Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies

Development of an artificial intelligence-based application for the diagnosis of sarcopenia: a retrospective cohort study using the health examination dataset

BACKGROUND

Medical imaging techniques for diagnosing sarcopenia have been extensively investigated. Studies have proposed using the T-score and patient information as key diagnostic factors. However, these techniques have either been time-consuming or have required separate calculation processes after collecting each parameter. To address this gap, we propose an artificial intelligence (AI)-based web application that automates the collection of data, classification of the lumbar spine 3 (L3) slices, segmentation of the subcutaneous fat, visceral fat, and muscle areas in the classified L3 slices, and quantitative analysis of the segmented areas.

METHODS

We developed an automated lumbar spine slice classification model using the CNN (EfficientNetV2) algorithm and an automated domain segmentation model to identify the subcutaneous fat, visceral fat, and muscle areas using the U-NET algorithm. These models were used to identify L3 slices from abdominal computed tomography images and divide the images into the three-segmented domains for sarcopenia diagnosis. Additionally, we developed an algorithm for the calculation of T-Score calculated as (measurement value-Young adult mean)/(Young adult SD) using the Aggregation Pipeline by MongoDB, with the mean and standard deviation for skeletal muscle area (SMA), SMA/height2, SMA/weight, and SMA/body mass index (BMI) for both sexes and different age groups.

RESULTS

The proposed system demonstrated high accuracy and precision, with an overall accuracy of 97.5% in classifying L3 slices and a segmentation accuracy of 92% for muscle, subcutaneous fat, and visceral fat areas. The T-Score-based analysis provided reliable diagnostic thresholds for sarcopenia, facilitating consistent and accurate assessments. Our diagnostic cutoff points for each index were as follows: SMA (-1.0: 152.55, -2.0: 125.89), SMA/height² (-1.0: 38.84, -2.0: 14.50), SMA/weight (-1.0: 2.14, -2.0: 1.89), and SMA/BMI (-1.0: 6.10, -2.0: 5.18) for men; SMA (-1.0: 96.08, -2.0: 76.96), SMA/height² (-1.0: 37.20, -2.0: 29.36), SMA/weight (-1.0: 1.80, -2.0: 1.61), and SMA/BMI (-1.0: 4.56, -2.0: 4.01) for women. SMA/BMI best reflected the loss of muscle mass in healthy populations by age, showing a more remarkable decrease in muscle mass in men than in women. The values for men gradually decreased after their 20s, and that for women gradually decreased after their 40s, which progressed to a more dramatic decline in the 70s for both sexes.

CONCLUSION

This AI-based web application addresses the limitations of previous diagnostic techniques by automatically analyzing medical images for the classification, segmentation, and calculation of T-scores. The study findings provide a more reliable and accurate diagnostic technique for sarcopenia that can consequently impact patient treatment and outcomes.

Effects of digital-based interventions on the outcomes of the eligibility criteria for sarcopenia in healthy older adults: A systematic review and meta-analysis

BACKGROUND

While the digital-based interventions targeting older adults to prevent age-related health problems such as sarcopenia have grown rapidly in recent years, there are no meta-analyses indicating synthesized pooled estimates.

OBJECTIVE

To examine the effects of digital-based interventions on sarcopenia-related measures, including physical performance and muscle mass, in healthy community-dwelling older adults.

METHODS

Systematic searches were performed on MEDLINE, Web of Science, and Cochrane Library for eligible studies published up to 31 March 2023. The mean difference with a 95 % confidence interval was calculated. Methodological quality was assessed using Cochrane RoB 2.0. The GRADE criteria were used to assess evidence certainty.

RESULTS

Thirteen randomized controlled trials with 742 participants were included in the meta-analysis. Handgrip strength, usual walking speed, five times sit-to-stand performance, and 30-second chair stand test showed significant enhancements with the digital-based interventions. However, there were no significant effects of digital-based interventions in appendicular muscle mass. The overall evidence certainty was low.

CONCLUSIONS

Although digital-based interventions for healthy older adults are effective in improving physical functions, evidence certainty is low. Additional randomized controlled trials are thus required to further validate the findings.

A study on the balance ability and plantar pressure of sarcopenia patients in different standing postures

BACKGROUND

Sarcopenia usually manifests as a decrease in muscle mass and strength, seriously affecting the quality of life and independent living ability of elderly people. Moreover, sarcopenia is associated with various adverse outcomes such as mortality, postoperative infections, and severe complications, as well as affecting the balance and plantar pressure of the elderly.

RESEARCH QUESTION

What are the characteristics of balance ability and plantar pressure in sarcopenia population across different standing postures?

METHODS

A plantar pressure measurement system was used to measure the COP parameters and plantar pressure of 70 individuals in four standing postures: Feet 10 cm apart (FA), Feet together (FT), Feet Semi Tandem (FST), and Feet Full Tandem (FFT). The plantar area was divided into ten regions based on the anatomical structure of the foot. An independent samples t-test was conducted for significance testing, and developed sarcopenia screening models based on binary logistic regression.

RESULTS

Research has found that there are significant differences in the center of plantar pressure (COP) speed, 95 % elliptical region, COP length, and short axis length between populations with and without sarcopenia in the FST stance. The analysis of plantar pressure showed that the main differences between the two groups were located in the metatarsal and heel regions, and the accuracy of the binary logistic regression model constructed based on the FFT stance plantar pressure data without weight-adjusted for screening sarcopenia was as high as 94.3 %, which was superior to other standing postures.

SIGNIFICANCE

The difference in balance ability between sarcopenia population and non-sarcopenia population is reflected in standing posture with a relatively narrower base of support on the plantar surface (FST), and FFT stance plantar pressure can be used as a new method for screening sarcopenia.

"No Matter the Age or Medical Complexity, People Benefit From That Intensity of Exercise": A Mixed-Methods Study Describing Rehabilitation Provider Perceptions of High-Intensity Resistance Training Among Veterans Receiving Post-Acute Care

BACKGROUND

In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption.

METHODS

Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program. Post-training, the validated Perceived Characteristics of Intervention Scale was used to evaluate i-STRONGER relative advantage, compatibility with practice, complexity, potential for reinvention (ie, adaptability), trialability, and risk. Providers reported the top 3 needs for successful i-STRONGER adoption and described i-STRONGER perceptions in training modules and focus groups. A convergent mixed-methods design was used to evaluate and describe clinician perceptions of i-STRONGER.

RESULTS

i-STRONGER program conceptually aligned with providers' practice. The patterns and was endorsed as feasible and adaptable as part of patient care; however, initial hesitancies surrounding patients' physical abilities and motivation were noted as barriers and appeared to reflect negative age-related beliefs and attitudes within SNF cultures. Providers feared patients would be unwilling or unable to engage with i-STRONGER activities due to their age, deconditioning, medical complexity, or expectation that rehabilitation should feel "easier." As providers began implementing i-STRONGER in real-time, concerns surrounding i-STRONGER's potential risks lessened as providers observed improvements in patient function and motivation, and patients were described as "embracing" i-STRONGER principles. Patient acceptance and satisfaction, equipment, time, and clear communication among providers were cited as critical needs for i-STRONGER adoption.

CONCLUSIONS

With i-STRONGER, a safe and effective approach for delivering resistance training to older adults in SNF settings, "seeing is believing." Real-time implementation of i-STRONGER facilitated an evolution of perspective among providers, fueled by observable, positive changes in patient function and affect as well as unexpected patient participation. Findings support i-STRONGER use in SNF settings, provided that specific training strategies showcase older adults with medical complexity participating in progressive resistance training.

Inflammation mediates the association between muscle mass and accelerated phenotypic aging: results from the NHANES 2011-2018

Background

Muscle mass plays a pivotal role in health maintenance, yet its connection to biological aging remains underexplored. This study investigates the association between appendicular skeletal muscle mass index (ASMI) and phenotypic age(PhenoAge), while examining the mediating role of systemic inflammation.

Methods

The analysis included 7,440 participants from the NHANES 2011-2018. Phenotypic Age Acceleration (PhenoAgeAccel) was calculated as the residuals from regressing PhenoAge on chronological age. Multivariable linear regression analyses were performed to assess the association between ASMI and PhenoAgeAccel. Mediation analysis was conducted to quantify the extent to which systemic inflammation contributes to this association.

Results

Our analysis revealed that higher ASMI is linked to slower biological aging, as evidenced by lower PhenoAgeAccel (β = -0.48, 95% CI: -0.66 to -0.29, p = 0.0001). Systemic inflammation partially mediated this effect, with a mediation proportion of 35.1%. The association varied notably across demographic and health-related subgroups, being particularly significant in females, individuals with obesity, and those with lower physical activity.

Conclusion

These findings highlight the critical importance of muscle mass in slowing biological aging, with systemic inflammation emerging as a key biological mediator. The public health implications are substantial, suggesting that targeted interventions-such as resistance training, anti-inflammatory diets, and personalized medical approaches-could play a pivotal role in decelerating biological aging and improving long-term health outcomes.

Ginsenoside Rc prevents dexamethasone-induced muscle atrophy and enhances muscle strength and motor function

Background

A decline in muscle mass and function can impact the health, disease vulnerability, and mortality of older adults. Prolonged use of high doses of glucocorticoids, such as dexamethasone (DEX), can cause muscle wasting and reduced strength. Ginsenoside Rc (gRc) has been shown to protect muscles by activating the PGC-1α pathway and improving mitochondrial function. The effects of gRc on muscle atrophy and function in mice are not fully understood.

Methods and results

The study discovered that gRc prevented the DEX-induced decrease in viability of C2C12 myoblasts and myotubes. Furthermore, gRc inhibited myotube degradation and the upregulation of muscle degradation proteins induced by DEX. Transcriptome analysis of myotubes showed that gRc enhances muscle generation processes while suppressing the TGF-β pathway and oxidative stress response. In mice, gRc effectively reversed the reductions in body weight, muscle mass, and muscle fibers caused by DEX. Furthermore, gRc significantly enhanced muscle strength and exercise capacity. Docking and transcriptome analyses indicated that gRc may act as a competitive inhibitor of DEX at the glucocorticoid receptor, potentially preventing muscle loss.

Conclusion

The study suggests that gRc can prevent DEX-induced muscle wasting and weakness. Consequently, it may be a viable treatment option for sarcopenia and muscle-related disorders in various medical conditions.

Grip-Strength-Lean-Mass Index (GSLMI) as a valuable tool for sarcopenia diagnosis and survival prognosis in cancer patients: a nationwide multicenter cohort study

OBJECTIVES

To identify whether the Grip-Strength-Lean-Mass Index (GSLMI) can precisely diagnose sarcopenia and predict prognosis for cancer patients in clinical settings.

DESIGN

A nationwide multicenter cohort study.

SETTING AND PARTICIPANTS

8,831 inpatients aged 18 years and older, histologically diagnosed with cancer and receiving anti-cancer therapy.

MEASUREMENTS

The GSLMI is the ratio of hand grip strength (HGS) divided by lean mass (LM), calculated by the formula: GSLMI = HGS (kg) / LM (kg). Kaplan-Meier curves and Cox models were used to estimate the association between the GSLMI and survival.

RESULTS

A total of 3,071 (48.40%) male and 3,274 (51.60%) female patients were enrolled in the study. The prevalence of GLIS-defined sarcopenia was 2,646 (41.70%). The optimal sex-specific thresholds with the best diagnostic performance to identify a low GSLMI were determined to be <0.61 for males and <0.47 for females based on the ROC curves. According to Kaplan-Meier curves, patients with a high GSLMI exhibited better overall survival than those with a low GSLMI (HR = 0.664, 95%CI = 0.604-0.729, log-rank P < 0.001). Multivariable survival analysis revealed that the GSLMI showed an independent association with a lower hazard of death as a continuous variable (HR = 0.70, 95% CI = 0.51-0.96).

CONCLUSIONS

The GSLMI may serve as a novel diagnostic tool for identifying sarcopenia and may have prognostic value for cancer patients. Using the GSLMI represents a feasible and promising option for better managing the health of patients with cancer.

Exploring the mediating role of depression in the relationship between sarcopenia and cardiovascular health in the middle-aged and elderly: A cross-sectional study

BACKGROUND

Cardiovascular health is influenced by various factors, including sarcopenia and depression. It has been demonstrated that sarcopenia has a negative impact on cardiovascular disease, with depression also being a contributing factor. However, the complex interplay between sarcopenia, depressive symptoms, and cardiovascular health in middle-aged and elderly populations is not fully explored.

METHODS

A total of 23,445 participants participated in China Health and Retirement Longitudinal Study and completed relevant measurements, including the Centre for Epidemiological Studies Depression Scale. The study also assessed sarcopenia and cardiovascular health score. The focus of the study was to test whether the association between sarcopenia and cardiovascular health scores was mediated by depression using PROCESS macros in R 4.3.2. Sensitivity analyses were conducted to affirm the robustness of our findings.

RESULT

The study revealed a partial mediation between sarcopenia and cardiovascular health score among the middle and elder adults, mediated by depression. Sarcopenia had a significant negative correlation with cardiovascular health score (B = -12.404, P < 0.05), and depression also showed a significant negative correlation (B = -1.515, P < 0.001).

CONCLUSION

The results support the notion that depression partially mediated the association between sarcopenia and cardiovascular health score. Therefore, interventions aimed at improving mood and addressing other cardiovascular risk factors may help alleviate the adverse effects of sarcopenia and potentially reduce the progression to cardiovascular disease.

Correlation and predictive value of novel anthropometric indicators with adult sarcopenia and sarcopenia obesity

The present study leverages the comprehensive data from the National Health and Nutrition Examination Survey (NHANES) to examine the Influencing factors of sarcopenia (SA) and sarcopenic obesity (SO). The investigation is designed to a non-invasive, cost-effective, and convenient method that is applicable to the adult population, enabling the accurate and simultaneous detection of risks associated with SA and SO. Furthermore, this research will evaluate the critical values of effective anthropometric indicators, providing early warning for risk management in self-health care and offering valuable insights for subsequent research and clinical practice. The data pertaining to NHANES participants were meticulously selected from the databases of six cycles, spanning from 2001 to 2004 and 2011 to 2018. Utilizing the diagnostic criteria established by the American Foundation for the National Institutes of Health (FNIH), anthropometric measurement data were extracted to construct composite indices. These indices were then cross-referenced with diagnostic assessments from dual-energy X-ray absorptiometry and bioelectrical impedance analysis to examine the correlations between various metrics and the incidence of diseases. R software (version 4.3.3) was used for analysis, and the primary analytical methods employed included logistic regression, restricted cubic splines (RCS), and the Receiver Operating Characteristic (ROC) curve analysis (AUC). Sarcopenia and sarcopenic obesity are commonly observed in individuals within the middle-aged and elderly demographics. The prevalence of these conditions is higher among middle-aged men of a given age when contrasted with women at the age of 40. All anthropometric indexes demonstrated a positive correlation with the onset of SA and SO, with the association with waist-to-height ratio (WHtR) showcasing a heightened strength subsequent to the adjustment for all covariates. The predictive models of all ROC curves performed commendably, particularly with the body roundness index and WHtR forecasting models exhibiting superior performance, the area under the AUC curve is 0.87 (95 CI% 0.85, 0.88) and 0.86 (95 CI% 0.85, 0.88), respectively. The RCS curve delineated a distinctive J-shaped distribution for each physical index in concurrence with SA and SO, signifying an optimal value at which the incidence of these conditions is minimal; conversely, deviations from this optimal value entailed an escalated risk of disease. Diverse anthropometric index metrics bear a strong correlation with adult onset of sarcopenia and sarcopenic obesity, each displaying commendable predictive capability. Notably, the body roundness index and waist-to-height ratio may harbor heightened potential as indicative anthropometric indexes. Furthermore, the dose-effect relationship analysis inferred that the lowest disease risk is manifested among individuals with specific index profiles, thereby advocating for autonomous health monitoring to promote physical activity and bolster nutrient intake, thus mitigating the risk of sarcopenia and sarcopenic obesity.

Systematic review of nutrition interventions in older patients with cancer: A synthesis of evidence and a future research priority

INTRODUCTION

Older patients with cancer (65 years and older) are a growing population with unique nutrition-and treatment-related issues that accelerate aging. Nutrition interventions attenuate nutritional decline, muscle loss, and risk of malnutrition and sarcopenia in patients with cancer, however the evidence for older patients with cancer is limited. The aim of this systematic review was to evaluate the efficacy of nutrition interventions on nutritional status, body weight/composition and clinical outcomes in older patients with cancer and to identify future research priority areas.

MATERIALS AND METHODS

Three databases were systematically searched from inception until January 2024. Eligible studies were randomised controlled trials (RCT) evaluating a nutrition intervention in older patients with cancer that reported nutrition-related and clinical outcomes. Studies including older patients were determined by the mean age ≥ 65 years with the error to the mean > 60 years. Between-group differences in nutritional and clinical outcomes were extracted.

RESULTS

Eleven studies describing nine RCTs were included in this review. Three trials specifically included patients 65 years and older. Most interventions intended to reduce malnutrition risk across a mix of cancer types and treatments, and one trial was designed to reduce comorbidities after treatment. Changes in dietary intake (n = 4), nutrition status (n = 1), weight (n = 5), and muscle mass (n = 3) were inconsistently reported, but preliminary evidence showed dietary counselling with oral nutrition supplements (ONS) resulted in improved weight maintenance in patients with pancreatic cancer. There was limited evidence of a benefit from nutrition interventions on treatment tolerance or quality of life. The heterogeneous findings in methodological design, including dietary prescription and frequency of consultations and reporting of outcomes, inhibits evidence-based recommendations for older adults with cancer.

DISCUSSION

Nutrition interventions designed specifically to address nutrition-related issues unique to older patients with cancer is a clear research priority. Research specifically targeting older patients post treatment, a period during which treatment-related side effects still occur, is limited. To support the growing population of older patients with cancer, future research must consistently report the dietary prescription, adherence to nutritional requirements, and clearly-defined nutrition-related parameters and clinical outcomes that are specific to older patients.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and sarcopenia based on NHANES

The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol, or NHHR, has garnered increased attention because of its connection to metabolic diseases. It is yet unknown, nevertheless, how NHHR and sarcopenia relate to one another in the US population. Examining the relationship between NHHR and the prevalence of sarcopenia in the US population is the main goal of this study. Utilizing information gathered from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, a study was conducted to look at the connection between NHHR and sarcopenia in the US population. The individuals' baseline features were categorized based on whether or not sarcopenia was present. We used subgroup analysis, restricted cubic spline (RCS), and weighted logistic regression to examine the connection between NHHR and sarcopenia prevalence. Sensitivity analysis was used to confirm that the study's findings were reliable and consistent. R (version 4.2.3) was used for all analyses, and P < 0.05 was used to indicate statistical significance. There were 10,087 individuals in all, 9,187 of whom were not sarcopenic and 900 of whom were. Sarcopenic patients were generally older, predominantly of Mexican American descent, and had lower educational levels. These patients were generally less active and exhibited higher levels of total cholesterol and BMI, along with lower HDL levels. Following complete adjustment, the weighted logistic regression model indicated that a 7% increased risk of sarcopenia was linked to every unit rise in NHHR (OR = 1.07, 95% CI = 1.02-1.13). An inflection point was identified at 2.90 by RCS analysis, which revealed a nonlinear association between NHHR and the prevalence of sarcopenia. Subgroup analysis showed that, regardless of the demographic group, there was a continuous positive correlation between NHHR and the prevalence of sarcopenia. The results of the interaction test provided evidence in favor of NHHR functioning as a stand-alone risk factor for sarcopenia. Our research suggests that a higher prevalence of sarcopenia may be linked to an increase in NHHR. Consequently, NHHR may function as a separate risk factor for sarcopenia.

Physical activity and cognition: longitudinal findings from the Thinking and Living with Cancer Study

BACKGROUND

Physical activity can improve cognition; however, little is known regarding the relationships between longitudinal objectively measured physical activity, cognition, and inflammation in older breast cancer survivors.

METHODS

Older (aged 60 years and older) breast cancer survivors (n = 216) and frequency-matched noncancer control participants (n = 216) were assessed at baseline (presystemic therapy for survivors) and annually for up to 5 years. Assessments included hip-worn actigraphs worn for 7 days, neuropsychological tests, the Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment subscale, and circulating levels of C-reactive protein and interleukin-6. Data were analyzed using linear mixed-effect, random-effect contemporaneous fluctuation, and multilevel mediation models, considering covariates; a P value less than .05 (2-sided) was considered statistically significant.

RESULTS

Survivors had fewer minutes of moderate-to-vigorous physical activity than controls at 36-, 48-, and 60-month time points (P < .03). Fewer survivors met aerobic physical activity guidelines at 36 months than control participants (17.7% vs 33.0%, P = .030). When guidelines were met (vs not), Functional Assessment of Cancer Therapy-Cognitive Function perceived cognitive impairment scores were 2.1 (1.0) (P = .034) points higher. Higher moderate-to-vigorous physical activity and meeting aerobic guidelines were not related to objective neuropsychological performance. Moderate-to-vigorous physical activity was inversely associated with C-reactive protein and interleukin-6 (P < .001), but inflammation did not mediate physical activity effects on perceived cognition.

CONCLUSIONS

Older breast cancer survivors were less physically active than older noncancer controls, especially farther from baseline. Meeting aerobic guidelines was associated with better perceived cognition in survivors. Survivorship care should consider physical activity monitoring and referral to rehabilitation and supervised exercise programs to promote physical activity and improve recovery in older survivors.

Association between the systemic inflammatory response index and mortality in patients with sarcopenia

BACKGROUND

Sarcopenia is closely linked to inflammation; however, the association between the systemic inflammatory response index (SIRI) and mortality in patients with sarcopenia remains unclear. This study aims to explore the relationship between SIRI and mortality in sarcopenia patients.

METHODS

We analyzed data from ten cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, selecting 3,141 sarcopenia patients. Mortality data were obtained from the National Death Index up to December 31, 2019. Participants were divided into three groups based on the ranking of their SIRI values. The association between SIRI and mortality was assessed using Cox proportional hazards models, with smooth curve fitting employed to test the correlation. Sensitivity analyses, subgroup analyses, and interaction tests were conducted to validate the stability of the findings.

RESULTS

A total of 101,316 individuals were included in this study. During a median follow-up of 10.4 years (minimum follow-up time of approximately 0.08 years, maximum follow-up time of 20.75 years), 667 participants died. Kaplan-Meier (KM) analysis indicated a higher risk of mortality in the SIRI Q3 group. Cox regression analysis showed a significant association between the SIRI Q3 group and all-cause mortality [HR 1.24 (95% CI: 1.05, 1.47)] and cardiovascular disease mortality [HR 1.46 (95% CI: 1.04, 2.04)]. Subgroup analysis revealed that SIRI was significantly associated with all-cause mortality across various demographic characteristics (e.g., gender, diabetes, hypertension, cardiovascular disease). Sensitivity analysis, excluding participants with cardiovascular disease, those who died within two years of follow-up, and those under 50 years old, indicated higher hazard ratios (HRs) for all-cause and cardiovascular mortality in the SIRI Q3 group.

CONCLUSION

This study demonstrates a significant association between SIRI and an increased risk of mortality in sarcopenia patients aged 20 years and older.

Myosteatosis: diagnostic significance and assessment by imaging approaches

Myosteatosis has emerged as an important concept in muscle health as it is associated with an increased risk of adverse health outcomes, a higher rate of complications, and increased mortality associated with ageing, chronic systemic and neuromuscular diseases, cancer, metabolic syndromes, degenerative events, and trauma. Myosteatosis involves ectopic infiltration of fat into skeletal muscle, and it exhibits a negative correlation with muscle mass, strength, and mobility representing a contributing factor to decreased muscle quality. While myosteatosis serves as an additional biomarker for sarcopenia, cachexia, and metabolic syndromes, it is not synonymous with sarcopenia. Myosteatosis induces proinflammatory changes that contribute to decreased muscle function, compromise mitochondrial function, and increase inflammatory response in muscles. Imaging techniques such as computed tomography (CT), particularly opportunistic abdominal CT scans, and magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), have been used in both clinical practice and research. And in recent years, ultrasound has emerged as a promising bedside tool for measuring changes in muscle tissue. Various techniques, including CT-based muscle attenuation (MA) and intermuscular adipose tissue (IMAT) quantification, MRI-based proton density fat fraction (PDFF) and T1-T2 mapping, and musculoskeletal ultrasound (MSUS)-based echo intensity (EI) and shear wave elastography (SWE), are accessible in clinical practice and can be used as adjunct biomarkers of myosteatosis to assess various debilitating muscle health conditions. However, a stan¬dard definition of myosteatosis with a thorough understanding of the pathophysiological mechanisms, and a consensus in assessment methods and clinical outcomes has not yet been established. Recent developments in image acquisition and quantification have attempted to develop an appropriate muscle quality index for the assessment of myosteatosis. Additionally, emerging studies on artificial intelligence (AI) may provide further insights into quantification and automated assessment, including MRS analysis. In this review, we discuss the pathophysiological aspects of myosteatosis, all the current imaging techniques and recent advances in imaging assessment as potential biomarkers of myosteatosis, and the most common clinical conditions involved.

Effects of soy protein-rich meals on muscle health of older adults in long-term care: A randomized clinical trial

OBJECTIVE

This study investigated the effects of a soy protein-rich meal intervention on the muscle health of older adults in long-term care facilities.

METHODS

A 12-week single-center randomized controlled trial with a control-group and open-label design was conducted. Eighty-four older adults from a long-term care facility participated in the study. The chefs at the facility cooked three meals using soy protein-rich recipes designed by dieticians. For 12 weeks, the intervention group participants consumed three meals with 30 g of soy protein (10 g/meal) per day, and the control group participants maintained their habitual diets.

RESULTS

The 84 participants (mean age, 84.9 ± 7.0 years; 61.9% female) were randomly assigned to an intervention group (43 participants) and a control group (41 participants). The intervention group exhibited significant increases in several lean mass indicators, namely soft lean mass (mean, 1.43 kg; 95% confidence interval [CI]: 0.20-1.65 kg), skeletal muscle mass (mean, 1.20 kg; 95% CI: 0.43-1.96 kg), appendicular skeletal muscle mass (mean, 0.79 kg; 95% CI: 0.07-1.52 kg), and skeletal muscle index (mean, 0.37 kg/m2; 95% CI: 0.05-0.68 kg/m2) (all P < 0.05). These changes were not observed in the control group (all P > 0.05). Notably, calf circumference decreased significantly in the control group (mean, -0.98 cm; 95% CI: -1.61 to -0.36 cm) but was maintained in the intervention group. The differences in the calf circumference and 6-m walk performance of the two groups were significant (P < 0.05).

CONCLUSIONS

The 12-week soy protein-rich meal intervention improved the muscle mass and 6-m walk performance of older adults in a long-term care facility.

Effect of body mass index on post-treatment oral function in patients with oral cancer: a cross-sectional study

This single-center cross-sectional study used sequential sampling to examine the influence of body mass index (BMI) on oral function after oral cancer treatment. Patients who completed primary oral cancer treatment between September 2019 and March 2023 (102 patients, 74 male [72.5%] and 28 female [27.5%]; mean age, 69.6 years) were analyzed. Patient background data were collected from electronic medical records. Post-treatment oral function measurements were conducted on all patients using six assessment tools. Statistical analysis was conducted using Pearson's correlation coefficient, one-way analysis of variance, the Jonckheere-Terpstra test, and multiple linear regression. Pre-treatment BMI showed a statistically significant relationship with postoperative oral function, particularly tongue pressure (P = 0.01). While the mean values of the groups showed no significant differences, the Jonckheere-Terpstra test revealed a statistically significant trend toward a stepwise increase in tongue pressure for each BMI group (P = 0.03). Multiple linear regression analysis revealed a statistically significant correlation between tongue pressure and pre-treatment BMI (P < 0.05). Pre-treatment BMI was significantly associated with tongue pressure. Since BMI is a variable factor that can be controlled by nutritional therapy even before treatment, nutritional intervention, weight control, and treatment strategies including reconstructive interventions to maintain tongue pressure may be important in oral cancer treatment.

Lipid metabolites and sarcopenia-related traits: a Mendelian randomization study

OBJECTIVE

To explore the influence of lipid metabolism on the risk of sarcopenia.

METHODS

Two-sample Mendelian randomization (MR) analysis was used to determine causality. A total of 179 lipid metabolism data points were used for exposure, and the data were obtained from a plasma lipid metabolite study of 7174 participants. The total muscle mass and total muscle strength, as well as the muscle strength and muscle mass of different sex groups, were selected as the relevant traits of sarcopenia. Data for outcomes were obtained from the UK Biobank, and sample sizes ranged from 135 468 to 450 243. Inverse-variance weighted (IVW), as the main method for evaluating the causal relationship between lipid metabolites and sarcopenia, uses the false discovery rate (FDR) for multiple comparisons and conducts heterogeneity, pleiotropy, and reverse causality tests.

RESULTS

Twenty-seven lipid metabolites, mainly phosphatidylcholine, phosphatidylethanolamine, ceramide, triacylglycerol, sphingomyelin, and sterol ester, were found to be associated with the risk of sarcopenia. Ceramide (d40:1), ceramide (d40:2), and sterol ester are risk factors for decreased muscle mass and strength. There is a positive causal relationship between various phosphatidylcholine lipids and muscle mass and strength. Sphingomyelin (d42:2) is a protective factor for total muscle strength and female muscle strength. There are inconsistent effects between different lipid metabolites, triacylglycerol, and muscle strength and muscle mass.

CONCLUSIONS

There was a causal relationship between 27 lipid metabolites and sarcopenia traits, and targeting specific lipid metabolites may benefit sarcopenia diagnosis, disease assessment, and treatment.

Impact of imaging-diagnosed sarcopenia on outcomes in patients with biliary tract cancer after surgical resection: a systematic review and meta-analysis

BACKGROUND AND AIMS

Sarcopenia has been associated with poor prognosis in patients with malignant tumors. However, its impact on the outcomes of patients with biliary tract cancer (BTC) undergoing surgical resection remains unclear and warrants further review. This study aims to summarize the available evidence on this issue.

METHODS

A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for eligible studies up to March 10, 2024. We extracted data on overall survival (OS), recurrence free survival (RFS), and postoperative major complications from the included studies as the outcomes of interest. Following data synthesis and analysis, we assessed the heterogeneity and performed subgroup analyses. Additionally, the potential for publication bias was evaluated.

RESULTS

A total of 26 studies involving 4292 BTC patients were ultimately retrieved. The findings indicated that sarcopenia was significantly associated with reduced OS in BTC patients after surgery (adjusted HR: 2.03, 95% CI: 1.65-2.48, P < 0.001, I2 = 57.4%). Moreover, sarcopenia may also be linked to poorer RFS (adjusted HR: 2.15, 95% CI: 1.79-2.59, P < 0.001, I2 = 0%) and increased postoperative major complications (OR: 1.22, 95% CI 1.02-1.47, P = 0.033, I2 = 29.2%) as well. Notably, no significant publication bias was detected through funnel plots and Egger's tests.

CONCLUSION

Sarcopenia is associated with poorer OS in BTC patients following surgery. Additionally, it may serve as a prognostic indicator for poorer RFS and increased postoperative major complications. Further studies are warrant to standardize existing definitions and validate these findings.

Sarcopenic Obesity and Cardiovascular Disease: An Overlooked but High-Risk Syndrome

PURPOSE OF REVIEW

Sarcopenic obesity (SO), defined as the coexistence of excess fat mass and reduced skeletal muscle mass and strength, has emerged as an important cardiovascular risk factor, particularly in older adults. This review summarizes recent findings on the diagnosis, prevalence, health impacts, and treatment of SO.

RECENT FINDINGS

Growing evidence suggests SO exacerbates cardiometabolic risk and adverse health outcomes beyond either condition alone; however, the heterogeneity in diagnostic criteria and the observational nature of most studies prohibit the evaluation of a causal relationship. This is concerning given that SO is increasing with the aging population, although that is also difficult to assess accurately given wide-ranging prevalence estimates. A recent consensus definition proposed by the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity provides a framework of standardized criteria to diagnose SO. Adopting uniform diagnostic criteria for SO will enable more accurate characterization of prevalence and cardiometabolic risk moving forward. Although current management revolves around diet for weight loss coupled with resistance training to mitigate further muscle loss, emerging pharmacologic therapies have shown promising results. As the global population ages, diagnosing and managing SO will become imperative to alleviate the cardiovascular burden.

Impact of Sarcopenia on Post-Liver Transplant Hospitalization: Insights From a South Asian Cohort

BACKGROUND

Sarcopenia's impact on post-liver transplant outcomes remains a subject of debate, with limited data from South Asia on its association with post-liver transplant hospital stays. This study aims to investigate sarcopenia's influence on post-transplant hospitalization duration in South Asians.

METHODS

In this retrospective study, patients with liver cirrhosis who underwent living-donor liver transplantation (LDLT) at Shifa International Hospital in Islamabad, Pakistan, between January 2022 and January 2023 were included. Computed tomography (CT) images were used to assess the skeletal muscle index (SMI). The areas of the psoas, erector spinae, multifidus, quadratus lumborum, rectus abdominis, transverse abdominis, and internal/external oblique muscles were quantified at the level of L3. The data were analyzed using SPSS version 29.0 (IBM).

RESULTS

There was a total of 84 patients. Mean age was 47.4 ± 12.0 years. There were 62 (73.8%) male patients and 22 (26.2%) female patients. Hepatitis C was noted in 36 (42.9%) patients. Twenty-two (26.2%) patients had hepatocellular carcinoma. Sarcopenia was identified in 58 (69.0%) patients. No significant association was observed between sarcopenia and intensive care unit (ICU) or general floor stays. Regression analysis identified pre-transplant model for end-stage liver disease-sodium (MELD-Na) score as the sole significant factor associated with both ICU and total length of stay (P value .002; P value .009).

CONCLUSION

In our population, sarcopenia did not correlate with post-transplant ICU or overall hospital stay. The pre-transplant MELD-Na score emerged as the most influential predictor of length of stay. Therefore, delaying liver transplant procedures based on muscle mass estimations may not be a practical clinical approach for South Asian patients.

Research Progress on Patients of Esophageal Cancer Complicated with Sarcopenia

Aims/Background The application of immunochemotherapy has significantly enhanced the quality of life and overall survival of patients with esophageal cancer. Sarcopenia, which is increasingly prevalent in these patients, markedly affects prognosis, but can be reversed by appropriate and effective treatment. Methods The narrative review was conducted on PubMed using the keywords ("esophageal" or "esophagus" and "sarcopenia"). Results This article reviews the measurement, timing, and intervention strategies for sarcopenia in patients with esophageal cancer. It summarizes the evaluation indicators of skeletal muscle loss in these patients, analyzes the barriers to intervention for frailty among esophageal cancer patients, and proposes corresponding countermeasures. Conclusion Patients with esophageal cancer often suffer from severe sarcopenia. Clinical intervention is crucial in addressing this issue.

Evaluating the efficacy of immunotherapy in gastric cancer: Insights from immune checkpoint inhibitors

The emergence of immunotherapy, particularly immune checkpoint inhibitors (ICIs), represents a groundbreaking approach to treating gastric cancer (GC). However, the prognosis of GC patients receiving ICI treatment is influenced by various factors. This manuscript identified sarcopenia and myosteatosis as inde-pendent prognostic factors impacting the outcomes of GC patients treated with ICIs. Additionally, this study introduced a visual predictive model to estimate the prognosis of GC patients. If confirmed by further studies, this observation could provide valuable insights to propel the advancement of personalized clinical medicine and the integration of precision medicine practices.

The prevalence of sarcopenia and risk factors in the older adult in China: a systematic review and meta-analysis

Background

Understanding the epidemiological information of a certain disease is the first step in related prevention and control work. This article aims to understand the prevalence and associated risk factors of sarcopenia among the older adult (≥60 years old) in China and to provide an evidence-based basis for early identification, management, and prevention of sarcopenia patients.

Methods

We searched seven databases: CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, and Cochrane Library databases from the establishment of the database until January 31, 2024. The Quality evaluation criteria of cross-sectional studies recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for literature quality evaluation. Stata 18.0 software was used for statistical analysis.

Results

We finally included 45 studies, involving a total of 37,571 cases. After statistical analysis, we found that the prevalence of sarcopenia among the older adult in China was 20.7% [95% CI (18.3, 23.0%)]. The results of subgroup analysis suggest that: ① According to gender, the prevalence rate of sarcopenia in women (21.6%) is higher than that in men (19.2%); ② According to age, the prevalence rate of older adult people aged ≥80 (45.4%) was the highest, followed by 70-79 (27.2%) and 60-69 (15.7%). ③ According to region, the prevalence rate of the older adult in the south (21.7%) is higher than that in the north (19.0%); ④ According to the time of publication, the prevalence of sarcopenia among the older adult in China has increased (from 19.2% in 2014-2018 to 21.4% in 2019-2024); ⑤ According to the diagnostic criteria, the detection rate of AWGS (2019) is higher than that of AWGS (2014) (24.5% vs. 19.3%). Finally, aging, low BMI, low leg circumference, smoking, depression, osteoporosis, malnutrition and malnutrition risk are all risk factors for sarcopenia among the older adult in China.

Conclusion

The prevalence of sarcopenia in the older adult in China was higher (20.7%), which should be paid attention to by relevant health authorities. In addition, aging, low BMI, low calf circumference, smoking, depression, osteoporosis, malnutrition and malnutrition risk are risk factors for the development of sarcopenia in the older adult in China. For these high-risk populations, early identification, prevention, and intervention can be carried out to delay the occurrence and progression of sarcopenia.

Association between serum cotinine and muscle mass: results from NHANES 2011-2018

PURPOSE

Recently, the detrimental effect of cigarette smoking on muscle metabolism has attracted much attention, but the relationship between cigarette smoking and muscle mass is poorly understood. Thus, this study investigated the association between exposure to cigarette smoke, defined based on serum cotinine, and muscle mass in the US population.

METHODS

We utilized National Health and Nutrition Examination Survey (NHANES) data between 2011 and 2018 for analysis. Data on serum cotinine, muscle mass (quantified by appendicular skeletal muscle mass index, ASMI), and covariates were extracted and analyzed. Weighted multivariate linear regression analyses and smooth curve fittings were performed to investigate the association between serum cotinine and ASMI. Subgroup analyses were stratified by gender, race and smoking status. When nonlinearity was detected, the threshold effects were analyzed using a two-piecewise linear regression model.

RESULTS

In total, 8004 participants were included for analysis. The serum level of cotinine was negatively associated with ASMI in the fully adjusted model. Furthermore, comparing participants in the highest vs. the lowest tertile of serum cotinine, we found that ASMI decreased by 0.135 Kg/m2. In subgroup analysis stratified by gender and race, the association between serum cotinine and ASMI remained significant in all genders and races. In addition, the association remained significant among current and former smokers, but not among those who never smoked. Smooth curve fittings showed nonlinear relationships between serum cotinine and ASMI, with the inflection points identified at 356 ng/mL.

CONCLUSIONS

Our study revealed that serum cotinine was negatively related to muscle mass. This finding improves our understanding of the deleterious effects of cigarette smoking on muscle mass and highlights the importance of smoking cessation for muscle health.

Health effect of multiple air pollutant mixture on sarcopenia among middle-aged and older adults in China

BACKGROUND

As the global aging process accelerates, the health challenges posed by sarcopenia among middle-aged and older adults are becoming increasingly prominent. However, the available evidence on the adverse effects of air pollution on sarcopenia is limited, particularly in the Western Pacific region. This study aimed to explore relationships of multiple air pollutants with sarcopenia and related biomarkers using the nationally representative database.

METHODS

Totally, 6585 participants aged over 45 years were enrolled from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 3443 of them were followed up until 2015. Air pollutants were estimated from high-resolution satellite-based spatial-temporal models. In the cross-sectional analysis, we used generalized linear regression, unconditional logistic regression analytical and restricted cubic spline (RCS) methods to assess the single-exposure and non-linear effects of multiple air pollutants on sarcopenia and related surrogate biomarkers (serum creatinine and cystatin C). Several popular mixture analysis techniques such as Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression, and quantile-based g-computation (Qgcomp) were further used to examinate the combined effects of multiple air pollutants. Logistic regression was used to further analyze the longitudinal association between air pollution and sarcopenia.

RESULTS

Each interquartile range increase in PM2.5, PM10 and NO2 was significantly associated with an increased risk of sarcopenia, with adjusted odds ratios (aORs) of 1.09 [95 % confidence interval (CI): 1.01, 1.20], 1.24 (95 % CI: 1.14, 1.35) and 1.18 (95 % CI: 1.08, 1.28), respectively. Our findings also showed that five air pollutants were significantly associated with the sarcopenia index. In addition, employing a mixture analysis approach, we confirmed significant combined effects of air pollution mixtures on sarcopenia risk and associated biomarkers, with PM10 and PM2.5 identified as major contributors to the combined effect. The results of the exposure-response (E-R) relationships, subgroup analysis, longitudinal analysis and sensitivity analysis all showed the unfavorable impact of air pollution on sarcopenia risk and related vulnerable populations.

CONCLUSIONS

Single-exposure and co-exposure to multiple air pollutants were positively associated with sarcopenia among middle-aged and older adults in China. Our study provided new evidence that air pollution mixture was significantly associated with sarcopenia related biomarkers.

Assessing Sarcopenia in Advanced-Stage Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Case Series

OBJECTIVES

In ovarian and other cancers, low muscle mass and density are associated with poorer clinical outcomes. However, screening for cancer-related sarcopenia (typically defined as low muscle mass) is not routinely conducted. The European Working Group on Sarcopenia in Older People (EWGSOP) recommends an algorithm for sarcopenia screening and diagnosis in clinical settings, with sarcopenia based on muscle strength and mass, and severity on physical performance. We explored the application of the EWGSOP2 algorithm to assess sarcopenia in six ovarian cancer patients receiving neoadjuvant chemotherapy.

METHODS

We assessed sarcopenia risk with the SARC-F screening questionnaire (at risk ≥4 points), muscle strength with a handgrip strength test (cut point <16 kg) and five times sit-to-stand test (cut point >15 s), muscle mass by skeletal muscle index (SMI in cm2/m2 from a single computed tomography [CT] image; cut point <38.5 cm2/m2), and physical performance with a 4-m gait speed test (cut point ≤0.8 m/s).

RESULTS

Of six participants, none were identified as "at risk" for sarcopenia based on SARC-F scores. Two participants were severely sarcopenic based on EWGSOP2 criteria (had low muscle strength, mass, and physical performance), and five participants were sarcopenic based on muscle mass only.

DISCUSSION

Ovarian cancer patients with low muscle mass during neoadjuvant chemotherapy may not be identified as sarcopenic based on the EWGSOP2 diagnostic algorithm. While lacking a universally accepted definition for cancer-related sarcopenia and cancer-specific recommendations for the screening, diagnosis, and treatment of sarcopenia, ovarian cancer clinicians should focus on the diagnosis and treatment of low muscle mass and density.

Sarcopenic obesity and pre-sarcopenia contribute to frailty in community-dwelling Italian older people: data from the FRASNET study

BACKGROUND

The ageing process is characterized by a change of body composition with an increase of fat mass and a reduction of muscle mass. Above a certain threshold these alterations configure a condition named sarcopenic obesity (SO). SO is associated with physical frailty in Asian and Brazilian populations. SO impacts on physical frailty in other ethnic groups but its influence on general frailty which is multidimensional and includes cognitive, social and physical factors, remain insufficiently explored in the Italian population.

METHODS

Frailty was measured in community dwelling Italian older adults enrolled in the FRASNET study with the frailty index (FI). The FI quantifies frailty as the ratio of the number of present health deficits to the total number of health deficits considered. Regression analyses were performed to assess the association between body composition categories and frailty. Classification and regression tree models were run to evaluate the frailty predictors.

RESULTS

One Thousand One Hundred Fourteen participants of the FRASNET study were included in the present analysis. The sample was composed for the 60.5% by females and its median age was 72 years. The median FI score was 0.11 (IQR 0.07-0.20); 234 individuals (21%) were frail (FI ≥ 0.25). SO (B 0.074, 95% C.I. 0.05-0.1, p < 0.001) and pre-sarcopenia (without obesity B 0.03, 95% C.I, 0.007-0.044, p < 0.001, with obesity B 0.11, 95% C.I. 0.05-0.16, p < 0.001) were associated with frailty. Fat mass percentage predicted frailty in people aged 65-70 years whereas, muscle strength predicted general frailty in people aged 70-81 years.

CONCLUSION

Pre-sarcopenia and SO represent potentially treatable predictors of frailty.

Skeletal Muscle Index-Based Cachexia Index as a Predictor of Prognosis in Patients With Cancer: A Meta-Analysis and Systematic Review

CONTEXT

Cachexia is associated with poor survival rates. In the clinical setting, the diagnosis of cancer cachexia is challenging. The cachexia index (CXI), a new index for predicting survival time, is a promising tool for diagnosing cancer cachexia; however, its efficacy in predicting patient survival has not been validated.

OBJECTIVE

This meta-analysis and systematic review aimed to explore the CXI's prognostic value in patients with cancer.

DATA SOURCES

The PubMed, Embase, MEDLINE, and Cochrane Library databases were searched for relevant studies to determine the association between CXI findings and prognosis.

DATA EXTRACTION

The outcomes were overall survival (OS), progression-, disease-, and recurrence-free survival (PFS/DFS/RFS) rates, and the rate of complete response.

DATA ANALYSIS

The QUality In Prognostic Studies (QUIPS) tool was used to evaluate the quality of the included trials. This meta-analysis comprised 14 studies involving 2777 patients. A low CXI was associated with decreased OS (hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.01-2.72; P < .001), PFS/DFS/RFS (HR 1.93, 95% CI 1.68-2.22; P < .001), and complete response (odds ratio [OR] 0.49, 95% CI 0.36-0.66; P < .001). Patients with a low CXI had a lower body mass index (mean difference [MD] -0.75, 95% CI -1.00 to 0.50; P < .001), skeletal muscle index (standardized MD -0.80, 95% CI -0.98 to -0.61; P < .001), and serum albumin level (MD -0.23, 95% CI -0.26 to -0.20; P < .001); and a higher neutrophil-lymphocyte ratio (MD 1.88, 95% CI 1.29-2.47; P < .001) and more advanced disease stages (OR 0.80, 95% CI 0.71-0.91; P = .001).

CONCLUSION

A low CXI was found to be associated with poor survival in patients with cancer. While the CXI is a promising marker for predicting cancer cachexia, further studies are required to verify its usefulness.

Association between sleep duration and possible sarcopenia in middle-aged and elderly Chinese individuals: evidence from the China health and retirement longitudinal study

BACKGROUND

Sarcopenia is a common cause of disability in the aging population, and managing sarcopenia is an important step in building intrinsic capacity and promoting healthy aging. A growing body of evidence suggests that sleep deprivation may be a mediator of the development of sarcopenia. The purpose of this study was to explore the longitudinal association between sleep duration and possible sarcopenia using data from a national sample.

METHODS

Two waves of data from the CHARLS database for 2011 and 2015 were used in this study. All possible sarcopenia participants met the Asia Working Group for Sarcopenia 2019 (AWGS 2019) diagnostic criteria. Sleep duration was assessed using a self-report questionnaire, and sleep duration was categorized as short (≤ 6 h), medium (6-8 h), or long (> 8 h) based on previous studies. Longitudinal associations between sleep duration and possible sarcopenia will be calculated by univariate and multifactorial logistic regression analyses and expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 5654 individuals participated in the follow-up study, with a prevalence of possible sarcopenia of 53.72% (578) in the short sleep duration group, 38.29% (412) in the medium sleep duration group, and 7.99% (86) in the long sleep duration group. According to the crude model of the second-wave follow-up study, short sleep durations were significantly more strongly associated with possible sarcopenia than were medium and long sleep durations (OR: 1.35, 95% CI: 1.17-1.55, P = 0.000). The association between short sleep duration and possible sarcopenia was maintained even after adjustment for covariates such as age, gender, residence, education level, BMI, smoking status, alcohol consumption and comorbidities (OR: 1.18, 95% CI: 1.02-1.36, P = 0.029). In the subgroup analysis, short sleep duration was associated with low grip strength (OR: 1.20, 95% CI: 1.02-1.41, P = 0.031).

CONCLUSIONS

Sleep deprivation may be closely associated with the development of possible sarcopenia in middle-aged and elderly people, which provides new insights and ideas for sarcopenia intervention, and further studies are needed to reveal the underlying mechanisms involved.

Differential Effects of Three Medium-Chain Fatty Acids on Mitochondrial Quality Control and Skeletal Muscle Maturation

Nutritional interventions are one focus of sarcopenia treatment. As medium-chain fatty acids (MCFAs) are oxidized in the mitochondria and produce energy through oxidative phosphorylation (OXPHOS), they are key parts of nutritional interventions. We investigated the in vitro effects of three types of MCFA, caprylic acid (C8), capric acid (C10), and lauric acid (C12), in skeletal muscle cells. Compared with C10 and C12, C8 promoted mitophagy through the phosphatase and tensin homolog (PTEN)-induced kinase 1-Parkin pathway and increased the expression of peroxisome proliferator-activated receptor gamma coactivator 1-α and dynamin-related protein 1 to reduce mitochondrial oxidative stress and promote OXPHOS. Furthermore, the expression of myogenic differentiation 1 and myosin heavy chain increased in myotubes, thus promoting muscle differentiation and maturation. These results suggest that C8 improves mitochondrial quality and promotes skeletal muscle maturation; in contrast, C10 and C12 poorly promoted mitochondrial quality control and oxidative stress and suppressed energy production. Future animal experiments are required to establish the usefulness of C8 for nutritional interventions for sarcopenia.

[Nephroprotection: General principles and application to the patients with cancers - when nephroprotection is essential for oncological care plan]

Nephroprotection is a set of recommendations that aim to prevent the risks of acute and/or chronic renal failure and to limit the progression of renal failure towards an end stage. Nephroprotection is not limited to nephrology and applies to all patients at risk of renal failure. Cancer patients are particularly at risk of developing intrinsic and extrinsic renal failure, as well as the toxicity of specific treatments. However, they are poorly included in nephroprotection studies. Thus, current guidelines have not been adapted to these pathologies and oncology-specific comorbidities, such as malnutrition or prognosis, are often not taken into account. In this article, we review the established recommendations by transposing them to the cancer patient as a whole. In addition to the reminder of hygiene and dietary rules to control blood pressure and diabetes, we discuss the importance of therapeutic education, iatrogeny and treatment options to control renal failure in this context. The lack of clearly established data in cancer confirms the needs to strengthen links between oncologists, hematologists and nephrologists and reinforces the emergence of onco-nephrology as a new discipline.

Nutritional Status and Body Composition at Diagnosis, of South Indian Children with Acute Lymphoblastic Leukaemia (ALL)

BACKGROUND

Accurate estimation of body composition, particularly, Body Cell Mass (BCM), which is independent of hydration status is important in children with cancer. This study aimed to accurately measure the anthropometry and body composition of children with Acute Lymphoblastic Leukaemia (ALL) at diagnosis and compare them with healthy children from South India.

METHODS

This was a cross-sectional study in children aged 2 to 8 y with ALL from St. John's Medical College Hospital, Bengaluru, and age and sex-matched, normal-weight children recruited as controls from communities. Anthropometry (weight, height, circumferences), skinfolds and body composition measurements using a whole-body potassium counter were performed. Body mass index-for-age, weight and height for age z-scores were calculated using WHO child growth standards. Biochemical markers, dietary intake and physical activity details were recorded. Categorical and continuous variables were analyzed by chi-square and independent t-tests respectively.     Results: The mean age of the children with ALL (n = 39) was 4.6±1.9 y and control group (n=39) was 4.7±1.9 y; 61.5% were boys. The prevalence of underweight, overweight/obesity and stunting were 17.9%, 7.7%, and 10.3% respectively. The mean weight and height, of children with ALL and children in the control group were 16.8±6.2 kg and 16.4±4.1 kg, 104.3±14.9 cm and 105.1±12.2 cm, respectively with no statistical difference. Children with ALL showed lower body cell mass index kg/m2 (4.6± 0.8), compared to children in the control group (4.7±0.9) p=0.527, but higher fat mass index kg/m2 (3.6±1.1 vs. 3.4±0.8) p=0.276.

CONCLUSION

At diagnosis, anthropometric and body composition measurements were similar between children with ALL and children in the control group. The BCM showed a non-significant trend of being lower in children with ALL, which requires close monitoring during treatment. Evaluating early-stage nutritional status and body composition can help in planning appropriate interventions during treatment to prevent long term non-communicable diseases.

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND

Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent.

AIM

To assess the influence of sarcopenia on outcomes in patients undergoing PD.

METHODS

The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.

RESULTS

Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding.

CONCLUSION

Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.

Causal effect of sarcopenia-related traits on the occurrence and prognosis of breast cancer - A bidirectional and multivariable Mendelian randomization study

Introduction

Background and aims: although sarcopenia is associated with several types of cancer, there is limited research regarding its effect on breast cancer. We aimed to explore the causality between sarcopenia-related traits and the incidence and prognosis of breast cancer. Methods: two-sample bidirectional and multivariate Mendelian randomization (MR) analyses were utilized in this study. Genome-wide association studies were used to genetically identify sarcopenia-related traits, such as appendicular lean mass, grip strength of both hands, and walking pace. Data on the incidence and prognosis of breast cancer were collected from two extensive cohort studies. Multivariate MR analysis was used to adjust for body mass index, waist circumference, and whole-body fat mass. The primary method used for analysis was inverse-variance weighted analysis. Results: a significant association was found between appendicular lean mass and ER- breast cancer (OR = 0.873, 95 % CI: 0.817-0.933, p = 6.570 × 10-5). Increased grip strength of the left hand was associated with a reduced risk of ER- breast cancer (OR = 0.744, 95 % CI: 0.579-0.958, p = 0.022). Stronger grip strength of the right hand was associated with prolonged survival time of ER+ breast cancer patients (OR = 0.463, 95 % CI: 0.242-0.882, p = 0.019). In the multivariable MR analysis, appendicular lean mass, grip strength of both hands, and walking pace were still genetically associated with the development of total breast cancer and ER-/+ breast cancer. Conclusions: several sarcopenia-related traits were genetically associated with the occurrence and prognosis of breast cancer. It is crucial for elderly women to increase their strength and muscle mass to help prevent breast cancer.

Use of 3D-CT-derived psoas major muscle volume in defining sarcopenia in colorectal cancer

BACKGROUND

Sarcopenia is characterized by reduced skeletal muscle volume and is a condition that is prevalent among elderly patients and associated with poor prognosis as a comorbidity in malignancies. Given the aging population over 80 years old in Japan, an understanding of malignancies, including colorectal cancer (CRC), complicated by sarcopenia is increasingly important. Therefore, the focus of this study is on a novel and practical diagnostic approach of assessment of psoas major muscle volume (PV) using 3-dimensional computed tomography (3D-CT) in diagnosis of sarcopenia in patients with CRC.

METHODS

The subjects were 150 patients aged ≥ 80 years with CRC who underwent primary tumor resection at Juntendo University Hospital between 2004 and 2017. 3D-CT measurement of PV and conventional CT measurement of the psoas major muscle cross-sectional area (PA) were used to identify sarcopenia (group S) and non-sarcopenia (group nS) cases. Clinicopathological characteristics, operative results, postoperative complications, and prognosis were compared between these groups.

RESULTS

The S:nS ratios were 15:135 for the PV method and 52:98 for the PA method. There was a strong positive correlation (r = 0.66, p < 0.01) between PVI (psoas major muscle volume index) and PAI (psoas major muscle cross-sectional area index), which were calculated by dividing PV or PA by the square of height. Surgical results and postoperative complications did not differ significantly in the S and nS groups defined using each method. Overall survival was worse in group S compared to group nS identified by PV (p < 0.01), but not significantly different in groups S and nS identified by PA (p = 0.77). A Cox proportional hazards model for OS identified group S by PV as an independent predictor of a poor prognosis (p < 0.05), whereas group S by PA was not a predictor of prognosis (p = 0.60).

CONCLUSIONS

The PV method for identifying sarcopenia in elderly patients with CRC is more practical and sensitive for prediction of a poor prognosis compared to the conventional method.

Evaluation of Sarcopenia in Patients with Monoclonal Gammopathy of Undetermined Significance

Background: We aimed to determine the prevalence of sarcopenia in patients with monoclonal gammopathy of undetermined significance (MGUS) and to evaluate the links between MGUS and sarcopenia. Methods: Eighty-two patients with a diagnosis of MGUS were enrolled in the study. Muscle strength was measured using the handgrip dynamometer. Physical performance was assessed by assessing gait speed over a 6-minute walking test. Muscle mass was determined using a bioelectrical impedance analyzer. Results: Sarcopenia was confirmed in 34.15% of patients. Male predominance was demonstrated in MGUS subjects with sarcopenia, particularly patients with low hand grip strength, low appendicular skeletal muscle mass (ASMM), or low ASMM index (p < 0.001, 0.013, and 0.001, respectively). Higher age and lower serum free light-chain Lambda levels were shown in MGUS patients with low muscle function scores compared to normal scores (p < 0.001, and 0.014, respectively). In addition, having a low ASMM score was related to low body mass index and high-risk group (p = 0.020, 0.033, respectively). Conclusions: We demonstrated that the frequency of sarcopenia is high in patients with MGUS. Whether sarcopenia has a possible role as a factor contributing to the pathogenesis of MGUS should be supported by further studies containing longitudinal data.

Does hip protector prevent falls and hip fractures? An umbrella review of meta-analyses

BACKGROUND

Wearing hip protectors is a measure used to prevent hip fractures caused by falls. However, its protective effect has remained controversial in previous studies. This study provides a rationale for the use of hip protectors by pooling all the current meta-analysis evidence.

METHODS

We conducted an umbrella review of all the current meta-analysis articles about the efficacy of hip protectors to reduce hip fractures and falls in communities and/or institutions. Major databases including EMBASE, Cochrane Library, PubMed and Web of Science, were searched up to June 2022. Two reviewers screened the studies, extracted the data, and conducted the methodological quality assessment independently. The primary outcome was the association statistic (odds ratio (OR), relative risk (RR), etc.) reported in the meta-analysis that quantified the influence of the intervention on hip fractures and falls compared to that of the control group. Narrative synthesis was also conducted. Forest plots and the AMSTAR score were used to describe the results and quality of the pooled literature, respectively.

RESULTS

A total of six meta-analysis articles were included in the study. Hip protectors were effective at reducing hip fractures in older individuals who were in institutions (nursing or residential care settings) but not in communities (RR = 0.70, 95% CI 0.58 to 0.85, I2 = 42%, P < 0.001) (RR = 1.12, 95% CI 0.94 to 1.34, I2 = 0%, P = 0.20), and they did not reduce falls (RR = 1.01, 95% CI 0.90 to 1.13, I2 = 0%, P = 0.89).

CONCLUSIONS

Hip protectors are effective at preventing hip fractures in institutionalized older adults but not in community-dwelling older adults.

TRIAL REGISTRATION

This study has been registered in PROSPERO (PROSPERO ID: CRD42022351773).

The Feasibilty of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Programme in Patients with Sarcopenia: A Pilot Study

Objectives

The objective of this pilot study was to investigate the feasibility of a three month 'Motor control Home ergonomics Elderlies' Prevention of falls' (McHeELP) programme on muscle mass, muscle strength, functionality, balance and fear of falling among older adults with sarcopenia.

Methods

A feasibility study of the McHeELP programme was performed in patients with sarcopenia. Primary outcome measures included number of participants; number of participants that showed engagement with the programme; adherence rates; data loss in questionnaires and secondary outcome measures; any adverse events, related or not to the intervention programme. All participants received a home-based motor control exercise programme combined with an ergonomic home modification for 12 weeks. Secondary outcome measures included Hand Grip Strength, Bioimpendance Analysis, Muscle Mass, Functionality and Fear of Falling.

Results

Twelve participants, (74.9±5 years), completed the pilot study. Significant differences were recorded before and after the programme on participants' functionality (p < 0.001), balance (p < 0.05) and fear of falling (p < 0.001).

Conclusions

The present study revealed that the McHeELP programme is fesasible and that it is possible to implement the programme in clinical practice. The McHeELP programme positively affects functionality, balance and fear of falling. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Sarcopenia: A dive into metabolism to promote a multimodal, preventive, and regenerative approach

Sarcopenia, the age-related loss of skeletal muscle mass and function, poses a significant challenge in the field of geriatrics and gerontology, impacting the health and independence of older adults. Understanding and addressing sarcopenia is crucial for optimizing clinical outcomes and enhancing the quality of life along with aging. By synthesizing current research findings and theoretical frameworks, this review elucidates the multifaceted mechanisms underlying sarcopenia, mainly focusing on energy balance and metabolic processes. Furthermore, the manuscript explores the implications of sarcopenia on overall health outcomes, functional decline, and quality of life in older individuals. The study concludes with a perspective on the role of preventive and regenerative medicine in sarcopenia, where the two main lifestyle pillars (exercise and diet) represent key factors.

Clinimetric Properties of the Chinese Short Form of the Sarcopenia Quality of Life Questionnaire in Patients With Cancer

BACKGROUND

Sarcopenia, prevalent in patients with cancer, negatively affects quality of life. However, generic tools are unable to capture the minor effects of sarcopenia on quality of life. The short-form version of the Sarcopenia Quality of Life (SF-SarQoL) questionnaire was developed as an efficient tool to assess the impact of sarcopenia on quality of life in older adults. However, its clinimetric properties in patients with cancer remain unknown.

PURPOSE

This study was designed to examine the clinimetric properties of the Chinese SF-SarQoL in patients with colorectal cancer, particularly with regard to its ability to detect changes in quality of life.

METHODS

A longitudinal survey was conducted using the SF-SarQoL and other questionnaires on 408 patients with colorectal cancer planning to undergo surgery. Follow-up was subsequently conducted on 341 of these patients 1 month after surgery. The clinimetric properties of the SF-SarQoL were examined, including reliability (internal consistency), validity (construct validity, concurrent validity), sensitivity (ability to detect changes, discriminative ability), and floor and ceiling effects.

RESULTS

The internal consistency of the SF-SarQoL was found to be acceptable (Cronbach's alpha = .94 and McDonald's omega = .94). Strong scalability of the total score and each item was confirmed using Mokken analysis. Concurrent validity analyses indicate the SF-SarQoL is significantly correlated with muscle-related and health-related questionnaire scores. The SF-SarQoL showed adequate sensitivity due to its good ability to detect changes in quality of life with a moderate effect size (Cohen's d = 0.56) and discriminate between sarcopenic and nonsarcopenic patients (area under the curve = 0.73, 95% CI [0.66, 0.79]) using receiver operating characteristic curve analyses. No floor or ceiling effects were observed.

CONCLUSIONS

The Chinese SF-SarQoL exhibits good clinimetric properties in preoperative patients with colorectal cancer and is sufficiently sensitive to capture changes in quality of life after surgery.

CT-determined low skeletal muscle index predicts poor prognosis in patients with colorectal cancer

BACKGROUND

Sarcopenia is highly prevalent among patients with colorectal cancer (CRC). Computed tomography (CT)-based assessment of low skeletal muscle index (SMI) is widely used for diagnosing sarcopenia. However, there are conflicting findings on the association between low SMI and overall survival (OS) in CRC patients. The objective of this study was to investigate whether CT-determined low SMI can serve as a valuable prognostic factor in CRC.

METHODS

We collected data from patients with CRC who underwent radical surgery at our institution between June 2020 and November 2021. The SMI at the third lumbar vertebra was calculated using CT scans, and the cutoff values for defining low SMI were determined using receiver operating characteristic curves. Univariate and multivariate analyses were performed to assess the associations between clinical characteristics and postoperative major complications.

RESULTS

A total of 464 patients were included in the study, 229 patients (46.7%) were classified as having low SMI. Patients with low SMI were older and had a lower body mass index (BMI), a higher neutrophil to lymphocyte ratio (NLR), and higher nutritional risk screening 2002 (NRS2002) scores compared to those with normal SMI. Furthermore, patients with sarcopenia had a higher rate of major complications (10.9% vs. 1.3%; p < 0.001) and longer length of stay (9.09 ± 4.86 days vs. 8.25 ± 3.12 days; p = 0.03). Low SMI and coronary heart disease were identified as independent risk factors for postoperative major complications. Moreover, CRC patients with low SMI had significantly worse OS. Furthermore, the combination of low SMI with older age or TNM stage II + III resulted in the worst OS in each subgroup analysis.

CONCLUSIONS

CT-determined low SMI is associated with poor prognosis in patients with CRC, especially when combined with older age or advanced TNM stage.

Lacticaseibacillus paracasei LC86 mitigates age-related muscle wasting and cognitive impairment in SAMP8 mice through gut microbiota modulation and the regulation of serum inflammatory factors

Purpose

Chronic inflammation contributes to the decline in muscle strength and cognitive abilities associated with aging. This study aims to clarify the effects of oral administration of Lacticaseibacillus paracasei LC86 on these age-related declines, as well as its impact on the composition of gut microbiota.

Methods

Senescence-accelerated mouse prone 8 (SAMP8) mice received a 12 week regimen of LC86 (1 × 109 CFU/day). Muscle strength was assessed through forelimb grip strength and four-limb hanging tests. Cognitive function was evaluated through behavioral performance tests, and changes in gut microbiota were analyzed.

Results

Administration of LC86 significantly enhanced muscle strength, demonstrated by increased grip strength and higher glycogen content in the gastrocnemius muscle (p = 0.041, p = 0.017, and p = 0.000, respectively). Behavioral tests suggested that LC86 mitigated age-related cognitive decline. Furthermore, there was a significant decrease in serum pro-inflammatory cytokines, such as IL-6, TNF-α, and MCP-1 (p = 0.002, p = 0.000, and p = 0.005, respectively), and an elevation in the anti-inflammatory cytokine IL-10 level (p = 0.000). An increase in hepatic antioxidant capacity was observed. Significant changes in the gut microbiota composition were noted, including increased populations of Bifidobacterium and Lactobacillus and decreased levels of Escherichia/Shigella and Bacteroides.

Conclusion

The findings suggest that LC86 supplementation mitigates muscle weakness and cognitive impairment in aging SAMP8 mice, potentially through the modulation of inflammation and gut microbiota composition. LC86 emerges as a promising candidate for ameliorating the decline of muscular and cognitive functions associated with aging.

Causal association of sarcopenia with hepatocellular carcinoma risk in European population: a Mendelian randomization study

Background

The causal association of sarcopenia with the incidence risk of hepatocellular carcinoma (HCC) in the European population, and the potential mediating role of C-reactive protein (CRP), remains unclear. This study employed a bidirectional two-sample, two-step Mendelian randomization (MR) analysis to investigate the causality and identify the mediator.

Methods

Summary statistics for HCC, CRP, and sarcopenia-related traits, including appendicular lean mass (ALM), hand grip strength (HGS), and walking pace (WP), were acquired from publicly available databases. We conducted bidirectional MR and Steiger tests of directionality to check the presence of reverse causality. Additionally, a two-step MR analysis was used to assess the mediating effect of CRP in the causality between sarcopenia and HCC. Tests for heterogeneity and horizontal pleiotropy were performed.

Results

As ALM increases, the risk of HCC occurrence decreases [odds ratio (OR), 95% confidence interval (CI): 0.703, 0.524-0.943; P = 0.019]. And, genetically predicted low-HGS (OR, 95%CI: 2.287, 1.013-5.164; P = 0.047) was associated with an increased incidence risk of HCC, with no reverse causality. However, we found no evidence supporting a causality between WP and HCC. CRP was identified as the mediator of the causal effect of ALM and low-HGS on HCC, with corresponding mediating effects of 9.1% and 7.4%.

Conclusions

This MR study effectively demonstrates that lower ALM and low-HGS are linked to an elevated risk of HCC within the European population, and the causality was not bidirectional. Furthermore, CRP serves as a mediator in the associations. These findings may help mitigate HCC risk among individuals with sarcopenia.

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk

BACKGROUND

A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures.

METHODS

Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia.

RESULTS

A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women.

CONCLUSIONS

Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Systemic immune-inflammation index and all-cause and cause-specific mortality in sarcopenia: a study from National Health and Nutrition Examination Survey 1999-2018

Background

Sarcopenia, common in the elderly, often linked to chronic diseases, correlates with inflammation.The association between SII and mortality in sarcopenia patients is underexplored, this study investigates this relationship in a U.S. adult cohort.

Methods

We analyzed 1999-2018 NHANES data, focusing on 2,974 adults with sarcopenia. Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31, 2019. Using a weighted sampling design, participants were grouped into three groups by the Systemic Immune-Inflammation Index (SII). We used Cox regression models, adjusting for demographic and clinical variables, to explore SII's association with all-cause and cause-specific mortality in sarcopenia, performing sensitivity analyses for robustness.

Results

Over a median follow-up of 9.2 years, 829 deaths occurred. Kaplan-Meier analysis showed significant survival differences across SII groups. The highest SII group showed higher hazard ratios (HRs) for all-cause and cause-specific mortality in both crude and adjusted models. The highest SII group had a higher HR for all-cause(1.57, 1.25-1.98), cardiovascular(1.61, 1.00-2.58), cancer(2.13, 1.32-3.44), and respiratory disease mortality(3.21, 1.66-6.19) in fully adjusted models. Subgroup analyses revealed SII's association with all-cause mortality across various demographics, including age, gender, and presence of diabetes or cardiovascular disease. Sensitivity analyses, excluding participants with cardiovascular diseases, those who died within two years of follow-up, or those under 45 years of age, largely reflected these results, with the highest SII group consistently demonstrating higher HRs for all types of mortality in both unadjusted and adjusted models.

Conclusion

Our study is the first to demonstrate a significant relationship between SII and increased mortality risks in a sarcopenia population.

Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support

AIM

To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure.

MATERIALS AND METHODS

A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival.

RESULTS

The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047).

CONCLUSIONS

Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.

Prevalence and clinical outcomes of sarcopenia in patients with esophageal, gastric or colorectal cancers receiving preoperative neoadjuvant therapy: A meta-analysis

Objective

To investigate the prevalence of sarcopenia and its impact on clinical outcomes in patients with esophageal, gastric, or colorectal cancer (EC, GC, and CRC) receiving neoadjuvant therapy through Meta-analysis.

Methods

We searched the PubMed, Embase databases, and Cochrane Library for the prevalence of sarcopenia and its impact on clinical outcomes in EC, GC, or CRC patients treated with neoadjuvant therapy (NAT) from inception to November 2022. The primary endpoints were the prevalence of sarcopenia and overall survival in patients with EC, GC, or CRC treated with NAT. Secondary outcomes included recurrence-free survival, total postoperative complications, grade 3-4 chemotherapy toxicity, and 30-day mortality after surgery.

Results

Thirty-one retrospective studies with 3651 subjects were included. In a fixed-effects model, the prevalence of muscle loss was higher in patients with EC, GC, or CRC at 50% (95% CI ​= ​42% to 58%). The results of the multivariate analysis showed that preoperative patients with sarcopenia had a 1.91 times shorter overall survival (95% CI ​= ​1.61-2.27) and a 1.77 times shorter recurrence-free survival time (95% CI ​= ​1.33-2.35) than patients without sarcopenia, and that patients with sarcopenia had a higher risk of total postoperative complications than patients without sarcopenia OR ​= ​1.27 (95% CI ​= ​1.03-1.57). However, the two groups had no statistical difference in grade 3-4 chemotherapy toxicity (P ​= ​0.84) or 30-d postoperative mortality (P ​= ​0.88).

Conclusions

The prevalence of sarcopenia in patients with EC, GC, or CRC during NAT is high, and it is associated with poorer clinical outcomes. Clinicians should closely monitor the changes in patients' body composition and guide patients to carry out a reasonable diet and appropriate exercise to improve their poor prognosis and quality of life.

Systematic review registration

CRD42023387817.

Osteosarcopenia impacts treatment outcomes for Barcelona Cancer Liver Classification stage A hepatocellular carcinoma

AIM

To study the effect of preoperative osteosarcopenia (OSP) on the prognosis of treatment (surgery or radiofrequency ablation (RFA)) in patients with Barcelona Cancer Liver Classification stage A hepatocellular carcinoma (BCLC A HCC).

METHODS

This study enrolled 102 patients with BCLC A HCC who underwent surgical resection (n = 45) and RFA (n = 57); the patients were divided into two groups: OSP (n = 33) and non-OSP (n = 69). Overall survival (OS) and disease-free survival (DFS) curves for both the groups and treatment methods (surgery and RFA) were generated using the Kaplan-Meier method and compared using the log-rank test. Univariate analyses for OS and DFS were performed using log-rank test. Multivariate analyses were performed for factors that were significant at univariate analysis by Cox proportional hazard model.

RESULTS

Multivariate analysis showed that OSP (HR 2.44; 95 % CI 1.30-4.55; p < 0.01) and treatment (HR 0.57; 95 % CI 0.31-0.99; p = 0.05) were significant independent predictors of DFS; and treatment (HR, 0.30; 95 % CI 0.10-0.85; p = 0.03) was a significant independent predictor of OS in the non-OSP group, in which the OS rate was significantly lower in patients treated with RFA than in those treated by resection (p = 0.01).

CONCLUSIONS

OSP is a prognostic factor for BCLC A HCC treatment. Surgical approach was associated with a significantly better prognosis in patients without OSP compared to those who underwent RFA.

Quantifying the severity of sarcopenia in patients with cancer of the head and neck

BACKGROUND & AIMS

Existing skeletal muscle index (SMI) thresholds for sarcopenia are inconsistent, and do not reflect severity of depletion. In this study we aimed to define criterion values for moderate and severe skeletal muscle depletion based on the risk of mortality in a population of patients with head and neck cancer (HNC). Additionally, we aimed to identify clinical and demographic predictors of skeletal muscle depletion, evaluate the survival impact of skeletal muscle depletion in patients with minimal nutritional risk or good performance status, and finally, benchmarking SMI values of patients with HNC against healthy young adults.

METHODS

Population cohort of 1231 consecutive patients and external validation cohorts with HNC had lumbar SMI measured by cross-sectional imaging. Optimal stratification determined sex-specific thresholds for 2-levels of SMI depletion (Class I and II) based on overall survival (OS). Adjusted multivariable regression analyses (tumor site, stage, performance status, age, sex, dietary intake, weight loss) determined relationships between 2-levels of SMI depletion and OS.

RESULTS

Mean SMI (cm2/m2) was 51.7 ± 9.9 (males) and 39.8 ± 7.1 (females). The overall and sex-specific population demonstrated an increased risk of mortality associated with decreasing SMI. Sex-specific SMI (cm2/m2) depletion thresholds for 2-levels of muscle depletion determined by optimal stratification for males and females, respectively (male: 45.2-37.5, and <37.5; female: 40.9-34.2, and <34.2). In the overall population, Normal SMI, Class I and II SMI depletion occurred in 65.0%, 24.0%, and 11.0%, respectively. Median OS was: Normal SMI (114 months, 95% CI, 97.1-130.8); Class I SMI Depletion (42 months, 95% CI, 28.5-55.4), and Class II SMI Depletion (15 months, 95% CI, 9.8-20.1). Adjusted multivariable analysis compared with Normal SMI (reference), Class I SMI Depletion (HR, 1.49; 95% CI, 1.18-1.88; P < .001), Class II SMI Depletion (HR, 1.91; 95% CI, 1.42-2.58; P < .001).

CONCLUSIONS

Moderate and severe SMI depletion demonstrate discrimination in OS in patients with HNC. Moderate and severe SMI depletion is prevalent in patients with minimal nutrition risk and good performance status. Benchmarking SMI values against healthy young adults exemplifies the magnitude of SMI depletion in patients with HNC and may be a useful method in standardizing SMI assessment.