to compare the preoperative details of the sarcopenic and non-sarcopenic groups: SMI, age, sex, type of fracture, type of operation, BMI, obesity, American society of Anesthesiologists (ASA) class, pre-injury mobility score, BMD, and follow-up period. We compared clinical outcomes, including Harris Hip Score (HSS) and the walking ability at the last follow-up visit and radiologic outcomes, including non-union and the time to union.

RESULTS

The average HHS and Parker's mobility score at the last follow-up were 81.7 and 6.9 in the sarcopenic group, and 77.6 and 6.3 in the non-sarcopenic group, respectively (p=0.149 and 0.122). Non-union was identified 0 (0%) in sarcopenic group and 4 (10%) in non-sarcopenic group (p=0.288). The mean union timer of the patients in the sarcopenia group was 4.0 months and that of patients in the non-sarcopenic group was 4.4 months (p=0.210). Multiple regression analysis did not show any significant association between sarcopenia and postoperative surgical outcomes, including HHS, mobility score at the last follow up, non-union, and time to union.

CONCLUSION

Although the present study showed that the prevalence of sarcopenia in hip fracture patients was 45.9% (62/135), there was no clinical association between sarcopenia and postoperative. Based on these results, the clinical impact of sarcopenia may be confined to increased risk of hip fracture occurrence and surgical outcomes of hip fracture may not be affected by sarcopenia.

LEVEL OF EVIDENCE

Level III, Therapeutic Study.

Sarcopenia, Obesity and Sarcopenia Obesity in Comparison: Prevalence, Metabolic Profile, and Key Differences: Results from WCHAT Study

OBJECTIVE

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects with non-sarcopenia/non-obesity (H), sarcopenia/non-obesity (S), non-sarcopenia/obesity (O) and sarcopenia obesity (SO) in a multi-ethnic population in west China.

DESIGN

A cross-sectional study.

SETTING

The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4,500 participants aged 50 years or older who did bioelectrical impedance in our analysis from West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all participants. We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia (AWGS). Obesity was defined as the highest sex-specific quintile of the percentage body fat. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences of metabolic profiles among different groups.

RESULTS

Of 4500 participants aged 50 years old or older, the proportions of H, O, S, SO were 63.0%, 17.7%, 16.7% and 2.6%, respectively. And the prevalence of S subjects in men was 18.3% and 15.7% in women, while the prevalence of SO was 3.7% in men and 2.0% in women. Data showed that the prevalence of S and SO has an aging increase pattern which was opposite with O. Both S and SO tends to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S seems to be worse than SO. Compared to H, S cohort showed a decrease in Vitamin D, triglyceride, albumin, fasting glucose, insulin, creatinine, ALT, nutrition scores and increase in HDL. SO cohort were observed for an increase in cholesterol, LDL, total protein and decrease in vitamin D. While O cohort showed an increase in triglyceride, cholesterol, LDL, total protein, glucose, insulin, WBC, uric acid, ALT and nutrition scores, but a decrease in HDL and vitamin D level.

CONCLUSIONS

Among individuals aged 50 years old or older in West China. S, O and SO participants demonstrate distinct differences in the life-styles, chronic disease profile, and metabolic profiles. The prevalence of S and SO has an aging increase pattern contrary to O. Both S and SO tend to be older, lower educational level, without spouse, smoking, comorbidity of chronic disease, poor nutrition status, depression and cognitive decline compared to H and S looks like to be worse than SO. Besides, the S subjects seem to have more metabolic index changes than SO compared to H. While O subjects have some contrary metabolic index to S subjects.

Handgrip Strength in the Korean Population: Normative Data and Cutoff Values

Background

We aimed to report the age- and sex-specific normative data of Korean handgrip strength (HGS) and to establish the cutoffs values of low HGS in Korean populations.

Methods

We analyzed the HGS data of 23,716 Koreans (10,793 men and 12,923 women) from the Korea National Health and Nutrition Examination Survey from 2014 to 2017. The means with standard deviations (SDs) of HGS were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and body mass index (BMI), correlation analysis was also performed. The sex-specific cutoff values for low HGS were presented by deriving the –2 SD values of healthy young adults.

Results

The mean HGS was 39.5±9.3 kg in men and 24.4±5.3 kg in women. The mean HGS increased from 10 to 39 years and peaked at 35–39 years in both men (46.0±7.2 kg) and women (27.2±4.6 kg). Men showed a higher correlation between HGS and BMI (r=0.378) than did women (r=0.134). The cutoff values for low HGS were 29.6 kg for men and 16.8 kg for women for –2 SD below the reference for healthy young adults.

Conclusion

In Koreans, the mean HGS peaked at 35–39 years in both men and women, and the aging curve of HGS was steeper in men than in women. The cutoff values for low HGS were 29.6 kg and 16.8 kg for men and women, respectively.

Relationship between visual acuity and muscle mass in the Korean older population: a cross-sectional study using Korean National Health and Nutrition Examination Survey

OBJECTIVES

We aimed to assess the effects of visual acuity on muscle mass, which is an important indicator of health in older populations.

DESIGN

Pooled-sample cross-sectional study.

SETTING

Nationally representative population survey data.

PARTICIPANTS

The present study analysed men aged 65 years or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2011).

PRIMARY AND SECONDARY OUTCOME MEASURES

Muscle mass was measured by dual-energy X-ray absorptiometry scan, and low muscle mass was defined as appendicular skeletal mass divided by height squared (kg/m2) <6.43 kg/m2 (lowest quintile of the older population in KNHANES, 2008-2011). Visual acuity was evaluated based on best-corrected visual acuity of the better eye.

RESULTS

Of the 1733 participants, 89.9% had good visual acuity. After adjusting for age, the height-adjusted appendicular skeletal muscle mass values were 7.16 and 7.00 kg/m2 in the good and poor vision groups, respectively (p=0.042). According to our criterion for low muscle mass, the prevalence of low muscle mass was 16.4% and 34.7% in the good and poor vision groups, respectively. After adjusting for age, smoking status, alcohol consumption status, frequency of physical activity, educational level, the status of basic livelihood recipient and history of stroke, the poor visual acuity group had higher odds of low muscle mass than the good visual acuity group (OR=1.60; 95% CI 1.02 to 2.50; p=0.040).

CONCLUSIONS

Older men with decreased visual acuity have low muscle mass. Poor vision might be an indicator of low muscle mass.

Sarcopenia: Tilting the Balance of Protein Homeostasis

Sarcopenia, defined as age-associated decline of muscle mass and function, is a risk factor for mortality and disability, and comorbid with several chronic diseases such as type II diabetes and cardiovascular diseases. Clinical trials showed that nutritional supplements had positive effects on muscle mass, but not on muscle function and strength, demonstrating our limited understanding of the molecular events involved in the ageing muscle. Protein homeostasis, the equilibrium between protein synthesis and degradation, is proposed as the major mechanism underlying the development of sarcopenia. As the key central regulator of protein homeostasis, the mammalian target of rapamycin (mTOR) is proposed to be essential for muscle hypertrophy. Paradoxically, sustained activation of mTOR complex 1 (mTORC1) is associated with a loss of sensitivity to extracellular signaling in the elderly. It is not understood why sustained mTORC1 activity, which should induce muscle hypertrophy, instead results in muscle atrophy. Here, recent findings on the implications of disrupting protein homeostasis on muscle physiology and sarcopenia development in the context of mTOR/protein kinase B (AKT) signaling are reviewed. Understanding the role of these molecular mechanisms during the ageing process will contribute towards the development of targeted therapies that will improve protein metabolism and reduce sarcopenia.

The association between sarcopenia and osteoporotic vertebral compression refractures

Sarcopenia was reported to be significantly associated with osteoporosis. In this study, we reported for the first time that sarcopenia was an independent risk predictor of osteoporotic vertebral compression refractures (OVCRFs). Other risk factors of OVCRFs are low bone mass density T-scores, female sex, and advanced age.

INTRODUCTION

The purpose of this study was to investigate the association between osteoporotic vertebral compression refractures (OVCRFs) and sarcopenia, and to identify other risk factors of OVCRFs.

METHODS

We evaluated 237 patients with osteoporotic vertebral compression fracture who underwent percutaneous kyphoplasty (PKP) in our hospital from August 2016 to December 2017. To diagnose sarcopenia, a cross-sectional computed tomography (CT) image at the inferior aspect of the third lumbar vertebra (L3) was selected for estimating muscle mass. Grip strength was used to assess muscle strength. Possible risk factors, such as age, sex, body mass index (BMI), bone mineral density (BMD), location of the treated vertebra, anterior-posterior ratio (AP ratio) of the fractured vertebra, cement leakage, and vacuum clefts, were assessed. The multivariable analysis was used to determine the risk factors of OVCRFs.

RESULTS

During the follow-up period, OVCRFs occurred in 64 (27.0%) patients. Sarcopenia was present in 48 patients (20.3%), including 21 OVCRFs and 27 non-OVCRFs patients. Sarcopenia was significantly correlated with advanced age, lower BMI, lower BMD, and hypoalbuminemia. Compared with non-sarcopenic patients, sarcopenic patients had higher OVCRFs risk. In univariate analysis, sarcopenia (p = 0.003), female (p = 0.024), advanced age (≥ 75 years; p < 0.001), lower BMD (p < 0.001), lower BMI (p = 0.01), TL junction (vertebral levels at the thoracolumbar junction) (p = 0.01), cardiopulmonary comorbidity (p = 0.042), and hypoalbuminemia (p = 0.003) were associated with OVCRFs. Multivariable analysis revealed that sarcopenia (OR 2.271; 95% CI 1.069-4.824, p = 0.033), lower BMD (OR 1.968; 95% CI 1.350-2.868, p < 0.001), advanced age (≥ 75 years; OR 2.431; 95% CI 1.246-4.744, p = 0.009), and female sex (OR 4.666; 95% CI 1.400-15.552, p = 0.012) were independent risk predictors of OVCRFs.

CONCLUSIONS

Sarcopenia is an independent risk predictor of osteoporotic vertebral compression refractures. Other factors affecting OVCRFs are low BMD T-scores, female sex, and advanced age.

Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis

The aim of this systematic review and meta-analyses was to calculate the pooled prevalence of sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) criteria among Japanese community-dwelling older adults. Data from 8 studies were used to determine the prevalence of sarcopenia in the overall population and in men; data from 9 studies were used to determine that of women. The pooled prevalence rates of sarcopenia using random-effects models were 9.9% (95% confidence interval [CI], 6.2%-15.4%) overall; 9.8% (95% CI, 6.2%-15.2%) among men; and 10.1% (95% CI, 6.4%-15.5%) among women. These findings would be useful to inform community-based strategies and advanced research addressing sarcopenia prevention.

A Pilot Study of Five Types of Maximum Hand Strength among Manufacturing Industry Workers in Taiwan

Background: The purpose of this study is to collect five types of maximum hand strength among workers in the manufacturing industry in Taiwan. Methods: This study is a cross sectional study with a stratified and convenient sample of workers on the production line in manufacturing industries in Central Taiwan. In total, we recruited 198 healthy subjects to participate in this study. Five types of hand strength were measured in both hands three times with 3 min rests between trials. Results: The strength of females for these five types of hand exertions were 52.0% to 67.6% of the strength of males (p < 0.001). For both genders, there was a main effect for the types of hand strength for the right hand (p < 0.001) and the left hand (p < 0.001). In general, the hand strength in U.S. and EU countries was 1.2 to 1.7 times greater than the strength among the three types of hand exertions in this study. Conclusion: These results can be used to evaluate the musculoskeletal burdens on the upper extremities in the manufacturing industry and could also be used for tool and job design and job modifications.

Factors associated with muscle mass in community-dwelling older people in Singapore: Findings from the SHIELD study

OBJECTIVES

Aging is associated with low muscle mass and has been linked to adverse health outcomes. The objectives of this cross-sectional study were: (1) to describe anthropometry, body composition, appendicular skeletal muscle mass index (ASMI; appendicular skeletal muscle mass/height2), and prevalence of low ASMI in older people with normal nutritional status (Malnutrition Universal Screening Tool score = 0); (2) to determine factors associated with ASMI, and odds ratios of having low ASMI.

METHODS

SHIELD is a study of community-dwelling older people aged 65 years and above in Singapore. ASMI was determined using bioelectrical impedance analysis and low ASMI was defined as <7.0 kg/m2 for males and <5.7 kg/m2 for females (Asian Working Group for Sarcopenia, 2014).

RESULTS

A total of 400 older people (183 males and 217 females) took part in this study. The overall prevalence of low ASMI was 20.6% (15.5% in males and 24.9% in females). Females had significantly lower ASMI than males (P < 0.0001), age was inversely associated with ASMI (P = 0.0024) while BMI and calf circumference were positively associated with ASMI (both P < 0.0001) in the total cohort. In addition, ASMI was positively associated with bone mass in both genders (both P < 0.0001). After adjusting for covariates, the odds ratios of having low ASMI with every 1 year and 10 years increase in age were 1.13 (95% CI: 1.06, 1.20) and 3.36 (95% CI: 1.82, 6.21) respectively.

CONCLUSIONS

The high prevalence of low ASMI in community-dwelling older people with normal nutritional status highlights the need for early screening. There was a strong inverse association between age and ASMI while BMI, calf circumference and bone mass were positively associated with ASMI. These findings will give further weight to the importance and development of public health strategies in maintaining and improving muscle health in this population group.

East meets West: current practices and policies in the management of musculoskeletal aging

Healthy aging is defined as the process of developing and maintaining the functional ability that enables wellbeing in older age. Healthy aging is dependent upon intrinsic capacity, a composite of physical and mental capacities, and the environment an individual inhabits and their interactions with it. Maintenance of musculoskeletal health during aging is a key determinant of functional ability. Sarcopenia, osteoporosis and osteoarthritis, are a triad of musculoskeletal diseases of aging that are major contributors to the global burden of disease and disability worldwide. The prevention and management of these disorders is of increasing importance with pressure mounting from the aging population. In a new initiative, the Chinese Medical Association, Chinese Society of Osteoporosis and Bone Mineral Research, and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases jointly organized a symposium to discuss current practices and policies in the management of musculoskeletal aging. The meeting allowed experts from Europe and China to share their experience and recommendations for the management of these three major diseases. Discussing and analyzing similarities and differences in their practice should lead, through a mutual enrichment of knowledge, to better management of these diseases, in order to preserve intrinsic capacity and retard the age-related degradation of physical ability. In future, it is hoped that sharing of knowledge and best practice will advance global strategies to reduce the burden of musculoskeletal disease and promote healthy aging tailored to meet the individual patient’s needs.