Sarcopenia

Inverse association between triglyceride glucose index and muscle mass in Korean adults: 2008-2011 KNHANES

Background

Since sarcopenia is an important risk factor for falls or cardiovascular disease, early detection and prevention of sarcopenia are being increasingly emphasized. Emerging evidence has indicated relationships between sarcopenia, insulin resistance, and inflammation. The triglyceride glucose (TyG) index, a novel surrogate marker of insulin resistance and systemic inflammation, has not yet been shown to be associated with sarcopenia. This study aimed to examine the relationship between the TyG index and muscle mass in Korean adults.

Methods

This study included 15,741 non-diabetic adults over 19 years old using data from the 2008–2011 Korea National Health and Nutrition Examination Survey. Participants were divided into three groups according to tertiles of the TyG index. A low skeletal muscle mass index (LSMI) was defined by the Foundation for the National Institutes of Health Sarcopenia Project criteria. A weighted multivariate logistic regression model was used to analyze relationships between TyG index tertiles and LSMI.

Results

The ORs (95% CIs) for LSMI in the second and third TyG tertiles, compared to the first tertile, were 1.463 (1.131–1.892) and 1.816 (1.394–2.366), respectively, after adjusting for confounding factors. Higher TyG index values were also associated with increased odds of LSMI in adults under 65 years who did not exercise regularly, who consumed less than 30 g of alcohol per day, who did not currently smoke, and who ate less than 1.5 g of protein/kg/day.

Conclusion

The TyG index was significantly and positively associated with LSMI in Korean adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-020-01414-4.

Changes in Muscle Mass in Patients With Renal Transplants Based on Ultrasound: A Prospective Study

OBJECTIVES

This original research aimed to investigate the value of ultrasound (US), including grayscale US and shear wave elastography (SWE), in quantitatively evaluating muscle mass after kidney transplantation.

METHODS

A total of 52 patients and 54 healthy control participants were recruited. High-frequency US was used to evaluate the echo intensity and muscle morphologic features. Muscle stiffness in the rectus femoris was assessed with SWE. Interclass and intraclass correlation coefficients were used for evaluating measurement reliability. The diagnostic performance of SWE was determined by a receiver operating characteristic curve analysis.

RESULTS

The intraobserver and interobserver repeatability was excellent (all correlation coefficients >0.940; P < .05). The best evaluation point after right iliac fossa transplantation was at the lower third of the right leg. In patients, the skin (0.154 versus 0.192 cm) and rectus femoris (0.700 versus 0.905 cm) were thinner, and the pinnate angle (6.500° versus 8.000°) and area (0.965 versus 1.270 cm² ) were smaller (all P < .05). The US results showed that, compared with the controls, all patients' rectus femoris echo intensity (P < .001 in the transverse section) and elastic modulus (P < .001 in the Young modulus and shear wave speed) increased significantly. The cutoff values were 10.05 and 10.37, and the areas under the receiver operating characteristic curves were 0.843 and 0.845 for predicting kidney transplant and sarcopenia, respectively.

CONCLUSIONS

This noninvasive and convenient technique might be effective for objectively evaluating the muscle mass of patients after kidney transplantation.

Association of dietary approaches to stop hypertension eating style and risk of sarcopenia

The association between habitual intake of the “dietary approaches to stop hypertension” (DASH) eating plan and sarcopenia has received limited attention. The present study aimed to investigate the association between adherence to DASH dietary pattern and sarcopenia and its components including muscle mass, muscle strength, and muscle performance among community-dwelling older adults population. This population-based cross-sectional study was performed in 2011 among 300 older people (150 men and 150 women) aged ≥ 55 years, who were selected using cluster random sampling method. Dietary intake of study participants were examined by the use of a Block-format 117-item food frequency questionnaire (FFQ). The DASH score was constructed based on eight main foods and nutrients emphasized or minimized in the DASH diet. All components of sarcopenia was measured using standard protocols and sarcopenia was defined based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. Mean age and BMI of study participants were 66.7 ± 7.7 years and 27.3 ± 4.2 kg/m², respectively. Totally, 31 individuals meet the criteria of EWGSOP2-sarcopenia. We found no significant association between adherence to the DASH diet and EWGSOP2-sarcopenia either before (OR 1.08; 95% CI 0.45–2.54) or after adjustment for potential confounders (OR 1.04; 95% CI 0.39–2.75). The same findings were obtained in the gender-stratified analyses (men: OR 2.29; 95% CI 0.39–13.29 and women: 0.75; 95% CI 0.23–2.45). In conclusion, we found that adherence to the DASH-style diet was not significantly associated with odds of sarcopenia. Future prospective studies are required to confirm these findings.

Neuromuscular Specializations of the Human Hypopharyngeal Muscles

The hypopharyngeal muscles in humans play a vital role in swallowing, speech, and respiration. Increasing evidence indicates that these muscles are specialized to perform life-sustaining upper aerodigestive functions. This review aims to provide current knowledge regarding the key structural, physiological, and biochemical features of the hypopharyngeal muscles, including innervation, contractile properties, histochemistry, biochemical properties, myosin heavy chain (MyHC) expression and regulation, and age-related alterations. These would clarify the unique neuromuscular specializations of the human hypopharyngeal muscles for a better understanding of the functions and pathological conditions of the pharynx and for the development of novel therapies to treat related upper airway disorders.

Secondary sarcopenia assessed by computed tomography can predict hospitalization for heart failure in adults with Fontan circulation

BACKGROUND

Sarcopenia is one of the important predictors of heart failure (HF) in patients with cardiac problems. Skeletal muscle pump is important to maintain Fontan circulation. We aimed to quantify the volume of the psoas major muscle (PMM) and investigate whether it is relevant to HF hospitalization in adults with Fontan circulation.

METHODS

A total of 154 adults with Fontan circulation, and 30 age-matched adults were studied retrospectively. We identified secondary sarcopenia by measuring the PMM volume, using non-contrast abdominal computed tomography.

RESULTS

PMM indexed volume in Fontan patients was lower than controls (206.4+/-18.0 cc/m² vs 288.0+/-61.1 cc/m², p < 0.0001). In Fontan men, PMM indexed volume correlated with New York Heart Association functional class (NYHA FC). PMM indexed volume in Fontan women correlated with age, NYHA FC, and serum creatinine. Using a multivariate Cox hazards analysis, NYHA FC ≧3 was an important predictor of hospitalization due to HF in Fontan men. In Fontan women, NYHA FC ≧3, brain natriuretic peptide, PMM indexed volume, and protein losing enteropathy were important predictions of hospitalization due to HF. Among all Fontan patients, those with low PMM volumes had a poorer prognosis in HF [log rank p = 0.012 (men) and 0.0009 (women)].

CONCLUSIONS

PMM volume reduction has an adjunctive prediction of HF hospitalization in adults with Fontan circulation, particularly in Fontan females. Secondary sarcopenia may have a negative impact on the prognosis of HF in this population. The assessment of skeletal muscle mass also may be a comprehensive screening tool for multi-organ dysfunction in Fontan circulation.

Muscle wasting as an independent predictor of survival in patients with chronic heart failure

BACKGROUND

Skeletal muscle wasting is an extremely common feature in patients with heart failure, affecting approximately 20% of ambulatory patients with even higher values during acute decompensation. Its occurrence is associated with reduced exercise capacity, muscle strength, and quality of life. We sought to investigate if the presence of muscle wasting carries prognostic information.

METHODS

Two hundred sixty-eight ambulatory patients with heart failure (age 67.1 ± 10.9 years, New York Heart Association class 2.3 ± 0.6, left ventricular ejection fraction 39 ± 13.3%, and 21% female) were prospectively enrolled as part of the Studies Investigating Co-morbidities Aggravating Heart Failure. Muscle wasting as assessed using dual-energy X-ray absorptiometry was present in 47 patients (17.5%).

RESULTS

During a mean follow-up of 67.2 ± 28.02 months, 95 patients (35.4%) died from any cause. After adjusting for age, New York Heart Association class, left ventricular ejection fraction, creatinine, N-terminal pro-B-type natriuretic peptide, and iron deficiency, muscle wasting remained an independent predictor of death (hazard ratio 1.80, 95% confidence interval 1.01-3.19, P = 0.04). This effect was more pronounced in patients with heart failure with reduced than in heart failure with preserved ejection fraction.

CONCLUSIONS

Muscle wasting is an independent predictor of death in ambulatory patients with heart failure. Clinical trials are needed to identify treatment approaches to this co-morbidity.

A low psoas muscle volume is associated with a poor prognosis in penile cancer

Background: Sarcopenia was initially recognized as a marker representing the nutritional condition or aging. Recently, sarcopenia has been associated with a poor prognosis and postoperative complications. We examined the importance of sarcopenia as a predictive marker of the prognosis in penile cancer.

Materials and Methods: A total of 25 patients diagnosed with penile cancer who underwent penile resection from 2000 to 2010 were analyzed in this study. The psoas muscle index (PMI) was calculated based on psoas area using preoperative axial computed tomography images at the right L3 level divided by the square of the body height.

Results: Nineteen (76.0%) patients underwent partial penectomy, and 6 (24.0%) underwent total penectomy. The median (mean ± standard deviation) age was 69.3 (69.0 ± 10.1) years old. Regarding the site of penile cancer, 17 (76.0%) cases were in the glans, 6 (24.0%) were in the foreskin, and 2 (8.0%) were in the shaft. Lymph node metastasis were seen in 6 cases (24.0%), and distant metastasis was seen in 1 case (4.0%). The lower PMI group (< 320.0) showed a significantly poorer progression-free survival than the higher PMI group (≥ 320.0) (p = 0.030), although no significant difference in the overall survival was noted (p = 0.076).

Conclusions: Sarcopenia might be a useful prognostic factor in penile cancer patients.

Association of Body Shape Index (ABSI) with Hand Grip Strength

Hand grip is a leading measure of muscle strength and general health, yet its association with body shape is not well characterized. Here, we examine correlations between grip strength, a body shape index (ABSI), and body mass index (BMI) in the 2011-2014 United States National Health and Nutrition Examination Survey cohorts. Grip strength was found to correlate negatively with ABSI (though positively with BMI), suggesting that those with a more central body profile tend to be weaker than others with the same weight. Individuals with low grip strength, as well as those with high ABSI, were more likely to die during follow up, whereas there was no association of BMI with mortality hazard. Transforming the grip strength, ABSI, and BMI by taking their logarithm prior to standardization did not meaningfully change the associations seen. These findings suggest that combining anthropometrics (ABSI, BMI) with grip strength may better identify individual mortality hazard in research studies and clinical practice.

Prognostic impact of sarcopenia in patients with metastatic hormone-sensitive prostate cancer

BACKGROUND

Cancer cachexia is associated with a poor prognosis. This study aimed to investigate the association between sarcopenia and survival in patients with metastatic hormone-sensitive prostate cancer.

METHODS

We retrospectively evaluated 197 patients diagnosed with metastatic hormone-sensitive prostate cancer in our department and its affiliated institution between January 2008 and December 2015. Sarcopenia was diagnosed according to the sex-specific consensus definition. Castration-resistance prostate cancer-free survival, cancer-specific survival and overall survival from the metastatic hormone-sensitive prostate cancer diagnoses were calculated using the Kaplan-Meier method and compared using the log-rank test. Risk factors affecting the survival outcomes were analyzed using the Cox proportional regression analysis.

RESULTS

In total, 163 patients (82.7%) had sarcopenia. Cancer-specific survival and overall survival were significantly shorter in sarcopenic patients than in non-sarcopenic patients (median cancer-specific survival: 77.0 months vs. not reached, P = 0.0099; overall survival: 72.0 months vs. not reached, P = 0.0465), whereas castration-resistance prostate cancer-free survival did not significantly differ between the groups (P = 0.6063). Multivariate analyses showed that sarcopenia was an independent factor for cancer-specific survival (hazard ratio: 2.18, P = 0.0451), together with the Gleason score (hazard ratio: 1.87, P = 0.0272) and LATITUDE risk classification (hazard ratio: 2.73, P = 0.0008). Moreover, the prognostic association of sarcopenia was remarkable in patients aged <73.0 years (cancer-specific survival: 82.0 months vs. not reached, P = 0.0027; overall survival: 72.0 months vs. not reached, P = 0.0078 in sarcopenic vs. non-sarcopenic patients), whereas the association was not significant in patients aged ≥73.0 years (cancer-specific survival: 76.0 and 75.0 months, respectively, P = 0.7879; overall survival: 67.0 and 52.0 months, respectively, P = 0.7263).

CONCLUSION

Sarcopenia was an independent risk factor of cancer-specific survival in patients with metastatic hormone-sensitive prostate cancer, especially in younger patients.

Physical Frailty among Urban-Living Community-Dwelling Older Adults in Malaysia

Frailty is a multidimensional syndrome, which is a worldwide concern within the field of geriatrics due to the aggravating effect on the physical and mental functions of the elderly. This study aimed to determine the prevalence and risk factors of the frailty syndrome among urban-living community-dwelling elderly in Malaysia. A cross-sectional study was conducted among 301 community-dwelling elders. Frailty status was assessed using the Fried phenotype criteria. Depressive symptoms were assessed using the Geriatric Depression Scale (M-GDS-14), whereas the functional abilities and cognitive status were measured using the Lawton Instrumental Activities of Daily Living (Lawton IADL) scale and the Mini-Mental State Examination (MMSE-M), respectively. Malnutrition risk was observed through the abridged version (Short Form) of the Mini Nutritional Assessment (MNA-SF). Multinomial logistic regression analysis was employed to determine the significant predictors of the frailty syndrome. Three hundred and one elderly persons engaged in this study, with a mean age of 67.08 ± 5.536 ranging between 60 to 84 years old. The prevalence values of frailty and pre-frail were 15.9% and 72.8%, respectively, in which women appeared to be at a higher risk of frailty. The multivariate model revealed that frailty could be predicted from an increase in age, lower household income, being at risk of malnutrition, wasting (low skeletal muscle mass), and high serum C-reactive protein (CRP) level. A holistic approach is suggested for managing the frailty syndrome as it involves a decline in the multiple components of the geriatric syndrome.

Habitual Aerobic Exercise Diminishes the Effects of Sarcopenia in Senescence-Accelerated Mice Prone8 Model

Loss of muscle mass and strength are progressing with aging. Exercise is a beneficial method to prevent physical dysfunction, and habitual exercise can improve the muscle quality. Therefore, we evaluated the effects of long-term habitual exercise's impact on sarcopenia utilizing the senescence-accelerated mice prone8 (SAMP8) model. Notably, 27 w SAMP8 were used in this study. Mice were classified into 28 (28 w) and 44 weeks old. The 44-week group was divided into the sedentary group (44 w) and a group exercising for 16 weeks (44 w + Ex). The 44 w + Ex performed habitual exercise from 28 to 44 weeks. Additionally, grip strength tests were performed with mice aged 28 and 44 weeks. Muscles were harvested and measured muscle weight at 44 w. Gastrocnemius decreased in 44 w, but was unchanged in 44 w + Ex. There was a trend for lower muscle grip strength in the 44 w group, but there was no change in 44 w + Ex. The phosphorylation levels of Akt and p70S6K as a protein synthesis marker were decreased in 44 w. Cytochrome c oxidase subunit IV (CoxIV) mRNA and protein levels decreased in 44 w. These results suggested that long-term habitual exercise attenuates muscle mass and strength decline, possibly through maintenance of muscle protein synthesis and mitochondrial maintenance.

Prevalence of sarcopenia in pre-frail community dwelling older adult and utility of SARC-F, SARC-CalF and calf circumference in case finding

OBJECTIVE

To determine the prevalence of sarcopenia in the pre-frail community dwelling older adults based on the Asian Workgroup for Sarcopenia (AWGS 2019) criteria. In addition, the utility of case finding using the SARC-F, SARC-CalF and calf circumference on impact of prevalence was explored.

METHODS

75 older adults ≥65 years old were recruited between October 2019 and March 2020. The algorithms of AWGS 2019 was applied retrospectively to pre-frail participants recruited for an intervention study in primary care setting. In addition to demographics, SARC-F, calf circumference (CC), muscle mass, grip strength, gait speed, 5-time chair stand timing and short physical performance battery test (SPPB) were measured, to determine sarcopenia using AWGS 2019. SARC-CalF was determined using SARC-F and CC.

RESULTS

The prevalence of sarcopenia based on AWGS 2019 algorithm was 16.0%, possible sarcopenia 73.3% and severe sarcopenia 12.0%. Using SARC-F for case finding reduced the overall prevalence of sarcopenia to 4.0%, possible sarcopenia to 12.0% and severe sarcopenia to 4.0%. Positive percentage agreement of case finding criteria of SARC-F, SARC-CaIF and calf circumference for sarcopenia was 33%, 42% and 58% respectively.

CONCLUSIONS

Using the AWGS 2019 without case finding, the prevalence of sarcopenia was 16%. However, using SARC-F for case finding underestimated prevalence in this group by 75%. Utility of SARC-F for case finding in pre-frail requires further evaluation.

Association of major dietary patterns with muscle strength and muscle mass index in middle-aged men and women: Results from a cross-sectional study

BACKGROUND

Dietary patterns may affect muscle mass, strength, and function; hence, we evaluated the association of major dietary patterns in relation to muscle mass index (MMI) and muscle strength in middle-aged adults. We hypothesized that unhealthy dietary patterns are associated with reduced muscle mass and muscle strength.

SUBJECTS

and methods: The present cross-sectional study recruited 270 adults (118 males and 152 females) aged between 18 and 75 years' old. Socio-demographic data, body composition and muscle strength were determined. MMI was calculated by total fat free mass (FFM) (kg)/height² (m). Dietary intake was assessed using a 168-item validated food frequency questionnaire. Factor analysis was conducted, and as a result, 3 factors were extracted. These factors were labeled as healthy, mixed and western dietary patterns.

RESULTS

After control for potential confounders, there were a positive trend between tertiles of "healthy dietary pattern" and muscle strength (p = 0.03). Moreover, we found that those who were in the third tertile of "mixed dietary pattern" compared to those at the first tertile had no significant relationship with muscle strength (p = 0.42) and MMI (p = 0.36) even after controlling for potential confounders. In contrast, the adherence to the "Western dietary pattern" was associated with reduced MMI (p = 0.02).

CONCLUSION

Adherence to healthy dietary pattern might be associated with better muscle strength and greater adherence to Western pattern appears to reduce MMI.

Muscle activity and architecture as a predictor of hand-grip strength

BACKGROUND

Grip strength is a powerful predictor of disability as well as a good indicator of physical activity.

OBJECTIVES

This study aimed to relate ultrasound (US) and electromyography (EMG) simultaneously to maximum hand-grip strength during an isometric contraction.

APPROACH

This is a cross-sectional study. Data acquisition was done with a dynamometer, US and EMG. Outcome variables included maximum strength during the hand-grip gesture, maximum muscle activity and change in muscle thickness. A non-linear regression analysis was performed to analyse the relationship between all outcome variables.

MAIN RESULTS

A total of 38 subjects (18 men and 20 women) participated in the study. The mean results for hand-grip strength were 25.50 (SD 6.55) kg of maximum strength, a change in muscle thickness of 1.83 (SD 0.75) mm and an EMG activity of 499.29 (SD 224.20) µV. Hand-grip strength had a high correlation with muscle thickness (R ² = 0.61) and EMG activity (R ² = 0.95). The correlation between maximum muscle activity and change in muscle thickness was R ² = 0.83.

SIGNIFICANCE

The results of the present study demonstrate that this new method based on electromyographic activity and muscule architecture could be important in the development of the hand-grip test.

Urinary titin N-terminal fragment concentration is an indicator of preoperative sarcopenia and nutritional status in patients with gastrointestinal tract and hepatobiliary pancreatic malignancies

OBJECTIVES

Recent reports indicate that preoperative patients with gastrointestinal malignancies often have sarcopenia. The diagnosis of sarcopenia is generally done by evaluation of walking speed, grip strength, and skeletal muscle volume of the limbs on computed tomography (CT). However, these parameters are objective indices, and new indicators for diagnosis, such as molecular biomarkers, have been anticipated. The aim of this study was to investigate whether titin, a muscular contractile protein present in sarcomeres, is an indicator of sarcopenia.

METHODS

We analyzed 39 patients with gastrointestinal tract and hepatobiliary pancreatic malignancies who underwent surgery. We compared urinary titin n-terminal fragment concentration (UTF) with clinical factors, subcutaneous fat volume, and skeletal muscle volume index, and also compared UTF levels between patients with and without sarcopenia.

RESULTS

The patients comprised 24 men and 15 women, with a mean age of 72 y (range: 35-85 y). Cancer locations were the pancreas (n = 17), liver (n = 9), stomach (n = 5), colorectum (n = 5), and esophagus (n = 3). UTF was significantly higher in patients with sarcopenia (P = 0.04), and showed statistically significant negative correlations with albumin (r = -2.61, P = 0.001), pre-albumin (r = -2.14, P = 0.02), body mass index (r = -0.49, P = 0.007), cholinesterase (r = -0.02, P = 0.01, skeletal muscle volume index (r = -0.16, P = 0.04), and subcutaneous fat volume (r = -0.03, P = 0.007).

CONCLUSION

UTF may be a new index for preoperative nutritional assessment in patients with gastrointestinal malignancies.

Metabolic syndrome-related sarcopenia is associated with worse prognosis in patients with gastric cancer: A prospective study

OBJECTIVES

Sarcopenia and metabolic syndrome (MetS) are associated with the prognosis from malignant tumors. However, evidence of the relationship between sarcopenia and MetS among gastric cancer (GC) patients following radical gastrectomy is lacking. This study assessed the association between preoperative sarcopenia and MetS among GC patients and analyzed the prognosis of patients with different malnutrition statuses.

METHODS

We prospectively assessed the preoperative statuses of sarcopenia and MetS among patients who underwent radical gastrectomy from July 2014 to December 2017. We combined sarcopenia and MetS to generate four groups: MetS-related sarcopenia group (MSS), sarcopenia group (S), MetS group (MS), and normal group (N).

RESULTS

A total of 749 patients with resectable GC were included in this study. Preoperative MetS was associated with sarcopenia (p < 0.001). Multivariate logistic regression presented that MetS-related sarcopenia (OR = 2.445; p = 0.010) and sarcopenia alone (OR = 2.117; p = 0.001) were independent predictors of grade Ⅱ and above complications, while MetS alone was not (p = 0.342). Cox regression analysis revealed that MetS-related sarcopenia led to the worst prognosis in the four groups (MSS vs MS: HR = 3.555, p < 0.001; MSS vs N: HR = 2.020, p = 0.003; MSS vs S: HR = 1.763, p = 0.021). However, the MetS group had better prognosis than the normal group (MS vs N: HR = 0.568, p = 0.048).

CONCLUSION

Preoperative MetS was associated with sarcopenia among GC patients. MetS-related sarcopenia resulted in a significantly worse prognosis. The long-term prognoses of patients with sarcopenia were impaired by preoperative MetS, while patients without sarcopenia benefited. Thus, patients with both sarcopenia and MetS require more medical interventions.

Bioelectrical impedance analysis and dual x-ray absorptiometry agreement for skeletal muscle mass index evaluation in sarcopenia diagnosis

BACKGROUND

All definitions for diagnosing sarcopenia include the estimation of muscle mass. This can be made using bioelectrical impedance analysis (BIA) or dual x-ray absorptiometry (DXA). BIA is a portable and inexpensive method suitable for clinical settings, while DXA is cumbersome, more expensive and less available.

OBJECTIVES

To evaluate the interchangeability of both techniques for skeletal muscle mass index (SMI) estimation, and assess whether the two methods are comparable for the diagnosis of sarcopenia.

APPROACH

Prospective, cross-sectional study.

SETTING

Faculty for Health Sciences, Universidad de Caldas, Colombia.

PARTICIPANTS

Seventy-two subjects aged 65-80 years were recruited.

MEASUREMENTS

BIA and DXA for SMI estimation and sarcopenia diagnoses using the definition of the European Working Group on Sarcopenia in Older People (EWGSOP). Of the 72 patients, 28 were diagnosed with sarcopenia by BIA and corroborated by DXA were included in the study. To establish the agreement between techniques, the intraclass correlation coefficient and the concordance correlation coefficient were calculated. A Bland-Altman plot evaluated the agreement. To evaluate agreement on the diagnosis of sarcopenia, a Cohen's kappa test was performed.

MAIN RESULTS

Agreement between SMI by BIA and DXA was good according to the intraclass correlation coefficient (ICC 0.7 95% CI 0.5 to 0.8) but poor when the concordance correlation coefficient was used (CCC 0.4 was calculated 95% CI 0.3 to 0.5). The Bland-Altman analysis showed a clinically unacceptable discrepancy between the methods; the confidence intervals were too wide; the difference between methods tends to get larger as the average increases and the scatter around the bias line get larger as the average gets higher. Cohen's kappa test was 0.2 (SEE: 0.1).

SIGNIFICANCE

The agreement between BIA and DXA was weak. We concluded that, in this studied population, the methods were not interchangeable. Results may improve if a specific formula in a greater sample size is used.

Sarcopenic obesity in ageing: cardiovascular outcomes and mortality

Obesity is a major public health issue with prevalence increasing worldwide. Obesity is a well-established risk factor for CVD and mortality in adult populations. However, the impact of being overweight or obese in the elderly on CVD and mortality is controversial. Some studies even suggest that overweight and obesity, measured by BMI, are apparently associated with a decreased mortality risk (known as the obesity paradox). Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass. Fat mass is positively associated and lean mass is negatively associated with risk of mortality. Therefore, in older adults BMI is not a good indicator of obesity. Sarcopenia has been defined as the degenerative loss of muscle mass, quality and strength with age and is of major concern in ageing populations. Sarcopenia has previously been associated with increased risks of metabolic impairment, cardiovascular risk factors, physical disability and mortality. It is possible for sarcopenia to co-exist with obesity, and sarcopenic obesity is a new class of obesity in older adults who have high adiposity levels together with low muscle mass, quality or strength. Therefore, sarcopenia with obesity may act together to increase their effect on metabolic disorders, CVD and mortality. This review will discuss the available evidence for the health implications of sarcopenic obesity on CVD and mortality in older adults.

Prevalencia de dinapenia (disminución de la fuerza), sarcopenia y posibles biomarcadores en rehabilitación cardíaca

Introducción: la relación entre dinapenia y sarcopenia da como resultado un aumento adicional en el riesgo de morbimortalidad en la población general, con un incremento progresivo de acuerdo con la edad. A partir de los 30 años debido a la disminución de la masa muscular y de la fuerza, se afecta la capacidad de ejercicio, la calidad de vida y el estado de ánimo. Objetivo: determinar la prevalencia de dinapenia y sarcopenia en los pacientes en rehabilitación cardíaca de un hospital colombiano, con mediciones de la fuerza y de los marcadores bioquímicos. Métodos: estudio de corte transversal en mayores de 40 años en rehabilitación cardíaca con controles al menos una vez por semana. La medición de la fuerza se realizó con dinamómetro de mano, la masa muscular con impedanciómetro bipolar y velocidad de la marcha con la prueba de caminata de 6 metros. Se tomaron mediciones de hormona de crecimiento (GH), testosterona libre, somatomedina IGF-1 y cortisol. Resultados: la disminución de la fuerza muscular fue prevalente en hombres (n=15, 19.4%; mujeres n=5, 10%). La prevalencia de dinapenia fue 15,7% y sarcopenia 0%. Los resultados obtenidos fueron GH 0.27 (0.08-1.18), testosterona 5.9 (0.3-8.5), IGF-1 126 (95.5-169) cortisol 13.9 (11.2-18.4). Las patologías más frecuentes de los pacientes del programa fueron infarto del miocardio, angioplastia e implantación de stent. Conclusiones: la prevalencia de dinapenia fue 15.7%. No se encontró diferencia alguna de los marcadores bioquímicos en los pacientes con y sin dinapenia.

Reliability and Validity of SARC-F Questionnaire to Assess Sarcopenia Among Vietnamese Geriatric Patients

Background

The SARC-F questionnaire has been developed as a rapid diagnostic test that can be used to screen for sarcopenia.

Aim

To investigate the reliability and validity of the Vietnamese version of SARC-F as a screening tool for sarcopenia in older patients in Vietnam.

Methods

A cross-sectional study was conducted in older people attending the outpatient clinics of the National Geriatric Hospital in Vietnam. Muscle mass (using dual-energy X-ray absorptiometry), handgrip strength and gait speed were assessed. SARC-F was validated against the three standard criteria for sarcopenia: the Foundation for the National Institutes of Health (FNIH), Asia Working Group for Sarcopenia (AWGS 2019) and European Working Group on Sarcopenia in Older People (EWGSOP2).

Results

There were 764 participants (mean age 71.5 ± 8.9 years). The Vietnamese SARC-F questionnaire had a good internal consistency (Cronbach’s alpha 0.85). The prevalence of sarcopenia was 49.2% according to SARC-F and 48.3%, 61.1% and 52.6% according to FNIH, AWGS 2019 and EWGSOP2, respectively. The sensitivity and specificity of SARC-F in identifying sarcopenia were 67.1% and 66.7% (for FINH), 66.7% and 67.1% (for AWGS 2019), and 64.9% and 68.2% (for EWGSOP2). The AUCs of SARC-F were 0.71–0.72 against the three sarcopenia criteria.

Conclusion

The Vietnamese version of SARC-F questionnaire has acceptable diagnostic value for sarcopenia. SARC-F could be used as an initial screening for sarcopenia in hospital clinics.

Malnutrition as Key Predictor of Physical Frailty among Malaysian Older Adults

Studies have been carried out on the association between frailty and malnutrition, but the similarities and divergence of the relationship remain debatable. This study aimed to explore the prevalence of malnutrition risk and frailty as well as the overlapping constructs. The associations that emerged were assessed independently of other risk factors. A total of 301 community-dwelling older adults with a mean age of 66.91 ± 5.59 years old were randomly recruited. Fried Criteria and Mini Nutritional Assessment-Short Form (MNA-SF) were used to assess frailty status and malnutrition, respectively. Other related nutritional assessments were assessed (body mass index (BMI), circumference measures, body fat % and skeletal muscle mass). The prevalence of frailty was 14.6% and prefrail was 59.7%; 29.6% were at risk of malnutrition, and 3.3% were malnourished. Malnutrition risk was significantly associated with a higher number of chronic diseases, BMI, circumference of mid-upper arm (MUAC), and calf, (CC)and skeletal muscle mass (SMM) and frailty, whereas frailty was significantly associated with higher number of chronic diseases, SMM and malnutrition. Frailty syndrome can be predicted with increasing age, body fat, lower skeletal muscle and malnutrition. Those who were frail were found to be five times more likely to be at risk of malnutrition. Results suggested that frailty and malnutrition shared considerable overlap, which emphasised the interrelated but discrete concepts. Therefore, the assessment of malnutrition is imperative and could be used as a practical implication in assessing frailty syndrome.

Notch Inhibition via GSI Treatment Elevates Protein Synthesis in C2C12 Myotubes

The role of Notch signaling is widely studied in skeletal muscle regeneration but little is known about its influences on muscle protein synthesis (MPS). The purpose of this study was to investigate whether Notch signaling is involved in the regulation of MPS. C2C12 cells were treated with a γ-secretase inhibitor (GSI), to determine the effect of reduced Notch signaling on MPS and anabolic signaling markers. GSI treatment increased myotube hypertrophy by increasing myonuclear accretion (nuclei/myotube: p = 0.01) and myonuclear domain (myotube area per fusing nuclei: p < 0.001) in differentiating C2C12 cells. GSI treatment also elevated myotube hypertrophy in differentiated C2C12s (area/myotube; p = 0.01). In concert, GSI treatment augmented pmTOR Ser2448 (p = 0.01) and protein synthesis (using SUnSET method) in myotubes (p < 0.001). Examining protein expression upstream of mTOR revealed reductions in PTEN (p = 0.04), with subsequent elevations in pAKT Thr308 (p < 0.001) and pAKT Ser473 (p = 0.05). These findings reveal that GSI treatment elevates myotube hypertrophy through both augmentation of fusion and MPS. This study sheds light on the potential multifaceted roles of Notch within skeletal muscle. Furthermore, we have demonstrated that Notch may modulate the PTEN/AKT/mTOR pathway.

Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia

Cancer cachexia is a multifactorial syndrome characterized by a progressive loss of skeletal muscle mass, along with adipose tissue wasting, systemic inflammation and other metabolic abnormalities leading to functional impairment. Cancer cachexia has long been recognized as a direct cause of complications in cancer patients, reducing quality of life and worsening disease outcomes. Some related conditions, like sarcopenia (age-related muscle wasting), anorexia (appetite loss) and asthenia (reduced muscular strength and fatigue), share some key features with cancer cachexia, such as weakness and systemic inflammation. Understanding the interplay and the differences between these conditions is critical to advance basic and translational research in this field, improving the accuracy of diagnosis and contributing to finally achieve effective therapies for affected patients.

Impact of using the updated EWGSOP2 definition in diagnosing sarcopenia: A clinical perspective

BACKGROUND AND PURPOSE

The revised European Working Group on Sarcopenia in Older People (EWGSOP2, version 2019) definition of sarcopenia differs with respect to the EWGSOP (version 2010) definition in applied criteria and their cut-off values. We aimed to investigate the impact of the new definition on sarcopenia prevalence in various populations of older adults.

METHODS

Eight cohorts, including community-dwelling older adults, geriatric outpatients and patients admitted to acute and subacute inpatient wards were assessed on sarcopenia prevalence.

RESULTS

A total of 2256 participants (56.4 % female) were included with a median age of the cohorts of 71.7-83.3 years. In males, sarcopenia prevalence was 31.9 % according to EWGSOP compared to 12.0 % according to EWGSOP2. In females, sarcopenia prevalence was 4.9 % and 6.1 % according to EWGSOP and EWGSOP2 respectively. Lower cut-off points for handgrip strength (27 kg versus 30 kg (males) and 16 kg versus 20 kg (females) for EWGSOP and EWGSOP2 respectively) resulted in the lower sarcopenia prevalence in males.

CONCLUSIONS

According to the EWGSOP2 definition, the prevalence of sarcopenia in males is significantly lower compared to the EWGSOP definition, whereas the prevalence among women is slightly higher. The lower cut-off points for handgrip strength result in fewer adults being diagnosed with sarcopenia.

Sarcopenia in distal radius fractures: systematic review of the literature and current findings

INTRODUCTION

Sarcopenia is a clinical syndrome characterized by the reduction in muscle mass, strength and physical ability. Although proximal femur fractures are one of the major burdens affecting the ageing population, distal radius fractures are equally important for frequency, clinical and social consequences. The aim of this study is to evaluate the incidence of sarcopenia in distal radius fractures and clinical implications in functional recovery.

MATERIALS AND METHODS

Scopus and PubMed search was performed to find relationship between sarcopenia and distal radius fractures. Literature search was performed between 2009 and 2019 including clinical trials and clinical studies related to "sarcopenia and distal radius fracture" and "sarcopenia and wrist fracture". After identification, studies were screened and analysed through the Oxford Level of Evidence.

RESULTS

According to the inclusion and exclusion criteria, five articles were included. Four articles analysed the incidence of sarcopenia and its role as a risk factor in patients with distal radial fractures, while one article focused on sarcopenia and clinical results of surgical treatment of distal radius fractures. Incidence of sarcopenia in patients older than 50 years with distal radius fracture varied between 29.7% and 31.7%. Patients with distal radial fractures did not show a significant inferior muscle mass than control group in examined population. Functional results of surgery were significantly inferior in sarcopenic patients than control group (no sarcopenia).

CONCLUSIONS

About 30% of patients older than 50 years with distal radius fracture suffered by sarcopenia; sarcopenic patients surgically treated had worse clinical results than no sarcopenic patients. Further studies with larger samples are needed to confirm these preliminary results.

Muscle Mass and Muscle Strength Relationships to Balance: The Role of Age and Physical Activity

OBJECTIVE

To investigate the relations of balance to muscle mass (MM) and muscle strength (MS), depending on age and physical activity, which is of particular importance to functional independence in older people.

METHODS

This cross-sectional study included 802 volunteers (69.82 ± 5.60 years). The Fullerton Advanced Balance scale was used to assess balance and a composite score, including arm curl and chair stand tests for assessing MS. MM was estimated by dual-energy X-ray absorptiometry and physical activity by questionnaire.

RESULTS

Greater MM (r = .26, p < .001) and MS (r = .53, p < .001) were positively correlated to balance. The old-old adults and less active individuals attained lower balance. Notably, moderation and subsequent simple slope analyses revealed that the relations of balance, MM, and MS were larger in less active and the old-old adults.

CONCLUSIONS

The old-old and less active adults were more prone to muscle weakness and balance impairments. Tailored interventions should particularly consider these vulnerable groups.

Comparing Longitudinal Sarcopenia Trends by Definitions Across Men and Women After Hip Fracture

OBJECTIVES

While sarcopenia is prevalent after hip fracture in the acute postfracture period, little is known about the prevalence after discharge. This study assessed longitudinal trends in sarcopenia prevalence over 12 months after hip fracture using three different operational definitions.

DESIGN

Prospective observational study.

SETTING

Baltimore Hip Studies seventh cohort.

PARTICIPANTS

A total of 82 men and 78 women, aged 65 years and older, with surgical repair of a nonpathological hip fracture.

MEASUREMENTS

Baseline assessment included a dual-energy X-ray absorptiometry scan and interview. Follow-up assessments, which additionally included performance measures, occurred 2, 6, and 12 months after admission. Using these measures, three sarcopenia definitions were assessed over the year following hip fracture: European Working Group on Sarcopenia in Older Persons (EWGSOP), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH).

RESULTS

EWGSOP and IWGS provided the highest prevalence of sarcopenia (62%-69% in men, 42%-62% in women), while prevalence by FNIH was much lower for men (15%-19%) and women (5%-12%). For both men and women, the agreement between EWGSOP and IWGS definitions was excellent, and FNIH showed poor agreement with them, supported by various statistical measures across first-year follow-up. Prevalence was stable over time in men by all definitions, while the prevalence in women by FNIH was lowest at 2 months, significantly increased at 6 months (P = .03), and remained higher at 12 months. Whether sarcopenia prevalence differed significantly by sex varied by time point and definition; however, when different, men had a higher prevalence than women (P < .05). While some participants recovered from sarcopenia over time, some also became newly sarcopenic.

CONCLUSION

The prevalence of sarcopenia after fracture differed greatly for EWGSOP and IWGS compared to FNIH. Overall, there appeared to be no reduction in sarcopenia over the year after hip fracture, regardless of definition. Future research should examine the relationship between sarcopenia prevalence and functional recovery. J Am Geriatr Soc 68:1537-1544, 2020.

Fucoxanthinol attenuates oxidative stress-induced atrophy and loss in myotubes and reduces the triacylglycerol content in mature adipocytes

The combination of sarcopenia and obesity (i.e., sarcopenic obesity) is more strongly associated with disability and metabolic/cardiovascular diseases than obesity or sarcopenia alone. Therefore, countermeasures that simultaneously suppress fat gain and muscle atrophy to prevent an increase in sarcopenic obesity are warranted. The aim of this study was to investigate the simultaneous effects of fucoxanthinol (FXOH) on fat loss in mature adipocytes and the inhibition of atrophy and loss in myotubes induced by oxidative stress. C2C12 myotubes were treated with FXOH for 24 h and further incubated with hydrogen peroxide (H₂O₂) for 24 h. The area of myosin heavy chain-positive myotubes and the ROS concentration were measured. Mature 3T3-L1 adipocytes were treated with FXOH for 72 h. The triacylglycerol (TG) content and glycerol and fatty acid (FA) release were biochemically measured. The myotube area was smaller in H₂O₂-treated cells than that in control cells. However, FXOH protected against the H₂O₂-induced decreases in myotube area. Further, the ROS concentration was significantly higher in the FXOH-treated cells compared with that in the control cells, although it was significantly lower than that in the H₂O₂-treated cells. On the other hand, in the mature adipocytes, the TG content was significantly decreased by FXOH treatment compared to that in the control. Moreover, FXOH treatment significantly increased glycerol and FA release compared with that of the control. These results suggest that FXOH inhibits H₂O₂-induced atrophy and loss in myotubes and activates lipolysis and decreases the TG content in mature adipocytes. Accordingly, FXOH has the potential to exert anti-sarcopenic obesity effects.

Preliminary report; Comparison of the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status

We investigated in a preliminarily study the circadian rest-activity rhythm of elderly Japanese community-dwellers according to sarcopenia status based upon the 2019 updated classification criteria of the Asian Working Group for Sarcopenia. A total of 30 participants were recruited from a single rehabilitation center in northern Japan between July and November 2019. The rest-activity rhythm of those with and without sarcopenia was assessed for 7 consecutive 24 h spans by wrist actigraphy in free-living condition and gait performance in the clinic. As group phenomena, the circadian activity rhythm of the sarcopenia cohort (N = 11) was of significantly lower amplitude and more fragmented than the non-sarcopenia cohort (N = 19). The nonparametric circadian rest activity (RAR) parameters of intra-daily variability (IV), relative amplitude (RA), most active 10-h span (M10), and the least active 5-h span (L5), but not interdaily stability (IS), of the sarcopenia group, were all significantly worse than those of the non-sarcopenia group. Gait performance for the sarcopenia group correlated strongly with the fragmentation and altered amplitude of the RAR. These preliminary findings motivated future longitudinal investigation both to improve the detection of sarcopenia in community dwelling elderly and to inform novel preventive or rehabilitative strategies.

Beef extract supplementation promotes myoblast proliferation and myotube growth in C2C12 cells

PURPOSE

We previously determined that the intake of beef extract for 4 weeks increases skeletal muscle mass in rats. Thus, this study aimed to clarify whether beef extract has a hypertrophic effect on muscle cells and to determine the signaling pathway underlying beef extract-induced myotube hypertrophy.

METHODS

We assessed the effects of beef extract supplement on mouse C2C12 skeletal muscle cell proliferation and differentiation and myotube growth. In addition, the phosphorylation of Akt, ERK1/2, and mTOR following beef extract supplementation was examined by western blotting. Furthermore, the bioactive constituents of beef extract were examined using amino acid analysis and dialysis.

RESULTS

In the proliferative stage, beef extract significantly increased myoblast proliferation. In the differentiation stage, beef extract supplementation did not promote myoblast differentiation. In mature myotubes, beef extract supplementation increased myotube diameter and promoted protein synthesis. Although Akt and ERK1/2 levels were not affected, beef extract supplementation increased mTOR phosphorylation, which indicated that the mTOR pathway mediates beef extract-induced myotube hypertrophy. The hypertrophic activity was observed in fractions of > 7000 Da.

CONCLUSIONS

Beef extract promoted C2C12 myoblast proliferation and C2C12 myotube hypertrophy. Myotube hypertrophy was potentially induced by mTOR activation and active components in beef extract were estimated to be > 7000 Da.

Indoxyl Sulfate Contributes to Uremic Sarcopenia by Inducing Apoptosis in Myoblasts

OBJETIVE

Uremic sarcopenia is a complication of chronic kidney disease, particularly in its later stages, which leads to musculoskeletal disability. Uremic toxins have been linked to the pathogenesis of several manifestations of uremic syndrome. We sought to investigate whether indoxyl sulphate (IS), a protein-bound uremic toxin, is implicated in the development of uremic sarcopenia.

MATERIAL AND METHODS

Myoblasts were exposed to IS at normal (0.6 mg/L, IS_0.6), uremic (53 mg/L, IS₅₃) or maximum uremic (236 mg/L, IS₂₃₆) concentrations for 24, 48 and 72 h. Cell viability was evaluated by MTT assay and by 7-aminoactinomycin D staining. ROS generation and apoptosis were evaluated by flow cytometry. MyoD and myogenin mRNA expression was evaluated by qRT-PCR and myosin heavy chain expression by immunocytochemistry.

RESULTS

Myoblast viability was reduced by IS236 in a time-dependent pattern (p <0.05; 84.4, 68.0, and 63.6%). ROS production was significantly higher (p <0.05) in cells exposed to IS₅₃ and IS₂₃₆ compared to control (untreated cells). The apoptosis rate was significantly higher in cells treated with IS₅₃ and IS₂₃₆ than in control after 48h (p <0.05; 4.7 ± 0.1% and 4.6 ± 0.3% vs. 3.1 ± 0.1%, respectively) and 72h (p <0.05; 9.6 ± 1.1% and 10.4 ± 0.3% vs. 3.1 ± 0.7%, respectively). No effect was observed on MyoD, myogenin, myosin heavy chain expression, and markers of myoblast differentiation at any IS concentration tested or time-point experiment.

CONCLUSIONS

These data indicate that IS has direct toxic effects on myoblast by decreasing its viability and increasing cell apoptosis. IS may be a potential target for treating uremic sarcopenia.

The Effects of Essential Oil on Salivary Oxytocin Concentration in Postmenopausal Women

Objectives: The aim of this study was to find essential oils that have increased the oxytocin concentration in postmenopausal women. Methods: Fifteen postmenopausal women participated in this study and the effects of 10 different essential oils were investigated. The essential oils included rose otto, sweet orange, lavender, neroli, frankincense, jasmine absolute, ylang ylang, roman chamomile, clary sage, and Indian sandalwood. The subjects were exposed to the control first for 20 min, followed by exposure to an essential oil for 20 min. Each subject received exposure to only a single kind of essential oil per day. Saliva was collected four times for each patient: immediately before and immediately after control exposure, and immediately before and immediately after essential oil exposure. The oxytocin concentration in the saliva was measured using a competitive ELISA kit. Results: The results showed that salivary oxytocin concentrations increased significantly more after exposure to lavender, neroli, jasmine absolute, roman chamomile, clary sage, and Indian sandalwood than after exposure to the control odor. Conclusions: The aroma of certain essential oils may elicit increased secretion of oxytocin in postmenopausal women. This study suggests that olfactory stimulation with any of a number of essential oils increases salivary oxytocin concentrations, which may inhibit aging-induced reduction in muscle mass and function in women.

Metformin: An old drug against old age and associated morbidities

Metformin represents a striking example of a "historical nemesis" of a drug. About 40 years after its marketing in Europe, once demonstrated its efficacy and safety, metformin was registered also in the U.S. A few years later, it has become a mainstay in T2DM treatment, according to all international Scientific Societies guidelines. Today, despite the advent of new innovative drugs, metformin still persists as a first-choice drug in T2DM. This success is largely justified. In fact, over the years, also positive effects on health increased. In particular, evidence has been accumulated on a beneficial impact against many other aging-related morbidities (obesity, metabolic syndrome, cardiovascular disease, cancer, cognitive decline and mortality). This literature review describes preclinical and clinical evidence favoring the "anti-aging" therapeutic potential of metformin outside of T2DM. The rationale to the use of metformin as part of a combined therapy in a variety of clinical settings, allowing for a reduction of the chemotherapy dose in cancer patients, has also been discussed. In particular, the focus was on metformin action on RAS/RAF/MAPK pathway. In the end, the real challenge for metformin could be to fully demonstrate beneficial effects on health even in non-diabetic subjects.

Decreased Serum Levels of C-Terminal Agrin in Postmenopausal Women Following Resistance Training

Elevated circulating C-terminal agrin fragment (CAF) is a marker of neuromuscular junction degradation and sarcopenia. This study sought to determine if resistance training (RT) impacted the serum levels of CAF in perimenopausal (PERI-M) and postmenopausal (POST-M) women. A total of 35 women, either PERI-M or POST-M, participated in 10 weeks of RT. Body composition, muscle strength, and serum estradiol and CAF were determined before and after the RT. The data were analyzed with two-way analysis of variance (p ≤ .05). Upper body and lower body strength was significantly increased, by 81% and 73% and 86% and 79% for the PERI-M and POST-M participants, respectively; however, there were no significant changes in body composition. Estradiol was significantly less for the POST-M participants at pretraining compared with the PERI-M participants. CAF moderately increased by 22% for the PERI-M participants in response to RT, whereas it significantly decreased by 49% for the POST-M participants. Ten weeks of RT reduced the circulating CAF in the POST-M women and might play a role in attenuating degenerative neuromuscular junction changes.

Abdominal Skeletal Muscle Index as a Potential Novel Biomarker in Adult Fontan Patients

Background

Fontan palliation results in a chronic multisystem disorder with diminished exercise capacity and increased risk of muscle wasting. The aims of this study were to assess the feasibility of skeletal muscle mass measurements in Fontan patients undergoing magnetic resonance imaging liver surveillance to compare muscle mass with a historic control and to assess its correlation with cardiorespiratory fitness.

Methods

Skeletal muscle area (SMA) and skeletal muscle index (SMI) were measured at T12 and L3. A young, healthy historic cohort was used as a comparison group.

Results

Forty patients with a Fontan circulation (mean age, 25.5 ± 7.9 years; 50% were men) were included. Measurements of SMA and SMI were feasible and highly reproducible. Mean SMA and SMI were significantly lower in women compared with men at both T12 (SMA: 25.1 ± 4.9 cm² vs 33.5 ± 8.4 cm², P < 0.001; SMI: 9.7 ± 2.1 cm²/m² vs 11.3 ± 2.7 cm²/m², P = 0.045) and L3 (SMA: 121 ± 12 cm² vs 162 ± 24 cm², P < 0.001; SMI: 46.9 ± 7.0 cm²/m² vs 54.5 ± 7.4 cm²/m², P = 0.002). Mean SMI at L3 was significantly lower in the male Fontan population compared with the healthy historic cohort (54.5 ± 7.4 cm²/m² vs 60.9 ± 7.8 cm²/m², P < 0.001), but was similar for women (46.9 ± 7.0 cm²/m² vs 47.5 ± 6.6 cm²/m², P = 0.692). SMI at L3, but not at T12, was positively correlated with peak oxygen consumption, oxygen pulse, and workload. Four patients (10%) met criteria for muscle wasting in the sarcopenic range based on L3 measurements.

Conclusions

Abdominal skeletal muscle mass can be reproducibly determined on surveillance liver magnetic resonance imaging scans. Muscle wasting appears to occur commonly in Fontan patients. Further research is needed to better define the value of SMI as a biomarker in the Fontan population.

Network analysis of human muscle adaptation to aging and contraction

Resistance exercise (RE) remains a primary approach for minimising aging muscle decline. Understanding muscle adaptation to individual contractile components of RE (eccentric, concentric) might optimise RE-based intervention strategies. Herein, we employed a network-driven pipeline to identify putative molecular drivers of muscle aging and contraction mode responses. RNA-sequencing data was generated from young (21±1 y) and older (70±1 y) human skeletal muscle before and following acute unilateral concentric and contralateral eccentric contractions. Application of weighted gene co-expression network analysis identified 33 distinct gene clusters ('modules') with an expression profile regulated by aging, contraction and/or linked to muscle strength. These included two contraction 'responsive' modules (related to 'cell adhesion' and 'transcription factor' processes) that also correlated with the magnitude of post-exercise muscle strength decline. Module searches for 'hub' genes and enriched transcription factor binding sites established a refined set of candidate module-regulatory molecules (536 hub genes and 60 transcription factors) as possible contributors to muscle aging and/or contraction responses. Thus, network-driven analysis can identify new molecular candidates of functional relevance to muscle aging and contraction mode adaptations.

ROMANIAN TRANSLATION AND VALIDATION OF THE SARC-F QUESTIONNAIRE

Context

Several studies have addressed the impact of sarcopenia on various health outcomes. As the most critical issue is the early identification of individuals, a short screening tool may help clinicians to simply test for sarcopenia and start early management of the disease. Recently, a simple questionnaire, Sarc-F was provided that may adequately realize this aim.

Subjects and Methods

To validate the questionnaire we translated the original Sarc-F according to the recommended methodology. A total of 80 people, aged 65+ were evaluated for sarcopenia. Muscle mass, strength, and physical performance were measured. Volunteers completed the Sarc-F as well as other two questionnaires. Discriminative power, reliability, construct validity analyses, specificity, sensitivity, negative and positive predictive value evaluations were made.

Results

A good discriminative power and internal consistency were found. With the functional sarcopenia diagnostic criteria the test demonstrates a high specificity (84%). The positive and negative predictive values were: 78% and 77%. Using the more conservative diagnostic criteria the negative predictive value was: 85.4%, sufficient to rule out those not at risk of having sarcopenia and eliminate the need for further investigations.

Conclusions

A valid Romanian Sarc-F questionnaire is now available to simply detect patients at risk/no risk of sarcopenia.

Frailty and Disability in Diabetes

Diabetes is an important health problem with the population aging. Previously, it is well established that diabetes is associated with microvascular and macrovascular complications, but recently, several data suggest that diabetes is accompanied with frailty as well as disability among the older adults. Considering the clinical significance of frailty and disability, it is important to understand the pathway from diabetes to frailty and/or disability. Additionally, it is strongly recommended to find a new therapeutic intervention are required to meet the increasing demand of managing older diabetic patients with the population aging.

In vivo assessment of mitochondrial capacity using NIRS in locomotor muscles of young and elderly males with similar physical activity levels

Mitochondrial capacity is pivotal to skeletal muscle function and is suggested to decline with age. However, there is large heterogeneity in current data, possibly due to effect modifiers such as physical activity, sex and muscle group. Yet, few studies have compared multiple muscle groups in different age groups with comparable physical activity levels. Here, we newly used near-infrared spectroscopy (NIRS) to characterise mitochondrial capacity in three different locomotor muscles in young (19-25 year) and older (65-71 year), healthy males with similar physical activity levels. Mitochondrial capacity and reperfusion after arterial occlusion was measured in the vastus lateralis (VL), the gastrocnemius (GA) and the tibialis anterior (TA). Physical activity was verified using accelerometry and was not different between the age groups (404.3 ± 214.9 vs 494.9 ± 187.0 activity kcal per day, p = 0.16). Mitochondrial capacity was significantly lower in older males in the GA and VL, but not in the TA (p = 0.048, p = 0.036 and p = 0.64, respectively). Reperfusion rate was not significantly different for the GA (p = 0.55), but was significantly faster in the TA and VL in the young group compared to the older group (p = 0.0094 and p = 0.039, respectively). In conclusion, we identified distinct modes of mitochondrial ageing in different locomotor muscles in a young and older population with similar physical activity patterns. Furthermore, we show that NIRS is suitable for relatively easy application in ageing research and can reveal novel insights into mitochondrial functioning with age.

Utilization of anthropometric parameters as a novel tool for detection of insulin resistance

BACKGROUND

Anthropometric parameters have been widely applied in evaluating muscle mass, insulin resistance (IR), and cardiometabolic diseases. Arm circumference (AC) and calf circumference (CC) are used as informative markers for sarcopenia. However, few studies concern the correlation between AC, CC and IR. The aim of the present survey is to investigate the relationship between AC, CC and homeostatic model assessment of insulin resistance (HOMA-IR).

METHODS

This cross-sectional observational study included 11,527 participants aged 40-85 years from the National Health and Nutrition Examination Survey (NHANES), 1999 to 2006. We divided the participants into male and female groups. Each group was then divided into four subgroups depending on their AC and CC levels.

RESULTS

After adjustment for multiple covariates, we observed a significant negative correlation between the CC and HOMA-IR. This study showed a significant positive correlation between the AC and HOMA-IR after multiple adjustments. Subjects in the highest CC quartiles tended to have the lowest HOMA-IR in both male and female group (P for trend <0.001 in all models).

CONCLUSIONS

CC may be a novel tool to guide public health policy and clinical predictor of IR in middle-aged and older people.

Effect of Sleep Quality on the Prevalence of Sarcopenia in Older Adults: A Systematic Review with Meta-Analysis

Sarcopenia is an age-related condition. However, the prevalence of sarcopenia may increase due to a range of other factors, such as sleep quality/duration. Therefore, the aim of the study is to conduct a systematic review with meta-analysis to determine the prevalence of sarcopenia in older adults based on their self-reported sleep duration. Methods: Three electronic databases were used-PubMed-Medline, Web of Science, and Cochrane Library. We included studies that measured the prevalence of sarcopenia, divided according to sleep quality and excluded studies (a) involving populations with neuromuscular pathologies, (b) not showing prevalence values (cases/control) on sarcopenia, and (c) not including classificatory models to determine sleep quality. Results: high prevalence values in older adults with both long and short sleep duration were shown. However, prevalence values were higher in those with inadequate sleep (<6-8 h or low efficiency) (OR 0.76; 95% CI (0.70-0.83); Q = 1.446; p = 0.695; test for overall effect, Z = 6.01, p < 0.00001). Likewise, higher prevalence levels were shown in men (OR 1.61; 95% CI (0.82-3.16); Q = 11.80; p = 0.0189) compared to women (OR 0.77; 95% CI (0.29-2.03); Q = 21.35; p = 0.0003). Therefore, the prevalence of sarcopenia appears to be associated with sleep quality, with higher prevalence values in older adults who have inadequate sleep.

Inflammaging as a common ground for the development and maintenance of sarcopenia, obesity, cardiomyopathy and dysbiosis

Sarcopenia, obesity and their coexistence, obese sarcopenia (OBSP) as well as atherosclerosis-related cardio-vascular diseases (ACVDs), including chronic heart failure (CHF), are among the greatest public health concerns in the ageing population. A clear age-dependent increased prevalence of sarcopenia and OBSP has been registered in CHF patients, suggesting mechanistic relationships. Development of OBSP could be mediated by a crosstalk between the visceral and subcutaneous adipose tissue (AT) and the skeletal muscle under conditions of low-grade local and systemic inflammation, inflammaging. The present review summarizes the emerging data supporting the idea that inflammaging may serve as a mutual mechanism governing the development of sarcopenia, OBSP and ACVDs. In support of this hypothesis, various immune cells release pro-inflammatory mediators in the skeletal muscle and myocardium. Subsequently, the endothelial structure is disrupted, and cellular processes, such as mitochondrial activity, mitophagy, and autophagy are impaired. Inflamed myocytes lose their contractile properties, which is characteristic of sarcopenia and CHF. Inflammation may increase the risk of ACVD events in a hyperlipidemia-independent manner. Significant reduction of ACVD event rates, without the lowering of plasma lipids, following a specific targeting of key pro-inflammatory cytokines confirms a key role of inflammation in ACVD pathogenesis. Gut dysbiosis, an imbalanced gut microbial community, is known to be deeply involved in the pathogenesis of age-associated sarcopenia and ACVDs by inducing and supporting inflammaging. Dysbiosis induces the production of trimethylamine-N-oxide (TMAO), which is implicated in atherosclerosis, thrombosis, metabolic syndrome, hypertension and poor CHF prognosis. In OBSP, AT dysfunction and inflammation induce, in concert with dysbiosis, lipotoxicity and other pathophysiological processes, thus exacerbating sarcopenia and CHF. Administration of specialized, inflammation pro-resolving mediators has been shown to ameliorate the inflammatory manifestations. Considering all these findings, we hypothesize that sarcopenia, OBSP, CHF and dysbiosis are inflammaging-oriented disorders, whereby inflammaging is common and most probably the causative mechanism driving their pathogenesis.

Age and Muscle Function Are More Closely Associated With Intracellular Magnesium, as Assessed by 31P Magnetic Resonance Spectroscopy, Than With Serum Magnesium

Total serum magnesium is a common clinical measurement for assessing magnesium status; however, magnesium in blood represents less than 1% of the body's total magnesium content. We measured intramuscular ionized magnesium by phosphorus magnetic resonance spectroscopy (³¹P-MRS) and tested the hypothesis that this measure better correlates with skeletal muscle function and captures more closely the effect of aging than the traditional measure of total serum magnesium. Data were collected from 441 participants (age 24-98 years) in the Baltimore Longitudinal Study of Aging (BLSA), a study of normative aging that encompasses a broad age range. Results showed that intramuscular ionized magnesium was negatively associated with age (β = -0.29, p < 0.001, R ² = 0.08) and positively associated with knee-extension strength (β = 0.31, p < 0.001, and R ² = 0.1 in women; and β = 0.2, p = 0.003, and R ² = 0.04 in men), while total serum magnesium showed no association with age or strength (p = 0.27 and 0.1, respectively). Intramuscular ionized magnesium was significantly lower in women that in men (p < 0.001), perhaps due to chronic latent Mg deficiency in women that is not otherwise detected by serum magnesium levels. Based on these findings, we suggest that intramuscular ionized magnesium from ³¹P-MRS is a better clinical measure of magnesium status than total serum magnesium, and could be measured when muscle weakness of unidentified etiology is detected. It may also be used to monitor the effectiveness of oral magnesium interventions, including supplementation.

Prevalence and co-existence of locomotive syndrome, sarcopenia, and frailty: the third survey of Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study

This study aimed to estimate the prevalence of locomotive syndrome, sarcopenia, and frailty and clarify their co-existence in a population-based cohort. The third survey of Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2012 and 2013, examining 963 subjects (aged ≥ 60 years; 321 men, 642 women). Locomotive syndrome, sarcopenia, and frailty were defined using three tests proposed by Japanese Orthopaedic Association, Asian Working Group for Sarcopenia criteria, and Fried's definition, respectively. Prevalence of locomotive syndrome stages 1 and 2 were 81.0% (men, 80.4%; women, 81.3%) and 34.1% (men, 30.5%; women, 35.8%), respectively, and those of sarcopenia and frailty were 8.7% (men, 9.7%; women, 8.3%) and 4.5% (men, 2.8%; women, 5.3%), respectively. Locomotive syndrome stage 1, sarcopenia, and frailty co-existed in 2.1%; 6.5% had locomotive syndrome stage 1 and sarcopenia, 2.4% had locomotive syndrome stage 1 and frailty, while none had sarcopenia and frailty. Locomotive syndrome stage 1 presented alone in 70.0%, sarcopenia in 0.1%, and no frailty. The remaining 18.9% had none of these conditions. Co-existence of locomotive syndrome stage 2, sarcopenia, and frailty was observed in 2.0%; 5.0% had locomotive syndrome stage 2 and sarcopenia, 2.2% had locomotive syndrome stage 2 and frailty, and 0.1% had sarcopenia and frailty. Locomotive syndrome stage 2, sarcopenia, and frailty alone, presented in 24.9%, 1.7%, and 0.2%, respectively. The remaining 64.0% had none of these conditions. Most subjects with sarcopenia and/or frailty also had locomotive syndrome. Preventing locomotive syndrome may help prevent frailty and sarcopenia and subsequent disability.

[Diagnosis and prevalence of sarcopenia in long-term care homes: EWGSOP2 versus EWGSOP1]

Introduction

Background: the definition and methodology recommended for the diagnosis of sarcopenia has been changing. The mostly applied consensus is the one published by the European Working Group in Older People in 2010 (EWGSOP1), which was updated in 2019 (EWGSOP2). Objectives: assessing the prevalence of sarcopenia in institutionalized older adults using the EWGSOP2 algorithm and comparing these results with the EWGSOP1 algorithm results. Methods: in order to diagnose sarcopenia, muscle mass was assessed using an impedanciometer, muscle strength with a dynamometer and walking speed over a four-meter course. For the comparison of the results, a sensitivity and specificity analysis were performed with the version 20 of SPSS. Results: according to the EWGSOP2, 60.1% of the participants had sarcopenia and 58.1% had severe sarcopenia, results with no statistical differences when they are compared to the results according to the EWGSOP1 (63% had sarcopenia and 61.2%, severe sarcopenia). Neither were statistical differences found when comparing subjects with low muscle mass according to the formulas suggested by both consensus, while there were differences when comparing subjects with low muscle strength due to the variation of cut-off points. Conclusions: the prevalence of sarcopenia in institutionalized older adults is high, being remarkable that the majority of the participants had low muscle strength and low physical performance. The utilization of the methodology proposed by the EWGSOP2 did not have influence in the results of prevalence of sarcopenia obtained when the EWGSOP1 recommendations were applied.