Sarcopenia

Prognostic Significance of Sarcopenia in Patients with Unresectable Advanced Esophageal Cancer

The prognostic significance of sarcopenia in unresectable advanced esophageal cancer remains unclear. Our study retrospectively evaluated 176 consecutive Japanese patients with esophageal squamous cell carcinoma who had been diagnosed with unresectable advanced cancer in Aichi Cancer Center Hospital between January 2007 and December 2014. Skeletal muscle mass was calculated from abdominal computed tomography (CT) scans before treatment, and patients were divided into sarcopenic and non-sarcopenic groups. Sarcopenia was present in 101 patients (57.4%). Eighty-two patients in the sarcopenic group and 63 patients in the non-sarcopenic group died during follow-up (mean: 20.3 months). The overall survival (OS) rate was significantly lower in the sarcopenic group compared to the non-sarcopenic group (2-year OS: 9.8% vs. 23.7%, p < 0.01). Cox regression analysis revealed only pretreatment sarcopenia as an independent prognostic factor (hazard ratio (HR): 1.48, 95% confidence interval (CI): 1.04-2.10, p = 0.03). In the sarcopenic group, withdrawn cases, for whom the planned treatment was discontinued for some reason, showed a significantly lower OS rate compared to complete cases (1-year OS: 11.0% vs. 59.9%, p < 0.01). The most common reason for discontinuation was aspiration pneumonia (64.5%). Presence of sarcopenia was an independent prognostic factor for unresectable advanced esophageal cancer. Identifying the presence of sarcopenia prior to treatment may improve the prognosis.

Sarcopenia: A Time for Action. An SCWD Position Paper

The term sarcopenia was introduced in 1988. The original definition was a "muscle loss" of the appendicular muscle mass in the older people as measured by dual energy x-ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC-F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease-related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age-related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age-related and disease-related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life-long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.

Association of low skeletal muscle mass with advanced liver fibrosis in patients with non-alcoholic fatty liver disease

BACKGROUND AND AIM

Although low skeletal muscle mass (LSMM) is known to increase the risk of non-alcoholic fatty liver disease (NAFLD), limited reports have described the relationship between LSMM and advanced fibrosis. Here, we investigated the association between LSMM and advanced liver fibrosis in NAFLD patients.

METHODS

Fatty liver was diagnosed using ultrasound, and appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis. LSMM was defined in two ways: ASM/body weight percentage (LSMM-BW) and ASM/body mass index. Liver fibrosis stage was assessed by two models, the NAFLD fibrosis score and the Fibrosis-4 index, which determined low and high cutoff values (COVs).

RESULTS

Of 10 711 NAFLD patients, 615 were diagnosed with LSMM-BW. LSMM patients were older (47.6 vs 52.5 years, P = 0.001) and had higher body mass index values (23.6 vs 29.1 kg/m² , P < 0.001) and waist circumferences (80.1 vs 93.3 cm, P < 0.001) than non-LSMM patients. LSMM was an independent risk factor for advanced fibrosis assessed by a low COV for the Fibrosis-4 index regardless of its classification (adjusted for metabolic and lipid profiles and sex, odds ratio [OR], 1.27-2.01; all P < 0.05). LSMM was an independent risk factor for advanced fibrosis assessed by both COVs of NAFLD fibrosis score (adjusted for obesity, hypertension, lipid profile, and sex; OR, 1.64-2.01, P < 0.01 in the low COV group; OR, 2.68-3.12, P = 0.002 in the high COV group).

CONCLUSIONS

Low skeletal muscle mass is associated with advanced fibrosis in NAFLD patients independent of metabolic risk factors.

Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features

We evaluated the presence of sarcopenia in a population of systemic sclerosis (SSc) patients, with respect to nutritional, clinical, and laboratory features. A total of 62 patients who met the ACR/EULAR 2013 classification criteria were enrolled. Sarcopenia was defined according to the Relative Skeletal Mass Index (RSMI) and hand grip strength (HGS). Body composition was assessed with the calculation of the Body Mass Index (BMI), lean body mass (LBM) and fat mass (FM). Malnutrition was evaluated according to the ESPEN criteria. Clinical evaluation included nailfold capillaroscopy and skin evaluation by modified Rodnan Skin Score (mRSS), pulmonary function tests (PFT) with diffusing capacity for carbon monoxide adjusted for hemoglobin (DLCO), high-resolution computed tomography (HR-CT) of the lungs, echocardiography and high-resolution manometry (HRM) for esophageal involvement. Laboratory evaluation included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, creatinine, creatine kinase (CK), transaminases, lipid profile, glycemia, albumin, and vitamin-D. Antinuclear antibodies (ANA) and extractable nuclear antigens (ENA) were also assessed. Considering RSMI, the prevalence of sarcopenia is 42%. In this case, age, malnutrition, disease duration, mRSS, capillaroscopy score, esophageal involvement, ESR, and ANA titer are higher in the sarcopenic group, while DLCO and LBM are lower. Considering HGS, the prevalence of sarcopenia is 55%. Age, disease duration, malnutrition, FM, mRSS, capillaroscopy score, esophageal involvement, ESR, and ENA positivity are higher in the sarcopenic group, while DLCO is lower. By using both RSMI and HGS to assess sarcopenia in SSc, the results of this study demonstrated that this condition correlates with different nutritional, clinical, and biochemical parameters associated with the worsening of the disease.

Murine models of accelerated aging and musculoskeletal disease

The primary risk factor for most musculoskeletal diseases, including osteoarthritis, osteoporosis and sarcopenia, is aging. To treat the diverse types of musculoskeletal diseases and pathologies, targeting their root cause, the aging process itself, has the potential to slow or prevent multiple age-related musculoskeletal conditions simultaneously. However, the development of approaches to delay onset of age related diseases, including musculoskeletal pathologies, has been slowed by the relatively long lifespan of rodent models of aging. Thus, to expedite the development of therapeutic approaches for age-related musculoskeletal disease, the implementation of mouse models of accelerated musculoskeletal aging are of great utility. Currently there are multiple genetically diverse mouse models that mirror certain aspects of normal human and mouse aging. Here, we provide a review of some of the most relevant murine models of accelerated aging that mimic many aspects of natural musculoskeletal aging, highlighting their relative strengths and weaknesses. Importantly, these murine models of accelerated aging recapitulate phenotypes of musculoskeletal age-related decline observed in humans.

Supervised Physical Training Enhances Muscle Strength but Not Muscle Mass in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Systematic Review and Meta-Analysis

Introduction: Androgen deprivation therapy (ADT) is considered the basic treatment for advanced prostate cancer, but it is highly associated with detrimental changes in muscle mass and muscle strength. The aim of this meta-analysis was to investigate the effects of supervised physical training on lean mass and muscle strength in prostate cancer patients undergoing ADT.

Methods: A systematic literature search was performed using MEDLINE, Embase, and ScienceDirect until October 2018. Only studies that examined both muscle mass and strength in prostate cancer patients undergoing ADT were included. Outcomes of interest were changes in lean body mass (surrogate for muscle mass) as well as upper and lower body muscle strength. The meta-analysis was performed with fixed-effects models to calculate mean differences between intervention and no-training control groups.

Results: We identified 8,521 publications through the search of the following key words: prostate cancer, prostate tumor, prostate carcinoma, prostate neoplasm, exercise, and training. Out of these studies, seven randomized controlled trials met the inclusion criteria and where included in the analysis. No significant mean differences for changes in lean mass were observed between the intervention and control groups (0.49 kg, 95% CI: −0.76, 1.74; P = 0.44). In contrast, the mean difference for muscle strength was significant both in chest (3.15 kg, 95% CI: 2.46, 3.83; P < 0.001) and in leg press (27.46 kg, 95% CI: 15.05, 39.87; p < 0.001).

Conclusion: This meta-analysis provides evidence that low- to moderate-intensity resistance and aerobic training is effective for increasing muscle strength but may not be sufficient to affect muscle mass in prostate cancer patients undergoing ADT. The underlying mechanisms for this maladaptation may in part be explained by an insufficient stimulus induced by the training regimens as well as a delayed initiation of training in relation to the start of ADT. When interpreting the present findings, one should bear in mind that the overall number of studies included in this review was rather low, emphasizing the need for further studies in this field.

Lipotoxicity, aging, and muscle contractility: does fiber type matter?

Sarcopenia is a universal characteristic of the aging process and is often accompanied by increases in whole-body adiposity. These changes in body composition have important clinical implications, given that loss of muscle and gain of fat mass are both significantly and independently associated with declining physical performance as well as an increased risk for disability, hospitalizations, and mortality in older individuals. This increased fat mass is not exclusively stored in adipose depots but may become deposited in non-adipose tissues, such as skeletal muscle, when the oxidative capacity of the adipose tissue itself is exceeded. The redistributed adipose tissue is thought to exert detrimental local effects on the muscle environment given the close proximity. Thus, sarcopenia observed with aging may be better defined in the context of loss of muscle quality rather than loss of muscle quantity per se. In this perspective, we briefly review the age-related physiological changes in cellularity, secretory profiles, and inflammatory status of adipose tissue which drive lipotoxicity (spillover) of skeletal muscle and then provide evidence of how this may affect specific fiber type contractility. We focus on biological contributors (cellular machinery) to contractility for which there is some evidence of vulnerability to lipid stress distinguishing between fiber types.

Chronic Pain Management in the Elderly

Chronic pain is extremely prevalent in older adults and is associated with significant morbidity, including limited mobility, social isolation, and depressed mood. Pain is defined by a biopsychosocial model highlighting the importance of a multidisciplinary approach to treatment, including multimodal medications, selected interventions, physical therapy and rehabilitation, and psychological treatments. In this narrative review, the authors highlight the use of these approaches in older adults with specific attention paid to considerations unique to aging, including alterations in drug metabolism, avoidance of polypharmacy, and physiologic changes predisposing to painful conditions.

Sarcopenia in osteoarthritis and rheumatoid arthritis: The association with self-reported fatigue, physical function and obesity

AIM

To determine if there is an association between sarcopenia, physical function and self-reported fatigue in osteoarthritis (OA) and rheumatoid arthritis (RA).

METHODS

A cross-sectional analysis of measurements from a cohort of 157 participants with OA or RA was performed. The relationship between muscle mass (appendicular muscle index (AMI)), physical function (timed up and go, 30-seconds sit-to-stand test, 40-meter fast-paced walk test and grip-strength) and two fatigue measures (Multidimensional Assessment of Fatigue (MAF) and a fatigue Visual Analogue Scale (VAS)) was explored using hierarchical linear regression or logistic regression with established AMI cut-offs for sarcopenia.

RESULTS

There were no significant differences for perceived fatigue-related variables between OA or RA sarcopenic or non-sarcopenic participants. Participants with OA had worse physical function (TUG; P = 0.029, STS; P = 0.004, WS; P = 0.003), but participants with RA had lower grip strength (P<0.001). The RA group had higher CRP (P = 0.006), were more likely to receive glucocorticoids (P<0.001), and experienced worse fatigue (P = 0.050). The hierarchical multiple regression showed that self-reported fatigue (VAS/MAF-distress) had a significant but weak association with AMI in RA. Participants with higher percentage body fat had a significantly stronger association with sarcopenia in both OA and RA.

CONCLUSION

Sarcopenia, when assessed by AMI, does not appear to be strongly associated with self-reported fatigue or physical function in participants with either OA or RA. Higher body fat had a moderately strong association with sarcopenia in this cross-sectional study, suggesting that body composition may be an important factor in the health of patients with longstanding OA or RA.

Effects of Whole-Body Vibration Therapy on Distal Tibial Myotendinous Density and Volume: A Randomized Controlled Trial in Postmenopausal Women

Whole‐body vibration (WBV) therapy has been proposed as a therapy to reduce sarcopenia and improve muscle strength. The purpose of this study was to explore whether 12 months of WBV therapy increases myotendinous density and volume of the distal tibia as measured by HR‐pQCT in postmenopausal women in a parallel group, randomized controlled trial with 1:1:1 allocation to three arms. Postmenopausal women (N = 202) with low hip BMD were randomized to 20 min daily of 0.3g 30‐Hz WBV therapy, 0.3g 90‐Hz WBV therapy using the Juvent platform (Juvent, Somerset, NJ, USA), or no WBV. The main outcome measure was myotendinous density (HU) and volume (mm³) at the distal tibia measured at baseline and 12 months with HR‐pQCT. There were no significant effects on myotendinous density or volume at the distal tibia after 12 months of daily 30‐ or 90‐Hz WBV therapy compared with no WBV therapy. Mean change (SD) in myotendinous density from baseline was 4.6 (5.7) HU in the 30‐Hz WBV group, 3.9 (6.1) HU in the 90‐Hz WBV group, and 3.9 (5.4) HU in the control group (p = 0.70). Mean change (SD) in myotendinous volume from baseline was −7 (503) mm³ in the 30‐Hz WBV group, 111 (615) mm³ in the 90‐Hz WBV group, and 35 (615) mm³ in the control group (p = 0.50). In conclusion, WBV therapy at 30‐ or 90‐Hz for 12 months had no significant effects on myotendinous density or volume at the distal tibia as measured by HR‐pQCT in postmenopausal women. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Prognostic Impact of Low Skeletal Muscle Mass on Major Adverse Cardiovascular Events in Coronary Artery Disease: A Propensity Score-Matched Analysis of a Single Center All-Comer Cohort

The impact of sarcopenia on atherosclerotic cardiovascular disease remains unclear. We aimed to investigate the prognostic impact of sarcopenia on coronary artery disease (CAD). A total of 475 patients with CAD who underwent successful percutaneous coronary intervention (PCI) and computed tomography (CT) were enrolled. The cross-sectional area of skeletal muscle at the first lumbar (L1) vertebral level was measured, and sex-specific cut-off values of L1 skeletal muscle index (L1 SMI; male <31.00 cm2/m2, female <25.00 cm2/m2) were obtained. The primary outcome was 3-year all-cause mortality and the secondary outcome was 3-year major adverse cardiovascular events (MACEs). Low L1 SMI was present in 141 (29.7%) of 475 patients. The incidence of all-cause mortality (23.7% vs. 5.9%, p < 0.001) and MACEs (39.6% vs. 11.8%, p < 0.001) was significantly higher in patients with low L1 SMI than in those with high L1 SMI. In multivariate analysis, low L1 SMI was an independent predictor of higher risk of all-cause mortality (hazard ratio (HR): 4.07; 95% confidence interval (CI): 1.95-8.45; p < 0.001) and MACEs (HR: 3.76; 95% CI: 2.27-6.23; p < 0.001). These findings remained consistent after propensity score-matched analysis with 91 patient pairs (C-statistic = 0.848). CT-diagnosed low skeletal muscle mass is a powerful predictor of adverse outcomes in patients with CAD undergoing PCI.

Schisandra chinensis extract ameliorates age-related muscle wasting and bone loss in ovariectomized rats

Exercise and healthy diet consumption support healthy aging. Schisandra chinensis (Turcz.) also known as "Baill." has anti-inflammatory and antioxidant properties. However, the role of S. chinensis as an antiaging compound has yet to be demonstrated. This study elucidated the antiaging effect of S. chinensis ethanol-hexane extract (C1) and the effect of C1 treatment on muscle and bone following physical exercise in ovariectomized (OVX) rats. RAW 264.7, human diploid fibroblasts (HDFs), C2C12 myoblasts, bone marrow macrophages, and MC3T3-E1 cells were used for in vitro, and muscle and bone of OVX rats were used for in vivo study to demonstrate the effect of C1. The C1 significantly inhibited the expression of inflammatory molecules, β-galactosidase activity, and improved antioxidant activity via down-regulation of reactive oxygen species in RAW 264.7 and aged HDF cells. The C1 with exercise improved muscle regeneration in skeletal muscle of OVX rats by promoting mitochondrial biogenesis and autophagy. C1 induced osteoblast differentiation, and C1 + exercise modulated the bone formation and bone resorption in OVX rats. C1 exhibited anti-inflammatory, antioxidant, myogenic, and osteogenic effects. C1 with exercise improved age-related muscle wasting and bone loss. Therefore, S. chinensis may be a potential prevent agent for age-related diseases such as sarcopenia and osteoporosis.

Frailty assessment: from clinical to radiological tools

Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.

Investigation of the relationship between bladder function and sarcopenia using pressure flow studies in elderly male patients

AIMS

Although detrusor underactivity is often encountered in elderly patients, the etiology remains unclear. We have hypothesized that sarcopenia was associated with impaired bladder contractility. Therefore, we have evaluated the relationship between bladder contractility and clinical parameters including sarcopenia markers in elderly male patients.

METHODS

This retrospective, single-centre study included male patients over 65 years of age who underwent a pressure flow study (PFS). We excluded patients with any previous medical histories that could affect bladder function, currently on urinary medication, and with no available data of abdominal CT scan. The psoas muscle area (PMA) (cm² /m² ) was measured as a surrogate for psoas muscle mass on computed tomography. PMA, serum CRP, and albumin are known as sarcopenia markers. Correlation and multiple regression analyses were performed to evaluate the association of bladder contractility index (BCI) with the following parameters: age, body mass index (BMI), prostate volume, bladder outlet obstruction index (BOOI), serum C-reactive protein (CRP), serum albumin, and PMA.

RESULTS

Out of 558 male patients identified in our PFS database, 119 patients were enrolled. In the correlation analysis, age, prostate volume, serum albumin, BOOI, and PMA significantly correlated with BCI. However, no significant correlation of BCI with CRP or BMI was observed. Multiple linear regression analysis showed that serum albumin, BOOI, and PMA were significantly associated with BCI.

CONCLUSIONS

We have demonstrated that serum albumin and PMA were significantly positively associated with detrusor contractility. It is possible that sarcopenia is associated with impaired detrusor contractility.

Tai Chi and whole-body vibrating therapy in sarcopenic men in advanced old age: a clinical randomized controlled trial

This study was to investigate the effects of Tai Chi (TC) and whole-body vibration (WBV) exercise in sarcopenic men in advanced old age. Ninety sarcopenic men (mean age 88.6 years; age range 85-101 years) were divided into three groups: TC group, WBV group, and control (CON) group. Patients in the two treatment groups received 8 weeks of training in either TC or WBV, while the control group received reminders not to change their level of physical exercise or lifestyle. Patients in all groups also received health information related to sarcopenia. Muscle mass, muscle strength, and physical performance [balance, gait speed, timed-up-and-go test (TUGT), and five-times-sit-to-stand test (FTSST)] were analyzed and compared among the three groups. Finally, seventy-nine subjects completed the study (TC n = 24; WBV n = 28; and CON 27). Muscle strength was significantly increased in the TC and WBV groups compared to the control group (P < 0.01). Following 8 weeks of exercise, improvements were observed in all physical performance tests for the TC and WBV groups (P < 0.05). The improvement in balance was greater in the TC group than the WBV group. Time × Group effects revealed significant improvements in muscle strength in the lower extremities (P < 0.05) and physical performance (P < 0.01) in both the TC and WBV groups. Changes in muscle mass, as measured by dual-energy X-ray absorptiometry, did not significantly differ between groups. These findings indicate that TC and WBV are effective treatments for improving muscle strength and physical performance in sarcopenic men in advanced old age.

Integrated method for quantitative morphometry and oxygen transport modeling in striated muscle

Identifying structural limitations in O2 transport is primarily restricted by current methods employed to characterize the nature of physiological remodeling. Inadequate resolution or breadth of available data has impaired development of routine diagnostic protocols and effective therapeutic strategies. Understanding O2 transport within striated muscle faces major challenges, most notably in quantifying how well individual fibers are supplied by the microcirculation, which has necessitated exploring tissue O2 supply using theoretical modeling of diffusive exchange. With capillary domains identified as a suitable model for the description of local O2 supply and requiring less computation than numerically calculating the trapping regions that are supplied by each capillary via biophysical transport models, we sought to design a high-throughput method for histological analysis. We present an integrated package that identifies optimal protocols for identification of important input elements, processing of digitized images with semiautomated routines, and incorporation of these data into a mathematical modeling framework with computed output visualized as the tissue partial pressure of O2 (Po2) distribution across a biopsy sample. Worked examples are provided using muscle samples from experiments involving rats and humans.

NEW & NOTEWORTHY Progress in quantitative morphometry and analytical modeling has tended to develop independently. Real diagnostic power lies in harnessing both disciplines within one user-friendly package. We present a semiautomated, high-throughput tool for determining muscle phenotype from biopsy material, which also provides anatomically relevant input to quantify tissue oxygenation, in a coherent package not previously available to nonspecialist investigators.

Impaired proteostasis during skeletal muscle aging

Aging is a complex phenomenon that has detrimental effects on tissue homeostasis. The skeletal muscle is one of the earliest tissues to be affected and to manifest age-related changes such as functional impairment and the loss of mass. Common to these alterations and to most of tissues during aging is the disruption of the proteostasis network by detrimental changes in the ubiquitin-proteasomal system (UPS) and the autophagy-lysosomal system (ALS). In fact, during aging the accumulation of protein aggregates, a process mainly driven by increased levels of oxidative stress, has been observed, clearly demonstrating UPS and ALS dysregulation. Since the UPS and ALS are the two most important pathways for the removal of misfolded and aggregated proteins and also of damaged organelles, we provide here an overview on the current knowledge regarding the connection between the loss of proteostasis and skeletal muscle functional impairment and also how redox regulation can play a role during aging. Therefore, this review serves for a better understanding of skeletal muscle aging in regard to the loss of proteostasis and how redox regulation can impact its function and maintenance.

Proprioceptive deficits in inactive older adults are not reflected in fast targeted reaching movements

During normal healthy ageing there is a decline in the ability to control simple movements, characterised by increased reaction times, movement durations and variability. There is also growing evidence of age-related proprioceptive loss which may contribute to these impairments. However, this relationship has not been studied in detail for the upper limb. We recruited 20 younger adults (YAs) and 31 older adults (OAs) who each performed 2 tasks on a 2D robotic manipulandum. The first assessed dynamic proprioceptive acuity using active, multi-joint movements constrained by the robot to a pre-defined path. Participants made perceptual judgements of the lateral position of the unseen arm. The second task required fast, accurate and discrete movements to the same targets in the absence of visual feedback of the hand, and without robotic intervention. We predicted that the variable proprioceptive error (uncertainty range) assessed in Task 1 would be increased in physically inactive OAs and would predict increased movement variability in Task 2. Instead we found that physically inactive OAs had larger systematic proprioceptive errors (bias) than YAs (t[33] = 2.8, p = 0.009), and neither proprioceptive uncertainty nor bias was related to motor performance in either age group (all regression model R2 ≤ 0.06). We suggest that previously reported estimates of proprioceptive decline with ageing may be exaggerated by task demands and that the extent of these deficits is unrelated to control of discrete, rapid movement. The relationship between dynamic proprioceptive acuity and movement control in other tasks with greater emphasis on online feedback is still unclear and warrants further investigation.

Health Care Costs Associated With Muscle Weakness: A UK Population-Based Estimate

Sarcopenia and muscle weakness are responsible for considerable health care expenditure but little is known about these costs in the UK. To address this, we estimated the excess economic burden for individuals with muscle weakness regarding the provision of health and social care among 442 men and women (aged 71-80 years) who participated in the Hertfordshire Cohort Study (UK). Muscle weakness, characterised by low grip strength, was defined according to the Foundation for the National Institutes of Health criteria (men < 26 kg, women < 16 kg). Costs associated with primary care consultations and visits, outpatient and inpatient secondary care, medications, and formal (paid) as well as informal care for each participant were calculated. Mean total costs per person and their corresponding components were compared between groups with and without muscle weakness. Prevalence of muscle weakness in the sample was 11%. Mean total annual costs for participants with muscle weakness were £4592 (CI £2962-£6221), with informal care, inpatient secondary care and primary care accounting for the majority of total costs (38%, 23% and 19%, respectively). For participants without muscle weakness, total annual costs were £1885 (CI £1542-£2228) and their three highest cost categories were informal care (26%), primary care (23%) and formal care (20%). Total excess costs associated with muscle weakness were £2707 per person per year, with informal care costs accounting for 46% of this difference. This results in an estimated annual excess cost in the UK of £2.5 billion.

Associations between Sarcopenic Obesity and Cognitive Impairment in Elderly Chinese Community-Dwelling Individuals

INTRODUCTION

This study aimed to estimate the prevalence of sarcopenic obesity (SO) and the association between cognitive impairment and SO in a cohort of elderly Chinese community-dwelling individuals.

METHODS

A total of 948 elderly Chinese community-dwelling individuals aged 60-92 years were recruited. The participants were categorized into the following four groups according to their sarcopenia and obesity status: sarcopenic obese, sarcopenic, obese and non-sarcopenic, and non-obese group. Sarcopenia was defined as appendicular skeletal muscle index of <7.0 kg/m2 in men and <5.7 kg/m2 in women; obesity was defined as values greater than the upper two quintiles for body fat percentage stratified by gender of the study population; cognitive impairment was measured using the Mini-Mental State Examination and defined as a score of <24.

RESULTS

A total of 945 participants were included in the statistical analyses with a mean age of 68.76 ± 6.50 years. The prevalence of SO was 6.0% (7.3% in men and 4.8% in women). The sarcopenic obese (odds ratio [OR]: 2.550, 95% confidence interval [CI], 1.196-5.435) and obese (ORs: 2.141, 95% CI, 1.230-3.728) groups had significantly increased risk for cognitive impairment in fully adjusted model, respectively.

CONCLUSION

The SO prevalence in elderly Chinese community-dwelling individuals was relatively low (6.0%). The present study suggested SO was independently associated with cognitive impairment.

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

OBJECTIVE

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.

METHODS

These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients

OBJECTIVES

To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures.

DESIGN

Retrospective cohort.

SETTING

Level I trauma center.

PATIENTS

Elderly trauma patients admitted from 2007 to 2014.

METHODS

We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex.

MAIN OUTCOME MEASUREMENT

One-year all-cause mortality defined as death within 12 months from date of hospitalization.

RESULTS

Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90-0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84-0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89-1.01), P = 0.103].

CONCLUSIONS

In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sarcopenia and chronic liver diseases

INTRODUCTION

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, which is commonly associated with various chronic diseases, including chronic liver diseases. Growing lines of evidence indicate that sarcopenia not only correlates with the clinical outcomes and survival of patients undergoing liver transplant, but also serves as a prognostic factor for candidates of liver transplantation and patients with hepatocellular carcinoma. Areas covered: In this review, we conducted a narrative review and search of literature from PubMed, Ovid MEDLINE, and the Cochrane Library database up to August 2018. Studies relevant to the emerging data of sarcopenia and chronic liver diseases were examined and discussed. Expert commentary: Although sarcopenia has been shown to play a vital role in the outcomes of cirrhotic patients with or without liver transplant, its impact on non-cirrhotic patients remains unclear and deserves future research efforts. To develop an effective and practical measurement of sarcopenia has become an urgent issue in the management of patients with chronic liver diseases.

ABBREVIATIONS

HCC: hepatocellular carcinoma; L3SMI: third lumbar vertebra skeletal muscle index; NAFLD: nonalcoholic fatty liver disease; VAT: visceral adipose tissue; PMA: psoas muscle area; LT: liver transplantation; AUC: area under the curve; LC: liver cirrhosis; SPPB: short physical performance battery; HU: Hounsfield units; ASM: appendicular skeletal muscle; SMI: skeletal muscle index; FLI: fatty liver index; PCLD: polycystic liver disease; DEXA: dual energy X-ray absorptiometry; BCAAs: branched-chain amino acids; BIA: bioelectrical impedance analysis; CT: computed tomography; OS: overall survival; CSA: cross-sectional area; NASH: nonalcoholic steatohepatitis; TPMT: transversal psoas muscle thickness; IMAC: intramuscular adipose tissue content; LDLT: living donor liver transplantation; PMI: psoas muscle mass index; PMTH: psoas muscle thickness by height; TPA: total psoas area; OLT: orthotopic liver transplantation; 6MWD: Six-minute walk distance; HRQOL: health-related quality of life; SMA: skeletal muscle area.

Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study

Purpose

Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and/or physical performance. This study was designed to demonstrate the relationship between sarcopenia and systemic inflammatory response (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], and large platelet/lymphocyte ratio [LPLR]) prior to radical gastrectomy for gastric cancer.

Patients and methods

We conducted a prospective study of gastric cancer patients who underwent radical gastrectomy. The clinical utility of the NLR, PLR, and LPLR was evaluated by receiver operating characteristic curves. Sarcopenia components including skeletal muscle index, handgrip strength, and 6 m usual gait speed were measured. Logistic analysis was used to identify the independent indices associated with sarcopenia.

Results

A total of 670 patients were included, representing 504 men and 166 women. Of these, 104 patients (15.5%) were diagnosed with sarcopenia and 567 (84.5%) were non-sarcopenia. PLR has a diagnostic sensitivity of 91.3% for sarcopenia. In addition to the indicators of preoperative age, nutritional risk screening, body mass index, preoperative albumin, and diabetes, the NLR and PLR were independent predictors for sarcopenia (P<0.05).

Conclusion

The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer. Due to the complex assessment of muscle condition, PLR may be used as a primary screening test for sarcopenia. How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes.

Obesity paradox in peripheral artery disease

BACKGROUND & AIMS

Previous studies have suggested an obesity survival paradox in patients with peripheral artery disease (PAD). We investigated the influence of obesity and underweight on adverse in-hospital outcomes in PAD.

METHODS

Patients diagnosed with PAD based on ICD-code I70.2 of the German nationwide database were stratified for obesity, underweight and a reference group with normal-weight/over-weight and compared regarding adverse in-hospital outcomes.

RESULTS

Between 01/2005-12/2015, 5,611,484 inpatients (64.8% males) were diagnosed with PAD; of those, 8.9% were coded with obesity and 0.3% with underweight. Obese patients were younger (70 (IQR 63/76) vs. 73 (66/80) years, P < 0.001), more frequently female (36.7% vs. 35.1%, P < 0.001), had less cancer (4.9% vs. 7.9%, P < 0.001) and had less treatment with major amputation (2.6% vs. 3.2%, P < 0.001) compared to the reference group. Overall, 277 876 (5.0%) patients died in-hospital. Obese patients showed lower mortality rate (3.2% vs. 5.1%, P < 0.001) compared to the reference group and reduced risk of in-hospital mortality (OR, 0.617 [95%CI 0.607-0.627], P < 0.001). This "obesity paradox" was demonstrated in obesity classes I (OR, 0.475 [95%CI 0.461-0.490], P < 0.001), II (OR, 0.580 [95%CI 0.557-0.605], P < 0.001), and III (OR, 0.895 [95%CI 0.857-0.934], P < 0.001) and was independent of age, sex and comorbidities. Underweight patients revealed higher in-hospital mortality (6.0% vs. 5.1%, P < 0.001) compared to the reference group (OR, 1.179 [95%CI 1.106-1.257], P < 0.001) and showed higher prevalence of cancer (22.0% vs. 7.9%, P < 0.001).

CONCLUSIONS

Coding for obesity is associated with lower in-hospital mortality in PAD patients relative to those with normal-weight/over-weight. This obesity survival paradox was independent of age, gender and comorbidities and observed for all obesity classes.

Improving nutritional status assessment in patients with chronic pancreatitis

INTRODUCTION

Chronic pancreatitis (CP) is a progressive inflammatory disorder causing irreversible destruction of pancreatic tissue, leading to malnutrition. A previous study has found that currently used screening methods (periodic recording of body weight and faecal and serological markers) fall short in identifying and curbing malnutrition. Moreover, data is lacking regarding change in nutritional status over time. The aim of our study is to investigate changes in nutritional status in CP patients over time and to determine whether a more extensive set of measurements would be beneficial for nutritional screening of these patients.

METHODS

CP patients who had undergone a nutritional assessment in 2012 were recruited to undergo a second assessment. The assessment consisted of anthropometric measurements, bioelectrical impedance analysis (BIA), handgrip strength (HGS), the Mini Nutritional Assessment (MNA), determination of faecal and serological markers and the Short Form Health (SF-36) questionnaire. These two assessments were compared and correlations between the various measures were calculated.

RESULTS

Twenty-eight patients underwent a second assessment. An increase in fat mass and a decrease in both fat free mass (FFM) and HGS were observed. The number of patients scoring under the 10th percentile for FFM (43%-54%) and HGS in their dominant side (38%-46%) increased. FFM and HGS were positively correlated (R = 0.57).

CONCLUSION

Even though current guidelines for CP follow-up were adhered to, there was a general deterioration in nutritional status. HGS correlated with FFM. HGS might be useful as a screening instrument for malnutrition in CP patients.

Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys

In this 4-year follow-up study including 1083 subjects (≥ 60 years), the prevalence of frailty was estimated to be 5.6%; osteoporosis was found to be significantly associated with frailty. Moreover, the presence of both osteoporosis and sarcopenia increased the risk of frailty compared to the presence of osteoporosis or sarcopenia alone.

INTRODUCTION

This study aims to examine the contribution of sarcopenia and osteoporosis to the occurrence of frailty using 4-year follow-up information of a population-based cohort study.

METHODS

The second survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2008 and 2010; 1083 subjects (aged ≥ 60 years, 372 men, 711 women) completed all examinations on frailty, sarcopenia, and osteoporosis, which were defined using Fried's definition, Asian Working Group for Sarcopenia criteria, and WHO criteria, respectively. The third survey was conducted between 2012 and 2013; 749 of 1083 individuals enrolled from the second survey (69.2%, 248 men, 501 women) completed assessments identical to those in the second survey.

RESULTS

The prevalence of frailty in the second survey was 5.6% (men, 3.8%; women, 6.6%). The cumulative incidence of frailty was 1.2%/year (men, 0.8%/year; women, 1.3%/year). After adjustment for confounding factors, logistic regression analysis indicated that osteoporosis was significantly associated with the occurrence of frailty (odds ratio, 3.07; 95% confidence interval, 1.26-7.36; p = 0.012). Moreover, the occurrence of frailty significantly increased according to the presence of osteoporosis and sarcopenia (odds ratio vs. neither osteoporosis nor sarcopenia: osteoporosis alone, 2.50; osteoporosis and sarcopenia, 5.80).

CONCLUSIONS

Preventing osteoporosis and coexistence of osteoporosis and sarcopenia may help reduce the risk of frailty.

Sarcopenic obesity associated with high-sensitivity C-reactive protein in age and sex comparison: a two-center study in South Korea

OBJECTIVES

To evaluate the association between high-sensitivity C-reactive protein (hs-CRP) and sarcopenic obesity, and to determine age or sex differences underlying the relationship between hs-CRP and sarcopenic obesity.

DESIGN

Observational study.

PARTICIPANTS

The study included 237 838 participants whose body composition and hs-CRP were analysed at the two health promotion centres in South Korea. Participants were divided into four groups based on body composition: normal, obesity only, sarcopenia only and sarcopenic obesity.

PRIMARY MEASURES

The levels of hs-CRP and proportion of participants with high (≥1.0 mg/L) hs-CRP. Sarcopenic obesity was defined as subjects fulfilling the criteria for sarcopenia (below 2 SD of mean of Skeletal Muscle Mass Index for young adults) and obesity (waist circumference ≥90 cm for men and ≥85 cm for women).

RESULTS

The level of hs-CRP was highest in the sarcopenic obesity group. Following adjustment for various confounders including age, sex, comorbidities, metabolic, health-related behaviour and demographic factors, the adjusted ORs (95% CI) for subjects with high hs-CRP associated with obesity, sarcopenia and sarcopenic obesity compared with normal group (reference) were 1.17 (1.05 to 1.31), 2.23 (1.21 to 4.07) and 3.23 (2.71 to 3.83), respectively. In age subgroup analyses, multivariate logistic regression analysis revealed that the association of high hs-CRP with sarcopenic obesity was stronger in younger (<60 years) participants than in older (≥60 years) participants (p for interaction <0.001). In subgroup analyses for sex, the association of high hs-CRP with sarcopenic obesity was higher in female participants than in males (p for interaction <0.001).

CONCLUSIONS

This study demonstrated that high level of hs-CRP was independently associated with sarcopenic obesity in Korean population. We found for the first time that there was a strong association between increased hs-CRP and sarcopenic obesity in female and younger (<60 years) subjects.

Nordic walking training and nutritional supplementation in pre-frail older Indians: an open-labelled experimental pre-test and post-test pilot study to develop intervention model

Background

Identifying and treating people in a pre-frail state may be an effective way to prevent or delay frailty and preserve their functional capacity. This study aimed to assess the efficacy of, and compliance with, a 12 week individualized nutritional supplementation (INS) and Nordic walking (NW) program in pre-frail older Indians. The primary measure is physical performance, as indicated by Fried’s Frailty scale. Other measures include: cognition, as indicated by the Hindi Mental Status Examination; mood, by the Geriatric Depression Scale; and nutritional status, by the Mini Nutritional Assessment.

Methods

This is an open-labeled experimental pre-test and post-test study, which took place from October 2012 to December 2014. The study was approved by Institute Ethics committee (IEC/NP-350/2012/RP-26/2012) at the All India Institute of Medical Sciences (AIIMS), New Delhi. Participants were sixty-six pre-frail elderly, who were randomly allocated into three subgroups, namely: A (NW only), B (INS only), and C (NW and INS). One-way ANOVA was used to statistically assess differences in baseline characteristics for quantitative variables, with the Chi-Square/Fischer exact test utilized for qualitative variables. Paired t-tests were used to assess pre and post intervention difference within the group for quantitative variables, with McNemar’s Chi-Square test used for qualitative variables. Kruskal Wallis test was used to assess significant intervention effects among the groups. A p-value < 0.05 was considered as statistically significant.

Results

There was significant effect of intervention in gait speed in group A (p = 0.001) and C (p = 0.002), but not in group B (p = 0.926). While there was no significant change in grip strength in Group A (p = 0.488) and B (p = 0.852), a statistically significant increase was observed in group C (p = 0.013). Mood significantly improved in group B (p = 0.025) and C (p = 0.021). No significant difference was noted in cognitive status across groups. Following the interventions, a total of 18.18% of pre-frail participants were classified as non-frail.

Conclusions

Combining NW and INS provides a simple, pragmatic intervention with efficacy in the management of functionally vulnerable older adults, and allows their maintained independence. Future studies should replicate this readily applicable intervention in a larger cohort with a longer follow-up period.

Trial registration

Clinical Trial Registry-India CTRI/2016/05/006937 [Registered on: 16/05/2016]; Trial was Registered Retrospectively.

Neck Muscle Mass Index as a Predictor of Post-Laryngectomy Wound Complications

OBJECTIVE

We investigated the relationship between paravertebral muscle cross-sectional area (PVM CSA) at the third vertebra (C3) level using computerized tomography (CT) neck images and its relationship with complications after total laryngectomy.

DESIGN

Retrospective analysis of 60 advanced laryngeal cancer patients who underwent total laryngectomy was performed. The cross-sectional areas of paravertebral neck muscles using neck CT at C3 level images obtained preoperatively were analyzed.

RESULTS

A significant difference in PVM CSA between complication and no complication groups, F(1, 53 = 4.319, P = .043), was identified by ANCOVA. There were no significant differences in between-subject effects: T-stage ( F = 1.652, P = .204), body mass index ( F = 0.889, P = .35), albumin ( F = .359, P = .552), age ( F = 1.623 P = .208), and smoking ( F = 4.319, P = .41).

CONCLUSION

The PVM CSA measured at C3 level on pretreatment CT may help identify patients at higher risk of postoperative wound complications after total laryngectomy and who may particularly benefit from preoperative optimization of nutritional status.

Efficiency of Bioelectric Impedance Analysis as an Evaluation Method of Skeletal Muscle Mass After Gastrectomy

Objective:

This study measured skeletal muscle mass (SMM) in postoperative gastric cancer patients, to compare SMM to traditional postoperative assessment based on anthropomorphic measures and blood tests, and evaluated the methods of SMM measurement.

Summary of Background Data:

SMM, which helps to maintain general health and quality of life, is very important. Measurement of total psoas major muscle area (TPA) by computed tomography imaging has recently been reported to be a useful index of SMM.

Methods:

This retrospective study included 92 patients who underwent distal gastrectomy for gastric cancer. SMM was measured by TPA index (computed tomography measurement of TPA / square of height) and bioelectric impedance analysis (BIA). Patients were divided into short-term (&lt;3 years) and long-term (≥3 years) postoperative follow-up groups. SMM and traditional postoperative assessment, as well as body mass index, albumin, hemoglobin, and total cholesterol, were compared between the 2 groups. The correlations between the TPA index and the SMM of BIA and traditional postoperative assessment were examined by simple regression analysis.

Results:

The SMM of BIA was 24.1 ± 4.1 kg in the short-term and 22.0 ± 4.7 kg in the long-term group (P = 0.02), and TPA index was 783.4 ± 166.9 mm2/m2 in the short-term and 687.5 ± 167.2 mm2/m2 in the long-term group (P = 0.01), whereas there were no significant differences in traditional postoperative assessment. On simple regression analysis, TPA index showed the strongest correlation with SMM of BIA (R = 0.56).

Conclusions:

Measurement of SMM is essential because the traditional postoperative assessments do not reflect the change in SMM. And SMM measurement, especially by BIA, would be useful.

An Update on Protein, Leucine, Omega-3 Fatty Acids, and Vitamin D in the Prevention and Treatment of Sarcopenia and Functional Decline

Aging is associated with sarcopenia and functional decline, leading to frailty and disability. As a modifiable risk factor, nutrition may represent a target for preventing or postponing the onset of these geriatric conditions. Among nutrients, high-quality protein, leucine, vitamin D, and omega-3 polyunsaturated fatty acids (n-3 PUFA) are of particular interest for their demonstrated effects on skeletal muscle health. This narrative review aims to examine the recent observational and interventional evidence on the associations and the role of these nutrients in the muscle mass, strength, mobility, and physical function of free-living older adults, who are either healthy or at risk of frailty. Recent evidence supports a higher protein intake recommendation of 1.0⁻1.2 g/kg/day in healthy older adults; an evenly distributed mealtime protein intake or minimal protein per meal may be beneficial. In addition, vitamin D supplementation of 800⁻1000 IU, particularly when vitamin D status is low, and doses of ~3 g/day of n-3 PUFA may be favorable for physical function, muscle mass, and strength. Reviewed studies are highly heterogenous, yet the quantity, quality, and timing of intakes should be considered when designing intervention studies. Combined protein, leucine, vitamin D, and n-3 PUFA supplements may convey added benefits and may represent an intervention strategy in the prevention of sarcopenia and functional decline.

High Prevalence of Sarcopenia in HIV-Infected Individuals

Background

Sarcopenia is a geriatric syndrome that leads to a loss of functionality and mortality.

Methods

We assessed the prevalence of sarcopenia in HIV-infected patients attended in our HIV Unit who had at least two DXA scans from 2000 to 2016 (1,720 DXA scans from 860 individuals). Sarcopenia was determinate according to appendicular skeletal muscle mass index (ASM) calculated as the ratio between skeletal muscle mass index (SMI) by DXA and height² (kg/m²). We stratified patients by gender and age (<40, 41-50, and >50 years) and according to the interval between DXAs (≤3, 3-7, 7-10, >10 years). The statistical analysis was performed using SPSS version 19.

Results

Median (IQR) age was 52 (47; 57) years, and 76% were male. The median (IQR) time with HIV infection was 8 (3; 15) years. The prevalence of sarcopenia was 25.7% (95% CI, 22.8-28.7), more prevalent in those aged >50 years (27.8%). Stratifying by gender, 43% of women aged >50 years presented sarcopenia compared with 8.8% of men. The frequency of sarcopenia increased from 37.6% to 49.4% when interval between DXA was 7-10 years (n=109), significantly higher in women than in men (p=0.016). In addition to the traditional risk factors, time with HIV infection was associated with sarcopenia [RR 1.780 (95% CI, 1.314-2.411), p=0.001].

Conclusion

The prevalence and progression of sarcopenia in HIV-infected patients were high, mainly among women. Further studies are necessary to assess the best approaches to prevent this condition and its consequences.

How do muscle and bone strengthening and balance activities (MBSBA) vary across the life course, and are there particular ages where MBSBA are most important?

This narrative review focuses on the role of strength and balance activities throughout the lifecycle to improve physical capacity and reduce all-cause mortality. The evidence suggests strong associations in middle and older age, with poor balance, poor strength or poor physical function having strong associations with mortality. Currently in the UK, the proportions of adults (69% of men and 76% of women) not meeting the strength and balance guidelines (of 2 or more sessions/week) is concerning. This report identifies specific time points in the lifecycle where specific promotion of and engagement with strength and balance activities would be most beneficial for health: 18-24y to maximize bone and muscle mass gains, 40-50y to maintain strength and reduce that downward cycle, and over 65s to preserve balance and strength and maintain independence). This review also suggests specific transition points/events in life where there may be an increase in sedentary behaviour or loss of muscle function (pregnancy, menopause, onset of on diagnosis of disease, retirement, on becoming a carer and following hospitalization), where it would be useful to initiate additional strength and balance exercises to improve future health outcomes.

Characteristics of hyperuricemia in older adults in China and possible associations with sarcopenia

OBJECTIVE

This cross-sectional study aimed to investigate the characteristics and epidemiology of hyperuricemia in older adults in China and evaluate possible associations between hyperuricemia and sarcopenia.

METHODS

Three hundred and eighty-eight study subjects (>60 years old) meeting the inclusion criteria received blood tests and standardized examinations for bone mineral density, muscle mass, muscle strength, and physical performance. Data including demographic and clinical characteristic and comorbidity were also collected. All data were analyzed retrospectively.

RESULTS

In the study population, higher uric acid levels were significantly correlated with higher muscle mass, grip strength, and bone density, but were unrelated to physical performance. When uric acid levels were separated into quartiles and the population was divided by sex, the correlation of uric acid to muscle mass was retained in some quartiles for both men and women, and the correlation to handgrip was only retained for one quartile for men. The correlation to bone density was retained in women in all analyses.

CONCLUSION

In the population as a whole, higher uric acid levels were significantly correlated with higher muscle mass, grip strength, and bone density, but had no relationship to physical performance. Differences between men and women in these relationships need to be studied further.

Clinical Management of Osteoporotic Fractures

PURPOSE OF REVIEW

This review examines recent literature regarding the clinical management of fragility fractures, provides insight into new practice patterns, and discusses controversies in current management.

RECENT FINDINGS

There are declining rates of osteoporosis management following initial fragility fracture. Management of osteoporotic fractures via a multidisciplinary team reduces secondary fracture incidence and improves overall osteoporotic care. Anabolic agents (abaloparatide and teriparatide) are effective adjuvants to fracture repair, and have shown positive results in cases of re-fracture in spite of medical management (i.e., bisphosphonates). For AO 31-A1 and A2 intertrochanteric hip fractures (non-reverse obliquity), no clinical advantage of intramedullary fixation over the sliding hip screw (SHS) has been proven; SHS is more cost-effective. As fragility fracture incidence continues to rise, orthopedic surgeons must play a more central role in the care of osteoporotic patients. Initiation of pharmacologic intervention is key to preventing subsequent fragility fractures, and may play a supportive role in initial fracture healing. While the media bombards patients with complications of medical therapy (atypical femur fractures, osteonecrosis of jaw, myocardial infarction), providers need to understand and communicate the low incidence of these complications compared with consequences of not initiating medical therapy.

Web-Based Telepresence Exercise Program for Community-Dwelling Elderly Women With a High Risk of Falling: Randomized Controlled Trial

Background

While physical exercise is known to help prevent falls in the elderly, bad weather and long distance between the home and place of exercise represent substantial deterrents for the elderly to join or continue attending exercise programs outside their residence. Conventional modalities for home exercise can be helpful but do not offer direct and prompt feedback to the participant, which minimizes the benefit.

Objective

We aimed to develop an elderly-friendly telepresence exercise platform and to evaluate the effects of a 12-week telepresence exercise program on fall-related risk factors in community-dwelling elderly women with a high risk of falling.

Methods

In total, 34 women aged 68-91 years with Fall Risk Assessment scores >14 and no medical contraindication to physical training-based therapy were recruited in person from a senior citizen center. The telepresence exercise platform included a 15-inch tablet computer, custom-made peer-to-peer video conferencing server system, and broadband Internet connectivity. The Web-based program included supervised resistance exercises performed using elastic resistance bands and balance exercise for 20-40 minutes a day, three times a week, for 12 weeks. During the telepresence exercise session, each participant in the intervention group was supervised remotely by a specialized instructor who provided feedback in real time. The women in the control group maintained their lifestyle without any intervention. Fall-related physical factors (body composition and physical function parameters) and psychological factors (Korean Falls Efficacy Scale score, Fear of Falling Questionnaire score) before and after the 12-week interventional period were examined in person by an exercise specialist blinded to the group allocation scheme.

Results

Of the 30 women enrolled, 23 completed the study. Compared to women in the control group (n=13), those in the intervention group (n=10) showed significant improvements on the scores for the chair stand test (95% confidence interval -10.45 to -5.94, P<.001), Berg Balance Scale (95% confidence interval -2.31 to -0.28, P=.02), and Fear of Falling Questionnaire (95% confidence interval 0.69-3.5, P=.01).

Conclusions

The telepresence exercise program had positive effects on fall-related risk factors in community-dwelling elderly women with a high risk of falling. Elderly-friendly telepresence technology for home-based exercises can serve as an effective intervention to improve fall-related physical and psychological factors.

Trial Registration

Clinical Research Information Service KCT0002710; https://cris.nih.go.kr/cris/en/search/ search_result_st01.jsp?seq=11246 (Archived by WebCite at http://www.webcitation.org/6zdSUEsmb)

Effect of dietary omega-3 fatty acid supplementation on frailty-related phenotypes in older adults: a systematic review and meta-analysis protocol

INTRODUCTION

The beneficial effect of dietary omega-3 supplementation in younger adults or older people with acute or chronic disease is established. Knowledge is now needed about the effect in medically stable older people. The objective of this study is to examine and assess the evidence for a role of dietary omega-3 polyunsaturated fatty acid (PUFA) supplementation in older adults on (1) muscle mass and muscle strength, (2) inflammatory biomarkers and (3) physical activity.

METHODS AND ANALYSIS

A systematic review and data synthesis will be conducted of randomised controlled trials in older people not recruited for any given disease diagnosis. Placebo-controlled studies reporting interventions involving dietary supplementation of omega-3 PUFAs, eicosapentaenoic acid and docosahexaenoic acid will be included. Outcomes must include changes from baseline to last available follow-up for one or more of the following: muscle mass, inflammatory biomarkers, physical activity, walking speed, weight change, hand grip strength or muscle strength. Once the search strategy has been carried out, two independent researchers will assess relevant papers for eligibility. Articles up until 31 December 2017 in any language will be included. We will provide a narrative synthesis of the findings from the included studies. Studies will be grouped for meta-analysis according to the outcome(s) provided. Where studies have used the same type of intervention, with the same outcome measure, we will pool the results using a random effects meta-analysis, with standardised mean differences for continuous outcomes and risk ratios for binary outcomes, and calculate 95% CI and two-sided p values for each outcome.

ETHICS AND DISSEMINATION

No research ethics approval is required for this systematic review as no confidential patient data will be used. The results of this systematic review will be disseminated through publication in an open-access peer-reviewed journal and through conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42017080240.

Sarcopenia: assessment of disease burden and strategies to improve outcomes

Life expectancy is increasing worldwide, with a resultant increase in the elderly population. Aging is characterized by the progressive loss of skeletal muscle mass and strength - a phenomenon called sarcopenia. Sarcopenia has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors - in particular, nutritional status and degree of physical activity. According to the operational definition by the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function, which can be defined by low muscle strength or low physical performance. Moreover, biomarkers of sarcopenia have been identified for its early detection and for a detailed identification of the main pathophysiological mechanisms involved in its development. Because sarcopenia is associated with important adverse health outcomes, such as frailty, hospitalization, and mortality, several therapeutic strategies have been identified that involve exercise training, nutritional supplementation, hormonal therapies, and novel strategies and are still under investigation. At the present time, only physical exercise has showed a positive effect in managing and preventing sarcopenia and its adverse health outcomes. Thus, further well-designed and well-conducted studies on sarcopenia are needed.

A non-invasive modifiable Healthy Ageing Nutrition Index (HANI) predicts longevity in free-living older Taiwanese

Nutritional factors contributing to disability and mortality are modifiable in later life. Indices would add utility. We developed a gender-specific Healthy Ageing Nutrition Index (HANI) for all-cause mortality in free-living elderly. We stratified 1898 participants aged ≥65 y from the 1999–2000 Nutrition and Health Survey in Taiwan by region and randomly allocated them into development and validation sets. Linkage to the National Death Registry database until December 31, 2008 enabled mortality prediction using Cox proportional-hazards models. Four factors (appetite, eating with others, dietary diversity score, and BMI) with best total of 25 HANI points for men; and 3 factors (cooking frequency, dietary diversity score, and BMI) with best total of 27 HANI points for women, were developed. In the validation set, the highest HANI group exhibited a greater intake of plant-derived food and associated nutrients, a favourable quality of life, and more muscle mass, compared with the lowest group. The highest HANI group predicts mortality risk lower by 44 percent in men and 61 percent in women. Adjusted mortality HRs were comparable between sets. HANI is a simple, non-invasive, inexpensive, and potentially modifiable tool for nutrition monitoring and survival prediction for older adults, superior to its individual components.