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Prakash SS, Priyadarshi RN, Surya H, Kumar S, Anand U, Kumar R. Bedside assessment of sarcopenia in hospitalized patients with liver cirrhosis: Magnitude and clinical implications. Indian J Gastroenterol 2024:10.1007/s12664-024-01642-x. [PMID: 39060903 DOI: 10.1007/s12664-024-01642-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Sarcopenia is associated with many adverse outcomes in patients with cirrhosis. The tools currently in use for assessing sarcopenia have numerous flaws. We evaluated the utility of portable ultrasonography and a dynamometer for the bedside assessment of sarcopenia and its implications in hospitalized cirrhosis patients. METHODS A dynamometer was used to test the hand-grip strength (HGS) and ultrasound was used to measure the thickness of the forearm and quadriceps muscles. HGS value < 27 kg for men and < 16 kg for women was taken as significant according to the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. The lower normal limit of muscle mass (5th percentile) was determined on 100 matched healthy controls. RESULTS According to the EWGSOP2 criteria and HGS values, the prevalence of sarcopenia and probable sarcopenia among 300 cirrhosis patients were 56% and 62.3%, respectively. HGS alone identified sarcopenia in 88.9% of patients, while overestimated it in 6.3% of cases. The prevalence rate of sarcopenic obesity was 11%. Compared to patients without sarcopenia, sarcopenic patients had more complications of cirrhosis such as ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, sepsis, hepatorenal syndrome and refractory ascites. In-hospital (p = 0.037), three-month (p < 0.001), and six-month (p < 0.001) mortality rates were all higher among sarcopenic patients. On cox regression survival analysis, overall six-month mortality was significantly higher in sarcopenic patients compared to patients without sarcopenia (hazard ratio, 6.37; 95% confidence interval, 3.15-12.8, p < 0.001). CONCLUSION Bedside assessment of sarcopenia using a portable ultrasound machine and a dynamometer detects liver cirrhosis patients with high risk of complications and mortality.
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Affiliation(s)
- Sabbu Surya Prakash
- Department of Gastroenterology, All India Institute of Medical Sciences, 4th Floor, OPD, D-Block, Patna, 801507, India
| | | | - Himanshu Surya
- Department of Gastroenterology, All India Institute of Medical Sciences, 4th Floor, OPD, D-Block, Patna, 801507, India
| | - Sudhir Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, 4th Floor, OPD, D-Block, Patna, 801507, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, 4th Floor, OPD, D-Block, Patna, 801507, India.
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Phillip JG, Minet LR, Smedemark SA, Ryg J, Andersen-Ranberg K, Brockhattingen KK. Comparative analysis of hand-held and stationary ultrasound for detection of sarcopenia in acutely hospitalised older adults-a validity and reliability study. Eur Geriatr Med 2024:10.1007/s41999-024-01021-x. [PMID: 39031330 DOI: 10.1007/s41999-024-01021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND AND PURPOSE Sarcopenia is a growing health concern among geriatric patients. Early diagnostics is importance to intervene and better muscle status and thus physical function. Ultrasound can be a valuable tool for patient-near diagnostics of sarcopenia. In recent time, ultrasound devices have evolved from larger stationary devices to minor hand-held devices that are more portable. However, the literature lacks research comparing quality of the different devices. The purpose of this study was to compare hand-held ultrasound (HH-US) to stationary ultrasound (S-US) in muscle assessment for detection of sarcopenia in acutely hospitalized older adults. METHODS A cross-sectional study using a convenience sample of acutely admitted older patients examined with both HH-US and S-US within a single session by the same examiner. Image analysis was performed using ImageJ, and was conducted by two raters: Rater 2 an experienced US examiner and Rater 1 an US examiner who received training from Rater 2. The Ultrasound sarcopenia index (USI) was used for evaluating sarcopenia. Validity and reliability of HH-US were analyzed using Cohen's Kappa and Student's t-test. RESULTS 21 participants (mean age 83.4 years, 52% female). Results showed "substantial" intra-rater reliability (κ = 0.77 for Rater 1) and 'near-perfect' validity (κ = 0.92 for Rater 2). Inter-rater comparisons revealed no significant differences (p < 0.05). CONCLUSION HH-US is a potential method for detection of sarcopenia in acutely hospitalized older adults.
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Affiliation(s)
- Jeppe Grabov Phillip
- Department of Geriatric Medicine, Odense University Hospital, Svendborg, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Rosenbek Minet
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Siri Aas Smedemark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Kittelmann Brockhattingen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Willemse L, Wouters EJM, Pisters MF, Vanwanseele B. Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol. BMC Sports Sci Med Rehabil 2024; 16:158. [PMID: 39033125 DOI: 10.1186/s13102-024-00944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Falling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program. METHODS For this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant's progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA's are used to analyze the trial outcomes. DISCUSSION The results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs. TRIAL REGISTRATION The trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).
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Affiliation(s)
- Lydia Willemse
- Fontys University of Applied Sciences, PO Box 347, Eindhoven, AH, 5600, The Netherlands.
- Department of Movement Sciences, KU Leuven, Tervuursevest 101 - box 1500, Louvain, 3001, Belgium.
- Tranzo, School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, LE, 5000, The Netherlands.
| | - Eveline J M Wouters
- Fontys University of Applied Sciences, PO Box 347, Eindhoven, AH, 5600, The Netherlands
- Tranzo, School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, LE, 5000, The Netherlands
| | - Martijn F Pisters
- Fontys University of Applied Sciences, PO Box 347, Eindhoven, AH, 5600, The Netherlands
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht University, PO Box 85500, Utrecht, GA, 3508, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, PO Box 85500, Utrecht, GA, 3508, The Netherlands
| | - Benedicte Vanwanseele
- Fontys University of Applied Sciences, PO Box 347, Eindhoven, AH, 5600, The Netherlands
- Department of Movement Sciences, KU Leuven, Tervuursevest 101 - box 1500, Louvain, 3001, Belgium
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Persits I, Mirzai S, Sarnaik KS, Volk MC, Yun J, Harb S, Puri R, Kapadia S, Krishnaswamy A, Chen PH, Reed G, Tang WHW. Sarcopenia and Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement. Am Heart J 2024:S0002-8703(24)00173-X. [PMID: 39032584 DOI: 10.1016/j.ahj.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Skeletal muscle mass (SMM) plays a crucial role in risk assessment in transcatheter aortic valve replacement (TAVR) candidates, yet it remains underutilized. Traditional methods focus on weakness or performance but omit SMM. This study compared traditional and novel markers of sarcopenia and frailty in terms of their ability to predict adverse outcomes post-TAVR. METHODS Three risk models were evaluated for the composite outcome of perioperative complications, 1-year rehospitalization, or 1-year mortality: (1) sarcopenia by combining low muscle mass (LMM) and weakness/performance assessed by hand grip strength or gait speed; (2) frailty by an Adapted Green score; and (3) frailty by the Green-SMI score incorporating LMM by multi-level opportunistic pre-TAVR thoracic CT segmentation. RESULTS In this study we included 184 eligible patients from January to December of 2018, (96.7%) of which were balloon expandable valves. The three risk models identified 22.8% patients as sarcopenic, 63.6% as frail by the Adapted Green score, and 53.8% as frail by the Green-SMI score. There were higher rates of the composite outcome in patients with sarcopenia (54.8%) and frailty (41.9% with the Adapted Green and 50.5% with the Green-SMI score) compared to their non-sarcopenic (30.3%) and non-frail counterparts (25.4% with the Adapted Green and 18.8% with the Green-SMI score). Sarcopenia and frailty by Green-SMI, but not by the Adapted Green, were associated with higher risks of the composite outcome on multivariable adjustment (HR 2.2 [95% CI: 1.25-4.02], p=0.007 and HR 3.4 [95% CI: 1.75-6.65], p<0.001, respectively). CONCLUSIONS The integration of pre-operative CT-based SMM to a frailty score significantly improves the prediction of adverse outcomes in patients undergoing TAVR.
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Affiliation(s)
- Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kunaal S Sarnaik
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - James Yun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Serge Harb
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Po-Hao Chen
- Section of Musculoskeletal Imaging, Diagnostics Institute, Cleveland Clinic, Cleveland, OH
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
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Güner M, Girgin S, Ceylan S, Özcan B, Öztürk Y, Okyar Baş A, Koca M, Balcı C, Doğu BB, Cankurtaran M, Yıldırım T, Halil M. The Role of Muscle Ultrasonography to Diagnose Malnutrition and Sarcopenia in Maintenance Hemodialysis. J Ren Nutr 2024; 34:330-336. [PMID: 38128851 DOI: 10.1053/j.jrn.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sarcopenia and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia in patients undergoing MHD and investigate the role of muscle ultrasound (US) parameters to predict sarcopenia and malnutrition. METHODS A total of 45 patients who have undertaken MHD for more than 6 months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF). RESULTS The prevalence of probable and confirmed sarcopenia was 51.1% (n = 23) and 35.6% (n = 16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n = 14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (P = .046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61 cm2, respectively (P < .05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; P = .011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; P = .017). CONCLUSION RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.
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Affiliation(s)
- Merve Güner
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye.
| | - Sinem Girgin
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Serdar Ceylan
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Berşan Özcan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Yelda Öztürk
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Arzu Okyar Baş
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Meltem Koca
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Cafer Balcı
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Burcu Balam Doğu
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Tolga Yıldırım
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
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Jenkins TO, Patel S, Edwards GD, Nolan CM, Canavan J, Kon S, Jones S, Barker RE, Littlemore H, Maddocks M, Man WDC. Longitudinal change in ultrasound-derived rectus femoris cross-sectional area in COPD. ERJ Open Res 2024; 10:00123-2024. [PMID: 39076527 PMCID: PMC11284593 DOI: 10.1183/23120541.00123-2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/27/2024] [Indexed: 07/31/2024] Open
Abstract
Background Skeletal muscle dysfunction is common in COPD. Ultrasound-derived rectus femoris cross-sectional area (RFCSA) is a radiation free, non-invasive measure of muscle bulk that relates to quadriceps strength in people with COPD. However, there are limited longitudinal data for RFCSA, and it is not known whether longitudinal change in RFCSA reflects change in quadricep strength, exercise capacity, lower limb function or muscle mass. We aimed to quantify longitudinal change in ultrasound-derived RFCSA and assess its relationship with change in quadriceps maximal voluntary contraction (QMVC), incremental shuttle walk test (ISWT), five-repetition sit-to-stand (5STS) and fat-free mass (FFM) over 12 months in people with COPD. Methods We measured ultrasound-derived RFCSA, QMVC, ISWT, 5STS and FFM (measured by bioelectric impedance analysis) at baseline and 12 months in 169 people with stable COPD. Change was correlated using Pearson's or Spearman's coefficients. Results Baseline characteristics: mean±sd age 70.4±9.4 years; FEV1 53.3±18.9% predicted. Over the course of 12 months mean RFCSA change was -33.7 mm2 (99% CI -62.6- -4.9 mm2; p=0.003) representing a mean±sd percentage change of -1.8±33.5%. There was a weak correlation between change in RFCSA and FFM (r=0.205, p=0.009), but not with change in QMVC, ISWT or 5STS. Conclusion There is a statistically significant decrease in ultrasound-derived RFCSA over 12 months in people with stable COPD, but this decrease does not correlate with change in quadriceps strength, exercise capacity, FFM or lower limb function.
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Affiliation(s)
- Timothy O. Jenkins
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - George D. Edwards
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Claire M. Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- College of Medicine, Health and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Jane Canavan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Samantha Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Sarah Jones
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Cardiac and Respiratory Specialist Service, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Ruth E. Barker
- Insight Team, Wessex Academic Health Science Network (trading as Health Innovation Wessex), Southampton, UK
| | | | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - William D-C. Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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7
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Rodriguez C, Mota JD, Palmer TB, Heymsfield SB, Tinsley GM. Skeletal muscle estimation: A review of techniques and their applications. Clin Physiol Funct Imaging 2024; 44:261-284. [PMID: 38426639 DOI: 10.1111/cpf.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
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Affiliation(s)
- Christian Rodriguez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Jacob D Mota
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Ty B Palmer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Steven B Heymsfield
- Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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8
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Vu PT, Chahine C, Chatterjee N, MacLean MT, Swago S, Bhattaru A, Thompson EW, Ikhlas A, Oteng E, Davidson L, Tran R, Hazim M, Raghupathy P, Verma A, Duda J, Gee J, Luks V, Gershuni V, Wu G, Rader D, Sagreiya H, Witschey WR. CT imaging-derived phenotypes for abdominal muscle and their association with age and sex in a medical biobank. Sci Rep 2024; 14:14807. [PMID: 38926479 PMCID: PMC11208425 DOI: 10.1038/s41598-024-64603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
The study of muscle mass as an imaging-derived phenotype (IDP) may yield new insights into determining the normal and pathologic variations in muscle mass in the population. This can be done by determining 3D abdominal muscle mass from 12 distinct abdominal muscle regions and groups using computed tomography (CT) in a racially diverse medical biobank. To develop a fully automatic technique for assessment of CT abdominal muscle IDPs and preliminarily determine abdominal muscle IDP variations with age and sex in a clinically and racially diverse medical biobank. This retrospective study was conducted using the Penn Medicine BioBank (PMBB), a research protocol that recruits adult participants during outpatient visits at hospitals in the Penn Medicine network. We developed a deep residual U-Net (ResUNet) to segment 12 abdominal muscle groups including the left and right psoas, quadratus lumborum, erector spinae, gluteus medius, rectus abdominis, and lateral abdominals. 110 CT studies were randomly selected for training, validation, and testing. 44 of the 110 CT studies were selected to enrich the dataset with representative cases of intra-abdominal and abdominal wall pathology. The studies were divided into non-overlapping training, validation and testing sets. Model performance was evaluated using the Sørensen-Dice coefficient. Volumes of individual muscle groups were plotted to distribution curves. To investigate associations between muscle IDPs, age, and sex, deep learning model segmentations were performed on a larger abdominal CT dataset from PMBB consisting of 295 studies. Multivariable models were used to determine relationships between muscle mass, age and sex. The model's performance (Dice scores) on the test data was the following: psoas: 0.85 ± 0.12, quadratus lumborum: 0.72 ± 0.14, erector spinae: 0.92 ± 0.07, gluteus medius: 0.90 ± 0.08, rectus abdominis: 0.85 ± 0.08, lateral abdominals: 0.85 ± 0.09. The average Dice score across all muscle groups was 0.86 ± 0.11. Average total muscle mass for females was 2041 ± 560.7 g with a high of 2256 ± 560.1 g (41-50 year old cohort) and a change of - 0.96 g/year, declining to an average mass of 1579 ± 408.8 g (81-100 year old cohort). Average total muscle mass for males was 3086 ± 769.1 g with a high of 3385 ± 819.3 g (51-60 year old cohort) and a change of - 1.73 g/year, declining to an average mass of 2629 ± 536.7 g (81-100 year old cohort). Quadratus lumborum was most highly correlated with age for both sexes (correlation coefficient of - 0.5). Gluteus medius mass in females was positively correlated with age with a coefficient of 0.22. These preliminary findings show that our CNN can automate detailed abdominal muscle volume measurement. Unlike prior efforts, this technique provides 3D muscle segmentations of individual muscles. This technique will dramatically impact sarcopenia diagnosis and research, elucidating its clinical and public health implications. Our results suggest a peak age range for muscle mass and an expected rate of decline, both of which vary between genders. Future goals are to investigate genetic variants for sarcopenia and malnutrition, while describing genotype-phenotype associations of muscle mass in healthy humans using imaging-derived phenotypes. It is feasible to obtain 3D abdominal muscle IDPs with high accuracy from patients in a medical biobank using fully automated machine learning methods. Abdominal muscle IDPs showed significant variations in lean mass by age and sex. In the future, this tool can be leveraged to perform a genome-wide association study across the medical biobank and determine genetic variants associated with early or accelerated muscle wasting.
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Affiliation(s)
- Phuong T Vu
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Chantal Chahine
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Neil Chatterjee
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Matthew T MacLean
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sophia Swago
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Abhi Bhattaru
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Elizabeth W Thompson
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Anooshey Ikhlas
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Edith Oteng
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Lauren Davidson
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Richard Tran
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mohamad Hazim
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Pavan Raghupathy
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Anurag Verma
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Duda
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - James Gee
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Valerie Luks
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Gershuni
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary Wu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hersh Sagreiya
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Walter R Witschey
- Department of Radiology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Di Ludovico A, La Bella S, Ciarelli F, Chiarelli F, Breda L, Mohn A. Skeletal muscle as a pro- and anti-inflammatory tissue: insights from children to adults and ultrasound findings. J Ultrasound 2024:10.1007/s40477-024-00917-5. [PMID: 38907089 DOI: 10.1007/s40477-024-00917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/11/2024] [Indexed: 06/23/2024] Open
Abstract
Previously regarded as a movement and posture control agent, the skeletal muscle is now recognized as an endocrine organ that may affect systemic inflammation and metabolic health. The discovery of myokines such as IL-6, released from skeletal muscle in response to physical exercise, is now one of the most recent insights. Myokines are the mediators of the balance between the pro-inflammatory and anti-inflammatory responses. This underscores the muscle function as a determinant of good health and prevention of diseases. Advances in ultrasound technology improved evaluation of muscle thickness, composition, and determining fat distribution. Combining imaging with molecular biology, researchers discovered the complicated interplay between muscle function, cytokine production and general health effects.The production of myokines with exercise showcasing the adaptability of muscles to high-stress conditions and contributing to metabolism and inflammation regulation. These findings have significant implications in order to provide improvement in metabolic and inflammatory diseases.
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Affiliation(s)
| | | | | | | | - Luciana Breda
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Chieti, Italy
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10
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Yang X, Zhang B, Liu Y, Lv Q, Guo J. Automatic Quantitative Assessment of Muscle Strength Based on Deep Learning and Ultrasound. ULTRASONIC IMAGING 2024:1617346241255590. [PMID: 38881032 DOI: 10.1177/01617346241255590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Skeletal muscle is a vital organ that promotes human movement and maintains posture. Accurate assessment of muscle strength is helpful to provide valuable insights for athletes' rehabilitation and strength training. However, traditional techniques rely heavily on the operator's expertise, which may affect the accuracy of the results. In this study, we propose an automated method to evaluate muscle strength using ultrasound and deep learning techniques. B-mode ultrasound data of biceps brachii of multiple athletes at different strength levels were collected and then used to train our deep learning model. To evaluate the effectiveness of this method, this study tested the contraction of the biceps brachii under different force levels. The classification accuracy of this method for grade 4 and grade 6 muscle strength reached 98% and 96%, respectively, and the overall average accuracy was 93% and 87%, respectively. The experimental results confirm that the innovative methods in this paper can accurately and effectively evaluate and classify muscle strength.
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Affiliation(s)
- Xiao Yang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Beilei Zhang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Ying Liu
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Qian Lv
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Jianzhong Guo
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
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11
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Zhang XY, Yang Y. The value of multi-modal ultrasound in the assessment of sarcopenia in maintenance hemodialysis patients. Rev Clin Esp 2024:S2254-8874(24)00082-1. [PMID: 38849074 DOI: 10.1016/j.rceng.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients. METHODS MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients. RESULTS The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511-0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV(P < 0.05), with a cut-off value of 0.69. CONCLUSIONS Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.
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Affiliation(s)
- X Y Zhang
- Chongqing Hospital of Traditional Chinese Medicine, China
| | - Y Yang
- Chongqing Hospital of Traditional Chinese Medicine, China.
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12
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Catikkas NM, Safer VB, Bas S, Gunay DS, Durak A, Utku IK, Safer U. Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:608-618. [PMID: 38600828 DOI: 10.1002/jcu.23688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIMS There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM). METHODS We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM. RESULTS We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022). CONCLUSION Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.
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Affiliation(s)
- Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Suleyman Bas
- Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Deniz Sevindik Gunay
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Ayfer Durak
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Irem Kirac Utku
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Umut Safer
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
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13
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Ito K, Tada Y, Suzuki M, Hashida N, Kato Y, Yokota T, Ishikawa J, Tamiya H. Relationship between muscle thickness measured by ultrasound and physical functions: A 2-year follow-up study of allogeneic hematopoietic stem cell transplantation recipients. PM R 2024; 16:570-585. [PMID: 37844015 DOI: 10.1002/pmrj.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for hematological malignancies. Several complications following allo-HSCT, such as graft-versus-host disease, infection, and malnutrition, often cause physical dysfunction, and the assessment of physical function and evaluation of muscle mass are incompletely performed. Use of ultrasound (US) allows muscle mass measurement in patients with poor general conditions. In allo-HSCT recipients, the correlation between physical function and muscle thickness, as measured by US, remains unclear. OBJECTIVE To clarify whether muscle thickness measured by US correlated with physical function in allo-HSCT recipients. DESIGN A single-center prospective cohort study. SETTING Hospital. PATIENTS Ninety-two patients underwent allo-HSCT at our hospital from April 2017 to March 2019. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Biceps and quadriceps muscle thickness measured by US, grip strength, isometric muscle strength (elbow flexion and knee extension), and 6-minute walking test (6MWT) before allo-HSCT and on days 30, 90, 180, 1 year, and 2 years after allo-HSCT. The implementation rates of these assessments were also investigated. RESULTS Correlations were observed between biceps thickness and elbow flexion muscle strength/grip strength before allo-HSCT, on days 30, 90, 180, 1 year, and 2 years after allo-HSCT (r = 0.71/0.74, 0.73/0.72, 0.70/0.79, 0.67/0.75, 0.72/0.75, and 0.85/0.79, respectively, all p < .001). At the same time points, quadriceps thickness moderately correlated with knee extensor strength (r = 0.49, 0.50, 0.45, 0.64, 0.61, and 0.58, all p < .001). However, biceps and quadriceps thicknesses did not correlate with the 6MWT. The percentages of patients measured with US and 6MWT were 93.4% and 82.4% (p = .01) on day 30 and 97.5% and 87.8% (p = .02) on day 90, respectively. CONCLUSIONS US assessment may be a useful alternative method for estimating muscle strength in fragile allo-HSCT recipients, particularly when physical function assessment is difficult to quantify.
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Affiliation(s)
- Kumiko Ito
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Yuma Tada
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Suzuki
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Nao Hashida
- Swallowing Center, Osaka University Hospital, Osaka, Japan
| | - Yuji Kato
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
| | - Takafumi Yokota
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Hironari Tamiya
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka, Japan
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka, Japan
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14
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Sousa P, Rodrigues C. Expanding ultrasound horizons in inflammatory bowel disease: Beyond the bowel. United European Gastroenterol J 2024; 12:541-542. [PMID: 38717018 PMCID: PMC11176905 DOI: 10.1002/ueg2.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Paula Sousa
- Department of Gastroenterology of Hospital São Teotónio – Unidade Local de Saúde Viseu‐Dão LafõesViseuPortugal
| | - Cláudio Rodrigues
- Department of Gastroenterology of Hospital São Teotónio – Unidade Local de Saúde Viseu‐Dão LafõesViseuPortugal
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15
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Fuentes-Abolafio IJ, Ricci M, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI, Pérez-Belmonte LM. Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction. Exp Gerontol 2024; 190:112412. [PMID: 38570057 DOI: 10.1016/j.exger.2024.112412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Muscle wasting is pronounced in patients with heart failure with preserved ejection fraction (HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in these patients. OBJECTIVE To describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age, body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with HFpEF. METHODS A cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex, age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction (MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analyses were conducted. RESULTS Seventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age and BMI. CONCLUSIONS Echotexture biomarkers are related to women's muscle strength and physical function, especially muscle energy, contrast, and entropy. Echotexture biomarkers assessed by the US could facilitate the management of older adults with HFpEF, monitor its progression and assess the effectiveness of treatments on the musculoskeletal structure. TRIAL REGISTRATION NCT03909919. April 10, 2019. Retrospectively registered.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain
| | - Michele Ricci
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María Rosa Bernal-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Luis Miguel Pérez-Belmonte
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Sobhy E, Kamal MM, Saad Y, Saleh DA, Elgohary R, Hassan MS. Effect of branched-chain amino acid supplementation and exercise on quadriceps muscle quantity and quality in patients with cirrhosis as assessed by ultrasonography: A randomized controlled trial. Clin Nutr ESPEN 2024; 61:108-118. [PMID: 38777422 DOI: 10.1016/j.clnesp.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND/AIM Sarcopenia and myosteatosis are common in patients with cirrhosis. The study aimed to evaluate efficacy of ultrasound to monitor muscle status during branched-chain amino acid (BCAA) supplementation and/or muscle exercise interventional approaches. PATIENTS AND METHODS A randomized controlled study, included 220 liver cirrhosis patients with Child- Pugh B and C, randomized into a control group (55 patients) received only the standard care, and interventional groups (165 patients) equally distributed into three subgroups, in addition to standard care, they received BCAA, programmed exercise, or BCAA and programmed exercise. At baseline and after 28 days, all participants were subjected to ultrasound-measured quadriceps muscle thickness and echo-intensity, muscle strength using handgrip, performance using short physical performance battery (SPPB), Model for End-Stage Liver Disease (MELD) score and nutritional assessment using 7- point Subjective Global Assessment Score (SGA) and laboratory assessment. RESULTS All interventional groups showed a significant improvement in the ultrasound detected quadriceps muscle thickness (p = 0.001) and echo intensity, in addition to muscle strength, muscle performance, and SGA. Hematological parameters (hemoglobin and platelet count), biochemical parameters (ALT, AST, bilirubin, creatinine, urea and INR) and MELD score were also improved in the interventional groups. In Child-Pugh B patients BCAA combined with exercise showed an add-on effect. CONCLUSION BCAA supplements, programed muscle exercise and both are useful interventional methods in improving muscle quality and quantity in cirrhosis patients, which can be monitored by ultrasound. The best results can be achieved by combined intervention in Child-Pugh B, while in Child-Pugh C single intervention may lead to an acceptable improvement. The trial was registered retrospectively in the Clinical Trials Registry (registration number NCT06088550).
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Affiliation(s)
- Elham Sobhy
- Intensive Care Unit, and Clinical Nutrition, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Mohamed Mahmoud Kamal
- Gastroenterology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Yasmin Saad
- Endemic Medicine, Faculty of Medicine, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Doaa Ahmed Saleh
- Community Medicine, Faculty of Medicine, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Rasmia Elgohary
- Rheumatology & Clinical Immunology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt.
| | - Mohamed Sayed Hassan
- Gastroenterology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt
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17
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Terlemez R, Caliskaner Ozturk B, Kurtoglu SS, Palamar D, Atahan E, Akgun K. Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study. Eur J Phys Rehabil Med 2024; 60:523-529. [PMID: 38551519 PMCID: PMC11255879 DOI: 10.23736/s1973-9087.24.08232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/05/2024] [Accepted: 03/13/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis. AIM To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness. DESIGN Observational, case-control study. SETTING Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study. METHODS The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS). RESULTS The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008). CONCLUSIONS Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up. CLINICAL REHABILITATION IMPACT The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.
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Affiliation(s)
- Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye -
| | - Buket Caliskaner Ozturk
- Department of Pulmonary Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Sevgi S Kurtoglu
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ersan Atahan
- Department of Pulmonary Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
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Staempfli JS, Kistler-Fischbacher M, Gewiess J, Bastian JD, Eggimann AK. The Validity of Muscle Ultrasound in the Diagnostic Workup of Sarcopenia Among Older Adults: A Scoping Review. Clin Interv Aging 2024; 19:993-1003. [PMID: 38831963 PMCID: PMC11146336 DOI: 10.2147/cia.s463917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Muscle ultrasound has emerged as a promising method in the diagnostic work-up of sarcopenia. The objective of this scoping review was to explore the validity of muscle ultrasound against the latest sarcopenia definitions among older adults. Methods We adhered to the PRISMA guidelines for scoping reviews. A systematic search of databases was performed by two independent reviewers. All articles comparing the performance of ultrasound to an internationally acknowledged sarcopenia definition among older adults (≥60 years) and published between 2019/01/01 (the year updated sarcopenia definitions were introduced) and 2023/11/15 were included. Data were extracted and collated by muscle and muscle parameters. Results Out of 2290 articles screened, six studies comprising 24 validity tests among a total of 1619 older adults (mean age 74.1 years, 52.2% female) were included. The validity tests investigated the rectus femoris (n = 7), biceps brachii (n = 5), gastrocnemius medialis (n = 4), tibialis anterior (n = 4), soleus (n = 3), and rectus abdominis (n = 1). The parameter muscle thickness (MT) (n = 14) was most commonly measured. The latest European and Asian sarcopenia definitions (EWGSOP2, AWGS2) were applied as reference standards in four validity tests each. None of the studies used the Sarcopenia Definition and Outcome Consortium (SDOC) criteria. The highest area under the curve AUC (0.92, 95% confidence interval [CI] 0.89-0.94) was found for the muscle thickness of the rectus femoris muscle. Due to substantial heterogeneity among the studies, pooling of data using a meta-analytic approach was not feasible. Conclusion Limited number of studies have examined the validity of muscle ultrasound for diagnosing sarcopenia based on recent definitions among older adults. Thereby, muscle thickness of the rectus femoris showed promising results regarding validity. Further studies are needed to investigate the validity of key muscles and to validate muscle ultrasound among older hospitalized patients.
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Affiliation(s)
| | - Melanie Kistler-Fischbacher
- Centre on Aging and Mobility, Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - Jan Gewiess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Anna K Eggimann
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, 3010, Switzerland
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Prell T, Grimm A, Axer H. Uncovering sarcopenia and frailty in older adults by using muscle ultrasound-A narrative review. Front Med (Lausanne) 2024; 11:1333205. [PMID: 38828232 PMCID: PMC11140070 DOI: 10.3389/fmed.2024.1333205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Muscle ultrasound is a valuable non-invasive and cost-effective method in assessing muscle mass and structure, both of which are significant indicators for the development of sarcopenia and frailty in elderly individuals. Sarcopenia refers to the loss of muscle mass and strength that occurs with age, whereas frailty is a complex geriatric syndrome characterized by reduced physical function and an increased susceptibility to negative health outcomes. Both conditions are prevalent in older adults and are associated with higher risks of falls, disability, and mortality. By measuring muscle size and structure and several other ultrasound parameters, including muscle thickness, cross-sectional area, echogenicity (brightness in the ultrasound image), pennation angle, and fascicle length ultrasound can assist in identifying sarcopenia and frailty in older adults. In addition, ultrasound can be used to evaluate muscle function such as muscle contraction and stiffness, which may also be affected in sarcopenia and frailty. Therefore, muscle ultrasound could lead to better identification and tracking of sarcopenia and frailty. Such advancements could result in the implementation of earlier interventions to prevent or treat these conditions, resulting in an overall improvement in the health and quality of life of the elderly population. This narrative review describes the benefits and challenges when using ultra-sound for the evaluation of frailty and sarcopenia.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
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Besora-Moreno M, Llauradó E, Jiménez-ten Hoevel C, Sepúlveda C, Queral J, Bernal G, Pérez-Merino L, Martinez-Hervas S, Alabadi B, Ortega Y, Valls RM, Solà R, Pedret A. New Perspectives for Low Muscle Mass Quantity/Quality Assessment in Probable Sarcopenic Older Adults: An Exploratory Analysis Study. Nutrients 2024; 16:1496. [PMID: 38794734 PMCID: PMC11123861 DOI: 10.3390/nu16101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Low muscle mass quantity/quality is needed to confirm sarcopenia diagnosis; however, no validated cut-off points exist. This study aimed to determine the diagnostic accuracy of sarcopenia through muscle mass quantity/quality parameters, using the bioimpedance analysis (BIA), isokinetic, and ultrasound tools in probable sarcopenic community-dwelling older adults (≥60 years). Also, it aimed to suggest possible new cut-off points to confirm sarcopenia diagnosis. METHODS A cross-sectional exploratory analysis study was performed with probable sarcopenic and non-sarcopenic older adults. BIA, isokinetic, and ultrasound parameters were evaluated. The protocol was registered on ClinicalTrials.gov (NCT05485402). RESULTS A total of 50 individuals were included, 38 with probable sarcopenia (69.63 ± 4.14 years; 7 men and 31 women) and 12 non-sarcopenic (67.58 ± 4.54 years; 7 men and 5 women). The phase angle (cut-off: 5.10° men, p = 0.003; 4.95° women, p < 0.001), peak torque (cut-off: 66.75 Newtons-meters (N-m) men, p < 0.001; 48.35 N-m women, p < 0.001), total work (cut-off: 64.00 Joules (J) men, p = 0.007; 54.70 J women, p = 0.001), and mean power (cut-off: 87.8 Watts (W) men, p = 0.003; 48.95 W women, p = 0.008) in leg extension, as well as the the forearm muscle thickness (cut-off: 1.41 cm (cm) men, p = 0.017; 0.94 cm women, p = 0.041), had great diagnostic accuracy in both sexes. CONCLUSIONS The phase angle, peak torque, total work, and mean power in leg extension, as well as forearm muscle thickness, had great diagnostic accuracy in regard to sarcopenia, and the suggested cut-off points could lead to the confirmation of sarcopenia diagnosis, but more studies are needed to confirm this.
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Affiliation(s)
- Maria Besora-Moreno
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Claudia Jiménez-ten Hoevel
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Cristina Sepúlveda
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Judit Queral
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Glòria Bernal
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Laura Pérez-Merino
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain; (S.M.-H.); (B.A.)
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Blanca Alabadi
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain; (S.M.-H.); (B.A.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Yolanda Ortega
- Institut Universitari d’Investigació en Atenció Primària-IDIAP Jordi Gol, 43202 Tarragona, Spain;
- Primary Care Centre Salou, Institut Català de la Salut, 43840 Tarragona, Spain
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Anna Pedret
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
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Campani F, Li Cavoli TV, Arena U, Marra F, Lynch EN, Campani C. Quick and easy assessment of sarcopenia in cirrhosis: Can ultrasound be the solution? World J Gastroenterol 2024; 30:2287-2293. [PMID: 38813055 PMCID: PMC11130576 DOI: 10.3748/wjg.v30.i17.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 04/30/2024] Open
Abstract
Cirrhosis is frequently associated with sarcopenia, with reported rates of over 80% in patients with decompensated alcohol-related liver disease. Sarcopenia negatively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma (HCC). For these reasons, identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population. Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia, but exposure to radiation and high costs limit its application in this setting, especially for repeated assessments. We believe that ultrasound, a cheap and harmless technique also used for HCC screening in cirrhotic patients, could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.
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Affiliation(s)
- Francesca Campani
- Department of Health Science, University Hospital Careggi, University of Florence, Florence 50134, Italy
| | - Tancredi Vincenzo Li Cavoli
- Internal Medicine and Liver Unit, University Hospital Careggi, University of Florence, Florence 50134, Italy
| | - Umberto Arena
- Internal Medicine and Liver Unit, University Hospital Careggi, University of Florence, Florence 50134, Italy
| | - Fabio Marra
- Internal Medicine and Liver Unit, University Hospital Careggi, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Claudia Campani
- Internal Medicine and Liver Unit, University Hospital Careggi, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
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Sabatino A, Kooman J, Avesani CM, Gregorini M, Bianchi S, Regolisti G, Fiaccadori E. Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis. J Nephrol 2024; 37:993-1003. [PMID: 38263531 DOI: 10.1007/s40620-023-01867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD). METHODS The cut-off values for low handgrip strength were < 27 kg for males and < 16 kg for females. The cut-off value for low lean tissue index was obtained from an age-matched healthy control group, with low lean tissue index being defined as values below the 10th percentile of the distribution of healthy subjects. The cut-off values for low quadriceps vastus intermedius thickness index were < 3.44 mm/m2 for males and < 3.52 mm/m2 for females. RESULTS Ultrasound and bioimpedance spectroscopy were performed in 99 patients, and handgrip strength was assessed in 64 patients, all on maintenance HD. After a median follow-up of 28 months (interquartile range 19-41 months) 38 patients died. Lean tissue index was not associated with mortality, while low quadriceps vastus intermedius thickness index and low handgrip strength were associated with an increased hazard of death. In the fully adjusted model, only the combination of low handgrip strength and low quadriceps vastus intermedius thickness index was significantly associated with higher mortality. CONCLUSION When combined with low handgrip strength, low quadriceps muscle US outperformed low lean tissue index as assessed by bioimpedance spectroscopy in predicting mortality in a cohort of patients on maintenance HD. Ultrasound may be a useful and convenient technique for the assessment of sarcopenia and protein-energy wasting in this patient population.
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Affiliation(s)
- Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy.
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
| | - Jeroen Kooman
- University Hospital Maastricht, Maastricht, The Netherlands
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | | | | | - Giuseppe Regolisti
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
- UO Clinica e Immunologia Medica, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliera Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
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Calulo Rivera Z, González-Seguel F, Horikawa-Strakovsky A, Granger C, Sarwal A, Dhar S, Ntoumenopoulos G, Chen J, Bumgardner VKC, Parry SM, Mayer KP, Wen Y. MyoVision-US: an Artificial Intelligence-Powered Software for Automated Analysis of Skeletal Muscle Ultrasonography. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.26.24306153. [PMID: 38746458 PMCID: PMC11092729 DOI: 10.1101/2024.04.26.24306153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Introduction/Aims Muscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of morphometry. This study aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and predictability of expert manual analysis quantifying lower limb muscle ultrasound images across healthy, acute, and chronic illness subjects. Methods Quadriceps complex (QC [rectus femoris and vastus intermedius]) and tibialis anterior (TA) muscle ultrasound images of healthy, intensive care unit, and/or lung cancer subjects were captured with portable devices. Automated analyses of muscle morphometry were performed using a custom-built deep-learning model (MyoVision-US), while manual analyses were performed by experts. Consistency between manual and automated analyses was determined using intraclass correlation coefficients (ICC), while predictability of MyoVision -US was calculated using adjusted linear regression (adj.R 2 ). Results Manual analysis took approximately 24 hours to analyze all 180 images, while MyoVision - US took 247 seconds, saving roughly 99.8%. Consistency between the manual and automated analyses by ICC was good to excellent for all QC (ICC:0.85-0.99) and TA (ICC:0.93-0.99) measurements, even for critically ill (ICC:0.91-0.98) and lung cancer (ICC:0.85-0.99) images. The predictability of MyoVision-US was moderate to strong for QC (adj.R 2 :0.56-0.94) and TA parameters (adj.R 2 :0.81-0.97). Discussion The application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong predictability compared with human analysis. Future work needs to explore AI-powered models for the evaluation of other skeletal muscle groups.
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Matsuo K, Yoneki K, Kobayashi K, Onoda D, Mibu K, Furuzono K, Mashimo N, Yasuda S, Suzuki T, Nakao K, Tatsuki H, Tamiya S. Impact of Changes in Rectus Femoris Cross-Sectional Area Measured by Ultrasound on the Prognosis of Patients With Acute Heart Failure. Circ J 2024; 88:713-721. [PMID: 38508754 DOI: 10.1253/circj.cj-23-0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Low muscle mass in patients with acute heart failure (AHF) is associated with poor prognosis; however, this is based on a single baseline measurement, with little information on changes in muscle mass during hospitalization and their clinical implications. This study investigated the relationship between changes in rectus femoris cross-sectional area (RFCSA) on ultrasound and the prognosis of patients with AHF.Methods and Results: This is a retrospective evaluation of 284 AHF patients (mean [±SD] age 79.1±11.9 years; 116 female). RFCSA assessments at admission (pre-RFCSA), ∆RFCSA (i.e., the percentage change in RFCSA from admission to 2 weeks), and composite prognosis (all-cause death and heart failure-related readmission) within 1 year were determined. Patients were divided into 4 groups according to their median pre-RFCSA and ∆RFCSA after sex stratification: Group A, higher pre-RFCSA/better ∆RFCSA; Group B, higher pre-RFCSA/worse ∆RFCSA; Group C, lower pre-RFCSA/better ∆RFCSA; Group D, lower pre-RFCSA/worse ∆RFCSA. In the Cox regression analysis, with Group A as the reference, the cumulative event rate of Group C (hazard ratio [HR] 3.39; 95% confidence interval [CI] 0.71-16.09; P=0.124) did not differ significantly; however, the cumulative event rates of Group B (HR 7.93; 95% CI 1.99-31.60; P=0.003) and Group D (HR 9.24; 95% CI 2.57-33.26; P<0.001) were significantly higher. CONCLUSIONS ∆RFCSA during hospitalization is useful for risk assessment of prognosis in patients with AHF.
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Affiliation(s)
- Koji Matsuo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kei Yoneki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | | | - Daiki Onoda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kazuhiro Mibu
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Noa Mashimo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Shiori Yasuda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Toru Suzuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Ken Nakao
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Seiji Tamiya
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital
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Keshoofi P, Schindler P, Rennebaum F, Cordes F, Morgul H, Wildgruber M, Heinzow HS, Pascher A, Schmidt HH, Hüsing-Kabar A, Praktiknjo M, Trebicka J, Seifert LL. Imaging-based diagnosis of sarcopenia for transplant-free survival in primary sclerosing cholangitis. BMC Gastroenterol 2024; 24:145. [PMID: 38664624 PMCID: PMC11044284 DOI: 10.1186/s12876-024-03232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Imaging-based assessment of sarcopenia is a well-validated prognostic tool for patients with chronic liver disease. However, little is known about its value in patients with primary sclerosing cholangitis (PSC). This cross-sectional study aimed to investigate the predictive value of the cross-sectional imaging-based skeletal muscle index (SMI) for transplant-free survival (TFS) in patients with PSC. METHODS A total of 95 patients with PSC who underwent abdominal cross-sectional imaging between 2008 and 2022 were included in this retrospective study. SMI was measured at the third lumbar vertebra level (L3-SMI). The cut-off values to define sarcopenia were < 50 cm²/m² in male patients and < 39 cm²/m² in female patients. The primary outcome of this study was TFS, which was defined as survival without liver transplantation or death from any cause. RESULTS Our study indicates that L3-SMI sarcopenia impairs TFS in patients with PSC (5-year TFS: 33.9% vs. 83.3%, p = 0.001, log-rank test). L3-SMI sarcopenia was independently associated with reduced TFS via multivariate Cox regression analysis (HR = 2.749; p = 0.028). Body mass index reduction > 10% at 12 months, which is used as MELD standard exception (SE) criterion in Eurotransplant (in Germany only until September 2023), was not significantly associated with TFS in the multivariate Cox regression analysis (HR = 1.417; p = 0.330). Substitution of BMI reduction with L3-SMI in the German SE criteria improved the predictive accuracy of TFS compared to the established SE criteria (multivariable Cox regression analysis: HR = 4.007, p < 0.001 vs. HR = 1.691, p = 0.141). CONCLUSION Imaging-based diagnosis of sarcopenia via L3-SMI is associated with a low TFS in patients with PSC and may provide additional benefits as a prognostic factor in patient selection for liver transplantation.
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Affiliation(s)
- Pedram Keshoofi
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany.
| | - Philipp Schindler
- Clinic for Radiology, University Hospital Muenster, 48149, Muenster, Germany
| | - Florian Rennebaum
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Friederike Cordes
- Medical Clinic II, Euregio Hospital Nordhorn, 48529, Nordhorn, Germany
| | - Haluk Morgul
- Department for General, Visceral and Transplant Surgery, University Hospital Muenster, 48149, Muenster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital LMU Munich, 81377, Munich, Germany
| | - Hauke S Heinzow
- Department of Internal Medicine I, Krankenhaus der Barmherzigen Brüder, 54292, Trier, Germany
| | - Andreas Pascher
- Department for General, Visceral and Transplant Surgery, University Hospital Muenster, 48149, Muenster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Michael Praktiknjo
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Jonel Trebicka
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Leon Louis Seifert
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany.
- The Rockefeller University Center for Clinical and Translational Science, 10065, New York, NY, United States of America.
- Laboratory of Virology and Infectious Disease, The Rockefeller University, 10065, New York, NY, United States of America.
- The Rockefeller University Hospital, 1230 York Avenue, 10065, New York, NY, USA.
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D'Lugos AC, Skotak NJ, Faris JJ, Thomas NT, Mazo CE, Dickinson JJ, Moore JG, Jorgensen TM, Dickinson JM. Skeletal muscle architecture and aging: A comparison of ultrasound techniques and an assessment of intrarater reliability. Clin Physiol Funct Imaging 2024. [PMID: 38616358 DOI: 10.1111/cpf.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To assess intrarater reliability of ultrasound-determined measurements of skeletal muscle characteristics across different measurement outcomes, imaging techniques, and age groups. METHODS 2D ultrasound images (B-mode) of the quadriceps were obtained from young (26 ± 4 year, n = 8 M, 8 F) and older (70 ± 7 year, n = 7 M, 5 F) adults on two occasions, separated by 6 ± 3 days. With participants in both standing and supine postures, images were collected from five anatomical sites along the anterior (two sites) and lateral (three sites) compartments of the thigh corresponding to 56%, 39%, and 22% (lateral only) of femur length. Images were analysed for muscle thickness, pennation angle, and echogenicity. Intraclass correlation coefficients (ICC) were used to assess reliability. RESULTS Muscle thickness values were higher (p < 0.05) on images collected in the stand versus supine posture only for muscles of the anterior compartment, independent of age. Echogenicity values were higher (p < 0.05) in the vastus intermedius on images collected in the supine versus stand posture only in older adults. Pennation angle values were not impacted by imaging posture (p > 0.05). ICC values for thickness, echogenicity, and pennation angle were generally higher for analyses conducted on images collected in the supine versus stand posture. Imaging posture generated a greater difference in ICC values in the lateral versus anterior muscles and in older versus younger participants. CONCLUSION Our findings suggest that participant posture during imaging impacts the absolute values and intrarater reliability of ultrasound-determined muscle characteristics in a muscle-specific fashion, and this effect is greater in older compared to younger individuals.
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Affiliation(s)
- Andrew C D'Lugos
- Department of Kinesiology, California State University Chico, Chico, California, USA
| | - Nathan J Skotak
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jacquelyn J Faris
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Nicholas T Thomas
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Corey E Mazo
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jonathan J Dickinson
- Department of Health Sciences, Central Washington University, Ellensburg, Washington, USA
| | - Jessy G Moore
- Department of Health Sciences, Central Washington University, Ellensburg, Washington, USA
| | - Theresa M Jorgensen
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Jared M Dickinson
- Department of Health Sciences, Central Washington University, Ellensburg, Washington, USA
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Wang L, Valencak TG, Shan T. Fat infiltration in skeletal muscle: Influential triggers and regulatory mechanism. iScience 2024; 27:109221. [PMID: 38433917 PMCID: PMC10907799 DOI: 10.1016/j.isci.2024.109221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Fat infiltration in skeletal muscle (also known as myosteatosis) is now recognized as a distinct disease from sarcopenia and is directly related to declining muscle capacity. Hence, understanding the origins and regulatory mechanisms of fat infiltration is vital for maintaining skeletal muscle development and improving human health. In this article, we summarized the triggering factors such as aging, metabolic diseases and metabolic syndromes, nonmetabolic diseases, and muscle injury that all induce fat infiltration in skeletal muscle. We discussed recent advances on the cellular origins of fat infiltration and found several cell types including myogenic cells and non-myogenic cells that contribute to myosteatosis. Furthermore, we reviewed the molecular regulatory mechanism, detection methods, and intervention strategies of fat infiltration in skeletal muscle. Based on the current findings, our review will provide new insight into regulating function and lipid metabolism of skeletal muscle and treating muscle-related diseases.
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Affiliation(s)
- Liyi Wang
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
| | | | - Tizhong Shan
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
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Yurumez B, Metin Y, Atmis V, Karadavut M, Ari S, Gemci E, Yigit S, Ozalp Ates FS, Gozukara MG, Kaplankiran C, Cosarderelioglu C, Yalcin A, Aras S, Varli M. A new possible marker: can pennation angle defined by ultrasound predict the frailty? Aging Clin Exp Res 2024; 36:53. [PMID: 38438616 PMCID: PMC10912255 DOI: 10.1007/s40520-023-02663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Frailty indicates older people who are vulnerable to stressors. The relation between ultrasonographic parameters of muscle and frailty among older people has yet to be investigated. AIMS The aim of the study is to investigate the relationship between frailty and the ultrasonographic measurements of the rectus femoris muscle (RFM). METHODS This cross-sectional study included 301 participants who were ≥65 years. The FRAIL questionnaire assessed frailty. The thickness, cross-sectional area (CSA), fascicle length, pennation angle (PA), stiffness, and echogenicity of RFM were assessed by ultrasound. The accuracy of parameters in predicting the frailty was evaluated by ROC analysis. RESULTS Of all 301 participants, 24.6% were frail. Pre-frail and frail participants had significantly lower thickness (p = 0.002), CSA (p = 0.009), and fascicle length (p = 0.043) of RFM compared to robust. PA was significantly lowest in frails (p < 0.001). The multivariate logistic regression analysis showed that PA values lower than 10.65 degrees were an independent predictor of frailty (OR = 0.83, 95% Cl: 0.70-0.97, p = 0.019). Results of ROC analysis demonstrated a satisfactory result between the PA and frailty (AUC = 0.692, p < 0.001). DISCUSSION Thickness, CSA, and PA of RFM were found to be lower in frail subjects, which may indicate the changes in muscle structure in frailty. Among all parameters, lower PA values were independent predictors of frailty. These findings may indicate a novel ultrasound-based method in frailty, that is more objective and unrelated to the cross-sectional evaluation. CONCLUSIONS Ultrasonographic measurements of RFM, especially the lower PA may predict frailty in older people. As an objective and quantitative method, PA may be used to define frailty with acceptable sensitivity.
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Affiliation(s)
- Busra Yurumez
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Yavuz Metin
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Volkan Atmis
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey.
| | - Mursel Karadavut
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Sinan Ari
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Emine Gemci
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Seher Yigit
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Funda Seher Ozalp Ates
- Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | | | - Ceren Kaplankiran
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Caglar Cosarderelioglu
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Sevgi Aras
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
| | - Murat Varli
- Division of Geriatrics, Department of Internal Medicine, Ankara University Faculty of Medicine, Ibn-I Sina Hospital, Altindag, Ankara, Turkey
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Güner G, Özçakar L, Baytar Y, Onur MR, Demir M, Aktaş BY, Aktepe OH, Güven DC, Taban H, Yıldırım HÇ, Akın S, Aksoy S, Kara M, Dizdar Ö. Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy. Cancers (Basel) 2024; 16:1061. [PMID: 38473418 DOI: 10.3390/cancers16051061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)-assessed by computed tomography (CT) and ultrasound (US)-and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (<18.0 mm) had a significantly higher incidence of grade ≥3 neutropenia (50.0% vs. 10.8%, p = 0.005), and males with low RF values (<20.0 mm) had a higher incidence (80.0% vs. 22.2%, p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3-4 neutropenia by 9.210 times (95% CI = 2.401-35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice.
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Affiliation(s)
- Gürkan Güner
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
- Department of Medical Oncology, Medical Point Hospital, Izmir Economy University Faculty of Medicine, Izmir 35575, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yusuf Baytar
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Metin Demir
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Burak Yasin Aktaş
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Serkan Akın
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
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Ben-Menachem E, Ashes C, Lepar G, Deacon J, Glavan N, Molan V, Watson A. Smaller rectus femoris size measured by ultrasound is associated with poorer outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1115-1122.e5. [PMID: 35995604 DOI: 10.1016/j.jtcvs.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery. METHODS A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA. RESULTS One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm2 (1.41 cm2), and range of 0.71 to 8.77 cm2. When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA. CONCLUSIONS Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures. TRIAL REGISTRY NUMBER ACTRN12620000678998.
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Affiliation(s)
- Erez Ben-Menachem
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; Notre Dame School of Medicine, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.
| | - Catherine Ashes
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Gila Lepar
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - James Deacon
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Nicole Glavan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Veronique Molan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Alasdair Watson
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
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31
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Kobayashi R, Haga S, Umehara A, Takakaze M, Akatsuka K, Nakano H. Quantitative and qualitative evaluation of the masseter muscle by ultrasonography and correlation with whole body health status. J Phys Ther Sci 2024; 36:136-141. [PMID: 38434992 PMCID: PMC10904220 DOI: 10.1589/jpts.36.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
[Purpose] Ultrasonography can be used to non-invasively analyze any cross-section of the human body and to measure tissue elasticity, thickness, and brightness. This study was performed to examine the quantitative and qualitative changes in the masseter muscle at rest and at maximal occlusion, and to evaluate the relationship between these changes and the general health of the individual. [Participants and Methods] The study cohort comprised 30 healthy adults. Correlations between basic participant information (sex, age, height, body weight, body mass index, body fat, maximum bite force, handgrip strength, and tongue pressure) and masseter muscle ultrasonographic data were examined. [Results] Masseter muscle thickness was significantly greater in males than in females. Body weight and body mass index correlated positively with masseter muscle thickness. Body mass index and body fat percentage correlated positively with masseter muscle brightness. Tongue pressure correlated positively with handgrip strength. [Conclusion] Our analyses of muscle thickness and brightness suggest that ultrasonography may be useful in evaluating masseter muscle quantity and quality, and that the condition of the masseter muscle may correlate with the overall health status of the individual.
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Affiliation(s)
- Rika Kobayashi
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Shugo Haga
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Akito Umehara
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Momoko Takakaze
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Kanako Akatsuka
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Haruhisa Nakano
- Department of Orthodontics, Showa University School of
Dentistry: 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
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Wullems JA, Degens H, Verschueren SMP, Morse CI, Grant DM, Onambélé-Pearson GL. Sedentary behaviour (especially accumulation pattern) has an independent negative impact on skeletal muscle size and architecture in community-dwelling older adults. PLoS One 2024; 19:e0294555. [PMID: 38394127 PMCID: PMC10889859 DOI: 10.1371/journal.pone.0294555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/03/2023] [Indexed: 02/25/2024] Open
Abstract
Prolonged sedentary behaviour (SB) i.e. longer bouts, is suggested to have a range of negative health effects, independent of habitual light and medium-to-vigorous physical activity (LIPA or MVPA). Any effect on musculoskeletal size, architecture or morphology has seldom been reported in older adults. Moreover, no study has yet determined if any association would persist following adjustment for covariates. Therefore, the aim of the present study was to investigate the associations between SB, and properties of the Gastrocnemius Medialis (GM) muscle, in a cross-sectional sample of older adults using compositional data analysis. 105 healthy older adults (73±6y) wore a thigh mounted tri-axial accelerometer for seven consecutive days, and underwent ultrasound [e.g. muscle length (Lm), anatomical cross-sectional area (ACSA), muscle volume (VM), fascicle length (LF), & physiological cross-sectional area (PCSA)], body composition (e.g. DEXA) and health (e.g. medical history) assessments. In-unadjusted models, SB time was negatively associated with ACSA at 75% of Lm (R2adj = 0.085), VM (R2adj = 0.020), and PCSA (R2adj = 0.039). Standing was positively associated with pennation angle (R2adj = 0.110), which persisted following co-variate adjustment (R2adj = 0.296). In fully adjusted models, both SB & LIPA time were associated with ACSA at 75% of Lm (Both R2adj = 0.393). Standing and light activity time were also associated with LF, VM, & PCSA (R2adj 0.116-0.573). In fully adjusted models, SB pattern parameters (i.e. the manner in which sedentary behaviour is accumulated daily throughout waking hours such as the timing, duration and frequency of sedentary bouts), were associated with GM muscle properties (R2adj 0.156-0.564) including LM, LF, and VM. The pattern, rather than accumulated daily SB time, was associated with the size and architecture of the GM. Our results suggest that regardless of co-existing habitual physical activities, SB bouts should be kept short and frequently interrupted to offset some of the deleterious ageing-related muscle architecture characteristics changes.
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Affiliation(s)
- Jorgen A. Wullems
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
- Lithuanian Sports University, Kaunas, Lithuania
| | - Sabine M. P. Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christopher I. Morse
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Dale M. Grant
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gladys L. Onambélé-Pearson
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
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Durak A, Binay Safer V, Catikkas NM. The relationship between pressure injuries and ultrasonographically measured rectus femoris muscle thickness. J Tissue Viability 2024; 33:60-66. [PMID: 38103986 DOI: 10.1016/j.jtv.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Ayfer Durak
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey.
| | - Vildan Binay Safer
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine / Department of Physical Medicine and Rehabilitation, Sancaktepe, 34785, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey
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Chen K, Hu S, Liao R, Yin S, Huang Y, Wang P. Application of conventional ultrasound coupled with shear wave elastography in the assessment of muscle strength in patients with type 2 diabetes. Quant Imaging Med Surg 2024; 14:1716-1728. [PMID: 38415110 PMCID: PMC10895149 DOI: 10.21037/qims-23-1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 02/29/2024]
Abstract
Background In patients with type 2 diabetes mellitus (T2DM), a decrease in muscle function may be related to changes in the biomechanical properties of skeletal muscles. However, the correlations between muscle function and the characteristics of muscle size and stiffness as measured by ultrasound in patients with T2DM are unclear. The aim of this study was to investigate the abilities of conventional ultrasound and shear wave elastography (SWE) to assess muscle properties in patients with T2DM and to correlate the findings with isokinetic muscle testing and functional tests. Methods Sixty patients from the Department of Endocrinology in The Third Affiliated Hospital of Southern Medical University diagnosed with T2DM were recruited in this cross-sectional study from September 2021 to September 2022. T2DM was defined based on the American Diabetes Association criteria. The exclusion criteria were a history of injury or operation of the lower limb or clinical signs of neuromuscular disorders, any muscle-induced disease, and the presence of other types of diabetes mellitus. Thirty-five matched healthy volunteers were continuously included in the control group. SWE was used to measure the muscle stiffness of the quadriceps femoris [vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), vastus intermedius (VI)] and the biceps brachii (BB) in a relaxed position, and the shear wave velocity (SWV) values were recorded. Muscle size was measured using conventional ultrasound. The participants underwent isokinetic knee extension/flexion (60°/sec) to assess muscle strength and functional tests of physical performance, including the short physical performance battery, 30-s chair stand test, timed up-and-go test, and 6-meter walk test. All demographics and measured variables were compared using the independent samples t-test. Interclass correlation coefficient analysis was performed on the measurement data obtained by the two operators, and Pearson correlation coefficients were used to determine the relationships between variables. Results Patients with T2DM exhibited worse physical performance (P<0.05) and weaker lower limb muscle strength (P<0.05) than did healthy controls, but their handgrip strength was comparable (P=0.102). Patients with T2DM had significantly decreased muscle thickness [RF thickness: 10.69±3.21 vs. 13.09±2.41 mm, mean difference =-2.40, 95% confidence interval (CI): -3.56 to -1.24, P<0.001; anterior quadriceps thickness: 23.45±7.11 vs. 27.25±5.25 mm, mean difference =-3.80, 95% CI: -6.33 to -1.26, P=0.004] and RF cross-sectional area (3.04±1.10 vs. 4.11±0.95 cm2, mean difference =-1.07, 95% CI: -1.49 to -0.64; P<0.001) compared to healthy controls. Smaller muscle size was associated with decreased muscle strength (r=0.44-0.69, all P values <0.001). Except for the BB (3.48±0.38 vs. 3.61±0.61 m/s, mean difference =-0.12, 95% CI: -0.35 to 0.11; P=0.257) and VI (2.59±0.34 vs. 2.52±0.23 m/s, mean difference =0.03, 95% CI: -0.06 to 0.18; P=0.299), the muscle stiffness in patients with T2DM was significantly decreased. For the patients with T2DM and healthy participants, the SWV of the RF was 1.66±0.23 and 1.83±0.18 m/s (mean difference =-0.17, 95% CI: -0.25 to -0.08; P<0.001), respectively; that of the VM was 1.34±0.15 and 1.51±0.16 m/s (mean difference =-0.17, 95% CI: -0.24 to -0.10; P<0.001), respectively; and that of VL was 1.38±0.19 and 1.53±0.19 m/s (mean difference =-0.15, 95% CI: -0.23 to -0.07; P<0.001), respectively. Excellent interobserver reliability of the SWV measurements on the muscle of T2DM patients was observed (all intraclass correlation coefficients >0.75; P<0.001). The SWV showed moderate correlations with muscle strength in the RF, VM, and VL (r=0.30-0.61; all P values <0.05). Conclusions Ultrasound technology exhibits good reliability for repeated measurements of muscle size and stiffness. Reduced muscle stiffness as detected by SWE was demonstrated in patients with diabetes and was associated with decreased muscle strength and impaired functional activity.
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Affiliation(s)
- Kaifan Chen
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Shidi Hu
- Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Renmou Liao
- Institute of Rehabilitation Medicine, The Foshan Fifth People's Hospital, Foshan, China
| | - Sishu Yin
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Yuqian Huang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Ping Wang
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
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Wu J, Chi H, Kok S, Chua JM, Huang XX, Zhang S, Mah S, Foo LX, Peh HY, Lee HB, Tay P, Tong C, Ladlad J, Tan CH, Khoo N, Aw D, Chong CX, Ho LM, Sivarajah SS, Ng J, Tan WJ, Foo FJ, Teh BT, Koh FH. Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery. Ann Coloproctol 2024; 40:3-12. [PMID: 37004990 PMCID: PMC10915526 DOI: 10.3393/ac.2022.01207.0172] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 04/04/2023] Open
Abstract
Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.
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Affiliation(s)
- Jingting Wu
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Hannah Chi
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Shawn Kok
- Department of Radiology, Sengkang General Hospital, Singapore
| | - Jason M.W. Chua
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Xi-Xiao Huang
- Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore
| | - Shipin Zhang
- Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore
| | - Shimin Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Li-Xin Foo
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Hui-Yee Peh
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Hui-Bing Lee
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Phoebe Tay
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Cherie Tong
- Department of Dietetics, Sengkang General Hospital, Singapore
| | - Jasmine Ladlad
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | | | - Darius Aw
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | | | | | - Jialin Ng
- Division of Surgery, Sengkang General Hospital, Singapore
| | | | - Fung-Joon Foo
- Division of Surgery, Sengkang General Hospital, Singapore
| | - Bin-Tean Teh
- Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore
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Tack W, De Cock AM, Dirinck EL, Bastijns S, Ariën F, Perkisas S. Pathophysiological interactions between sarcopenia and type 2 diabetes: A two-way street influencing diagnosis and therapeutic options. Diabetes Obes Metab 2024; 26:407-416. [PMID: 37854007 DOI: 10.1111/dom.15321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
This review will try to elucidate the interconnected pathophysiology of sarcopenia and type 2 diabetes (T2D) and will try to identify a common pathway to explain their development. To this end, the PubMed and Scopus databases were searched for articles published about the underlying pathophysiology, diagnosis and treatment of both sarcopenia and T2D. The medical subject heading (MeSH) terms 'sarcopenia' AND 'diabetes mellitus' AND ('physiopathology' OR 'diagnosis' OR 'therapeutics' OR 'aetiology' OR 'causality') were used. After screening, 32 papers were included. It was evident that sarcopenia and T2D share multiple pathophysiological mechanisms. Common changes in muscle architecture consist of a shift in myocyte composition, increased myosteatosis and a decreased capacity for muscle regeneration. Further, both diseases are linked to an imbalance in myokine and sex hormone production. Chronic low-grade inflammation and increased levels of oxidative stress are also known pathophysiological contributors. In the future, research efforts should be directed towards discovering common checkpoints in the development of T2D and sarcopenia as possible shared therapeutic targets for both diseases. Current treatment for T2D with biguanides, incretins and insulin may already convey a protective effect on the development of sarcopenia. Furthermore, attention should be given to early diagnosis of sarcopenia within the population of people with T2D, given the sizeable physical and medical burden it encompasses. A combination of simple diagnostic techniques could be used at regular diabetes check-ups to identify sarcopenia at an early stage and start lifestyle modifications and treatment as soon as possible.
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Affiliation(s)
- Wouter Tack
- ZNA (ZiekenhuisNetwerk Antwerpen), University Center for Geriatrics, Antwerp, Belgium
| | - Anne-Marie De Cock
- ZNA (ZiekenhuisNetwerk Antwerpen), University Center for Geriatrics, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Eveline Lia Dirinck
- Department of Endocrinology, Diabetology and Metabolism, Anwerp University Hospital, Edegem, Belgium
| | - Sophie Bastijns
- ZNA (ZiekenhuisNetwerk Antwerpen), University Center for Geriatrics, Antwerp, Belgium
| | - Femke Ariën
- ZNA (ZiekenhuisNetwerk Antwerpen), University Center for Geriatrics, Antwerp, Belgium
| | - Stany Perkisas
- ZNA (ZiekenhuisNetwerk Antwerpen), University Center for Geriatrics, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Xin C, Ma M, Wang Q, Li T, Sun Q, Jiang M, Du J, Li Z, Ma J. Correlation of ultrasound measurement of limb muscle thickness and echo intensity with frailty assessment in elderly patients undergoing malignancies surgery. Heliyon 2024; 10:e24017. [PMID: 38230231 PMCID: PMC10789593 DOI: 10.1016/j.heliyon.2024.e24017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
Introduction It remains controversial which frailty score correlates with adverse outcomes. Instead of these subjective and time consuming scores, we studied whether ultrasound guided lower extremity thickness measurements more closely are associated with adverse outcomes. Method Patients undergoing gastrointestinal malignancy surgery were included as study subjects. Frailty was identified using the FRAIL scale assessment. Ultrasound measured the muscle thickness and echo intensity of the patient's upper and lower limbs. ANOVA was used to analyze the relationship between muscle data and frailty assessment. Significant indicators from the one-way analysis were included in the multivariate logistic regression equation. Results A total of 160 study subjects were included, 52 in the normal group, 78 in the prefrailty group, and 30 in the frailty group. The ANOVA showed that there were significant differences in age, hemoglobin, albumin, history of hypertension, history of coronary artery disease, the history of cerebrovascular disease, rate of postoperative complications, rate of transferring to intensive care unit, time out of bed, length of hospitalization, thickness and echo intensity of quadriceps femoris the vastus lateralis and the tibialis anterior, echo intensity of the medial gastrocnemius among the three groups (P < 0.05). Pearson's correlation analysis showed FRAIL score was correlated with muscle thickness and echo intensity of the lower limbs. Multifactor logistic regression analysis showed that the prefrailty group was positively correlated with age(β = 0.146, P = 0.004), echo intensity of the medial gastrocnemius (β = 0.055, P = 0.031), and rate of postoperative complications(β = 1.439, P = 0.021), also negatively correlated with muscle thickness of the tibialis anterior(β = -2.124, P = 0.007). The frailty group was positively correlated with age(β = 0.22, P = 0.005), tibialis anterior echo intensity (β = 0.082, P = 0.015), medial gastrocnemius echo intensity (β = 0.089, P = 0.026), cerebrovascular disease history (β = 2.311, P = 0.04), and postoperative complication rate (β = 2.684, P = 0.003). It was negatively correlated with albumin (β = -0.26, P = 0.017), quadriceps muscle thickness (β = -2.257, P = 0.017), and tibialis anterior muscle thickness (β = -5.408, P = 0.001). Conclusion Ultrasound measurement of lower (not upper) extremity muscle thickness and echo intensity was significantly associated with discriminating severity of frailty and postoperative outcomes than frailty scores in elderly patients.
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Affiliation(s)
- Chengjian Xin
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Mengzhuo Ma
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Qian Wang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Tao Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Qiaoxia Sun
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Meiru Jiang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Juan Du
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Zhi Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Jiahai Ma
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
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Yang Q, Zhang C, Zhang Z, Su B. Muscle ultrasound to diagnose sarcopenia in chronic kidney disease: a systematic review and bayesian bivariate meta-analysis. BMC Nephrol 2024; 25:12. [PMID: 38178026 PMCID: PMC10768384 DOI: 10.1186/s12882-023-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for sarcopenia among chronic kidney disease (CKD) populations. BACKGROUND Sarcopenia has become a worldwide health issue, especially for CKD patients. Conventional techniques of muscle mass assessment often prove limited, thus prompts increasing interest in ultrasound suitability. METHODS We searched the Cochrane Library, PubMed and Embase for literature published up to June 2023. Ultrasound diagnosis of sarcopenia in CKD patients was included. Two independent investigators used the Quality Assessment Tool for Diagnosis Accuracy Studies (QUADAS-2) to assess the quality. We extracted valuable information from eligible studies. Using a Bayesian bivariate model, we pooled sensitivity and specificity values and summary receiver operating characteristic (SROC) curves. RESULTS Five articles, involving 428 participants at various stages of CKD were included. Three studies diagnosed by the cross-sectional area (CSA) of the rectus femoris, while two others by muscle thickness (MT) and shear wave elastography (SWE) from the same muscle, separately. Overall, CSA or SWE had a pooled sensitivity of 0.95 (95% CrI, 0.80, 1.00), and the specificity was 0.73 (95% CrI, 0.55, 0.88) for diagnosing sarcopenia in CKD patients. CONCLUSIONS Ultrasound measurements of CSA and SWE were more sensitive for diagnosing sarcopenia in the CKD population than in the general population. Ultrasound assessment from a single peripheral skeletal muscle site may serve as a rapid screening tool for identifying sarcopenic individuals within the CKD population, if a specific cut-off value could be determined.
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Affiliation(s)
- Qinbo Yang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chen Zhang
- West China Hospital, West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Zhuyun Zhang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Med+ Biomaterial Institute of West China Hospital/West China School of Medicine, Sichuan University, Guoxue Alley No. 37, Chengdu, Sichuan Province, 610041, Chengdu, China.
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Lin T, Jiang T, Huang X, Xu P, Liang R, Song Q, Tu X, Zhao Y, Huang L, Yue J, Wu C. Diagnostic test accuracy of serum creatinine and cystatin C-based index for sarcopenia: a systematic review and meta-analysis. Age Ageing 2024; 53:afad252. [PMID: 38251741 DOI: 10.1093/ageing/afad252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Sarcopenia is an important prognostic factor, but its optimal screening methods remain challenging. Several new indices developed based on serum creatinine (Cr) and cystatin C (CysC) have been proposed to be diagnostic biomarkers for sarcopenia screening. OBJECTIVE This review aimed to evaluate the diagnostic accuracy of serum Cr- and CysC-based indices for sarcopenia diagnosis. METHODS We systematically searched MEDLINE, EMBASE, SCIE and SCOPUS from inception to 2 April 2023. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model was used to synthesise the pooled sensitivity, specificity and area under the curves of the summary receiver operating characteristic (SROC-AUC). RESULTS We retrieved 936 publications and included 16 studies with 5,566 participants (mean age ranged: 51.0-78.4 years, 50.2% men). The prevalence of sarcopenia ranged from 7.8 to 69.5%. All included studies presented a moderate to high risk of bias. The serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia (pooled sensitivity: 0.67, 95% CI 0.57-0.75; pooled specificity: 076, 95% CI 0.67-0.83; pooled SROC-AUC: 0.78, 95% CI 0.74-0.81). The Cr/CysC ratio is the most widely studied index, followed by the Cr × eGFRcys index. Overall, both indicators had satisfactory and comparable performance in screening sarcopenia. CONCLUSION Serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia. The most studied indices-the Cr/CysC ratio and Cr × eGFRcys index-had comparable diagnostic accuracy for evaluating sarcopenia and may serve as surrogate markers for sarcopenia. However, further validation is required to verify these findings.
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Affiliation(s)
- Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Tingting Jiang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiaotao Huang
- Department of Gastroenterology, Jiangyou 903 Hospital, Mianyang, Sichuan, China
| | - Ping Xu
- Department of Biomedical Engineering, Sichuan University Library, Chengdu, Sichuan, China
| | - Rui Liang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiangping Tu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Li Huang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
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Lima J, Foletto E, Cardoso RCB, Garbelotto C, Frenzel AP, Carneiro JU, Carpes LS, Barbosa-Silva TG, Gonzalez MC, Silva FM. Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings. Clin Nutr 2024; 43:95-110. [PMID: 38016244 DOI: 10.1016/j.clnu.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
AIMS This scoping review aimed to identify, explore, and map the objectives, methodological aspects, and results of studies that used ultrasound (US) to assess skeletal muscle (SM) in critically ill patients. METHODS A scoping review was conducted according to the Joanna Briggs Institute's methodology. All studies that evaluated SM parameters from the US in patients admitted to the intensive care unit (ICU) were considered eligible. We categorized muscle thickness and cross-sectional area as parameters for assessing SM quantity, while echogenicity, fascicle length, and pennation angle analysis were used to evaluate muscle "quality" (composition/architecture). A literature search was conducted using four databases for articles published until December 2022. Independent reviewers selected the studies and extracted data. Descriptive statistics were calculated to present the results. RESULTS A total of 107 studies were included, the majority of which were prospective cohort studies (59.8 %) conducted in general ICUs (49.5 %). The most frequent objective of the studies was to evaluate SM quantity depletion during the ICU stay (25.2 %), followed by determining whether a specific intervention would modify SM (21.5 %). Most studies performed serial SM evaluations (76.1 %). The rectus femoris muscle thickness was evaluated in most studies (67.9 %), followed by the rectus femoris cross-sectional area (54.3 %) and the vastus intermedius muscle thickness (40.2 %). The studies demonstrated the feasibility and reproducibility of US for SM evaluation, especially related to quantitative parameters. Most studies (70.3 %) reported significant SM quantity depletion during hospitalization. However, the accuracy of the US in measuring SM varied across the studies. CONCLUSIONS The lack of detailed description and standardization in the protocols adopted by the studies included in this scoping review precludes the translation of the evidence related to US for SM assessment into clinical practice.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Estéfani Foletto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Rafaella C B Cardoso
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Charlles Garbelotto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas Brazil
| | - Juliana U Carneiro
- Multiprofessional Residency Program: Intensive Care. Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Larissa S Carpes
- Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre Brazil
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas Brazil
| | | | - Flávia M Silva
- Nutrition Department and Nutrition Science Graduate Program. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre Brazil.
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López Jiménez E, Neira Álvarez M, Menéndez Colino R, Checa López M, Grau Jiménez C, Pérez Rodríguez P, Vasquez Brolen B, Arias Muñana E, Ramírez Martín R, Alonso Bouzón C, Amor Andrés MS, Bermejo Boixareu C, Brañas F, Alcantud Ibáñez M, Alcantud Córcoles R, Cortés Zamora EB, Gómez Jiménez E, Romero Rizos L, Avendaño Céspedes A, Hernández Socorro CR, Abizanda P. Muscle mass loss measured with portable ultrasound in hospitalized older adults: The ECOSARC study. J Nutr Health Aging 2024; 28:100010. [PMID: 38267149 DOI: 10.1016/j.jnha.2023.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The main objective was to analyze the evolution of muscle of the Quadriceps Rectus Femoris (QRF) between admission and discharge, in older adults hospitalized with an acute medical disease in Acute Geriatric Units (AGUs). DESIGN Prospective multicentric observational cohort study. SETTING Seven AGUs from University Hospitals in Spain. PARTICIPANTS Hospitalized adults ≥ 70 years old, able to ambulate and without severe dementia. MEASUREMENTS Ultrasound measurements of QRF were acquired at 2/3 distal between anterior-superior iliac spine and patella in both legs by trained Geriatricians. Ultrasound Chison model ECO2 was used. QRF area, thickness, edema, echogenicity, and fasciculations were measured. RESULTS From the complete sample (n = 143), in 45 (31.5%) participants, ultrasound images were classified as non-valid by an expert radiologist. Mean age was 87.8 (SD 5.4). Mean hospital stay 7.6 days (SD 4.3). From those with valid images, 36 (49.3%), 2 (2.7%), and 35 (47.9%) presented a decrease, equal values, or an increase in QRF area from baseline to discharge, respectively, and 37 (50.0%), 2 (2.7%), and 35 (47.3%) presented a decrease, equal values, or an increase in QRF thickness, respectively. 26 (35.6%) presented a decrease in more than 0.2 cm2 of QRF area, and 23 (31.1%) a decrease in more than 0.1 cm of QRF thickness. Only 4 (5.4%) patients presented new edema, while 13 (17.6%) worsened echogenicity. CONCLUSION One third of older adults develop significant muscle loss during a hospitalization for acute medical diseases. TRIAL REGISTRATION NUMBER NCT05113758.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fátima Brañas
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Rubén Alcantud Córcoles
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Belén Cortés Zamora
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Gómez Jiménez
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Luis Romero Rizos
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | - Almudena Avendaño Céspedes
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | - Pedro Abizanda
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain.
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Zhong Y, Liu X, Lin T. The Relationship between Muscle Ultrasound Parameters and Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. J Diabetes Res 2023; 2023:8897065. [PMID: 38148834 PMCID: PMC10751167 DOI: 10.1155/2023/8897065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023] Open
Abstract
Background Muscle dysfunction is an early complication of diabetic peripheral neuropathy (DPN). As a convenient and low-cost tool, muscle ultrasound has been used to assess muscle quality and muscle mass. However, the relationship between different muscle ultrasound parameters and DPN is unclear. Objectives This study was designed to investigate the relationship between ultrasound parameters of different muscles and DPN among patients with type 2 diabetes mellitus, including the rectus femoris (RF), tibialis anterior (TA), and medial head of gastrocnemius (MG). Materials and Methods The research enrolled 90 patients with type 2 diabetes mellitus (T2DM). All images were attained from both sides. Muscle measurements contained muscle thickness (MT), cross-sectional area (CSA), echo intensity (EI), and corrected EI. The binary logistic regression and multiple linear regression were used to investigate the association between muscle ultrasound parameters and DPN or vibration perception threshold (VPT). Results EI, corrected EI, MT of MG, and EI of TA were associated with DPN separately after adjusting other clinical variates. Among these muscle parameters, the EI of MG had a better predictive value (OR: 1.114, 95% CI: 1.039, 1.196) of DPN. Combined with CSA of RF, peripheral artery disease (PAD), and sex, the corrected EI of MG was associated with the vibration perception threshold (VPT) (standard β = 0.242, p < 0.001), better than the EI of MG (standard β = 0.215, p = 0.002). Conclusions MG (MT, EI, and corrected EI) and TA (EI) were associated with DPN, respectively. CSA of RF and corrected EI or EI of MG combined with PAD and sex were associated with VPT significantly, which supported that muscle ultrasound might be a substantial quantitative tool for detecting the exercise benefits for DPN.
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Affiliation(s)
- Yanling Zhong
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, China
- Shantou University Medical College, Shantou, Guangdong 515000, China
| | - Xiaojia Liu
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, China
| | - Teng Lin
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, China
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Sahiner Z, Mangır N, Güner M, Ceylan S, Hafizoglu M, Karaduman D, Atbas C, Bas AO, Özer YP, Balcı C, Dogu BB, Halil M, Cankurtaran M. The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment. Eur Geriatr Med 2023; 14:1319-1325. [PMID: 37837573 DOI: 10.1007/s41999-023-00874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. METHODS Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. RESULTS The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). CONCLUSIONS We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.
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Affiliation(s)
- Zeynep Sahiner
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey.
| | - Naside Mangır
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Merve Güner
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Serdar Ceylan
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Merve Hafizoglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Didem Karaduman
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Cansu Atbas
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Arzu Okyar Bas
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Yasemin Polat Özer
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Cafer Balcı
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Burcu Balam Dogu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Meltem Halil
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, 06230, Altındağ, Ankara, Turkey
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Nagae M, Umegaki H, Yoshiko A, Fujita K. Muscle ultrasound and its application to point-of-care ultrasonography: a narrative review. Ann Med 2023; 55:190-197. [PMID: 36538042 PMCID: PMC9788691 DOI: 10.1080/07853890.2022.2157871] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Technological advances of hand-held ultrasound devices and educational programmes for their use, such as point-of-care ultrasonography (POCUS) training, have contributed to the increasing application of these devices in clinical practice. With the greater impact of frailty and sarcopenia in aging societies, attention is being focused on the use of ultrasound for skeletal muscle assessment. In this narrative review, we discuss how ultrasound can be applied to skeletal muscle assessment, especially that of the quadriceps muscle, in clinical practice. Muscle thickness by ultrasound has been shown to have good reliability and validity for the evaluation of muscle size, and echo intensity has been used to evaluate muscle quality. Muscle ultrasound has not only been useful to diagnose sarcopenia in various settings, but has also been validated to predict health-related outcomes such as death and functional disability. Recommended methods for muscle ultrasound was published recently, and the results of future studies are expected to be comparable. Although several challenging issues with muscle ultrasound remain, if it could be incorporated into educational programmes such as POCUS training, more clinicians may be able to use ultrasound for skeletal muscle assessment in the future.KEY MESSAGESThe evolution of hand-held ultrasound devices enables physicians to perform ultrasound at the bedside as part of regular medical examinations.Muscle ultrasound is considered an effective tool for evaluating muscle size and quality, and has been studied in various settings.More clinicians may be able to evaluate skeletal muscle assessment with the development of educational programmes on muscle ultrasound in the future.
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Affiliation(s)
- Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Akito Yoshiko
- Faculty of Liberal Arts and Sciences, Chukyo University, Aichi, Japan
| | - Kosuke Fujita
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
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Kamwa V, Jackson T, Hassan-Smith Z, Sapey E. Exploring fraity and sarcopenia in older adults admitted to acute medical unit, looking at prevalence, trajectory, and outcomes: A protocol testing the feasibility and acceptability of the TYSON study. PLoS One 2023; 18:e0293650. [PMID: 37922241 PMCID: PMC10624263 DOI: 10.1371/journal.pone.0293650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Frailty and sarcopenia are common in older people and are associated with adverse outcomes including increased mortality and morbidity. It is unclear whether screening for frailty and sarcopenia would identify specific populations most at risk of poor outcomes during unplanned hospital admissions, which screening tools should be used and what the trajectory of both conditions are over the course of an admission. The TYSON study is an observational cohort study aiming to determine the prevalence, trajectory and outcomes associated with frailty and sarcopenia in different patient cohorts. This protocol tests the feasibility and acceptability of TYSON processes. OBJECTIVES To determine in acutely admitted medical patients who are older adults: Primary: The feasibility and acceptability of frailty and sarcopenia assessments; Secondary: (1) Differences in community and hospital frailty assessments, as assessed by the medical team, the patient and elderly care physicians, (2) The dynamic changes in frailty and sarcopenia during a hospital admission, and patient outcomes; Exploratory: Inflammatory and metabolic mediators associated with frailty and sarcopenia. METHODS A single centre, prospective observational study including patients aged ≥ 65 years admitted to an acute medical unit. Frailty assessments include the Rockwood clinical frailty and e-frailty index. Sarcopenia assessments include the Bilateral Anterior Thigh Thickness (BATT) measurement. Each participant will be asked to complete 5 visits, at day 0, day 3, day 7, month 3 and month 6. Blood samples will be collected to explore inflammatory and metabolic markers associated with frailty and sarcopenia. The study and protocol have been ethically approved by the Health Research Authority (REC 20/WA/0263). DISCUSSION The study will determine the feasibility and acceptability of frailty and sarcopenia assessments in an acute hospital setting, and inform on the prevalence, trajectory and associated outcomes of frailty and sarcopenia in this group of patients. An inflammatory and metabolic profile will be explored in frailty and sarcopenia.
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Affiliation(s)
- Vicky Kamwa
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Thomas Jackson
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Department of Geriatrics, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
| | - Zaki Hassan-Smith
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Elizabeth Sapey
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
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Catikkas NM, Binay Safer V. Biceps brachii muscle cross-sectional area measured by ultrasonography is independently associated with one-month mortality: A prospective observational study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1512-1521. [PMID: 37787651 DOI: 10.1002/jcu.23571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Studies examining mortality in palliative care units are limited. We aimed to investigate the mortality and associated factors including ultrasonographic muscle parameters in hospitalized palliative patients with a subgroup analysis of older patients. METHODS A prospective-observational study. We recorded the demographics, number of diseases, diagnoses, and the Charlson comorbidity index (CCI), palliative performance scale (PPS), and nutritional risk screening-2002 (NRS-2002) scores. We noted the nutritional parameters and mortality. We measured the subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris and biceps brachii using ultrasonography. RESULTS We enrolled 100 patients (mean age: 73.2 ± 16.4 years, 53%: female). One-month mortality was 42%. The non-survivors had significantly higher malignancy, increased CCI and NRS-2002 scores, lower required energy intake, calorie sufficiency rate, and biceps brachii SFT, MT, and CSA than the survivors. The independent mortality predictors were malignancy and biceps brachii CSA while the PPS score and malignancy were significantly associated with mortality in the older subgroup. CONCLUSION The malignancy and biceps brachii CSA might have prognostic value in predicting mortality in palliative patients. This was the first study investigating the mortality-associated factors including ultrasonographic muscle measurements of both the lower and upper limbs in a palliative care center.
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Affiliation(s)
- Nezahat Muge Catikkas
- Department of Internal Medicine, Division of Geriatrics, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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Kitagawa T, Nakamura M, Fukumoto Y. Usefulness of muscle echo intensity for evaluating functional performance in the older population: A scoping review. Exp Gerontol 2023; 182:112301. [PMID: 37776985 DOI: 10.1016/j.exger.2023.112301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
Muscle echo intensity, as measured by ultrasonography, could be used as a new marker of functional performance in older populations. This scoping review aimed to present evidence on the utility of muscle echo intensity as determined by ultrasonography for assessing functional performance in older adults. The eligibility criterion included observational studies that investigated the associations between muscle echo intensity and functional performance in older adults. Terms, such as "echo intensity" and "older adults", were searched for in databases, such as PubMed, Web of Science, the Cochrane database of systematic reviews, and the Cumulative Index of Nursing and Allied Health Literature, in April 2021. Two independent reviewers screened and extracted the data; 46 papers, of which almost one-third were Japanese, were subsequently identified for inclusion. The representative functional performances included in this review were muscle strength, gait speed, sit-to-stand test results, and timed up-and-go test results. Poor to moderate associations were found between muscle echo intensity and functional performance; however, heterogeneities were observed in the characteristics of study participants. Moreover, the accurate effect size and causal inferences between muscle echo intensity and functional performance remained unclear. Further longitudinal studies are needed to determine these causal inferences.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki 842-8585, Japan.
| | - Yoshihiro Fukumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Japan.
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48
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Kokura Y, Nishioka S, Maeda K, Wakabayashi H. Ultrasound utilized by registered dietitians for body composition measurement, nutritional assessment, and nutritional management. Clin Nutr ESPEN 2023; 57:173-180. [PMID: 37739653 DOI: 10.1016/j.clnesp.2023.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Ultrasound has been used primarily as a tool for body composition measurement in the field of clinical nutrition. Although many recent reports have demonstrated that ultrasound could be a useful tool for nutritional assessment, it is not well incorporated into registered dietitians' (RDs) practice. The aim of this review was to summarize the usefulness of ultrasound in assessing body composition and nutritional status and in nutritional management by RDs. METHODS Studies on ultrasonography, nutritionists, body composition, nutritional assessment, and diet therapy was searched using the MEDLINE databases. RESULTS After reviewing the articles, we categorized them into the following topics; 1) principles of muscle measurement using the ultrasound, types of muscle that can be measured, 2) indices of muscle and muscle mass and quality as assessed using ultrasound and its relationship to nutritional indicator, 3) diagnosis of the Global Leadership Initiative on Malnutrition (GLIM) criteria malnutrition using ultrasound, 4) practical nutritional management using ultrasound and 5) education and issues for ultrasound implementation. Ultrasound can evaluate low body mass index, unintentional loss of body weight, low skeletal muscle mass index, decreased food intake/assimilation, and disease burden/inflammation, all which are essential items of the phenotypic and etiologic criteria of the GLIM. CONCLUSION Ultrasound may be useful for RDs to perform body composition measurement, nutritional assessment, and nutritional management. It will be important to identify the cutoff values for ultrasound-based measurements of muscle mass. In order for RDs to perform a body composition measurement, nutritional assessment, and nutritional management using ultrasound, educational issues need to be addressed.
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Affiliation(s)
- Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-term Care, Anamizu, Japan.
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospita, Nagakute, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Becchetti C, Berzigotti A. Ultrasonography as a diagnostic tool for sarcopenia in patients with cirrhosis: Examining the pros and cons. Eur J Intern Med 2023; 116:27-33. [PMID: 37385916 DOI: 10.1016/j.ejim.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Sarcopenia has emerged as a significant prognostic factor in liver disease, posing a significant risk to patients in terms of morbidity and mortality. However, the evaluation of skeletal muscle mass and quality remains challenging, as cross-sectional imaging is not a suitable screening tool. In order to better include this crucial variable in the routine risk stratification of patients with chronic liver disease, there is an urgent need for simple and reliable non-invasive diagnostic tools for sarcopenia. Therefore, the use of ultrasound techniques has garnered attention as a promising alternative for detecting sarcopenia and muscle abnormalities. This narrative review aims to provide an overview of the current literature on the use of ultrasound as a diagnostic tool for sarcopenia, with particular focus on patients with cirrhosis, emphasizing its potential limitations and future prospects.
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Affiliation(s)
- Chiara Becchetti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Hepatology and Gastroenterology Division, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Hospital, Milan, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland.
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50
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López-Gómez JJ, García-Beneitez D, Jiménez-Sahagún R, Izaola-Jauregui O, Primo-Martín D, Ramos-Bachiller B, Gómez-Hoyos E, Delgado-García E, Pérez-López P, De Luis-Román DA. Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition. Nutrients 2023; 15:3923. [PMID: 37764706 PMCID: PMC10534706 DOI: 10.3390/nu15183923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.
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Affiliation(s)
- Juan José López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | | | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - David Primo-Martín
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Beatriz Ramos-Bachiller
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Esther Delgado-García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Paloma Pérez-López
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Daniel A. De Luis-Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
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