Welcome to the ICD-10 code for sarcopenia

Prevalence of Sarcopenia Among Slovenian Older Adults and Associated Risk Factors

Introduction

Sarcopenia is a multifaceted condition affecting between 10 and 16% of the global population, and although multiple classification algorithms exist, no prevalence has been reported for a representative sample of the Slovenian population. Furthermore, multiple behavioural factors, such as malnutrition, physical inactivity, sedentary lifestyle and lower cognitive function, can contribute to the risk of sarcopenia. This study aims to: a) determine sarcopenia prevalence among Slovenian older adults according to different classification algorithms, b) compare the agreement among the algorithms and c) evaluate the relationship between proposed risk factors and sarcopenia.

Methods

654 participants (≥60 years, 30.4% males) have been classified into sarcopenia groups according to eight algorithms, and agreement (Fleiss K) between them was calculated. Additionally, age, sex, nutritional status, physical activity, sedentary levels and cognitive function were assessed as sarcopenia risk/protective factors.

Results

The prevalence of sarcopenia according to EWGSOP2 was 4.1%, ranging from 2.1% to 15.3%, when classified by all eight algorithms. Overall agreement between algorithms was weak (K=.429; 95% CI .414 to .444) with 0.6% of participants classified as sarcopenic by all eight algorithms. Adequate nutrition and physical activity were identified as protective factors, while age, lower cognitive function and sedentary lifestyle were considered risk factors.

Conclusion

Sarcopenia prevalence among the Slovenian general population was lower than in the global population. We can conclude that different sarcopenia algorithms lead to a different prevalence of sarcopenia. It is of great importance to be cautious when comparing prevalences among studies and to further validate the classification algorithms.

Androgens as the "old age stick" in skeletal muscle

Aging is associated with a reduction in skeletal muscle fiber size and number, leading to a decline in physical function and structural integrity-a condition known as sarcopenia. This syndrome is further characterized by elevated levels of inflammatory mediators that promote skeletal muscle catabolism and reduce anabolic signaling.Androgens are involved in various biological processes, including the maintenance, homeostasis and trophism of skeletal muscle mass. The decline in androgen levels contributes, indeed, to androgen deficiency in aging people. Such clinical syndrome exacerbates the muscle loss and fosters sarcopenia progression. Nevertheless, the mechanism(s) by which the reduction in androgen levels influences sarcopenia risk and progression remains debated and the therapeutic benefits of androgen-based interventions are still unclear. Given the significant societal and economic impacts of sarcopenia, investigating the androgen/androgen receptor axis in skeletal muscle function is essential to enhance treatment efficacy and reduce healthcare costs.This review summarizes current knowledge on the role of male hormones and their-dependent signaling pathways in sarcopenia. We also highlight the cellular and molecular features of this condition and discuss the mechanisms by which androgens preserve the muscle homeostasis. The pros and cons of clinical strategies and emerging therapies aimed at mitigating muscle degeneration and aging-related decline are also presented.

The diagnostic performance of phase angle for sarcopenia among older adults: A systematic review and diagnostic meta-analysis

OBJECTIVE

Phase angle is a promising tool for diagnosing sarcopenia. This study aimed to summarize its diagnostic performance by performing a systematic review and meta-analysis.

METHODS

We conducted a systematic search of PubMed, Web of Science, Embase, and Scopus. The Quality Assessment of Diagnostic Accuracy Studies, Version 2, was used to evaluate the quality of the studies. A bivariate random effects model was employed for data synthesis, and diagnostic performance was reported in terms of pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve (AUC). Additionally, meta-regression, subgroup analyses, and sensitivity analyses were performed.

RESULTS

A total of 15 studies were included in this meta-analysis, involving 4,063 participants. The overall risk of bias in the included studies was high. The meta-analysis revealed that the pooled sensitivity and specificity across all studies were 0.74 [95 % confidence interval (CI): 0.71-0.78] and 0.75 (95 % CI: 0.70-0.79), respectively, with an AUC of 0.79 (95 % CI: 0.76-0.83). Meta-regression indicated that study design, country, population, sex-specificity, and age may influence the diagnostic performance of phase angle. The optimal diagnostic performance was observed in the cut-off interval of 4.20 to 4.50°.

CONCLUSION

The phase angle demonstrated moderate diagnostic performance for sarcopenia, and the possible cut-off interval is 4.20 to 4.50 °. However, large-scale, multicenter prospective studies are necessary to assess its clinical applicability at specific cut-off values.

The effects of β-hydroxy-β-methylbutyrate supplementation in patients with sarcopenia: A systematic review and meta-analysis

OBJECTIVES

To undertake a systematic review and meta-analysis to examine the evidence base for the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in patients with sarcopenia.

DESIGN

Systematic review and meta-analysis.

METHODS

The literature was searched via the PubMed, MEDLINE, Web of Science, EMBASE, CINAHL, Scopus, WANFANG, CNKI and VIP databases, through 23rd February 2024. The inclusion criteria were: randomized controlled trials (RCTs); patients diagnosed with sarcopenia defined according to well-accepted clinical consensus; HMB as an intervention; outcomes on muscle mass and/or muscle strength and/or physical performance. Data extraction was completed by independent pairs of reviewers. Meta-analyses of continuous outcomes were performed on the extracted data. Standard mean difference (SMD) with 95 % confidence intervals (CIs) between treatment and control group were used to express intervention effect estimates of HMB for each study. Risk of bias was assessed according to Version 2 of the Cochrane tool for assessing risk of bias in randomized trials (ROB 2).

RESULTS

Of 196 records retrieved and screened, five RCTs met the eligibility criteria for qualitative and quantitative analysis, yielding 154, 359 and 359 participants for muscle mass, muscle strength, and physical performance, respectively. For the overall risk of bias, no studies were graded as "high risk of bias", one (20.0 %) as "some concerns", and four (80.0 %) as "low risk of bias" according to the ROB 2. The overall meta-analysis revealed a beneficial effect on muscle mass and strength, as demonstrated by a higher skeletal muscle mass index (SMD = 0.32; 95 % CI: [0.00,0.64]; Z value =1.98; P = 0.048), along with an elevated handgrip strength (SMD = 0.65; 95 % CI: [0.05, 1.25]; Z value = 2.12; P = 0.034) in the HMB intervention groups compared with the control groups. However, there was no evidence of a benefit on physical performance, assessed by gait speed (SMD = 0.19; 95 % CI: [-0.14, 0.53]; Z value = 1.14; P = 0.255).

CONCLUSION

Overall, although limited and requiring interpretation with utmost caution, current evidence indicates that HMB supplementation is beneficial for improving muscle mass and strength, but there is no evidence of a benefit on physical performance in patients with sarcopenia. In future, more well-designed HMB intervention trials should be conducted that include populations diagnosed with sarcopenia according to well-accepted clinical consensus.

Impact of Bariatric and Metabolic Surgery on Sarcopenia-Related Parameters According to the EWGSOP2 Consensus Criteria in Persons Living with Obesity

Although bariatric and metabolic surgery (BS) has proved effective in the treatment of obesity based on the reduction in fat mass and the remission of comorbidities, there is also loss of lean mass after BS which could compromise muscle functionality. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia is a disease associated with loss of muscle mass, strength, and function. Through a comprehensive review of the literature, we identified a range of studies focusing on evaluating sarcopenia-related parameters according to the EWGSOP2 consensus criteria, before and after BS. Although most studies reported reductions in skeletal muscle mass and absolute muscle strength after surgery, improvements in muscle functionality were generally achieved, independent of the type of BS.

Mesenchymal stem cell-specific Sirt1 overexpression prevents sarcopenia induced by 1,25-dihydroxyvitamin D deficiency

Sarcopenia, characterized by an age-related decline in skeletal muscle mass and function, is closely linked to vitamin D deficiency. This study examines the role of Sirtuin 1 (Sirt1) and its regulation by vitamin D in preventing sarcopenia. Utilizing wild-type, 1α-hydroxylase knockout (1α(OH)ase-/-), and Sirt1 transgenic (Sirt1Tg) 1α(OH)ase-/- mice, we investigated muscle Sirt1 levels, muscle mass, fiber type, and senescence markers. Our results demonstrated that 1,25-Dihydroxyvitamin D (1,25(OH)2D3) upregulated Sirt1 and myogenic factor MyoD1 expression in C2C12 myoblasts via VDR-mediated transcription. Sirt1 overexpression in mesenchymal stem cells (MSCs) significantly mitigated muscle mass reduction, improved fiber cross-sectional area, and increased type II fiber numbers in 1α(OH)ase-/- mice. Mechanistically, 1,25(OH)2D3 promoted muscle cell health by enhancing Sirt1 expression, which in turn reduced muscle cell senescence and the senescence-associated secretory phenotype (SASP) through decreased levels of acetylated nuclear p53 and p65, maintaining their cytoplasmic localization. Additionally, Sirt1 overexpression accelerated muscle regeneration post-injury by increasing embryonic myosin heavy chain expression and cell proliferation. These findings underscore the therapeutic potential of targeting vitamin D and Sirt1 pathways to prevent sarcopenia, suggesting that supplementation with active vitamin D and consequent Sirt1 activation could be effective strategies for managing age-related muscle wasting.

Reliability and Clinical Validity of the SARC-Global Questionnaire for Sarcopenia and Sarcopenic Obesity in Spanish Older Adults

BACKGROUND/OBJECTIVES

Sarcopenia and sarcopenic obesity (SO) are related to an increased risk of adverse outcomes. The objective of this study was to assess the internal and clinical validation of the Spanish version of the SARC-Global questionnaire, a sarcopenia risk screening tool, and its ability to detect sarcopenia, severe sarcopenia, and SO in adults aged ≥ 60 years.

METHODS

A total of 167 participants (73.22 ± 6.70 years, 71.26% women) completed the study. First, reliability was assessed by the inter-rater and the test-retest analyses. For the clinical validation, the risk of sarcopenia (SARC-Global) was compared to sarcopenia diagnosed using three operational definitions. The SARC-Global's ability to detect severe sarcopenia (SS) and sarcopenic obesity assessed with body mass index (SO-BMI) and body fat percentage (SO-BFP), considering nutritional status and physical activity level, was also analyzed.

RESULTS

The Spanish SARC-Global questionnaire showed a substantial to excellent inter-rater and test-retest reliability. Regarding the clinical validation, sensitivity/specificity values to detect cases of sarcopenia were 85.71%/64.38% (EWGSOP2), 83.33%/65.81% (FNIH), and 54.55%/63.46% (AWGS-2019). Diagnostic accuracy ranged from 67.07% (FNIH) to 62.87% (AWGS-2019). The analysis also indicated that SARC-Global cutoff of 13.5 was the optimal score for severe sarcopenia (100.00% sensitivity and 80.49% specificity), SO-BMI (100% sensitivity and 80.49% specificity), and SO-PBF (80.00% sensitivity and 80.86% specificity).

CONCLUSIONS

The Spanish version of the SARC-Global questionnaire is a reliable and clinically valid instrument for identifying people at the risk of sarcopenia, severe sarcopenia, and sarcopenic obesity in Spanish older adults.

Physical exercise for primary sarcopenia: an expert opinion

Sarcopenia is the age-related loss of skeletal muscle mass and function. Recently, research has focused on defining diagnostic criteria for this condition, now recognized as a muscle disease with a specific identifying code (ICD-10: M62.84). The diagnostic process for sarcopenia involves several stages, including the use of dedicated questionnaires and objective measurements of muscle strength and mass. According to international guidelines, therapeutic exercise is recommended to improve muscle mass, muscle strength, and physical performance. However, much of the supporting evidence comes from studies on non-sarcopenic elderly patients. Among types of therapeutic exercise, guidelines mainly emphasize muscle strengthening. The prescription of therapeutic exercise must consider the clinical and functional conditions of the patient (e.g., the presence of severe sarcopenia) and patient preferences. Muscle strengthening should target large muscle groups and include low-intensity resistance exercise for strength improvement, or high-intensity resistance exercise for additional benefits in muscle mass and function. Evidence suggests that an ideal therapeutic exercise program for sarcopenic patients should be multimodal, incorporating muscle strengthening, aerobic exercise, and balance control programs. This approach could enhance patient adherence by offering variety. Although multimodal therapeutic exercise improves muscle mass and function, these benefits can be lost during prolonged physical inactivity. Therefore, the exercise prescription must define intensity, volume (repetitions and sets), frequency, rest intervals, and duration, tailored to the type of exercise. Aerobic training programs improve endurance and optimize mitochondrial function. Balance training, important for reducing the risk of falls, should be done at least three times a week. Muscle strengthening should be done at least two days a week, starting at 50%-60% of 1 repetition maximum (RM) and progressing to 60%-80% of 1 RM, with approximately 10 exercises per session. Adopting comprehensive prescription protocols, such as those proposed in this paper, can significantly aid in the functional recovery and well-being of patients with sarcopenia.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

The role of AGEs in muscle ageing and sarcopenia

Sarcopenia is an ageing-related disease featured by the loss of skeletal muscle quality and function. Advanced glycation end-products (AGEs) are a complex set of modified proteins or lipids by non-enzymatic glycosylation and oxidation. The formation of AGEs is irreversible, and they accumulate in tissues with increasing age. Currently, AGEs, as a biomarker of ageing, are viewed as a risk factor for sarcopenia. AGE accumulation could cause harmful effects in the human body such as elevated inflammation levels, enhanced oxidative stress, and targeted glycosylation of proteins inside and outside the cells. Several studies have illustrated the pathogenic role of AGEs in sarcopenia, which includes promoting skeletal muscle atrophy, impairing muscle regeneration, disrupting the normal structure of skeletal muscle extracellular matrix, and contributing to neuromuscular junction lesion and vascular disorders. This article reviews studies focused on the pathogenic role of AGEs in sarcopenia and the potential mechanisms of the detrimental effects, aiming to provide new insights into the pathogenesis of sarcopenia and develop novel methods for the prevention and therapy of sarcopenia.

Physical inactivity, depressive symptoms, and progression to sarcopenia in older adults: a 4-year longitudinal study

OBJECTIVES

To examine the combined association of physical inactivity and depressive symptoms with the progression to sarcopenia in community-dwelling older adults.

DESIGN

A 4-year follow-up longitudinal study.

SETTING

Community-dwelling older adults living in Japan, who were not sarcopenic at baseline.

PARTICIPANTS

The participants were 2,538 community-dwelling older adults and with a mean age of 70.9 ± 4.6 years, of whom 1,327 (52.3%) were women.

MEASUREMENTS

Sarcopenia, defined according to the European Working Group on Sarcopenia in Older People 2, was assessed at baseline and at the 4-year follow-up. Participants were divided into four groups according to their inactivity and depressive symptoms. Physical inactivity was assessed using two face-to-face questions regarding the frequency of regular exercise, sports, and light exercise per week. Depressive symptoms were defined as a score of six or higher on the Geriatric Depression Scale 15-item version. Logistic regression analysis was used to determine whether inactivity and depressive symptoms were associated with progression to sarcopenia 4 years later. For participants who could not be followed and participants with missing data in the follow-up assessment, the data at the follow-up assessment were imputed using the multiple imputations.

RESULTS

After 4 years, 518 participants (20.4%) with complete data progressed to sarcopenia. The rate of progression to sarcopenia after multiple imputations was 23.4%. Logistic regression analysis after multiple imputations showed that the group with both factors was significantly associated with the progression to sarcopenia [Odds ratio, 1.64 (95% Confidence interval 1.11-2.44), p = 0.014]. By contrast, no significant association was found for either inactivity or depressive symptoms alone.

CONCLUSION

This study indicates that the coexistence of physical inactivity and depressive symptoms may contribute to the progression of sarcopenia. Addressing both physical and mental factors, rather than limiting the problem to a single factor, may be essential for preventing sarcopenia.

Relationship Between Lifestyle and Physical Fitness Among Older Women with Sarcopenia

This cross-sectional study aimed to identify the interactions between lifestyle-related, diagnostic, and physical strength-related sarcopenia factors. The study included 512 female participants aged 60-100 years from Incheon, Republic of Korea, recruited from 12 institutions. Participants engaged in the study from June to August 2023. We administered questionnaires on demographic characteristics and health indicators and undertook physical measurements, including grip strength and body composition. Hierarchical regression analysis and two-way analysis of variance were conducted to examine the association between sarcopenia and the examined variables. Statistical significance was set at p < 0.05. Hierarchical regression analysis of the variables affecting sarcopenia showed each characteristic's effect: Model 1 (basic characteristic): R2, 0.391; p < 0.001; Model 2 (Model 1 + additional characteristics): R2, 0.427; p < 0.001. Hierarchical regression analysis of diagnostic and fitness factors affecting sarcopenia also showed an effect on sarcopenia (Model 1 (basic characteristics): R2, 0.318; p < 0.001; Model 2 (Model 1 + body composition): R2, 0.419; p < 0.001; Model 3 (Model 2 + fitness factors): R2, 0.664; p < 0.001). This study enhances the understanding of sarcopenia by investigating its connections with sociodemographic factors, lifestyle choices, and physical activity. The study underscores that lifestyle factors sustainably influence sarcopenia while confirming its correlation with fitness-related factors. Notably, this study highlights the results that muscle function is very important in preventing sarcopenia and that continuous physical activity and types of physical activity affect it.

Prevalence and influencing factors of sarcopenia among older adults in rural coastal areas of Ningbo City

Sarcopenia has become a critical health concern in the global older population. However, limited studies have investigated the epidemiological characteristics and potential risk factors of sarcopenia in older individuals residing in rural coastal areas of China. This cross-sectional study involving sarcopenia screening was conducted in Ningbo City, including body composition measurements, and questionnaire surveys. Sarcopenia was diagnosed using the criteria outlined in the Asian Working Group for Sarcopenia 2019 Consensus. A total of 902 older adults aged ≥ 60 years (average age: 69.76 years) were included using a two-stage random sampling method from three villages in Ningbo. The prevalence of sarcopenia was 11.53%, with men (16.36%) exhibiting higher rates than women (7.93%). Multivariate logistic regression analysis identified age (odds ratio [OR]: 6.708, 95% confidence interval [CI]: 2.520-17.855), stroke (OR: 9.232, 95% CI: 1.917-44.447), and waist circumference (OR: 1.095, 95% CI: 1.030-1.165) as factors positively correlated with the occurrence of sarcopenia. Conversely, body mass index (OR: 0.347, 95% CI: 0.270-0.445) was negatively correlated with sarcopenia development. These findings underscore the need for specific health education, the collaborative prevention of comorbidities, and active screening for sarcopenia in the older population to reduce its disease burden.

Association between sensory impairment and sarcopenia in older Chinese adults: a 4-Year longitudinal study

OBJECTIVES

Sarcopenia is a common geriatric syndrome that significantly increases the risk of falls, fractures, disability, and death in older adults. Sensory impairments are also prevalent among the elderly and may exacerbate the decline in physical function, even affecting muscle health. Understanding whether sensory impairments are risk factors affecting sarcopenia in older adults is crucial for developing effective public health policies and intervention strategies. Therefore, this study aims to explore the association between sensory impairments and sarcopenia and its components.

METHODS

This study, based on the Chinese Health and Retirement Longitudinal Study (CHARLS), included 4,195 participants aged 60 and above. The assessment of sensory impairment was based on self-reported visual and hearing capabilities. The diagnosis of sarcopenia followed the consensus of the Asian Working Group on Sarcopenia (AWGS) from 2019. Data analysis was conducted using an ordered logistic regression model, and the results report the odds ratios (ORs) and their 95% confidence intervals (CI).

RESULTS

Single sensory impairments at baseline showed no significant correlation with sarcopenia four years later, while dual sensory impairments (DSI) at baseline were significantly associated with sarcopenia (ORs: 1.308, 95% CI: 1.126-1.519). In the analysis of trends over time, transitions from no sensory impairments (NSI) to DSI (ORs: 1.372, 95% CI: 1.028-1.830), from hearing impairments (HI) to DSI (ORs: 1.334, 95% CI: 1.002-1.778), and persistent DSI (ORs: 1.470, 95% CI: 1.159-1.864) were all significantly associated with sarcopenia. Additionally, we found DSI is associated with poor physical performance and muscle mass but not muscle strength.

CONCLUSIONS

Our study indicates that DSI have a more severe impact on sarcopenia compared to single sensory impairments. Our findings offer a new perspective for prevention and intervention strategies, suggesting the inclusion of sensory impairment assessments in the clinical evaluation of sarcopenia risk. For elderly individuals with DSI, comprehensive intervention measures should be provided, such as sensory rehabilitation, nutritional support, and guidance on physical activities. For those with only a single sensory impairment, proactive preventive measures should be taken to prevent the progression to DSI.

The role of chronic low-grade inflammation in the development of sarcopenia: Advances in molecular mechanisms

With the exacerbation of global population aging, sarcopenia has become an increasingly recognized public health issue. Sarcopenia, characterized by a progressive decline in skeletal muscle mass, strength, and function, significantly impacts the quality of life in the elderly. Herein, we explore the role of chroniclow-gradeinflammation in the development of sarcopenia and its underlying molecular mechanisms, including chronic inflammation-associated signaling pathways, immunosenescence, obesity and lipid infiltration, gut microbiota dysbiosis and intestinal barrier disruption, and the decline of satellite cells. The interplay and interaction of these molecular mechanisms provide new perspectives on the complexity of the pathogenesis of sarcopenia and offer a theoretical foundation for the development of future therapeutic strategies.

Perceptions of sarcopenia in patients, health and care professionals, and the public: a scoping review of studies from different countries

RATIONALE AND OBJECTIVE

Perceptions of sarcopenia have rarely been explored, yet understanding these will be key for successful translation of sarcopenia research findings into meaningful benefits for patients and the public. This scoping review aimed to explore how sarcopenia is perceived amongst patients, health and care professionals (HCP), and the public in different countries.

METHODS

Seven electronic databases were searched from inception up to December 2023 with no geographical or language limitations. Studies were included if they were peer-reviewed research of any design where the focus related to perceptions of sarcopenia. Studies using alternative descriptors only, such as "skeletal muscle weakness/loss" were excluded. Study characteristics were charted, and thematic synthesis conducted.

RESULTS

Following independent screening of 11,533 records, 20 articles were included in this review representing 19 countries. Five studies focused on patient perceptions, 11 investigated HCP, and four the public. Three key themes were identified: (1) Low awareness of sarcopenia-among all groups, its nature as a disease was contested. (2) The "know-do" gap in healthcare-even where knowledge among HCP existed, this had not translated into clinical practice, in part, due to perceptions of sarcopenia and its management. (3) Experiencing weakness-living with sarcopenia had physical and psychological sequalae.

KEY CONCLUSIONS

These findings reveal perceptions that may be contributing to the slow adoption of sarcopenia prevention, screening, diagnosis, and management. Addressing these areas has the potential to aid translation of sarcopenia research findings into improved clinical care and benefits for patients and the public.

Patient-reported outcomes in sarcopenia: An ICFSR task force report

The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2024 to address patient-reported outcomes measures (PROMs) in the field of sarcopenia. PROMs are crucial to enhance healthcare services at both individual and societal levels. PROMs complement objective outcome measures by capturing insights that patients are best suited to judge. In recent years, there has been an increase in the recognition of PROMs' importance within clinical trials by pharmaceutical industries and regulatory agencies. Consequently, it has become imperative to develop valid and reliable tools tailored to capture various aspects of patient's experience and health status. This report aims to present the state-of-the-art available and validated PROMs for sarcopenia that can be used within clinical settings by various stakeholders, and to highlight several research gaps and barriers that need to be addressed to expedite and improve the use of these outcome measures within the context of clinical trials.

Mapping Normative Muscle Health Metrics Across the Aging Continuum: A Multinational Study Pooling Data From Eight Cohorts in Japan, Malaysia and Taiwan

BACKGROUND

The vigour of our musculature wanes as the years advance, and prognosticating the concomitant trajectories throughout the course of life assumes paramount importance for judicious and timely interventions. In the present study, we aimed to establish age- and sex-specific reference centiles for multiple muscle health metrics and reveal the distributions of these metrics throughout the aging process in the Asian population.

METHODS

By using cross-sectional pooled data of community dwellers aged 20 years or older in eight cohorts from Taiwan, Japan and Malaysia, normative values for muscle health metrics (calf circumference (cm), relative appendicular skeletal muscle (RASM) (kilogram per square metre), body mass index (BMI)-adjusted appendicular skeletal muscle mass (kilogram/(kilogram per square metre)), handgrip strength (kilogram), five-time chair stand (seconds) and gait speed (metre per second)) in men and women, categorized by age groups, are calculated. The mean values, along with the 5th, 25th, 50th, 75th and 95th percentiles of these muscle health metrics, are also delineated for both sexes.

RESULTS

Among 34 265 (16 164 men, 18 101 women) participants from eight cohorts, calf circumference declined in age groups from 60 years onward. RASM values declined from the 50s in men but were stable in women until the 80s. ASM/BMI values showed declines in older age groups for both sexes. Handgrip strength declined similarly from 40 years of age in both sexes. Five-time chair stand performance declined from the 30s. Gait speed peaked at 1.6 m/s in men in their 50s and then declined, while it declined in women in their 60s. The inflection points for decline differed by metric and sex. The 20th percentile cutoffs for individuals aged 65-69 years were as follows: calf circumference, 33.0 cm (men) and 31.5 cm (women); RASM, 7.0 kg/m2 (men) and 5.5 kg/m2 (women); ASM/BMI, 0.78 kg/(kg/m2) (men) and 0.56 kg/(kg/m2) (women); handgrip strength, 30.4 kg (men) and 18.1 kg (women); five-time chair stand, 9.4 s (men) and 10.0 s (women); and gait speed, 0.9 m/s (both). Those in the fifth percentile of all muscle health metrics faced earlier declines than their 95th percentile counterparts did, highlighting the critical roles in identifying these high-risk groups.

CONCLUSION

The pooled analysis of eight Asian cohorts clearly outlined the age-related changes in various muscle health metrics, with the inflection point of accelerated decline showing age- and sex-specific characteristics. Defining trajectories of muscle health metrics across life stages facilitates timely interventions to mitigate age-related risks and promote healthy longevity.

Are Dietary Patterns Relevant for Reducing the Risk of Fractures and Sarcopenia?

PURPOSE OF REVIEW

This review aims to summarise recent evidence on the effects of dietary patterns on the risk of bone fractures and sarcopenia.

RECENT FINDINGS

Several dietary patterns have been investigated in relation to musculoskeletal health, including Mediterranean Dietary Patterns (MDP), Dietary Inflammatory Indices, vegetarian and vegan diets. Adherence to 'healthier' dietary patterns appears to be protective against fractures and sarcopenia, with the strongest protective associations found between the MDP and fractures. Individuals following vegan or vegetarian eating patterns need to be aware of calcium and vitamin D requirements to maintain musculoskeletal health. Although more healthy dietary patterns may be protective for musculoskeletal health the current evidence base is limited by variation in the construction of dietary pattern scores and reported outcome measures. Future research should fully report scoring methods, intakes of dietary components across scoring groups or categories, and consider outcome measures that allow for better comparison between studies.

Serum ALT activity and its isoenzymes as potential biomarkers for diagnosis of Sarcopenia in older adults: a retrospective, cross-sectional study

BACKGROUND

Alanine aminotransferase (ALT) is an enzyme crucial for energy and protein metabolism in muscle cells. Despite this, its association with sarcopenia remains inadequately explored. This study aims to investigate the correlation between serum levels of ALT-related indicators (ALT activity, ALT1, ALT2, and ALT1/ALT2 ratio) and sarcopenia measures, as well as to develop a diagnostic model for sarcopenia in older individuals.

METHODS

This retrospective study assessed 653 older adults (aged ≥ 55 years), 109 of whom were studied for the association of ALT1, ALT2, and ALT1/ALT2 ratio with sarcopenia measures. Muscle mass was measured by dual energy X-ray absorptiometry. Hand grip strength (HGS) was measured with a digital dynamometer, and physical performance was assessed through the 6-meter gait speed and the five-times sit-to-stand test (FTSST). Binary logistic regression analysis was used to evaluate associations between ALT-related indicators (ALT activity and ALT1/ALT2 ratio) and sarcopenia. The diagnostic model was developed using binary logistic regression with backward selection, and the diagnostic performance of the model was evaluated by the receiver operator characteristic curve (ROC) curve.

RESULTS

Older adults with sarcopenia exhibited a lower serum ALT activity and a higher ALT1/ALT2 ratio compared to those without sarcopenia. ALT activity tertiles, but not ALT1 or ALT2 tertiles alone, correlated with HGS, gait speed, FTSST, and appendicular skeletal muscle mass index (ASMI), serving as independent protective factors for low HGS, low physical performance, low ASMI, and sarcopenia. Tertiles of the ALT1/ALT2 ratio were significantly associated with HGS and FTSST, and were proved independent risk factors for low physical performance and sarcopenia by binary logistic regression analysis. An optimal Model A (based on ALT activity) was established for sarcopenia to develop a new Logit_P1 (p < 0.001). Similarly, an optimal Model B (based on ALT1/ALT2 ratio tertiles) was established for sarcopenia to develop a new Logit_P2 (p < 0.001). According to the ROC curve analysis for discriminating sarcopenia, the performance of Logit_P2 (area under the curve = 0.830) seemed better than that of Logit_P1 (area under the curve = 0.789), although the difference was not statistically significant (p = 0.214).

CONCLUSIONS

In older adults, a low serum ALT activity level was an independent risk factor for low ASMI, HGS, physical performance, and sarcopenia. The serum ALT1/ALT2 ratio emerged as an independent risk factor for low physical performance and sarcopenia. The new indices, Logit_P1 and Logit_P2, demonstrated diagnostic value for sarcopenia.

Call to Improve Coding of Cancer-Associated Cachexia

Cachexia is a systemic wasting syndrome prevalent in patients with cancer that significantly affects quality of life, health care costs, and therapeutic outcomes. Despite its clinical importance, cachexia is rarely formally diagnosed. This deficiency presents a challenge for effective patient management and care, health care resource allocation, and the advancement of therapeutic approaches. Here, we highlight impedances to the diagnosis and coding of cachexia, including the absence of standardized therapy, a lack of incentives for accurate coding, and overlapping clinical features with other conditions. We differentiate cachexia from related conditions like unintentional weight loss, sarcopenia, frailty, and protein-calorie malnutrition, outlining their distinct clinical features and inter-relations. We propose an approach to enhance diagnostic accuracy and coding for cachexia. This effort will enable better prevalence data, translation of mechanism-based therapy development, patient identification and stratification, and ultimately advanced diagnostics and US Food and Drug Administration-approved treatments for cachexia.

Role of Medical Nutrition Therapy as Treatment of Sarcopenia in Older People with Type 2 Diabetes

BACKGROUND

Globally, the progressive increase in the aging population has led to social and health problems associated with age-related chronic diseases, such as type 2 diabetes mellitus (T2DM) and sarcopenia. Recent studies have highlighted that sarcopenia and diabetes have a bidirectional relationship. Nutritional therapy is a key element in the treatment of both sarcopenia and diabetes. To date, there are no nutritional guidelines for the management of sarcopenia in T2DM. The aim of this study was to evaluate the efficacy of a muscle-targeted nutritional intervention in older people with sarcopenia and type 2 diabetes based on the Italian nutrition guidelines.

METHODS

A total of 211 subjects (117 M and 94 F) affected by T2DM with a mean age of 74 ± 6.0 years were screened for sarcopenia, using EWGSOP2 diagnosis criteria, and enrolled to receive personalized dietary plans with two main targets: a daily energy intake of 25-30 kcal/kg body weight and a daily protein intake of at least 1.1-1.2 g/kg body weight.

RESULTS

In total, 34 subjects (24 M and 10 F) were sarcopenic with a prevalence of 16%, which was higher in men. After six months of treatment, handgrip strength increased by 0.83 kg (19.57 ± 5.70 kg vs. 20.40 ± 6.10 kg, p = 0.649), protein intake improved (0.91 ± 0.28 g/kg body weight vs. 1.03 ± 0.40 g/kg body weight, p = 0.115), and the glycated hemoglobin decreased (7.39 ± 0.49% to 6.82 ± 0.98%, p = 0.010). Seven younger subjects had an improvement of sarcopenia with a decrease in HbA1c (7.50 ± 0.59% vs. 6.91 ± 0.79, p = 0.19). The difference over time in the consumption of saturated fatty acids (OR 0.6, 95% CI 0.33-1.09, p = 0.096) and simple sugars (OR 0.91, 95% CI 0.80-1.01, p = 0.090) appeared to be associated with an improvement of sarcopenia status. A total of 177 subjects did not meet the criteria for a diagnosis of sarcopenia, and 148 subjects were assessed. The handgrip strength (26.22 ± 9.36 vs. 26.18 ± 9.24 kg, p0.974) and the glycated hemoglobin (7.21 ± 1.07 vs. 7.27 ± 0.98%, p = 0.735) remained stable over time, while protein intake at six months increased (0.81 ± 0.29 vs. 0.91 ± 0.29 g/kg body weight, p = 0.024). Four people were diagnosed with sarcopenia at follow-up, with a lower handgrip strength test result. These subjects were older and had worse glycemic control (HbA1c + 0.5%).

CONCLUSIONS

Lifestyle modification is important to prevent or reverse the development of the disease. Nutritional therapy in this population is therefore aimed at meeting all nutritional needs and promoting better glycemic control, in terms of glycated hemoglobin, in order to reduce the development of sarcopenia. Although promising, the intervention requires validation in larger studies with control groups.

Association between Pan-Immune Inflammation Value and Sarcopenia in Hypertensive Patients, NHANES 1999-2018

Sarcopenia worsens the prognosis in hypertensive patients, leading to complications such as proteinuria, osteoporosis, disability, and cognitive impairment. Early screening and intervention for sarcopenia in these patients may improve outcomes. This cross-sectional study utilized data from 9253 hypertensive patients in the 1999-2018 National Health and Nutrition Examination Survey (NHANES). We used logistic and linear regression models, restricted cubic splines (RCS), and subgroup analyses to evaluate the relationship between pan-immune-inflammation value (PIV) and sarcopenia. Patients were divided into quartiles based on PIV levels. After controlling for confounding factors, our study found that those in the highest PIV quartile faced a 36% greater risk of developing sarcopenia compared to those in the lowest quartile (OR = 1.36, 95% confidence interval [CI]: 1.04-1.77). The RCS analysis indicated a linear increase in sarcopenia risk as PIV levels rose (non-linear p = 0.130). Subgroup analysis demonstrated that diabetes synergistically increased sarcopenia risk (p for interaction = 0.007). Elevated PIV levels were identified as an independent risk factor for sarcopenia, with diabetes amplifying this risk. These findings highlight the importance of early identification and management of elevated PIV levels to improve outcomes for hypertensive patients at risk of sarcopenia.

Acute muscle loss in elderly hospitalized patients: Risk factors and adverse clinical outcomes

OBJECTIVE

To assess muscle loss via ultrasound in the elderly and its link to clinical outcomes and risk factors.

METHODS

This retrospective cohort study assessed muscle loss in hospitalized elderly via ultrasound, comparing bilateral anterior thigh thickness (BATT) at admission and after seven days, exploring its relation to hospital-acquired complications (HACs).

RESULTS

In 86 patients (mean age 83.6), a 4.2% BATT decline over a week was seen, with 39.5% losing more than 10%. BATT changes correlated with HACs, with a -10% change as a predictive threshold. Risk factors for severe muscle loss in elderly hospitalized patients include female gender, higher baseline nutrition risk screening 2002 (NRS2002) scores and higher level of coefficient of variation of red blood cell distribution width (RDW-CV).

CONCLUSIONS

Elderly hospitalized patients were at risk of acute muscle loss during their hospital stay. Severe BATT decline during hospitalization in elderly patients was independently associated with HACs.

Causal Relationship Between Circulating Metabolites and Sarcopenia-Related Traits: A Mendelian Randomization and Experimental Study

Sarcopenia (SP), an age-associated condition marked by muscle weakness and loss has been strongly connected with metabolic factors according to substantial evidence. Nevertheless, the causal correlation between SP and serum metabolites, and the biological signaling pathways involved, is still not well understood. We performed a bidirectional two-sample Mendelian randomization (MR) analysis to examine the causal relationships between 1091 levels and 309 ratios of metabolites with SP traits, alongside investigating the relevant biological signaling pathways. Additionally, we explored the differential expression of plasma metabolites and potential biological signaling pathways in an animal model of SP. When SP was utilized as the outcome, we identified 11 robust causal associations between seven metabolite levels/ratios and SP-related traits using Bonferroni's correction (threshold: p < 0.05). We verified the stable causal association of glycine levels and SP in the validation. As for the reverse MR analysis, there were 11 strong causal relationships with 11 plasma metabolite levels/ratios remaining after multiple contrast correction. Additionally, biological signaling pathway analysis showed that glycine metabolism, insulin resistance, and cAMP signaling pathways may contribute to the connection between metabolites and SP. Mendelian validation of various datasets and observations in animal serum metabolomics suggests a strong association between glycine metabolism and SP. Our results indicate that the identified metabolites and biosignaling pathways could serve as important circulatory metabolic biomarkers for the screening and prevention of SP in clinical settings. Additionally, they represent potential molecules for future exploration of mechanisms and selection of drug targets.

Multicenter research in dialysis centers in Brazil: recruitment and implementation of the SARC-HD study

INTRODUCTION

Multicenter research initiatives in Brazilian dialysis centers are scarce. We described the recruitment and implementation phases of the SARC-HD study, aimed at investigating sarcopenia and its impact on adverse clinical outcomes.

METHODS

The SARC-HD is a cohort study being conducted with patients on hemodialysis in Brazil. The recruitment phase was defined as the period from the invitation to the center until the start of patient enrollment, whereas the implementation phase lasted from then until the completion of enrollment and baseline data collection. Upon implementation, a structured questionnaire was distributed to collect feedback from principal investigators.

RESULTS

21 centers from three Brazilian regions consented to participate, with two dropping out. Ten principal investigators oversaw the 19 sites. Nine centers (47%) were funded entirely by health insurance companies. A total of 1525 patients were screened for eligibility and 1008 were enrolled, with a 66.1% recruitment rate. Recruitment and baseline data collection took 12 [interquartile range: 5-15] weeks. Qualitative content analysis identified barriers such as a lack of infrastructure and logistics for research. Facilitators included the management and organization of the steering committee. Data collection challenges were mainly reported with the subjective 7-point global assessment and the international physical activity questionnaire. The main challenge for the ongoing maintenance phase will be the lack of standardized information in electronic health records.

CONCLUSIONS

The recruitment and implementation phases of the multicenter SARC-HD study were feasible. Barriers and facilitators identified by principal investigators may help future multicenter initiatives to integrate research-related tasks into clinical routine, facilitating successful experiences.

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.

Sarcopenia in older people with multiple sclerosis: A cross-sectional study

BACKGROUND

Older people with multiple sclerosis (pwMS) make up over one-third of the MS population. Ageing increases the risk of sarcopenia, characterised by reduced muscle mass, strength, and function. MS symptoms likely exacerbate sarcopenia, but its impact on older pwMS remains largely unexplored OBJECTIVES: The primary aim of this study was to investigate how the diagnosis of sarcopenia using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) diagnostic tool in older pwMS is influenced by using upper extremity-based or lower extremity-based tests.

METHODS

The present cross-sectional study analysed baseline data from the PoTOMS trial. A total of n = 41 older pwMS and n = 27 healthy controls (HC) were included. Participants were assessed for sarcopenia using the EWGSOP2 diagnostic tools and a lower extremity muscle strength test.

RESULTS

Older pwMS had a preferentially lower muscle mass and strength in the lower extremities compared to HC. According to EWGSOP2 criteria, 5 % of older pwMS had reduced upper extremity strength, 7 % had reduced lower extremity strength, and 15 % had sarcopenic muscle mass. However, only 5 % were diagnosed with sarcopenia despite these reductions.

CONCLUSION

The present study shows that the sarcopenia diagnosis in older pwMS is more sensitive when using a lower extremity test, underlined by the preferentially lower muscle mass and strength in older pwMS compared to HC. Hence, when evaluating sarcopenia in older pwMS the diagnostics test should rely on the lower extremity test.

Prevalence and risk factors of sarcopenia in patients with stroke: a systematic review and meta-analysis

Stroke is the second leading cause of death and the third-leading cause of disability in the world. The skeletal muscles play a key role in disability following stroke. Although many studies have reported the prevalence and risk factors of sarcopenia in patients with stroke, the results have not been synthesized. This systematic review was conducted to explore the prevalence and risk factors of sarcopenia in patients with stroke. PubMed, Embase, The Cochrane Library, Web of Science, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Weipu Database (VIP), Wanfang Database were comprehensively searched for studies exploring the prevalence and risk factors of sarcopenia in patients with stroke from inception to October 5th, 2022. This review included 19 studies involving 4148 subjects. The total prevalence of sarcopenia in patients with stroke is 46% (95% confidence interval, CI: 40% to 52%, I2 = 94%, P < 0.001). Age (MD = 0.43, 95%CI: 0.06 to 0.81, I2 = 88.3%, P < 0.001), stroke duration (MD = 0.20, 95%CI: 0.05 to 0.34, I2 = 37.2%, P = 0.189), length of hospital stay (MD = 0.40, 95%CI: 0.20 to 0.59, I2 = 0, P = 0.393), pneumonia history (OR = 3.21, 95%CI: 1.98 to 5.20, I2 = 0, P = 0.343), female (OR = 1.36, 95%CI: 1.09 to 1.70, I2 = 48.7%, P = 0.069), albumin (MD = -0.43, 95%CI: -0.58 to -0.28, I2 = 13.7%, P < 0.001), hemoglobin (MD = -0.47, 95%CI: -0.62 to -0.32, I2 = 0, P = 0.687) were risk factors for sarcopenia in patients with stroke. The current analysis indicated sarcopenia was common in patients with stroke. Age, low albumin, low hemoglobin, stroke duration, length of hospital stay, and pneumonia history were the risk factors for sarcopenia in patients with stroke. This review will provide evidence for the screening and early identification of high-risk groups and the prevention of sarcopenia to improve the quality of life of stroke patients.

Bifidobacterium animalis Probio-M8 improves sarcopenia physical performance by mitigating creatine restrictions imposed by microbial metabolites

Sarcopenia is a major health challenge due to an aging population. Probiotics may improve muscle function through gut-muscle axis, but their efficacy and mechanisms in treating sarcopenia remain unclear. This study investigated the impact of Bifidobacterium animalis subsp. lactis Probio-M8 (Probio-M8) on old mice and sarcopenia patients. We analyzed 43 subjects, including gut microbiome, fecal metabolome, and serum metabolome, using a multi-omics approach to assess whether Probio-M8 can improve sarcopenia by modulating gut microbial metabolites. Probio-M8 significantly improved muscle function in aged mice and enhanced physical performance in sarcopenia patients. It reduced pathogenic gut species and increased beneficial metabolites such as indole-3-lactic acid, acetoacetic acid, and creatine. Mediating effect analyses revealed that Probio-M8 effectively reduced n-dodecanoyl-L-homoserine lactone level in gut concurrent with increased creatine circulation, to significantly enhance host physical properties. These findings provide new insights into probiotics as a potential treatment for sarcopenia by modulating gut microbiota metabolism.

Diagnostic accuracy analysis of SARC-F, its modified versions and the Quality of Life in Sarcopenia questionnaire in screening for sarcopenia in nursing home residents

AIM

Sarcopenia, which is among the most important geriatric syndromes, is also a public health challenge. This study evaluated the performance of the SARC-F, its modified versions and the Quality of Life in Sarcopenia (SarQoL) in screening for sarcopenia.

METHODS

In the diagnostic accuracy study carried out with a total of 195 nursing home residents, sarcopenia was evaluated according to the European Working Group on Sarcopenia in Older Persons 2 algorithm. For SARC-CalFs, the calf circumference standard and its population-specific reference (31 cm, 32/33 cm, respectively) were used, whereas for SARC + elderly and body mass index information, age (>75 years) and body mass index (<21 kg/m2) were used. Screening test performance was evaluated with receiver operating characteristic analysis, and the optimal cut-off points were determined according to the Youden index.

RESULTS

The prevalence of sarcopenia was 33.8%. Although SarQoL and SARC-CalF scores were lower in individuals with sarcopenia, standard SARC-F and SARC-F + elderly and body mass index information scores were not different. SARC-F had the poorest screening performance, whereas the SarQoL scale had the best screening performance (area under the curve 0.502 vs 0.787). SARC-CalF (32/33 cm) had the best performance among the modified versions of SARC-F. The optimal cut-off point for SarQoL was <64.56, and its sensitivity in sarcopenia screening was 74.24% (95% CI 62.0-84.2) and its specificity was 79.07% (95% CI 71.0-85.7). All the modified versions of SARC-CalF had higher sensitivity and area under the curve compared with SARC-F.

CONCLUSIONS

SarQoL screening performance might be conducive to providing clinical discrimination in a nursing home sample. Further research is needed for the use of SarQoL as a potential sarcopenia screening strategy. Additionally, SARC-CalFs, especially the population-specific SARC-CalF (32/33 cm), might improve screening performance compared with standard SARC-F. Geriatr Gerontol Int 2024; 24: 1335-1342.

Sarcopenia Is Associated with Neoplasm of Bone and Articular Cartilage: Findings from Mendelian Randomized Study

Exploring the causal relationship between sarcopenia and neoplasm of bone and articular cartilage (NBAC) by bidirectional Mendelian randomization (MR). Genome-wide association study (GWAS) data on sarcopenia-associated traits including appendicular lean mass, low handgrip strength (including criteria from the European Working Group on Sarcopenia in Older People and the Foundation for the National Institutes of Health), and usual walking speeds were obtained from the UK Biobank. GWAS data for NBAC (benign and malignant) were provided by the Finnish Genetic Database. Three different methods of MR analysis, including inverse-variance weighted, Mendelian randomized Egger regression, and weighted median methods, were utilized. MR analysis showed that high appendicular lean mass was positively associated with the risk of developing benign NBAC (odds ratio and 95% confidence interval = 1.236 (1.026,1.489), p = 0.025). At the same time, there is no statistically significant association was found between traits related to sarcopenia and malignant neoplasm of bone and articular cartilage. There was also no reverse causal correlation between NBAC and traits related to sarcopenia. In European populations, better appendicular lean body mass is positively associated with the risk of benign neoplasm of bone and articular cartilage, representing the possibility that sarcopenia may be a protective factor against neoplasm of bone and articular cartilage.

Molecular mechanism of skeletal muscle loss and its prevention by natural resources

A skeletal muscle disorder has drawn attention due to the global aging issues. The loss of skeletal muscle mass has been suggested to be from the reduced muscle regeneration by dysfunction of muscle satellite cell/fibro-adipogenic progenitor cells and the muscle atrophy by dysfunction of mitochondria, ubiquitin-proteasome system, and autophagy. In this review, we highlighted the underlying mechanisms of skeletal muscle mass loss including Notch signaling, Wnt/β-catenin signaling, Hedgehog signaling, AMP-activated protein kinase (AMPK) signaling, and mammalian target of rapamycin (mTOR) signaling. In addition, we summarized accumulated studies of natural resources investigating their roles in ameliorating the loss of skeletal muscle mass and demonstrating the underlying mechanisms in vitro and in vivo. In conclusion, following the studies of natural resources exerting the preventive activity in muscle mass loss, the signaling-based approaches may accelerate the development of functional foods for sarcopenia prevention.

Prevalence and Clinical Impact of Sarcopenia in Patients Undergoing Total Joint Arthroplasty: A Systematic Review and a Meta-Analysis

BACKGROUND

Sarcopenia is a progressive loss of skeletal muscle mass and function. It is associated with adverse outcomes after several orthopaedic procedures. However, its role in total joint arthroplasty (TJA) is not fully explored. Therefore, we wanted to conduct a systematic review and meta-analysis to answer the following questions: (1) What is the prevalence of sarcopenia in patients undergoing TJA?; (2) What factors are associated with the prevalence of sarcopenia in patients undergoing TJA?; What is the impact of sarcopenia on medical outcomes following TJA?; and (4) What is the impact of sarcopenia on surgical outcomes following TJA?

METHODS

Electronic databases PubMed, Scopus, Cochrane, and Google Scholar were searched. The data were pooled using the random-effects model and graphically represented by a forest plot. We included a total of 13 studies, evaluating 399,097 patients.

RESULTS

The pooled prevalence of sarcopenia was 20.1% (95% confidence interval [CI] 13.6 to 28.8%; P < .00001; I2 = 94.7%) in total knee arthroplasty (TKA) and 5.2% (95% CI 0.1 to 69.7%; P = .128; I2 = 99.6%) in total hip arthroplasty (THA). Meta-regression found no links between age, sex, body mass index, diabetes, obesity, arthroplasty type, and sarcopenia prevalence in TJA. Sarcopenia increased risk of blood transfusion (odds ratio [OR] 4.68 [95% CI 3.51 to 6.25]; P < .00001), pneumonia (OR 1.94 [95% CI 1.14 to 3.30]; P = .01), urinary tract infection (UTI) (OR 1.64 [95% CI 1.31 to 2.05]; P < .001), prosthetic fracture (OR 2.12 [95% CI 1.51 to 2.98]; P < .0001), prosthetic dislocation (OR 1.99 [95% CI 1.62 to 2.44]; P < .00001), and mechanical loosening (OR 1.78 [95% CI 1.43 to 2.22]; P < .00001) in TKA. Sarcopenic patients were at an increased risk of UTI (OR 1.79 [95% CI 1.32 to 2.43]; P = .0002) and prosthetic loosening (OR 1.97 [95% CI 1.10 to 3.53]; P = .02) post-THA.

CONCLUSIONS

Baseline sarcopenia was prevalent in patients undergoing TJA. It was associated with an increased risk of UTI and prosthetic loosening following TKA and THA. Increased risk of blood transfusion, pneumonia, prosthetic fractures, and mechanical loosening following TKA.

Correlates and predictors of sarcopenia among men with metastatic castrate-resistant prostate cancer

INTRODUCTION

Sarcopenia is a predictor of clinical outcomes in men with metastatic castrate-resistant prostate cancer (mCRPC); however, correlates and predictors of sarcopenia are poorly understood in this population. The aim of this study was to examine correlates and predictors of sarcopenia in men with mCRPC prior to treatment.

METHODS

A secondary analysis of an observational study was performed. Participants were receiving care for mCRPC at the Princess Margaret Cancer Centre. Sarcopenia was assessed prior to treatment and was defined as the combination of low grip strength (<35.5 kg), low gait speed (<0.8 m/s), and computed tomography-derived low muscle mass or density. Participants' sociodemographic and clinical characteristics, comorbidity information, and clinically relevant blood markers were collected prior to treatment and were used to identify correlates and predictors of sarcopenia through Spearman correlations and multivariable logistic regression, respectively.

RESULTS

In total, 110 men had complete data on sarcopenia measures and were included in the analysis. Sarcopenia was identified in 30 (27.3%) participants. Pre-treatment sarcopenia was moderately correlated with dependence in one or more instrumental activities of daily living (IADLs) (r=0.412), Vulnerable Elders Survey-13 (r=0.404), and a lower hemoglobin (r=0.407 per 10 g/L decrease). In adjusted logistic regression, dependence in one or more IADLs (odds ratio [OR] 4.37, 95% confidence interval [CI] 1.37-13.86, p=0.012), and a 10 g/L decrease in hemoglobin (OR 1.70, 95% CI 1.13-2.57, p=0.012) were significantly associated with sarcopenia.

CONCLUSIONS

In settings where assessment of sarcopenia is not feasible, evaluation of IADLs and hemoglobin may be used to identify high-risk patients that can benefit from supportive care strategies aiming to improve muscle mass and function.

An Artificial Intelligence Approach for Test-Free Identification of Sarcopenia

BACKGROUND

The diagnosis of sarcopenia relies extensively on human and equipment resources and requires individuals to personally visit medical institutions. The objective of this study was to develop a test-free, self-assessable approach to identify sarcopenia by utilizing artificial intelligence techniques and representative real-world data.

METHODS

This multicentre study enrolled 11 661 middle-aged and older adults from a national survey initialized in 2011. Follow-up data from the baseline cohort collected in 2013 (n = 9403) and 2015 (n = 10 356) were used for validation. Sarcopenia was retrospectively diagnosed using the Asian Working Group for Sarcopenia 2019 framework. Baseline age, sex, height, weight and 20 functional capacity (FC)-related binary indices (activities of daily living = 6, instrumental activities of daily living = 5 and other FC indices = 9) were considered as predictors. Multiple machine learning (ML) models were trained and cross-validated using 70% of the baseline data to predict sarcopenia. The remaining 30% of the baseline data, along with two follow-up datasets (n = 9403 and n = 10 356, respectively), were used to assess model performance.

RESULTS

The study included 5634 men and 6027 women (median age = 57.0 years). Sarcopenia was identified in 1288 (11.0%) individuals. Among the 20 FC indices, the running/jogging 1 km item showed the highest predictive value for sarcopenia (AUC [95%CI] = 0.633 [0.620-0.647]). From the various ML models assessed, a 24-variable gradient boosting classifier (GBC) model was selected. This GBC model demonstrated favourable performance in predicting sarcopenia in the holdout data (AUC [95%CI] = 0.831 [0.808-0.853], accuracy = 0.889, recall = 0.441, precision = 0.475, F1 score = 0.458, Kappa = 0.396 and Matthews correlation coefficient = 0.396). Further model validation on the temporal scale using two longitudinal datasets also demonstrated good performance (AUC [95%CI]: 0.833 [0.818-0.848] and 0.852 [0.840-0.865], respectively). The model's built-in feature importance ranking and the SHapley Additive exPlanations method revealed that lifting 5 kg and running/jogging 1 km were relatively important variables among the 20 FC items contributing to the model's predictive capacity, respectively. The calibration curve of the model indicated good agreement between predictions and actual observations (Hosmer and Lemeshow p = 0.501, 0.451 and 0.374 for the three test sets, respectively), and decision curve analysis supported its clinical usefulness. The model was implemented as an online web application and exported as a deployable binary file, allowing for flexible, individualized risk assessment.

CONCLUSIONS

We developed an artificial intelligence model that can assist in the identification of sarcopenia, particularly in settings lacking the necessary resources for a comprehensive diagnosis. These findings offer potential for improving decision-making and facilitating the development of novel management strategies of sarcopenia.

The chest CT perspective on sarcopenia: Exploring reference values for muscle mass quantity/quality and its application in elderly adults

OBJECTIVE

To determine reference values for diagnosing sarcopenia through chest CT scans and evaluate their suitability for use among the Chinese elderly population.

METHODS

Chest CT scans were obtained from 500 healthy individuals aged 19-39. Skeletal muscle mass was assessed on chest CT at the level of T4 by the skeletal muscle area (T4SMA), skeletal muscle index (T4SMI), T12 erector spinae muscle area (T12ESMA), and T12 skeletal muscle index (T12SMI), as well as skeletal muscle density (SMD) at T4 and T12 levels. The diagnostic threshold for sarcopenia was defined as a gender-specific value below 2 SD of the mean value in the young group. These cutoff values were then applied to a group of older adults aged 65 and over.

RESULTS

Diagnostic thresholds for low skeletal muscle in men were 110.05 cm², 36.01 cm²/m², 29.56 cm², and 9.65 cm²/m² for T4SMA, T4SMI, T12ESMA, and T12SMI, respectively. For women, the thresholds were: 69.93 cm², 26.51 cm²/m², 17.84 cm²/m², and 6.87 cm²/m², respectively. Diagnostic thresholds for low SMD were 38.63HU in men, 34.74 HU for women at T4 level. At T12 level, the cutoff values were 40.94 HU for men and 36.63 HU for women. Sarcopenia prevalence in men, defined by T4SMA, T4SMI, T12ESMA, and T12SMI cutoffs, was 35.6%, 18.9%, 36.7%, and 23.7%, respectively. In women, sarcopenia prevalence was 5.1%, 3.2%, 3.2%, and 1.9%, respectively.

CONCLUSION

This study established reference values for sarcopenia diagnosis through chest CT scans among the Chinese population, highlighting the importance of utilizing chest CT scans for sarcopenia detection and muscle health monitoring in older adults.

Sarcopenia Is a Prognostic Factor of Adverse Effects and Mortality in Patients With Tumour: A Systematic Review and Meta-Analysis

BACKGROUND

The relationship between sarcopenia and the prognosis of patients with tumours who received radio- and/or chemotherapy still needs to be determined. In this study, we aim to investigate the relationship between sarcopenia and adverse effects and mortality in patients with tumours that received radio- and/or chemotherapy, stratified by study design, tumour category, the method sarcopenia assessed, treatment options, study location and among other factors.

METHODS

PubMed, Web of Science and Embase were searched from inception to 15 August 2024, without language restrictions and with a manual search of references for additional articles retrieval. Cohort studies of ≥ 100 patients with tumours that evaluated the association between sarcopenia or muscle mass and the adverse effects or overall survival induced by radio- and/or chemotherapy were included.

RESULTS

Thirty-nine studies were included, involving 8966 patients with tumours, including 3383 patients with sarcopenia. The pooled prevalence of sarcopenia in patients with tumours was 0.42 (95% CI 0.36-0.48, p < 0.001) overall. The prevalence of sarcopenia is higher in Oceania patients 0.60 (95% CI 0.28-0.89, p < 0.001), those with reproductive tumour 0.57 (95% CI 0.30-0.83, p < 0.001), and sarcopenia assessed by the lumbar-skeletal muscle index 0.46 (95% CI 0.39-0.53, p < 0.001) than in other subgroups, but not show significant differences in sex. Sarcopenia was associated with an increased risk of adverse effects in patients who received radio- and/or chemotherapy, with a relative risk (RR) of 1.44 (95% CI 1.21-1.71, p < 0.001). Retrospective studies (RR = 1.49; 95% CI 1.24-1.79; p < 0.001), sarcopenia assessed by other methods (RR = 2.98; 95% CI 1.52-5.87; p < 0.001), and patients in Europe (RR = 1.92; 95% CI 1.15-3.22; p = 0.013), received chemoradiotherapy (RR = 1.47; 95% CI 1.23-1.76; p < 0.001), and with head and neck tumours (RR = 1.54; 95% CI 1.17-2.01; p = 0.010) had higher relative risk than other subgroups. Sarcopenia was also associated with reduced overall survival in patients with tumours, with a pooled hazard ratio (HR) of 1.66 (95% CI 1.40-1.96, p < 0.001). Prospective studies (HR = 1.72; 95% CI 0.97-3.07; p = 0.065), sarcopenia assessed by the cervical-skeletal muscle index (HR = 2.66; 95% CI 1.73-4.09; p < 0.001), and patients in Asia (HR = 1.91; 95% CI 1.50-2.42; p < 0.001), received chemoradiotherapy (HR = 1.85; 95% CI 1.46-2.45; p < 0.001) and with head and neck tumours (HR = 2.35; 95% CI 1.88-2.95; p < 0.001) had higher HR than other subgroups.

CONCLUSIONS

Sarcopenia was associated with a higher risk of adverse effects and mortality in patients with tumours received radio- and/or chemotherapy.

Novel insights into the association between genetically proxied inhibition of proprotein convertase subtilisin/kexin type 9 and risk of sarcopenia

BACKGROUND

The effects of lipid-lowering drugs [including statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors] on hyperlipidaemia have been established. Some may have treatment effects beyond their reported properties, offering potential opportunities for drug repurposing. Epidemiological studies have reported conflicting findings on the relationship between lipid-lowering medication use and sarcopenia risk.

METHODS

We performed a two-sample Mendelian randomization (MR) study to investigate the causal association between the use of genetically proxied lipid-lowering drugs (including statins, ezetimibe, and PCSK9 inhibitors, which use low-density lipoprotein as a biomarker), and sarcopenia risk. The inverse-variance weighting method was used with pleiotropy-robust methods (MR-Egger regression and weighted median) and colocalization as sensitivity analyses.

RESULTS

According to the positive control analysis, genetically proxied inhibition in lipid-lowering drug targets was associated with a lower risk of coronary heart disease [PCSK9 (OR, 0.67; 95% CI, 0.61 to 0.72; P = 7.7E-21); 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR; OR, 0.68; 95% CI, 0.57 to 0.82; P = 4.6E-05), and Niemann-Pick C1-like 1 (NPC1L1; OR, 0.53; 95% CI, 0.40 to 0.69; P = 3.3E-06)], consistent with drug mechanistic actions and previous trial evidence. Genetically proxied inhibition of PCSK9 (beta, -0.040; 95% CI, -0.068 to -0.012; P = 0.005) and circulating PCSK9 levels (beta, -0.019; 95% CI, -0.033 to -0.005; P = 0.006) were associated with reduced appendicular lean mass (ALM) with concordant estimates in terms of direction and magnitude. Validation analyses using a second instrument for PCSK9 yielded consistent results in terms of direction and magnitude [(PCSK9 to ALM; beta, -0.052; 95% CI, -0.074 to -0.032; P = 7.1E-7); (PCSK9 protein to ALM; beta, -0.060; 95% CI, -0.106 to -0.014; P = 0.010)]. Genetically proxied inhibition of PCSK9 gene expression in the liver may be associated with reduced ALM (beta, -0.013; 95% CI, -0.035 to 0.009; P = 0.25), consistent with the results of PCSK9 drug-target and PCSK9 protein MR analyses, but the magnitude was less precise. No robust association was found between HMGCR inhibition (beta, 0.048; 95% CI, -0.015 to 0.110; P = 0.14) or NPC1L1 (beta, 0.035; 95% CI, -0.074 to 0.144; P = 0.53) inhibition and ALM, and validation and sensitivity MR analyses showed consistent estimates.

CONCLUSIONS

This MR study suggested that PCSK9 is involved in sarcopenia pathogenesis and that its inhibition is associated with reduced ALM. These findings potentially pave the way for future studies that may allow personalized selection of lipid-lowering drugs for those at risk of sarcopenia.

Sarcopenia screening and clinical outcomes in surgical patients: A longitudinal study

BACKGROUND

The SARC-CalF was developed as a screening tool for sarcopenia, but little is still known about its validity in surgical patients. Thus, this study aimed to assess the prognostic value of SARC-CalF in predicting clinical outcomes in patients admitted for any elective surgery in a hospital.

METHODS

Cohort study with prospective data collection of surgical patients ≥18 years of age screened for sarcopenia within 48 h of admission using the SARC-CalF (score ≥11 points classified patients at suggestive signs of sarcopenia). A standard questionnaire for sociodemographic and clinical data was filled and anthropometric data were measured. Clinical outcomes of interest comprised postoperative complications, length of postoperative hospital stay (LPHS), length of hospital stay (LOS), and in-hospital death.

RESULTS

Among the 303 patients admitted for elective surgery across various specialties (58.2 ± 14.6 years; 53.8% men) included, 21.5% presented suggestive signs of sarcopenia (SARC-CalF ≥11). LOS (16.0 [10.0-29.0] vs 13.5 [8.0-22.0] days; P < 0.05) and LPHS (6.0 [3.0-14.5] vs 5.0 [1.0-8.2] days; P < 0.05) were longer in patients with SARC-CalF ≥11 compared with those without this condition. The frequency of severe postoperative complications (23.1% vs 8.8%; P < 0.05) and the incidence of death (12.3% vs 2.9%; P < 0.05) were higher in patients with SARC-CalF ≥11. However, in the multivariate analyses, no association between SARC-CalF ≥11 and clinical outcomes was found.

CONCLUSION

Signs of sarcopenia (SARC-CalF ≥11) were present in >20% of patients who were hospitalized for any elective surgery, but it was not an independent predictor of extended hospital stay, complications, and death.

Therapeutic strategies to modulate gut microbial health: Approaches for sarcopenia management

Sarcopenia is a progressive and generalized loss of skeletal muscle and functions associated with ageing with currently no definitive treatment. Alterations in gut microbial composition have emerged as a significant contributor to the pathophysiology of multiple diseases. Recently, its association with muscle health has pointed to its potential role in mediating sarcopenia. The current review focuses on the association of gut microbiota and mediators of muscle health, connecting the dots between the influence of gut microbiota and their metabolites on biomarkers of sarcopenia. It further delineates the mechanism by which the gut microbiota affects muscle health with progressing age, aiding the formulation of a multi-modal treatment plan involving nutritional supplements and pharmacological interventions along with lifestyle changes compiled in the review. Nutritional supplements containing proteins, vitamin D, omega-3 fatty acids, creatine, curcumin, kefir, and ursolic acid positively impact the gut microbiome. Dietary fibres foster a conducive environment for the growth of beneficial microbes such as Bifidobacterium, Faecalibacterium, Ruminococcus, and Lactobacillus. Probiotics and prebiotics act by protecting against reactive oxygen species (ROS) and inflammatory cytokines. They also increase the production of gut microbiota metabolites like short-chain fatty acids (SCFAs), which aid in improving muscle health. Foods rich in polyphenols are anti-inflammatory and have an antioxidant effect, contributing to a healthier gut. Pharmacological interventions like faecal microbiota transplantation (FMT), non-steroidal anti-inflammatory drugs (NSAIDs), ghrelin mimetics, angiotensin-converting enzyme inhibitors (ACEIs), and butyrate precursors lead to the production of anti-inflammatory fatty acids and regulate appetite, gut motility, and microbial impact on gut health. Further research is warranted to deepen our understanding of the interaction between gut microbiota and muscle health for developing therapeutic strategies for ameliorating sarcopenic muscle loss.

A novel treatment strategy targeting cellular pathways with natural products to alleviate sarcopenia

Sarcopenia is a condition marked by a significant reduction in muscle mass and strength, primarily due to the aging process, which critically impacts muscle protein dynamics, metabolic functions, and overall physical functionality. This condition leads to increased body fat and reduced daily activity, contributing to severe health issues and a lower quality of life among the elderly. Recognized in the ICD-10-CM only in 2016, sarcopenia lacks definitive treatment options despite its growing prevalence and substantial social and economic implications. Given the aging global population, addressing sarcopenia has become increasingly relevant and necessary. The primary causes include aging, cachexia, diabetes, and nutritional deficiencies, leading to imbalances in protein synthesis and degradation, mitochondrial dysfunction, and hormonal changes. Exercise remains the most effective intervention, but it is often impractical for individuals with limited mobility, and pharmacological options such as anabolic steroids and myostatin inhibitors are not FDA-approved and are still under investigation. This review is crucial as it examines the potential of natural products as a novel treatment strategy for sarcopenia, targeting multiple mechanisms involved in its pathogenesis. By exploring natural products' multi-targeted effects, this study aims to provide innovative and practical solutions for sarcopenia management. Therefore, this review indicates significant improvements in muscle mass and function with the use of specific natural compounds, suggesting promising alternatives for those unable to engage in regular physical activity.

Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts health outcomes in older adults. This review explores the evolving landscape of sarcopenia research, with a particular focus on its unique characteristics in Asian populations and emerging pharmaceutical interventions. Recent studies have revealed distinct patterns of muscle mass decline in Asian adults, particularly in women, challenging the universal application of global sarcopenia diagnostic criteria. The Asian Working Group for Sarcopenia has proposed region-specific diagnostic criteria, acknowledging these ethnic variations. Prevalence estimates of sarcopenia vary widely, ranging from 10% to 40% in community-dwelling older adults. For specific chronic conditions, the prevalence of sarcopenia is notably higher, reaching 35% for cardiovascular diseases and 24.5% for chronic kidney disease. Sarcopenia is strongly associated with various chronic conditions, increasing the risk of falls by 1.5 to 3 times and significantly increasing mortality risk by 29% to 51%. Current management strategies primarily involve resistance exercise and nutritional interventions, with a recommended daily protein intake of at least 1.2 g/kg to maintain muscle health. Pharmaceutical development has gained significant momentum, with over 20 compounds in various stages of clinical trials. These include myostatin inhibitors, selective androgen receptor modulators, ghrelin receptor agonists, mesenchymal stem cell therapy, and follistatin gene therapy. However, the unique dietary patterns, cultural contexts, and potentially distinct drug responses in Asian populations necessitate tailored interventions and Asia-specific clinical trials. Future directions include refining Asian-specific diagnostic criteria, conducting large-scale epidemiological studies across multiple Asian countries, developing culturally appropriate interventions, integrating sarcopenia management into chronic disease care, and advancing pharmaceutical research with a focus on Asian populations. In conclusion, sarcopenia emerges as a critical nexus in the aging process, intricately linked with multiple organ systems and chronic conditions, underscoring the imperative for its recognition as a cornerstone in person-centered care and the holistic management of age-related health challenges.

Metformin restores autophagic flux and mitochondrial function in late passage myoblast to impede age-related muscle loss

Sarcopenia, which refers to age-related muscle loss, presents a significant challenge for the aging population. Age-related changes that contribute to sarcopenia include cellular senescence, decreased muscle stem cell number and regenerative capacity, impaired autophagy, and mitochondrial dysfunction. Metformin, an anti-diabetic agent, activates AMP-activated protein kinase (AMPK) and affects various cellular processes in addition to reducing hepatic gluconeogenesis, lowering blood glucose levels, and improving insulin resistance. However, its effect on skeletal muscle cells remains unclear. This study aimed to investigate the effects of metformin on age-related muscle loss using a late passage C2C12 cell model. The results demonstrated that metformin alleviated hallmarks of cellular senescence, including SA-β-gal activity and p21 overexpression. Moreover, treatment with pharmacological concentrations of metformin restored the reduced differentiation capacity in late passage cells, evident through increased myotube formation ability and enhanced expression of myogenic differentiation markers such as MyoD, MyoG, and MHC. These effects of metformin were attributed to enhanced autophagic activity, normalization of mitochondrial membrane potential, and improved mitochondrial respiratory capacity. These results suggest that pharmacological concentrations of metformin alleviate the hallmarks of cellular senescence, restore differentiation capacity, and improve autophagic flux and mitochondrial function. These findings support the potential use of metformin for the treatment of sarcopenia.

Sex-Specific Association of Low Muscle Mass with Depression Status in Asymptomatic Adults: A Population-Based Study

BACKGROUND

The objective of this study was to examine the correlation between low muscle mass (LMM) and depression, with a specific focus on identifying the sex-specific relationship between LMM and depression in a large sample.

METHODS

This population-based cross-sectional study involved 292,922 community-dwelling adults from 2012 to 2019. Measurements were taken using the Center for Epidemiological Studies Depression (CESD) scale and body composition analyses. Depression was defined as a CESD score ≥ 16, and severe depression as a CESD score ≥ 22. LMM was defined as an appendicular muscle mass/height2 below 7.0 kg/m2 in men and below 5.4 kg/m2 in women. Sex-based multivariable logistic regression analyzed the LMM-depression association, adjusting for confounders, with depression status and severe depression status as dependent variables.

RESULTS

Both men and women in the LMM group had an increased odds of depression (men, adjusted odds ratio = 1.13 [95% confidence interval = 1.03-1.12]; women, 1.07 [1.03-1.23]) and severe depression (men, 1.20 [1.05-1.36]; women, 1.10 [1.04-1.15]) compared to those in the control group. Men showed a stronger association between LMM and the presence of depression (p for interaction = 0.025) and the presence of severe depression (p for interaction = 0.025) compared to women.

CONCLUSIONS

Decreased muscle mass was independently associated with increased chances of depression and severe depression in both sexes, with a significantly stronger association in men compared to women. This highlights the potential significance of LMM as a predictor of depression, particularly in men.

Causal relationship between sarcopenia and rotator cuff tears: a Mendelian randomization study

Background

Sarcopenia and rotator cuff tears are common among elderly patients. However, the role of sarcopenia in the management of rotator cuff tears has been often overlooked. This study aimed to elucidate the effects of sarcopenia-related traits on rotator cuff tears.

Methods

Two-sample Mendelian randomization (MR) analyses based on genome-wide association study data were used to evaluate the causal relationships among appendicular lean mass (ALM), usual walking pace, low hand grip strength, and rotator cuff tears. Multivariate Mendelian randomization (MVMR) analyses were used to evaluate the direct effects of each muscle trait on the causal relationship.

Results

Univariate MR analysis showed that ALM and usual walking pace were causally related to rotator cuff tears (odds ratio (OR) = 0.895; 95% confidence interval (CI), 0.758-0.966, P<0.001 and OR = 0.458, 95% CI, 0.276-0.762, P = 0.003, respectively), and there was no evidence of causality between low hand grip strength and rotator cuff tears (OR = 1.132, 95% CI, 0.913-1.404, P = 0.26). MVMR analysis confirmed the causal effects of ALM and walking pace on rotator cuff tears (OR = 0.918, 95% CI, 0.851-0.990, P = 0.03 and OR = 0.476, 95% CI, 0.304-0.746, P = 0.001, respectively).

Conclusion

A causal genetic relationship exists between sarcopenia and rotator cuff tears. Sarcopenia-related traits including low muscle mass and physical function, increase the risk of rotator cuff tears. These findings provide new clinical insights and evidence-based medicine to optimize management of rotator cuff tears.

The application of Chinese version of SARC-F and SARC-CalF in sarcopenia screening against five definitions: a diagnostic test accuracy study

BACKGROUND

SARC-F questionnaire is a simple and convenient tool for sarcopenia screening, and SARC-CalF is a modified version of it. The developments of their Chinese versions are warranted for the clinical use for Chinese population. This study aimed to culturally adapt the SARC-F questionnaire into Chinese using standardized methods, validate the reliability and diagnostic accuracy of the Chinese version SARC-F and SARC-CalF against five sarcopenia diagnosis criteria, and determine optimal cut-off values for clinical practice in Chinese population.

METHODS

The translation and cross-cultural adaptation of SARC-F into Chinese were conducted following the methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. The Chinese version of SARC-F was validated through a diagnostic test, using diagnostic criteria of sarcopenia recommended by the revised 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, Asian Working Group for Sarcopenia (AWGS2019) consensus, the International Working Group on Sarcopenia (IWGS), the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium and the Sarcopenia Definition and Outcomes Consortium (SDOC). Additional analysis was done against the criteria of severe sarcopenia according to the revised EWGSOP2 and AWGS2019.

RESULTS

The Chinese version of SARC-F was well translated and demonstrated good reliability and acceptability. The diagnostic test included 1859 community-dwelling older individuals from two medical centers. Against five different definitions of sarcopenia, the Chinese version of SARC-F showed reasonable diagnostic accuracy for sarcopenia screening (AUC 0.614-0.821), and was demonstrated low sensitivity (13.7-37.9%) but high specificity (94.8-97.7%) with a cut-off value of ≥ 4. SARC-CalF significantly enhanced the diagnostic accuracy of SARC-F when using definitions of EWGSOP2, AWGS2019 and IWGS (all P ≤ 0.001). A score of ≥ 2 for SARC-F and ≥ 7 for SARC-CalF were established as optimal cut-off points for identifying older individuals as at risk of sarcopenia in Chinese population.

CONCLUSIONS

The Chinese version SARC-F is of reasonable reliability and validity for sarcopenia screening. Despite its low sensitivity, it proves to be a useful tool to identify severe cases in community taking advantage of its simplicity. SARC-CalF appears to be a more suitable screening tool for clinical use in detecting sarcopenia.

Sarcopenia screening based on the assessment of gait with inertial measurement units: a systematic review

BACKGROUND

Gait variables assessed by inertial measurement units (IMUs) show promise as screening tools for aging-related diseases like sarcopenia. The main aims of this systematic review were to analyze and synthesize the scientific evidence for screening sarcopenia based on gait variables assessed by IMUs, and also to review articles that investigated which gait variables assessed by IMUs were related to sarcopenia.

METHODS

Six electronic databases (PubMed, SportDiscus, Web of Science, Cochrane Library, Scopus and IEEE Xplore) were searched for journal articles related to gait, IMUs and sarcopenia. The search was conducted until December 5, 2023. Titles, abstracts and full-length texts for studies were screened to be included.

RESULTS

A total of seven articles were finally included in this review. Despite some methodological variability among the included studies, IMUs demonstrated potential as effective tools for detecting sarcopenia when coupled with artificial intelligence (AI) models, which outperformed traditional statistical methods in classification accuracy. The findings suggest that gait variables related to the stance phase such as stance duration, double support time, and variations between feet, are key indicators of sarcopenia.

CONCLUSIONS

IMUs could be useful tools for sarcopenia screening based on gait analysis, specifically when artificial intelligence is used to process the recorded data. However, more development and research in this field is needed to provide an effective screening tool for doctors and health systems.

Construction of frailty and risk prediction models in maintenance hemodialysis patients: a cross-sectional study

Objective

As the prevalence of diabetic nephropathy and hypertensive nephropathy increases with age in mainland China, the number of patients with end-stage renal disease is increasing, leading to an increase in the number of patients receiving maintenance hemodialysis. Considering the harmful effects of frailty on the health of maintenance hemodialysis patients, this study aims to identify hemodialysis patients at risk for frailty at an early stage, in order to prevent or delay the progression of frailty in the early stage, so as to prevent the adverse consequences of frailty.

Methods

A total of 479 patients admitted to the blood purification centers of two grade tertiary hospitals in Anhui Province, China, using convenient sampling. The Frailty Scale, the SARC-F questionnaire, the Simplified Food Appetite Questionnaire (SNAQ) and the mini nutritional assessment short-form (MNA-SF) were used in the study. Pearson correlation analysis was used to explore the correlation among the frailty influencing factors.

Results

The incidence of frailty was 24.0% among 479 Chinese hemodialysis patients. Gender (p < 0.05), Malnutrition (p < 0.001), sarcopenia (p < 0.001), and feel tired after dialysis (p < 0.001) were highly correlated with frailty in Chinese hemodialysis patients. Serum albumin concentration (p < 0.05) was a protective factor of frailty.

Conclusion

This survey shows that frailty was highly prevalent among Chinese hemodialysis patients. Medical staff and their families should make early judgments and carry out interventions on the risk of frailty.