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Seo E, Kwon Y, ALRomi A, Eledreesi M, Park S. A multifaceted and inclusive methodology for the detection of sarcopenia in patients undergoing bariatric surgery: an in-depth analysis of current evidence. Rev Endocr Metab Disord 2024; 25:677-689. [PMID: 38427134 DOI: 10.1007/s11154-023-09864-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 03/02/2024]
Abstract
Bariatric surgery is widely recognized as the most effective intervention for obesity and offers benefits beyond weight loss. However, not all patients achieve satisfactory weight loss, balanced changes in body composition, and resolution of comorbidities. Therefore, thorough pre- and postoperative evaluations are important to predict success and minimize adverse effects. More comprehensive assessments require broadening the focus beyond body weight and fat measurements to consider quantitative and qualitative evaluations of muscles. Introducing the concept of sarcopenia is useful for assessing the degradative and pathological changes in muscles associated with cardiometabolic function, physical performance, and other obesity-related comorbidities in patients undergoing bariatric surgery. However, there is currently no consensus or definition regarding the research and clinical use of sarcopenia in patients undergoing bariatric surgery. Therefore, this review aimed to define the concept of sarcopenia applicable to patients undergoing bariatric surgery, based on the consensus reached for sarcopenia in the general population. We also discuss the methods and significance of measuring muscle mass, quality, and strength, which are key variables requiring a comprehensive assessment.
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Affiliation(s)
- Eunhye Seo
- Keimyung University College of Nursing, Daegu, Republic of Korea
| | - Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, 73 Goryeodae- ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ahmad ALRomi
- Ministry of Health Jordan, General surgery affiliationision, prince Hamzah hospital, Amman, Jordan
| | | | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, 73 Goryeodae- ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea.
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Espino-Gonzalez E, Dalbram E, Mounier R, Gondin J, Farup J, Jessen N, Treebak JT. Impaired skeletal muscle regeneration in diabetes: From cellular and molecular mechanisms to novel treatments. Cell Metab 2024; 36:1204-1236. [PMID: 38490209 DOI: 10.1016/j.cmet.2024.02.014] [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: 09/07/2023] [Revised: 01/10/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
Diabetes represents a major public health concern with a considerable impact on human life and healthcare expenditures. It is now well established that diabetes is characterized by a severe skeletal muscle pathology that limits functional capacity and quality of life. Increasing evidence indicates that diabetes is also one of the most prevalent disorders characterized by impaired skeletal muscle regeneration, yet underlying mechanisms and therapeutic treatments remain poorly established. In this review, we describe the cellular and molecular alterations currently known to occur during skeletal muscle regeneration in people with diabetes and animal models of diabetes, including its associated comorbidities, e.g., obesity, hyperinsulinemia, and insulin resistance. We describe the role of myogenic and non-myogenic cell types on muscle regeneration in conditions with or without diabetes. Therapies for skeletal muscle regeneration and gaps in our knowledge are also discussed, while proposing future directions for the field.
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Affiliation(s)
- Ever Espino-Gonzalez
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Emilie Dalbram
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Rémi Mounier
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, Université Claude Bernard Lyon 1, CNRS UMR 5261, Inserm U1315, Univ Lyon, Lyon, France
| | - Julien Gondin
- Institut NeuroMyoGène, Unité Physiopathologie et Génétique du Neurone et du Muscle, Université Claude Bernard Lyon 1, CNRS UMR 5261, Inserm U1315, Univ Lyon, Lyon, France
| | - Jean Farup
- Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Niels Jessen
- Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus 8200, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Jonas T Treebak
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.
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Flores-Opazo M, Kopinke D, Helmbacher F, Fernández-Verdejo R, Tuñón-Suárez M, Lynch GS, Contreras O. Fibro-adipogenic progenitors in physiological adipogenesis and intermuscular adipose tissue remodeling. Mol Aspects Med 2024; 97:101277. [PMID: 38788527 DOI: 10.1016/j.mam.2024.101277] [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: 02/01/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Excessive accumulation of intermuscular adipose tissue (IMAT) is a common pathological feature in various metabolic and health conditions and can cause muscle atrophy, reduced function, inflammation, insulin resistance, cardiovascular issues, and unhealthy aging. Although IMAT results from fat accumulation in muscle, the mechanisms underlying its onset, development, cellular components, and functions remain unclear. IMAT levels are influenced by several factors, such as changes in the tissue environment, muscle type and origin, extent and duration of trauma, and persistent activation of fibro-adipogenic progenitors (FAPs). FAPs are a diverse and transcriptionally heterogeneous population of stromal cells essential for tissue maintenance, neuromuscular stability, and tissue regeneration. However, in cases of chronic inflammation and pathological conditions, FAPs expand and differentiate into adipocytes, resulting in the development of abnormal and ectopic IMAT. This review discusses the role of FAPs in adipogenesis and how they remodel IMAT. It highlights evidence supporting FAPs and FAP-derived adipocytes as constituents of IMAT, emphasizing their significance in adipose tissue maintenance and development, as well as their involvement in metabolic disorders, chronic pathologies and diseases. We also investigated the intricate molecular pathways and cell interactions governing FAP behavior, adipogenesis, and IMAT accumulation in chronic diseases and muscle deconditioning. Finally, we hypothesize that impaired cellular metabolic flexibility in dysfunctional muscles impacts FAPs, leading to IMAT. A deeper understanding of the biology of IMAT accumulation and the mechanisms regulating FAP behavior and fate are essential for the development of new therapeutic strategies for several debilitating conditions.
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Affiliation(s)
| | - Daniel Kopinke
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, 32610, FL, USA; Myology Institute, University of Florida College of Medicine, Gainesville, FL, USA.
| | | | - Rodrigo Fernández-Verdejo
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Mauro Tuñón-Suárez
- Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Anatomy and Physiology, The University of Melbourne, Melbourne, Victoria, Parkville 3010, Australia.
| | - Osvaldo Contreras
- Developmental and Regenerative Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, 2010, Australia; School of Clinical Medicine, UNSW Sydney, Kensington, NSW 2052, Australia.
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4
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Pandey A, Patel KV, Segar MW, Ayers C, Linge J, Leinhard OD, Anker SD, Butler J, Verma S, Joshi PH, Neeland IJ. Effect of liraglutide on thigh muscle fat and muscle composition in adults with overweight or obesity: Results from a randomized clinical trial. J Cachexia Sarcopenia Muscle 2024; 15:1072-1083. [PMID: 38561962 PMCID: PMC11154779 DOI: 10.1002/jcsm.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/28/2024] [Accepted: 02/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. METHODS This is a pre-specified secondary analysis of a randomized, double-blind, placebo-controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30 kg/m2 or ≥27 kg/m2 and metabolic syndrome. Participants were randomly assigned to a once-daily subcutaneous injection of liraglutide (target dose 3.0 mg) or matching placebo for 40 weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40-week follow-up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least-square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. RESULTS Among the 128 participants with follow-up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow-up of 36 weeks was -2.87% among participants randomized to liraglutide (n = 73) and 0.05% in the placebo group (absolute change: -0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was -0.24% (95% CI, -0.41 to -0.06, P-value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow-up with liraglutide, but there was no change with placebo. CONCLUSIONS In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once-daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.
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Affiliation(s)
| | - Kershaw V. Patel
- Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTXUSA
| | | | - Colby Ayers
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Jennifer Linge
- AMRA Medical and Linköping UniversityLinköpingSweden
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist MedicineLinköping UniversityLinköpingSweden
| | - Olof D. Leinhard
- AMRA Medical and Linköping UniversityLinköpingSweden
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist MedicineLinköping UniversityLinköpingSweden
| | - Stefan D. Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) Partner Site BerlinCharité UniversitätsmedizinBerlinGermany
| | - Javed Butler
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Department of MedicineUniversity of Mississippi School of MedicineJacksonMSUSA
| | - Subodh Verma
- St. Michael's HospitalUniversity of TorontoTorontoONCanada
| | - Parag H. Joshi
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Ian J. Neeland
- Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center and Case Western Reserve University School of MedicineClevelandOHUSA
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5
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Covello A, Toprover M, Oh C, Leroy G, Kumar A, LaMoreaux B, Mechlin M, Fields TR, Pillinger MH, Becce F. Skeletal muscle mass and quality in gout patients versus non-gout controls: A computed tomography imaging study. Joint Bone Spine 2024; 91:105743. [PMID: 38795766 DOI: 10.1016/j.jbspin.2024.105743] [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: 02/01/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Patients with gout are at elevated risk of multiple vascular and metabolic comorbidities. Whether they are also at risk of sarcopenia, which is known to affect patients with other rheumatic diseases, has not been previously assessed. We examined whether patients with gout have decreased lumbar muscle quality and quantity, indicating an association between gout and sarcopenia. METHODS Fifty gout subjects and 25 controls, ages 45-80, underwent computed tomography imaging of the lumbosacral spine. We measured muscle quantity (skeletal muscle area [SMA] and index [SMI]) and quality (skeletal muscle radiation attenuation [SMRA] and intermuscular adipose tissue [IMAT] area and index [IMATI]) of the psoas and erector spinae muscles at the L3 level. RESULTS Seventy subjects (45 gout and 25 controls) were included in the analysis. Gout subjects had higher BMI, more kidney disease and hypertension, lower exercise frequency, and higher mean serum urate and creatinine vs. controls. Lumbar SMRA was significantly lower in gout subjects vs. controls, indicating reduced muscle quality. Lumbar IMAT area was significantly higher in gout subjects vs. controls, as was lumbar IMATI, indicating increased muscle adiposity. These differences persisted after adjusting for potential confounders. In contrast, there was no significant difference between gout and control groups in lumbar SMA or lumbar SMI, suggesting that muscle quantity may not be routinely affected by the diagnosis of gout. CONCLUSIONS Gout patients exhibit decreased lumbar muscle quality compared with controls, consistent with an association between gout and sarcopenia.
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Affiliation(s)
- Allyson Covello
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA.
| | - Michael Toprover
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA
| | - Cheongeun Oh
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, 550, First Avenue, New York, NY, USA
| | - Gregoire Leroy
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
| | - Ada Kumar
- Amgen Inc, 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Brian LaMoreaux
- Amgen Inc, 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Michael Mechlin
- Division of Musculoskeletal Radiology, Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA
| | - Theodore R Fields
- Division of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, USA
| | - Michael H Pillinger
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, USA; Rheumatology Section, NY Harbor Health Care System, New York Campus, United States Department of Veterans Affairs, 423 E 23rd Street, New York, NY, USA
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
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6
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Garigipati P, Rehman M, Xi Y, Chhabra A. Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study. J Comput Assist Tomogr 2024; 48:432-435. [PMID: 38213036 DOI: 10.1097/rct.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA). MATERIALS AND METHODS We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated. RESULTS A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m 2 , and for the OA group, average body mass index was 29.9 kg/m 2 , with no significant difference ( P > 0.05). Two-sample t test showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability. CONCLUSIONS Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.
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Affiliation(s)
| | | | - Yin Xi
- From the Department of Radiology
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7
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Altajar S, Wang N, Rosenthaler MP, Murabito JM, Long MT. NAFLD Associates with Sarcopenia Defined by Muscle Mass and Slow Walking Speed: A Cross-Sectional Analysis from the Framingham Heart Study. J Clin Med 2023; 12:7523. [PMID: 38137592 PMCID: PMC10743412 DOI: 10.3390/jcm12247523] [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: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Sarcopenia is associated with NAFLD. It is unknown if the association is explained by shared risk factors. Our study sought to investigate the association between liver fat and sarcopenia in our cohort. Liver fat was measured on CT between 2008 and 2011. We excluded heavy alcohol use and missing covariates. Muscle mass in a subset (n = 485) was measured by 24 h urinary creatinine. Physical function was defined by h strength and walking speed. Sarcopenia was defined as low muscle mass and/or low physical function. We created multivariable-adjusted regression models to evaluate cross-sectional associations between liver fat and low muscle mass, grip strength, and walking speed. The prevalence of hepatic steatosis was 30% (n = 1073; 58.1% women; mean age 65.8 ± 8.6 years). There was a significant positive association between liver fat and muscle mass in linear regression models. The association was not significant after adjusting for BMI. The odds of sarcopenia increased by 28% for each SD in liver fat (OR 1.28; 95% CI 1.02, 1.60) and persisted after accounting for confounders in multivariable-adjusted models (OR 1.30, 95% CI 1.02, 1.67). Further studies are needed to determine if there is a causal relationship between liver fat and sarcopenia and whether treatment of sarcopenia improves liver fat.
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Affiliation(s)
- Sarah Altajar
- Division of Gastroenterology and Hepatology, University of Miami Health System, Miami, FL 33136, USA;
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Max P. Rosenthaler
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Joanne M. Murabito
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Michelle T. Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA;
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8
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Santanasto AJ, Zmuda JM, Cvejkus RK, Gordon CL, Nair S, Carr JJ, Terry JG, Wheeler VW, Miljkovic I. Thigh and Calf Myosteatosis are Strongly Associated with Muscle and Physical Function in African Caribbean Men. J Gerontol A Biol Sci Med Sci 2023; 78:527-534. [PMID: 35661875 PMCID: PMC9977257 DOI: 10.1093/gerona/glac124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND African Caribbeans have higher levels of myosteatosis than other populations; however, little is known about the impact of myosteatosis on physical function in African Caribbeans. Herein, we examined the association between regional myosteatosis of the calf, thigh, and abdomen versus physical function in 850 African-Ancestry men aged 64.2 ± 8.9 (range 50-95) living on the Caribbean Island of Tobago. METHODS Myosteatosis was measured using computed tomography and included intermuscular adipose tissue (IMAT) and muscle density levels of the thigh, calf, psoas, and paraspinous muscles. Outcomes included grip strength, time to complete 5 chair-rises, and 4-meter gait speed. Associations were quantified using separate linear models for each myosteatosis depot and were adjusted for age, height, demographics, physical activity, and chronic diseases. Beta coefficients were presented per standard deviation of each myosteatosis depot. RESULTS Higher thigh IMAT was the only IMAT depot significantly associated with weaker grip strength (β = -1.3 ± 0.43 kg, p = .003). However, lower muscle density of all 4 muscle groups was associated with weaker grip strength (all p < .05). Calf and thigh myosteatosis (IMAT and muscle density) were significantly associated with both worse chair rise time and gait speed (all p < .05), whereas psoas IMAT and paraspinous muscle density were associated with gait speed. CONCLUSION Myosteatosis of the calf and thigh-but not the abdomen-were strongly associated with grip strength and performance measures of physical function in African Caribbean men. However, posterior abdominal myosteatosis may have some utility when abdominal images are all that are available.
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Affiliation(s)
- Adam J Santanasto
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan K Cvejkus
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sangeeta Nair
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James G Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victor W Wheeler
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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9
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Cesanelli L, Kamandulis S, Volungevičius G, Satkunskiene D. Relationships between muscle quality, subcutaneous adipose tissue, and sprint performance markers of competitive cyclists. J Sports Med Phys Fitness 2023; 63:104-110. [PMID: 35333030 DOI: 10.23736/s0022-4707.22.13613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Many variables are considered to be determinants of cycling sprint performance. Among them, the importance of skeletal muscle properties in relation to cycling performance has been consistently underlined. The aim of the present study was to evaluate the vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VM), echo intensity (EI) and subcutaneous adipose tissue (SAT) content in a group of competitive cyclists and to identify whether these are related to sprint performance. METHODS Muscle echo intensity was evaluated by ultrasound in 16 highly trained competitive cyclists. The cyclists performed a maximal-intensity sprint session comprising four 15 s maximal sprints on a Wingate bike with 2 min of recovery between each. Pearson correlational analysis with linear regression was used to identify significant relationships between the criteria EI and SAT content and the sprint performance variables. RESULTS Muscle EI correlated strongly with sprint performance markers (r=from 0.54 to 0.62; P<0.05), while SAT content and body fat percentage correlated trivially to moderately with sprint performance (r=from 0.07 to 0.40; P>0.05). CONCLUSIONS Overall, muscle quality of knee extensors was positively related to sprint performance markers, but SAT content was not. Although additional studies are needed, muscle quality may represent a valid body composition indicator and may be helpful for supporting sprint performance optimization procedures in competitive cyclists.
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Affiliation(s)
- Leonardo Cesanelli
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania -
| | - Sigitas Kamandulis
- Institute of Sports Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | | | - Danguole Satkunskiene
- Institute of Sports Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
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10
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Sex differences in frailty of geriatric outpatients with type 2 diabetes mellitus: a multicentre cross-sectional study. Sci Rep 2022; 12:16122. [PMID: 36167775 PMCID: PMC9515181 DOI: 10.1038/s41598-022-20678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty and type 2 diabetes mellitus (T2DM) can occur concurrently and are increasingly prevalent in older populations. There is a marked variability in frailty progression between men and women. This study aimed to investigate sex differences in the prevalence and factors associated with frailty in older outpatients with T2DM. This multicentre cross-sectional study included 638 outpatients (aged ≥ 60 years; median age 71 years [interquartile range, 66-77]; male, 55.5%) and was conducted from January 2019 to July 2020. Frailty was assessed using the Fried frailty phenotype. Factors associated with frailty were assessed using a logistic regression analysis. The overall frailty prevalence was 28.2% (men, 26.8%; women, 29.9%; P = 0.388). In the adjusted model, the factors associated with greater odds of being frail were older age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.05-1.11; P < 0.001) and body mass index (BMI) less than 20 kg/m2 (OR, 1.96; 95% CI, 1.16-3.32; P = 0.012). Higher education (OR, 0.64; 95% CI, 0.42-0.98; P = 0.041) and productive work (OR, 0.11; 95% CI, 0.03-0.36; P < 0.001) were protective factors against frailty. Frailty was associated with all four factors in women, but only with older age and productive work in men. Our study found that the prevalence of frailty in older outpatients with T2DM was 28.2%, though not significantly different between men and women. While older age and BMI less than 20 kg/m2 can increase the odds of frailty, and higher education and productive work can decrease the odds of frailty in women, only age and productive work were associated with frailty in men with T2DM.
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11
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Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, Arai H. Combined effect of lower muscle quality and quantity on incident falls and fall-related fractures in community-dwelling older adults: A 3-year follow-up study. Bone 2022; 162:116474. [PMID: 35752409 DOI: 10.1016/j.bone.2022.116474] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Falls and fractures are serious geriatric adverse events worldwide, and skeletal muscle is considered to be a key factor in these incidents. The objective of this study was to investigate the combined effect of lower muscle quality and quantity on the incidence of falls and fall-related fractures in a 3-year follow-up period among community-dwelling older adults. METHODS We recruited community-dwelling adults aged 65 years and older who were living independently in 2018. A total of 773 older participants were analyzed in this study. The outcomes were incident falls and fall-related fractures during the 3-year follow-up period. At baseline, we assessed muscle quality and quantity using ultrasonography, and we categorized the participants into four groups based on their combination of poor/better muscle quality and poor/better muscle quantity. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the relationships among items in the four groups and the time to incident falls and fall-related fractures. RESULTS During the 3-year follow-up period, 178 participants (23.0 %) had a fall incident and 51 participants (6.6 %) had fall-related fractures. Older adults with lower muscle quality and quantity had significantly elevated risks of incident falls according to multivariate analyses using older adults with better muscle quality and quantity as the reference (adjusted HR: 1.54 [95 % CI 1.06-2.23]). However, there were no significant differences in fall-related fractures among the four groups. CONCLUSION We found that lower muscle quality and quantity led to higher incidents of falls; thus, identifying community-dwelling older adults with lower muscle quality and quantity is necessary to provide them fall preventive measures and maybe to reduce fall-related outcomes.
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Affiliation(s)
- Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Yuhei Otobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi 474-8511, Japan.
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12
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Kitagawa F, Ogawa M, Yoshiko A, Oshida Y, Koike T, Akima H, Tanaka NI. Factors related to trunk intramuscular adipose tissue content - A comparison of younger and older men. Exp Gerontol 2022; 168:111922. [PMID: 35964898 DOI: 10.1016/j.exger.2022.111922] [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: 05/18/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
The present study investigated factors related to trunk intramuscular adipose tissue (IntraMAT) content in younger and older men. Twenty-three healthy younger (20 to 29 years) and 20 healthy older men (63 to 79 years) participated in this study. The trunk IntraMAT content was measured using magnetic resonance imaging at the height of the 3rd lumbar vertebra. In addition to blood properties and physical performance, dietary intake was assessed by a self-administered diet history questionnaire. The dietary intake status was quantified using the nutrient adequacy score for the intake of 10 selected nutrients by summing the number of items that met the criteria of dietary reference intakes for Japanese individuals. The results obtained revealed that the trunk IntraMAT content was significantly higher in the older group than in the younger group (p < 0.05). In the younger group, the trunk IntraMAT content significantly correlated with systolic and diastolic blood pressure and HbA1c (rs = 0.443 to 0.464, p < 0.05). In the older group, significant and negative correlations were observed between the trunk IntraMAT content and 5-m usual walking speed, handgrip strength, and nutrient adequacy scores (rs = -0.485 to -0.713, p < 0.05). These results indicate that factors associated with the trunk IntraMAT content differed in an age dependent manner. In the younger group, the trunk IntraMAT content correlated with the metabolic status such as blood pressure and HbA1c. In the older group, physical performance and the dietary intake status negatively correlated with the trunk IntraMAT content.
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Affiliation(s)
- Funa Kitagawa
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan.
| | - Madoka Ogawa
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan
| | - Akito Yoshiko
- Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550, Japan
| | - Yoshiharu Oshida
- Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550, Japan; Research Center of Health, Fitness and Sports, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan
| | - Teruhiko Koike
- Graduate School of Medicine, Nagoya University, 65 Tsurumai, Showa, Nagoya, Aichi 466-8550, Japan; Research Center of Health, Fitness and Sports, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan
| | - Hiroshi Akima
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan; Research Center of Health, Fitness and Sports, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan
| | - Noriko I Tanaka
- Graduate School of Education and Human Development, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan; Research Center of Health, Fitness and Sports, Nagoya University, Furo-cho, Chikusa, Nagoya, Aichi 464-8601, Japan
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13
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Huynh K, Ayers C, Butler J, Neeland I, Kritchevsky S, Pandey A, Barton G, Berry JD. Association Between Thigh Muscle Fat Infiltration and Incident Heart Failure: The Health ABC Study. JACC. HEART FAILURE 2022; 10:485-493. [PMID: 35772859 DOI: 10.1016/j.jchf.2022.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excess adiposity is a well-known risk factor for heart failure (HF). Fat accumulation in and around the peripheral skeletal muscle may further inform risk for HF. OBJECTIVES The purpose of this study was to evaluate the association between intramuscular and intermuscular fat deposition and incident HF in a longitudinal cohort of community-dwelling older adults. METHODS The associations of intramuscular and intermuscular fat with incident HF were assessed using Cox models among 2,399 participants from the Health ABC (Health, Aging and Body Composition) study (70-79 years of age, 48% male, 40.2% Black) without baseline HF. Intramuscular fat was determined by bilateral thigh muscle density on computed tomography and intermuscular fat area was determined with computed tomography. RESULTS After a median follow-up of 12.2 years, there were 485 incident HF events. Higher sex-specific tertiles of intramuscular and intermuscular fat were each associated with HF risk. After multivariable adjustment for age, sex, race, education, blood pressure, fasting blood sugar, current smoking, prevalent coronary disease, and creatinine, higher intramuscular fat, but not intermuscular fat, was associated with higher risk for HF (HR: 1.34 [95% CI: 1.06-1.69]; P = 0.012, tertile 3 vs tertile 1). This association remained significant after additional adjustment for body mass index (HR: 1.32 [95% CI: 1.03-1.69]), total percent fat (HR: 1.33 [95% CI: 1.03-1.72]), visceral fat (HR: 1.30 [95% CI: 1.01-1.65]), and indexed thigh muscle strength (HR: 1.30 [95% CI: 1.03-1.64]). The association between higher intramuscular fat and HF appeared specific to higher risk of incident HF with reduced ejection fraction (HR: 1.53 [95% CI: 1.03-2.29]), but not with HF with preserved ejection fraction (HR: 1.28 [95% CI: 0.82-1.98]). CONCLUSIONS Intramuscular, but not intermuscular, thigh muscle fat is independently associated with HF after adjustment for cardiometabolic risk factors and other measurements of adiposity.
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Affiliation(s)
- Kevin Huynh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Javed Butler
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ian Neeland
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen Kritchevsky
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory Barton
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Miao SL, Ye XN, Lin TT, Qiu YH, Huang JY, Zheng XW, Chen FF. The psoas muscle density as a predictor of postoperative complications and 30-day mortality for acute mesenteric ischemia patients. Abdom Radiol (NY) 2022; 47:1644-1653. [PMID: 32892241 DOI: 10.1007/s00261-020-02714-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Low muscle mass and quality is associated with poor surgical outcomes. Psoas muscle density (PMD)is a validated surrogate for muscle quality that can be easily measured from a clinical computed tomography (CT) scan. The objective of this study was to investigate the association between PMD and short-term postoperative outcomes in patients with acute mesenteric ischemia (AMI). METHODS From April 2006 and September 2019, the clinical data of all patients who underwent surgical intervention with a preoperative diagnosis of AMI and had preoperative non-contrast CT images available were retrospectively reviewed. PMD was measured by CT at the third lumbar vertebra. The lowest quartile of PMD for men and women in all patients was used as sex-specific cut-off values for low PMD. Univariate and multivariate analyses evaluating risk factors of postoperative complications and 30-day mortality were performed. RESULTS The cohort consisted of 88 patients with a mean age of 58.8 ± 16.2 years, of whom 21 (23.9%) patients had low PMD based on the diagnostic cut-off values (40.5 HU for men and 28.4 HU for women), 35 (39.8%) patients developed complications within 30 days of the operation, and 10 (11.3%) patients died within 30 days of surgery. Low PMD patients had a higher risk of postoperative complications and 30-day mortality than patients without low PMD patients. In a multivariate analysis, low PMD and low psoas muscle area (PMA) were independent predictors of postoperative complications. However, only low PMD remained an independent risk factor for 30-day mortality. CONCLUSIONS Preoperative assessment of the PMD on CT can be a practical method for identifying AMI patients at risk for postoperative complications and 30-day mortality.
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Affiliation(s)
- Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Xiao-Ning Ye
- The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ting-Ting Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Yi-Hui Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Xiang-Wu Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China.
| | - Fan-Feng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China.
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15
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Vella CA, Miljkovic I, Price CA, Allison M. Physical Activity Type and Intensity Are Associated With Abdominal Muscle Area and Density: The Multiethnic Study of Atherosclerosis. J Phys Act Health 2022; 19:256-266. [PMID: 35276663 PMCID: PMC10275369 DOI: 10.1123/jpah.2021-0409] [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: 06/17/2021] [Revised: 12/04/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Using data from a multiethnic cohort, the authors tested associations of multiple types and intensities of physical activity (PA) with abdominal muscle area and density. METHODS 1895 Multiethnic Study of Atherosclerosis participants (mean age 64.6 [9.6] y) completed health history and PA questionnaires and computed tomography to quantify body composition and measurements of cardiovascular and inflammatory biomarkers. Analyses included multivariable regression. RESULTS Compared with those not meeting PA guidelines for Americans, those meeting the guidelines had higher total abdominal muscle area (odds ratio, 95% confidence interval 1.60, 1.20 to 2.15), stability muscle area (1.68, 1.28 to 2.20), and stability muscle density (1.35, 1.03 to 1.76). After adjustment for relevant covariates, each SD increase in total moderate to vigorous PA was associated with a higher total abdominal (β, 95% confidence interval = 0.068, 0.036 to 0.173), stability (0.063, 0.027 to 0.099), and locomotor (0.069, 0.039 to 0.099) muscle area and higher locomotor muscle density (0.065, 0.022 to 0.108, P < .01). Only intentional and conditioning exercise were associated with total abdominal and stability muscle density (P < .05). Light PA and walking were not associated with muscle area or density. CONCLUSIONS Most types of PA are positively associated with abdominal muscle area and density across functional categories, independent of relevant covariates. These results provide additional evidence for promoting PA for healthy muscle aging.
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Affiliation(s)
- Chantal A Vella
- Department of Movement Sciences, College of Education, Health and Human Sciences, University of Idaho, Moscow, ID,USA
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,USA
| | - Candice A Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA,USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA,USA
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16
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Imani M, Bani Hassan E, Vogrin S, Ch'Ng ASTN, Lane NE, Cauley JA, Duque G. Validation of a Semiautomatic Image Analysis Software for the Quantification of Musculoskeletal Tissues. Calcif Tissue Int 2022; 110:294-302. [PMID: 34518923 PMCID: PMC8863586 DOI: 10.1007/s00223-021-00914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Accurate quantification of bone, muscle, and their components is still an unmet need in the musculoskeletal field. Current methods to quantify tissue volumes in 3D images are expensive, labor-intensive, and time-consuming; thus, a reliable, valid, and quick application is highly needed. Tissue Compass is a standalone software for semiautomatic segmentation and automatic quantification of musculoskeletal organs. To validate the software, cross-sectional micro-CT scans images of rat femur (n = 19), and CT images of hip and abdomen (n = 100) from the Osteoporotic Fractures in Men (MrOS) Study were used to quantify bone, hematopoietic marrow (HBM), and marrow adipose tissue (MAT) using commercial manual software as a comparator. Also, abdominal CT scans (n = 100) were used to quantify psoas muscle volumes and intermuscular adipose tissue (IMAT) using the same software. We calculated Pearson's correlation coefficients, individual intra-class correlation coefficients (ICC), and Bland-Altman limits of agreement together with Bland-Altman plots to show the inter- and intra-observer agreement between Tissue Compass and commercially available software. In the animal study, the agreement between Tissue Compass and commercial software was r > 0.93 and ICC > 0.93 for rat femur measurements. Bland-Altman limits of agreement was - 720.89 (- 1.5e+04, 13,074.00) for MAT, 4421.11 (- 1.8e+04, 27,149.73) for HBM and - 6073.32 (- 2.9e+04, 16,388.37) for bone. The inter-observer agreement for QCT human study between two observers was r > 0.99 and ICC > 0.99. Bland-Altman limits of agreement was 0.01 (- 0.07, 0.10) for MAT in hip, 0.02 (- 0.08, 0.12) for HBM in hip, 0.05 (- 0.15, 0.25) for bone in hip, 0.02 (- 0.18, 0.22) for MAT in L1, 0.00 (- 0.16, 0.16) for HBM in L1, and 0.02 (- 0.23, 0.27) for bone in L1. The intra-observer agreement for QCT human study between the two applications was r > 0.997 and ICC > 0.99. Bland-Altman limits of agreement was 0.03 (- 0.13, 0.20) for MAT in hip, 0.05 (- 0.08, 0.18) for HBM in hip, 0.05 (- 0.24, 0.34) for bone in hip, - 0.02 (- 0.34, 0.31) for MAT in L1, - 0.14 (- 0.44, 0.17) for HBM in L1, - 0.29 (- 0.62, 0.05) for bone in L1, 0.03 (- 0.08, 0.15) for IMAT in psoas, and 0.02 (- 0.35, 0.38) for muscle in psoas. Compared to a conventional application, Tissue Compass demonstrated high accuracy and non-inferiority while also facilitating easier analyses. Tissue Compass could become the tool of choice to diagnose tissue loss/gain syndromes in the future by requiring a small number of CT sections to detect tissue volumes and fat infiltration.
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Affiliation(s)
- Mahdi Imani
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia
| | - Ebrahim Bani Hassan
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia
| | - Aaron Samuel Tze Nor Ch'Ng
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California at Davis School of Medicine, 4625 2nd Avenue Suite 2000, Sacramento, CA, 95817, USA
| | - Jane A Cauley
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, 3021, Australia.
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Xiao Y, Xiao-Yue Z, Yue W, Ruo-Tao L, Xiang-Jie L, Xing-Yuan W, Qian W, Xiao-Hua Q, Zhen-Yi J. Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances. Nutr Clin Pract 2022; 37:583-593. [PMID: 35191086 DOI: 10.1002/ncp.10847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/14/2021] [Accepted: 01/22/2022] [Indexed: 11/12/2022] Open
Abstract
Sarcopenia, also known as muscle decay, is associated with high morbidity among surgical patients. It is highly correlated with adverse clinical outcomes, such as increased postoperative complications, prolonged hospital stay, and increased mortality. Computed tomography (CT) is one of the main methods for diagnosing sarcopenia, which has the advantages of intuitiveness, rapidity, and accuracy. Clinical studies have shown that CT-defined sarcopenia can help predict the clinical outcomes and prognosis of surgical patients and provide an important reference for the formulation of antitumor treatment protocols. In recent years, some scholars have tried to construct an intelligent CT-based diagnostic model, which is expected to improve the diagnostic efficiency and establish standardized diagnostic criteria for CT-defined sarcopenia. In this review, we summarize the recent progress in the understanding of the diagnosis of sarcopenia and its potential prognostic value in surgery.
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Affiliation(s)
- Yu Xiao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhou Xiao-Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Yue
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Ruo-Tao
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Wang Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Xiao-Hua
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Zhen-Yi
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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18
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Arieta LR, Giuliani-Dewig HK, Gerstner GR, Mota JA, Ryan ED. Segmental bioelectrical impedance spectroscopy: A novel field assessment of muscle size and quality in normal weight and obese older men. Exp Gerontol 2022; 162:111745. [DOI: 10.1016/j.exger.2022.111745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
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García-Alonso Y, García-Hermoso A, Alonso-Martínez AM, Legarra-Gorgoñon G, Izquierdo M, Ramírez-Vélez R. Associations between physical fitness components with muscle ultrasound parameters in prepuberal children. Int J Obes (Lond) 2022; 46:960-968. [PMID: 35031698 DOI: 10.1038/s41366-022-01066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Muscle ultrasound is a convenient technique to visualize normal and pathological muscle tissue as it is non-invasive and real-time. This technique is related to several physical performance parameters and body composition components in adults; however, this relationship remains unexplored in early aged. We aimed to evaluate the association between physical fitness components with muscle ultrasound parameters in prepuberal children. METHODS A sample of 282 prepuberal children aged 5-9 years (144 boys) participated in the study. A trained sonographer obtained six B-mode images from femoral rectus for muscle thickness, subcutaneous adipose tissue (SAT) and area of the muscle of interest, were captured, and muscle ultrasound parameters (echo-intensity: EI uncorrected, EI correct equations) and intramuscular adipose tissue (IMAT) were extracted. Lean muscle tissue has low EI, whereas intramuscular fat and connective tissue have high EI. Physical fitness components (cardiorespiratory fitness, upper and lower muscle strength, speed-agility, and overall fitness levels) were also evaluated. Children were categorized as fit or unfit for each specific fitness test. RESULTS After adjustment for sex and age, higher physical fitness components and overall fitness (z-score) levels were negatively associated with EI, IMAT, and SAT (cardiorespiratory fitness β range = -0.264 to -0.298; upper-muscular strength β range = -0.389 to -0.457; and lower-muscular strength β range = -0.202 to -0.279; and speed-agility β range = -0.257 to -0.302). Children categorized as fit according to four physical fitness components had lower EI uncorrected, EI correct equation 1-2, IMAT, and SAT than unfit children for each respective tests (all Ps < 0.001). CONCLUSION Physical fitness components are inversely associated with EI, IMAT, SAT after adjusting for potential confounders, including sex and age, in prepuberal children. The present study strengthens the idea that muscle and adiposity parameters is affected by physical fitness even from early childhood.
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Affiliation(s)
- Yesenia García-Alonso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia M Alonso-Martínez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Gaizka Legarra-Gorgoñon
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain. .,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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20
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Hsu BG, Lin YL. Assessment of uremic sarcopenia in dialysis patients: An update. Tzu Chi Med J 2022; 34:182-191. [PMID: 35465288 PMCID: PMC9020246 DOI: 10.4103/tcmj.tcmj_254_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/09/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Uremic sarcopenia, which is highly prevalent in dialysis patients, leads to an increased risk of adverse outcomes, such as poor quality of life, falls, fracture, hospitalization, and even mortality. Therefore, early detection of uremic sarcopenia is crucial for administering quick and adequate multidisciplinary therapy to improve clinical outcomes. This review updates the current information about uremic sarcopenia assessment in chronic dialysis patients. We discuss the methods of assessing skeletal muscle mass, strength, and physical performance. We also discuss surrogate markers derived from serum and dialysate creatinine, in addition to emerging screening tools. The prevalence, clinical relevance, and impact of uremic sarcopenia on survival are reviewed and we discuss the limitations and challenges in applying the current working definition of sarcopenia based on the senior population to dialysis patients. The review shows that dialysis patients with skeletal muscle weakness or poor physical performance, either with or without low skeletal muscle mass, should undergo multidisciplinary therapy, included nutritional counseling, lifestyle modification, and exercise intervention, to mitigate the detrimental effects of uremic sarcopenia.
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21
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Fanelli E, Abate Daga F, Pappaccogli M, Eula E, Astarita A, Mingrone G, Fasano C, Magnino C, Schiavone D, Rabbone I, Gollin M, Rabbia F, Veglio F. A structured physical activity program in an adolescent population with overweight and obesity: a prospective interventional study. Appl Physiol Nutr Metab 2021; 47:253-260. [PMID: 34706211 DOI: 10.1139/apnm-2021-0092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity is a significant health problem, with increasing involvement of young population worldwide. The aim of this study was to evaluate the effects of two different types of physical exercise (resistance vs combined aerobic-resistance) on cardiovascular and anthropometric profile of a sample of sedentary adolescents with overweight and obesity. METHODS After undergoing clinical, cardiovascular and anthropometric-metabolic evaluation (T0), subjects with overweight and obesity were randomized to a 6-months resistance or combined aerobic-resistance training program. Clinical, cardiovascular and anthropometric-metabolic evaluations were repeated after 6 months of training (T1) and after 3 months of detraining (T2). RESULTS Thirty adolescents with overweight/obesity were enrolled; 20 subjects completed training program. A significant improvement in body composition was detected after 6 months, with a reduction of BMI (32.1 [30.5-34.4] vs 31.1 [29.6-33.4] kg/m2, p=0.02) and adipose tissue (45.5 [41.1-49.7] vs 41.6 [37.0-49.2] Kg, p<0.01). A reduction in Diastolic blood pressure (75.5 ± 8.9 vs 68.2 ± 6.4 mmHg, p=0.02) and Pulse Wave Velocity (5.7 [5.1-5.9] vs 5.2 [4.7-5.7] m/s, p=0.04) was also observed. Persistence of the effect on the most important parameters was observed also after detraining period. CONCLUSIONS Regular physical exercise induces positive metabolic and cardiovascular effects, with persistence also after brief discontinuation. Novelty bullets. Physical exercise induces positive effect on cardiovascular risk profile. Positive effects persist also after brief discontinuation. Physical exercise reduces early signs of autonomic disfunction.
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Affiliation(s)
- Elvira Fanelli
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy, 10124;
| | - Federico Abate Daga
- Università degli Studi di Torino, 9314, Dipartimento di Scienze delle attività motorie e sportive, Torino, Italy;
| | - Marco Pappaccogli
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Elisabetta Eula
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Anna Astarita
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Giulia Mingrone
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Chiara Fasano
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Corrado Magnino
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Domenica Schiavone
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Ivana Rabbone
- Università degli Studi di Torino, 9314, Dipartimento di Pediatria, Torino, Italy.,Università degli Studi del Piemonte Orientale Amedeo Avogadro Facoltà di Medicina e Chirurgia, 60252, Divisione di Pediatria, Novara, Piemonte, Italy;
| | - Massimiliano Gollin
- Università degli Studi di Torino, 9314, Dipartimento di Scienze delle Attività motorie e sportive, Torino, Italy;
| | - Franco Rabbia
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
| | - Franco Veglio
- Università degli Studi di Torino, 9314, Dipartimento di Scienze Mediche, Torino, Italy;
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22
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Yamaguchi K, Nakagawa K, Yoshimi K, Ariya C, Nakane A, Furuya J, Tohara H. Age-related changes in swallowing muscle intramuscular adipose tissue deposition and related factors. Exp Gerontol 2021; 153:111505. [PMID: 34343633 DOI: 10.1016/j.exger.2021.111505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate age-related changes in the intramuscular adipose tissue (IAT) of the tongue and geniohyoid muscle (GHM) and associated factors. DESIGN Exploratory cross-sectional study. SETTING AND PARTICIPANTS This study included 89 participants recruited from a health survey, which included 38 younger adults (age range, 20-63 years) and 51 older adults (age range, 65-87 years). MEASUREMENTS Age, body mass index, body fat, lean body mass, skeletal muscle mass index, trunk muscle mass index, tongue pressure, jaw opening force, and oral diadochokinesis were assessed. The cross-sectional area (CSA) and echo intensity (EI) of the tongue and GHM were measured using ultrasonography. IAT was assessed according to EI values. The factors related to the IAT of each muscle were examined using multiple regression analysis. We also investigated the correlation of IAT with factors related to oral function and systemic and morphological factors. RESULTS Neither the EI of the tongue nor that of the GHM had a significant correlation with factors related to oral function and systemic factors. In the multiple regression analysis, significant explanatory variables for EI of the tongue and GHM were age (β = 0.14, P = 0.019; tongue and β = 0.13, P = 0.017; GHM) and the CSA of each muscle (β = -0.01, P = 0.042; tongue and β = -0.04, P = 0.003; GHM). EI was positively associated with age and negatively associated with muscle CSA. CONCLUSION Age-related changes in the IAT show the same trend for both the tongue and GHM, unlike age-related changes in muscle mass. The IATs of the tongue and GHM were not significantly correlated with oral function and systemic factors. Therefore, EI may not be a useful index for the functional evaluation of the tongue and GHM.
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Affiliation(s)
- Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Chantaramanee Ariya
- Department of Preventive Dentistry, Naresuan University, 99 Moo 9, Phitsanulok-Nakhon Sawan Road, Tha Pho, Mueang Phitsanulok 65000, Thailand
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Junichi Furuya
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Geriatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-ku, Tokyo 145-8515, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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23
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Farsijani S, Santanasto AJ, Miljkovic I, Boudreau RM, Goodpaster BH, Kritchevsky SB, Newman AB. The Relationship Between Intermuscular Fat and Physical Performance Is Moderated by Muscle Area in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:115-122. [PMID: 32614950 DOI: 10.1093/gerona/glaa161] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Age-related deposition of fat in skeletal muscle is associated with functional limitations. Skeletal muscle fat may be present in people with preserved muscle mass or accompanied by muscle wasting. However, it is not clear if the association between muscle fat deposition and physical performance is moderated by muscle mass. OBJECTIVE To determine whether the association between midthigh intermuscular fat and physical performance is moderated by muscle area. METHODS We performed a cross-sectional analysis of the Health, Aging, and, Body Composition (ABC) study data collected in 2002-2003 (n = 1897, women: 52.2%). Midthigh muscle cross-sectional area (by computed tomography) and physical performance measures were compared across quartiles of intermuscular fat absolute area. Moderation analysis was performed to determine the conditional effect of intermuscular fat on physical performance as a function of muscle area. Conditional effects were evaluated at three levels of muscle area (mean and ± 1 standard deviation [SD]; 213.2 ± 53.2 cm2). RESULTS Simple slope analysis showed that the negative association between intermuscular fat area (cm2) and leg strength (N·m) was of greater magnitude (beta coefficient [b], 95% confidence interval [CI] = -0.288 [-0.427, -0.148]) in participants with greater muscle area (ie, 1 SD above the mean) compared to those with lower muscle area (ie, at mean [b = -0.12 {-0.248, 0.008}] or 1 SD below the mean [b = 0.048 {-0.122, 0.217}]). Similarly, the negative association of intermuscular fat with 400-m walk speed (m/s) and chair stand (seconds) was greater in those with higher muscle areas (p < .001) compared to those with lower muscle areas. CONCLUSIONS The association between higher intermuscular fat area and impaired physical function in aging is moderated by muscle area.
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Affiliation(s)
- Samaneh Farsijani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, Florida.,Sanford Burnham Presby Medical Discovery Institute, La Jolla, California
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Center for Aging and Population Health, University of Pittsburgh, Pennsylvania
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24
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Kemper M, Molwitz I, Krause L, Reeh M, Burdelski C, Kluge S, Yamamura J, Izbicki JR, de Heer G. Are muscle parameters obtained by computed tomography associated with outcome after esophagectomy for cancer? Clin Nutr 2021; 40:3729-3740. [PMID: 34130018 DOI: 10.1016/j.clnu.2021.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Esophageal cancer patients often suffer from cancer-related malnutrition and, as a result, sarcopenia. Whether sarcopenia worsens the outcome after esophagectomy is unclear. Inconsistent study results are partly caused by varying cut-off values used for defining sarcopenia. To overcome this challenge, a new statistical approach is proposed in this study: analyzing the linear association of computer tomography derived muscle parameters with important clinical short- and long-term outcomes post esophagectomy, regardless of cut-offs. METHODS Skeletal muscle index (SMI), quantifying muscle mass, was assessed with computed tomography (CT) in 98 patients undergoing esophagectomy. Muscle radiation attenuation (MRA) was measured to evaluate muscle quality. To evaluate the influence of the SMI and MRA on post-surgery complications, logistic regression models were used. To analyze the relationship of lengths of stay to muscle parameters, the competing risk approach introduced by Fine and Gray was applied. For survival analysis, log-rank test and Cox proportional hazards regression modeling were used. RESULTS Neither a relevant association of SMI nor MRA with pneumonia and esophagoenteric leak were observed. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. If the SMI increased, the odds for pleural effusion and pleural empyema decreased, but the odds of a pulmonary embolism increased. Univariate, unadjusted long-term survival analysis revealed that lower MRA and lower SMI were associated with shorter survival (P = 0.03). However, if the analysis was adjusted for confounders, e.g., Charlson Comorbidity Index, no relevant association regarding long-term survival was detected. CONCLUSION Consequently, poor muscle status, determined by CT imaging, does not justify denying a patient an oncologic resection. The Charlson Comorbidity Index, however, was superior for preoperative risk stratification.
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Affiliation(s)
- Marius Kemper
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicines, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Burdelski
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicines, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Geraldine de Heer
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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25
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Baker JF, Mostoufi-Moab S, Long J, Taratuta E, Leonard MB, Zemel B. Association of Low Muscle Density With Deteriorations in Muscle Strength and Physical Functioning in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:355-363. [PMID: 31841259 DOI: 10.1002/acr.24126] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with low muscle density due to the accumulation of intramuscular fat. The present study was undertaken to identify predictors of changes in muscle density and to determine whether low muscle density predicted changes in strength and physical function. METHODS Patients with RA, ages 18-70 years, completed whole-body dual-energy x-ray absorptiometry and peripheral quantitative computed tomography to quantify lean and fat mass indices and muscle density. Dynamometry was used to measure strength at the hand, knee, and lower leg. Disability and physical function were measured with the Health Assessment Questionnaire (HAQ) and the Short Physical Performance Battery (SPPB). Assessments were performed at baseline and at follow-up. Regression analyses assessed associations between patient characteristics, muscle density, and deteriorations in strength and function. RESULTS Muscle density was assessed at baseline in 107 patients with RA. Seventy-nine of these patients (74%) returned for a follow-up assessment at a median follow-up time of 2.71 years (interquartile range 2.35-3.57). Factors associated with declines in muscle density included female sex, higher disease activity, smoking, and lower insulin-like growth factor 1 (IGF-1) levels. Greater muscle density Z score at baseline (per 1 SD) was associated with less worsening per year according to HAQ, SPPB, and 4-meter walk time scores and a lower risk of a clinically important worsening in HAQ score (odds ratio [OR] 1.90 [95% confidence interval (95% CI) 1.06, 3.42]; P = 0.03) and walking speed (OR 2.87 [95% CI 1.05, 7.89]; P = 0.04). CONCLUSION Worsening of skeletal muscle density occurred in patients with higher disease activity, in smokers, and in those with lower IGF-1. Low muscle density was associated with worsening of physical function. Interventions addressing reductions in muscle quality might prevent functional decline.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | | | - Jin Long
- Stanford University, Palo Alto, California
| | | | | | - Babette Zemel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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26
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Carvalho de Abreu DC, Freire Junior RC, Mello Porto J, Errera Magnani P, Silva Tofani P, Rodrigues Iosimuta NC. Functional performance of older adults: A comparison between men and women. Women Health 2021; 61:372-380. [PMID: 33726633 DOI: 10.1080/03630242.2021.1896628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objective of this study was to compare the functional performance of community-dwelling older adults of both sexes and investigate the possible mediation aspects that may influence the sex differences regarding socioeconomic and anthropometric characteristics, health status, and quadriceps muscle strength. 233 Brazilian older adults were assessed, and men's and women's sociodemographic data, physical activity level, quadriceps muscle strength, functional performance (gait speed and the SPPB), and history of falls were compared. Sex differences in functional performance were observed even after statistically adjusting the model (age, body mass, income, physical activity level, and occurrence of falls). When quadriceps muscle strength was included in the adjusted model, the sex difference remained only for gait speed. When stature was included in the adjusted model, the sex difference in gait speed disappeared. Our results suggest that the sex difference in functional performance assessed by the SPPB can be explained due to the fact that men are stronger than women. In addition, the sex difference regarding gait speed was explained by the sex difference in stature. Public actions that encourage older women to practice physical activities that promote increased muscle strength can positively interfere with their best functional performance for as long as possible.
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Affiliation(s)
| | - Renato Campos Freire Junior
- Faculty of Physical Education and Physiotherapy, Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Jaqueline Mello Porto
- Department of Health Sciences at the Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Paola Errera Magnani
- Department of Health Sciences at the Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Patrícia Silva Tofani
- Department of Physiotherapy, Federal University of Sergipe, Lagarto, Sergipe, Brazil
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27
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Figueiredo P, Marques EA, Gudnason V, Lang T, Sigurdsson S, Jonsson PV, Aspelund T, Siggeirsdottir K, Launer L, Eiriksdottir G, Harris TB. Computed tomography-based skeletal muscle and adipose tissue attenuation: Variations by age, sex, and muscle. Exp Gerontol 2021; 149:111306. [PMID: 33713735 DOI: 10.1016/j.exger.2021.111306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to investigate how skeletal muscle attenuation and adipose tissue (AT) attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle vary according to the targeted muscles, sex, and age. DESIGN Population-based cross-sectional study. SETTING Community-dwelling old population in Reykjavik, Iceland. SUBJECTS A total of 5331 older adults (42.8% women), aged 66-96 years from the Age, Gene/Environment Susceptibility (AGES)- Reykjavik Study, who participated in the baseline visit (between 2002 and 2006) and had valid thigh and abdominal computed tomography (CT) scans were studied. METHODS Muscle attenuation and AT attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle were determined using CT. Linear mixed model analysis of variance was performed for each sex, with skeletal muscle or AT attenuation as the dependent variable. RESULTS Muscle attenuation decreased, and AT attenuation increased with age in both sexes, and these differences were specific for each muscle, although not in all age groups. Age-related differences in muscle and AT attenuation varied with specific muscle. In general, for both sexes, skeletal muscle attenuation of the hamstrings declined more than average with age. Men and women displayed a different pattern in the age differences in AT attenuation for each muscle. CONCLUSIONS Our data support the hypotheses that skeletal muscle attenuation decreases, and AT attenuation increases with aging. In addition, our data add new evidence, supporting that age-related differences in skeletal muscle and AT attenuation vary between muscles.
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Affiliation(s)
- Pedro Figueiredo
- Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA; Research Center in Sports Sciences, Health Sciences and Human Development - CIDESD, University Institute of Maia - ISMAI, Maia, Portugal; Portugal Football School, Portuguese Football Federation, Oeiras, Portugal.
| | - Elisa A Marques
- Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA; Research Center in Sports Sciences, Health Sciences and Human Development - CIDESD, University Institute of Maia - ISMAI, Maia, Portugal
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - Thor Aspelund
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kristin Siggeirsdottir
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; Janus Rehabilitation, Reykjavik, Iceland
| | - Lenore Launer
- Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | - Tamara B Harris
- Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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28
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Ida S, Kaneko R, Imataka K, Fujiwara R, Katsuta M, Shirakura Y, Okubo K, Azuma K, Murata K. [Multimodal treatment program for elderly diabetic patients with sarcopenia improves the muscle strength and physical function]. Nihon Ronen Igakkai Zasshi 2021; 58:143-151. [PMID: 33627551 DOI: 10.3143/geriatrics.58.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effects of a multimodal treatment program on the muscle strength, physical function, and skeletal muscle mass in elderly diabetic patients with sarcopenia. METHODS Diabetic patients over 65 years old attending the Department of Diabetes and Metabolism, Ise Red Cross Hospital, were included. The diagnosis of sarcopenia was based on the Asian Working Group for Sarcopenia 2019. The measurement of extremity skeletal muscle mass was assessed by the multi-frequency bioelectrical impedance method, muscle strength was assessed by the grip strength, and the physical function was assessed by the 5-time chair stand test. The muscle strength, physical function, extremity skeletal muscle mass, and other parameters were assessed before and after 12 weeks of the multimodal treatment program (optimization of protein intake, resistance training, and patient education on sarcopenia) and then compared. Paired t-tests were used for the statistical analysis. RESULTS Fourteen patients (3 men and 11 women) were included in the analysis of this study. The mean age was 74.4±4.7 years old. Significant improvements in the grip strength (male, 23.2±5.6 kg to 25.6±5.5 kg, P=0.014; female, 15.5±5.0 kg to 18.9±5.0 kg, P<0.001) and 5-time chair stand test (11.2±2.5 seconds to 8.6±1.7 seconds, P=0.002) were found with the multimodal treatment program. There was also a significant decrease in HbA1c (8.1±0.7% to 7.7±0.9%, P=0.004). However, although an increasing trend in the amount of extremity skeletal muscle mass was noted, there was no significant difference. CONCLUSIONS A multimodal treatment program for elderly diabetic patients with sarcopenia showed an improvement in the muscle strength and physical function.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Mai Katsuta
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | | | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital
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29
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Kang S, Oh TJ, Cho BL, Park YS, Roh E, Kim HJ, Lee S, Kim BJ, Kim M, Won CW, Jang HC. Sex differences in sarcopenia and frailty among community-dwelling Korean older adults with diabetes: The Korean Frailty and Aging Cohort Study. J Diabetes Investig 2021; 12:155-164. [PMID: 32627923 PMCID: PMC7858110 DOI: 10.1111/jdi.13348] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to examine the prevalence of sarcopenia and frailty in Korean older adults with diabetes compared with individuals without diabetes. MATERIALS AND METHODS We analyzed the data of 2,403 participants aged 70-84 years enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was defined using the Asian Working Group for Sarcopenia and the Foundation for the National Institutes of Health. Frailty was assessed by the Cardiovascular Health Study frailty phenotype criteria. RESULTS The mean age of the participants was 76.0 ± 3.9 years, and 47.2% were men. The prevalence of diabetes was 30.2% in men and 25.8% in women. Adults with diabetes showed a lower muscle mass index (appendicular skeletal muscle mass/body mass index) and handgrip strength in both sexes, but only the women showed decreased physical performance. Women with diabetes presented a higher prevalence of sarcopenia diagnosed by the Foundation for the National Institutes of Health criteria, and frailty compared with participants without diabetes (sarcopenia 14.7% vs 8.5%, P = 0.001; frailty 9.5% vs 4.9%, P = 0.003). Men in the high and middle tertiles for homeostatic model assessment of insulin resistance presented a significantly higher prevalence of sarcopenia, compared with men in the low tertile homeostatic model assessment of insulin resistance (high tertile 16.6%, middle tertile 13.3%, low tertile 8.6%). CONCLUSIONS In older adults with diabetes, muscle mass index and muscle strength were lower than in those without diabetes. However, the prevalence of sarcopenia and frailty was higher and physical performance was lower only in women with diabetes.
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Affiliation(s)
- Sunyoung Kang
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
| | - Tae Jung Oh
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Be Long Cho
- Department of Family MedicineSeoul National University HospitalSeoulKorea
| | - Yong Soon Park
- Department of Family MedicineChuncheon Sacred Heart HospitalChuncheonKorea
| | - Eun Roh
- Department of Internal MedicineKorea University Guro HospitalSeoulKorea
| | - Hyeon Ju Kim
- Department of Family MedicineJeju National University HospitalJejuKorea
| | - Sam‐Gyu Lee
- Department of Physical & Rehabilitation MedicineChonnam National University HospitalGwangjuKorea
| | - Bong Jo Kim
- Department of PsychiatryGyeongsang National University HospitalJinjuKorea
| | - Miji Kim
- Department of Biomedical Science and TechnologyKyung Hee UniversitySeoulKorea
| | - Chang Won Won
- Department of Family MedicineKyung Hee University HospitalSeoulKorea
| | - Hak Chul Jang
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
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Reinmann A, Gafner SC, Hilfiker R, Bruyneel AV, Pataky Z, Allet L. Bariatric Surgery: Consequences on Functional Capacities in Patients With Obesity. Front Endocrinol (Lausanne) 2021; 12:646283. [PMID: 33868175 PMCID: PMC8049139 DOI: 10.3389/fendo.2021.646283] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/02/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Bariatric surgery leads to loss of fat and fat-free mass (FFM). To preserve FFM it is recommended that weight loss interventions are accompanied by physical activity. However, it remains unknown if functional capacities spontaneously improve after a substantial weight loss. Study's aim was to assess the effect of bariatric surgery on strength, functional capacities and quality of life of participants with a body mass index (BMI) ≥ 35 kg/m2. METHOD Anthropometric parameters (weight, BMI, waist circumference), physical functions (quadriceps strength, walking capacity, spatio-temporal gait parameters, dynamic balance, lower limb power) and quality of life were assessed before and at three months after the bariatric surgery in 33 individuals who did not follow any physical activity program. RESULTS The anthropometric parameters, quality of life and three functional abilities (walking capacity, normal gait speed and lower limb power) improved significantly three months post-surgery. In contrast, fast gait speed, absolute strength, normalized strength, and dynamic balance did not improve. DISCUSSION A massive weight loss should be accompanied by an exercise program aiming to maintain FFM and to enhance muscle strength and balance. Such a program might also enhance functional capacities and help to sustain the weight loss over time.
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Affiliation(s)
- Aline Reinmann
- Geneva School of Health Sciences, Haute Ecole Spécialisée de Suisse Occidentale (HES-SO) University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- *Correspondence: Aline Reinmann,
| | - Simone Chantal Gafner
- Geneva School of Health Sciences, Haute Ecole Spécialisée de Suisse Occidentale (HES-SO) University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Roger Hilfiker
- Valais-Wallis School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Anne-Violette Bruyneel
- Geneva School of Health Sciences, Haute Ecole Spécialisée de Suisse Occidentale (HES-SO) University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Zoltan Pataky
- Department of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Lara Allet
- Valais-Wallis School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
- Department of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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Appelhans BM, Lange-Maia BS, Pettee Gabriel K, Karvonen-Gutierrez C, Karavolos K, Dugan SA, Greendale GA, Avery EF, Sternfeld B, Janssen I, Kravitz HM. Body mass index versus bioelectrical impedance analysis for classifying physical function impairment in a racially diverse cohort of midlife women: the Study of Women's Health Across the Nation (SWAN). Aging Clin Exp Res 2020; 32:1739-1747. [PMID: 31584147 DOI: 10.1007/s40520-019-01355-8] [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: 06/18/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Body composition strongly influences physical function in older adults. Bioelectrical impedance analysis (BIA) differentiates fat mass from skeletal muscle mass, and may be more useful than body mass index (BMI) for classifying women on their likelihood of physical function impairment. AIMS This study tested whether BIA-derived estimates of percentage body fat (%BF) and height-normalized skeletal muscle mass (skeletal muscle mass index; SMI) enhance classification of physical function impairment relative to BMI. METHOD Black, White, Chinese, and Japanese midlife women (N = 1482) in the Study of Women's Health Across the Nation (SWAN) completed performance-based measures of physical function. BMI (kg/m2) was calculated. %BF and SMI were derived through BIA. Receiver-operating characteristic (ROC) curve analysis, conducted in the overall sample and stratified by racial group, evaluated optimal cutpoints of BMI, %BF, and SMI for classifying women on moderate-severe physical function impairment. RESULTS In the overall sample, a BMI cutpoint of ≥ 30.1 kg/m2 correctly classified 71.1% of women on physical function impairment, and optimal cutpoints for %BF (≥ 43.4%) and SMI (≥ 8.1 kg/m2) correctly classified 69% and 62% of women, respectively. SMI did not meaningfully enhanced classification relative to BMI (change in area under the ROC curve = 0.002; net reclassification improvement = 0.021; integrated discrimination improvement = - 0.003). Optimal cutpoints for BMI, %BF, and SMI varied substantially across race. Among Black women, a %BF cutpoint of 43.9% performed somewhat better than BMI (change in area under the ROC curve = 0.017; sensitivity = 0.69, specificity = 0.64). CONCLUSION Some race-specific BMI and %BF cutpoints have moderate utility for identifying impaired physical function among midlife women.
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Affiliation(s)
- Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA.
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 2150 W. Harrison St., Room 278, Chicago, IL, 60612, USA.
| | - Brittney S Lange-Maia
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health - Austin Campus, The University of Texas Health Science Center, Austin, USA
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, USA
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, USA
| | | | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, USA
| | - Gail A Greendale
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, USA
| | - Elizabeth F Avery
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 2150 W. Harrison St., Room 278, Chicago, IL, 60612, USA
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Giuliani HK, Shea NW, Gerstner GR, Mota JA, Blackburn JT, Ryan ED. The Influence of Age and Obesity-Altered Muscle Tissue Composition on Muscular Dimensional Changes: Impact on Strength and Function. J Gerontol A Biol Sci Med Sci 2020; 75:2286-2294. [DOI: 10.1093/gerona/glaa206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The purpose of this study was to determine if muscular dimensional changes with increases in torque production are influenced by age- and obesity-related increases in intramuscular fat, and its relationship to percent body fat (%BF), echo intensity (EI), strength, and maximum walking speed. Sixty-six healthy men were categorized into 3 groups based on age and body mass index status (young normal weight [YNW], older normal weight [ONW], and older obese [OB]). Participants underwent %BF assessments, resting ultrasonography to determine muscle size (cross-sectional area [CSA]) and EI of the superficial quadriceps, and a 10-m maximum walking speed assessment. Maximal and submaximal (rest–100% MVC in 10% increments) isometric leg extension strength was assessed while changes in rectus femoris (RF) CSA, width, and depth were obtained with ultrasonography. Echo intensity and %BF were different among all groups (p ≤ .007), with the YNW and OB groups exhibiting the lowest and highest %BF and EI values, respectively. The RF increased in depth and decreased in width with increases in torque intensity for all groups. The ONW group demonstrated no change (−0.08%) in RF CSA across torque intensities, whereas the YNW group (−11.5%) showed the greatest decrease in CSA, and the OB group showed a more subtle decrease (−4.6%). Among older men, a greater change in RF CSA was related to poorer EI (r = −0.355) and higher %BF (r = −0.346), while a greater decrease in RF width was associated with faster walking speeds (r = −0.431). Examining muscular dimensional changes during contraction is a unique model to investigate the influence of muscle composition on functional performance.
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Affiliation(s)
- Hayden K Giuliani
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Nic W Shea
- School of Biological Sciences, Georgia Institute of Technology, Atlanta
| | - Gena R Gerstner
- Department of Human Movement Sciences, Old Dominion University, Norfolk, Virginia
| | - Jacob A Mota
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Eric D Ryan
- Neuromuscular Assessment Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
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Tabara Y, Ikezoe T, Setoh K, Sugimoto K, Kawaguchi T, Kosugi S, Nakayama T, Ichihashi N, Tsuboyama T, Matsuda F. Comparison of diagnostic significance of the initial versus revised diagnostic algorithm for sarcopenia from the Asian Working Group for Sarcopenia. Arch Gerontol Geriatr 2020; 89:104071. [DOI: 10.1016/j.archger.2020.104071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
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El Khoudary SR, Chen X, Nasr A, Shields K, Barinas-Mitchell E, Janssen I, Everson-Rose SA, Powell L, Matthews K. Greater Periaortic Fat Volume at Midlife Is Associated with Slower Gait Speed Later in Life in Women: The SWAN Cardiovascular Fat Ancillary Study. J Gerontol A Biol Sci Med Sci 2020; 74:1959-1964. [PMID: 30977813 DOI: 10.1093/gerona/glz095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Higher perivascular adipose tissue (PVAT) contributes to adverse physiologic alterations in the vascular wall, and thus could potentially limit normal physical function later in life. We hypothesize that higher PVAT volume at midlife is prospectively associated with slower gait speed later in life, independent of overall adiposity and other risk factors. METHODS Participants from the Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study were included. PVAT volume around the descending aorta was quantified using existing computed tomography scans at midlife, while gait speed was measured after an average of 10.4 ± 0.7 years. RESULTS Two hundred and seventy-six women (aged 51.3 ± 2.8 years at PVAT assessment) were included. Mean gait speed was 0.96 ± 0.21 m/s. Adjusting for study site, race, education level, menopausal status, and length of descending aorta at PVAT assessment, and age, body mass index, difficulty paying for basics, overall health and smoking status at gait speed assessment, a higher midlife PVAT volume was associated with a slower gait speed later in life (p = .03). With further adjustment for presence of any comorbid conditions by the time of gait speed assessment, the association persisted; every 1SD increase in log-PVAT was associated with 3.3% slower gait speed (95% confidence interval: 0.3-6.3%; p = .03). CONCLUSION Greater PVAT in midlife women may contribute to poorer physical function in older age supporting a potential role of midlife PVAT in multiple domains of healthy aging. Additional research is needed to fully elucidate the physiologic changes associated with PVAT that may underlie the observed associations.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Xirun Chen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Alexis Nasr
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Kelly Shields
- Enterprise Analytics, Highmark Health, Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis
| | - Lynda Powell
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
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Poltronieri TS, de Paula NS, Chaves GV. Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies. Clin Physiol Funct Imaging 2020; 40:207-223. [PMID: 32196914 DOI: 10.1111/cpf.12629] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Low-radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut-off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat-infiltrated muscle tissue, which will favour the nomenclature uniformization.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
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Wang SH, Keenan BT, Wiemken A, Zang Y, Staley B, Sarwer DB, Torigian DA, Williams N, Pack AI, Schwab RJ. Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index. The Importance of Tongue Fat. Am J Respir Crit Care Med 2020; 201:718-727. [PMID: 31918559 PMCID: PMC7068828 DOI: 10.1164/rccm.201903-0692oc] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022] Open
Abstract
Rationale: Obesity is the primary risk factor for obstructive sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown.Objectives: To determine the effect of weight loss on upper airway anatomy in subjects with obesity and OSA. We hypothesized that weight loss would decrease soft tissue volumes and tongue fat, and that these changes would correlate with reductions in apnea-hypopnea index (AHI).Methods: A total of 67 individuals with obesity and OSA (AHI ≥ 10 events/h) underwent a sleep study and upper airway and abdominal magnetic resonance imaging before and after a weight loss intervention (intensive lifestyle modification or bariatric surgery). Airway sizes and soft tissue, tongue fat, and abdominal fat volumes were quantified. Associations between weight loss and changes in these structures, and relationships to AHI changes, were examined.Measurements and Main Results: Weight loss was significantly associated with reductions in tongue fat and pterygoid and total lateral wall volumes. Reductions in tongue fat were strongly correlated with reductions in AHI (Pearson's rho = 0.62, P < 0.0001); results remained after controlling for weight loss (Pearson's rho = 0.36, P = 0.014). Reduction in tongue fat volume was the primary upper airway mediator of the relationship between weight loss and AHI improvement.Conclusions: Weight loss reduced volumes of several upper airway soft tissues in subjects with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.
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Affiliation(s)
- Stephen H. Wang
- Albert Einstein College of Medicine, Bronx, New York
- Center for Sleep and Circadian Neurobiology
| | | | | | | | | | - David B. Sarwer
- Center for Obesity Research and Education at the College of Public Health at Temple University, Philadelphia, Pennsylvania
| | | | | | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Richard J. Schwab
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Tanaka M, Okada H, Hashimoto Y, Kumagai M, Nishimura H, Oda Y, Fukui M. Relationship between metabolic syndrome and trunk muscle quality as well as quantity evaluated by computed tomography. Clin Nutr 2019; 39:1818-1825. [PMID: 31439352 DOI: 10.1016/j.clnu.2019.07.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Metabolic syndrome is a cluster of metabolic abnormalities. Skeletal muscle attenuation and area evaluated by computer tomography (CT) may provide valuable information about patients with metabolic disorder. Therefore, we examined the association between skeletal muscle characteristics and metabolic syndrome, and investigated the combined effect of quantitative and qualitative muscle parameters. METHODS In this cross-sectional study, we analyzed 808 middle-aged Japanese subjects. The cross-sectional area of skeletal muscle was evaluated based on CT at the third lumbar vertebrae. The subjects were divided into four groups according to the median levels of skeletal muscle index (SMI) and density (SMD). RESULTS Eighty-five men and twenty-two women had metabolic syndrome. In the adjusted model, SMI and SMD had an interaction effect on the number of metabolic syndrome components (p = 0.0398 in men and p = 0.0306 in women). When SMI and SMD were considered as independent variables for multiple regression analysis, SMI (β = -0.155, p = 0.0019 in men and β = -0.295, p < 0.0001 in women) and SMD (β = -0.355, p < 0.0001 in men and β = -0.324, p < 0.0001 in women) were both independently associated with the number of metabolic syndrome components. The subgroup with presence of low SMI and low SMD levels had a significantly higher prevalence of metabolic syndrome than that observed in other groups. CONCLUSIONS Therefore, we suggest that not only muscle quantity but also quality is independently associated with metabolic syndrome.
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Affiliation(s)
- Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
| | - Hiroshi Okada
- Department of Internal Medicine, Matsushita Memorial Hospital, Osaka, Japan.
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
| | - Muneaki Kumagai
- Medical Corporation Soukenkai, Nishimura Clinic, Kyoto, Japan.
| | | | - Yohei Oda
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
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Zhang C, Whitney DG, Singh H, Slade JM, Shen Y, Miller F, Modlesky CM. Statistical Models to Assess Leg Muscle Mass in Ambulatory Children With Spastic Cerebral Palsy Using Dual-Energy X-Ray Absorptiometry. J Clin Densitom 2019; 22:391-400. [PMID: 30661746 PMCID: PMC7333971 DOI: 10.1016/j.jocd.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 12/25/2022]
Abstract
Cerebral palsy (CP) is a movement disorder associated with small and weak muscles. Methods that accurately assess muscle mass in children with CP are scarce. The purpose of this study was to determine whether dual-energy X-ray absorptiometry (DXA) accurately estimates midleg muscle mass in ambulatory children with spastic CP. Ambulatory children with spastic CP and typically developing children 5-11 y were studied (n = 15/group). Fat-free soft tissue mass (FFST) and fat mass at the middle third of the tibia (i.e., midleg) were estimated using DXA. Muscle mass (muscleMRI) and muscle mass corrected for intramuscular fat (muscleMRIfc) in the midleg were estimated using magnetic resonance imaging (MRI). Statistical models were created to predict muscleMRI and muscleMRIfc using DXA. Children with CP compared to typically developing children had lower FFST (38%), muscleMRI (40%) and muscleMRIfc (47%) (all p < 0.05) and a lower ratio of muscleMRIfc to FFST (17%, p < 0.05). DXA-based models developed using data from typically developing children overestimated muscleMRI (13%) and muscleMRIfc (22%) (both p < 0.05) in children with CP. DXA-based models developed using data from children with CP explained 91% of the variance in muscleMRI and 90% of the variance in muscleMRIfc in children with CP (both p < 0.05). Moreover, the estimates were not different from muscleMRI and muscleMRIfc (both p > 0.99). We conclude that DXA-based statistical models accurately estimate midleg muscle mass in children with CP when the models are composed using data from children with CP rather than typically developing children.
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Affiliation(s)
- Chuan Zhang
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Harshvardhan Singh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jill M Slade
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Freeman Miller
- Department of Orthopedics, Nemours AI duPont Hospital for Children, Wilmington, DE, USA
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Shah RV, Yeri AS, Murthy VL, Massaro JM, D'Agostino R, Freedman JE, Long MT, Fox CS, Das S, Benjamin EJ, Vasan RS, O'Donnell CJ, Hoffmann U. Association of Multiorgan Computed Tomographic Phenomap With Adverse Cardiovascular Health Outcomes: The Framingham Heart Study. JAMA Cardiol 2019; 2:1236-1246. [PMID: 28975197 DOI: 10.1001/jamacardio.2017.3145] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Increased ability to quantify anatomical phenotypes across multiple organs provides the opportunity to assess their cumulative ability to identify individuals at greatest susceptibility for adverse outcomes. Objective To apply unsupervised machine learning to define the distribution and prognostic importance of computed tomography-based multiorgan phenotypes associated with adverse health outcomes. Design, Setting, and Participants This asymptomatic community-based cohort study included 2924 Framingham Heart Study participants between July 2002 and April 2005 undergoing computed tomographic imaging of the chest and abdomen. Participants are from the offspring and third-generation cohorts. Exposures Eleven computed tomography-based measures of valvular/vascular calcification, adiposity, and muscle attenuation. Main Outcomes and Measures All-cause mortality and cardiovascular disease (myocardial infarction, stroke, or cardiovascular death). Results The median age of the participants was 50 years (interquartile range, 43-60 years), and 1422 (48.6%) were men. Principal component analysis identified 3 major anatomic axes: (1) global calcification (defined by aortic, thoracic, coronary, and valvular calcification); (2) adiposity (defined by pericardial, visceral, hepatic, and intrathoracic fat); and (3) muscle attenuation that explained 65.7% of the population variation. Principal components showed different evolution with age (continuous increase in global calcification, decrease in muscle attenuation, and U-shaped association with adiposity) but similar patterns in men and women. Using unsupervised clustering approaches in the offspring cohort (n = 1150), we identified a cohort (n = 232; 20.2%) with an unfavorable multiorgan phenotype across all 3 anatomic axes as compared with a favorable multiorgan phenotype. Membership in the unfavorable phenotypic cluster was associated with a greater prevalence of cardiovascular disease risk factors and with increased all-cause mortality (hazard ratio, 2.61; 95% CI, 1.74-3.92; P < .001), independent of coronary artery calcium score, visceral adipose tissue, and 10-year global cardiovascular disease Framingham risk, and it provided improvement in metrics of discrimination and reclassification. Conclusions and Relevance This proof-of-concept analysis demonstrates that unsupervised machine learning, in an asymptomatic community cohort, identifies an unfavorable multiorgan phenotype associated with adverse health outcomes, especially in elderly American adults. Future investigations in larger populations are required not only to validate the present results, but also to harness clinical, biochemical, imaging, and genetic markers to increase our understanding of healthy cardiovascular aging.
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Affiliation(s)
- Ravi V Shah
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Ashish S Yeri
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | | | - Joe M Massaro
- Department of Statistics, Boston University, Boston, Massachusetts
| | - Ralph D'Agostino
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | | | - Michelle T Long
- Framingham Heart Study, Framingham, Massachusetts.,Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline S Fox
- Framingham Heart Study, Framingham, Massachusetts.,Merck Research Laboratories, Boston, Massachusetts
| | - Saumya Das
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Emelia J Benjamin
- Framingham Heart Study, Framingham, Massachusetts.,Cardiology and Preventive Medicine and Epidemiology Sections, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Christopher J O'Donnell
- Cardiology Section, Department of Medicine, Boston VA Healthcare, Boston, Massachusetts.,Associate Editor
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston
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Baker JF, Mostoufi-Moab S, Long J, Zemel B, Ibrahim S, Taratuta E, Leonard MB. Intramuscular Fat Accumulation and Associations With Body Composition, Strength, and Physical Functioning in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:1727-1734. [PMID: 29481721 DOI: 10.1002/acr.23550] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/20/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with adverse body composition profiles and low muscle density due to the accumulation of intramuscular fat. Linear regression was used to assess differences between RA patients and controls and to determine associations between muscle density, strength, and physical functioning. METHODS Patients with RA, ages 18-70 years, and healthy control subjects underwent whole-body dual x-ray absorptiometry and peripheral quantitative computed tomography, in order to quantify the appendicular lean mass index (ALMI) and the fat mass index (FMI), visceral fat area, and muscle density. Dynamometry was used to measure hand grip strength and muscle strength at the knee and lower leg. Disability and physical functioning were measured using the Health Assessment Questionnaire (HAQ) and the Short Physical Performance Battery (SPPB). Linear regression analyses were performed to assess differences related to RA and associations between muscle density, strength, and function. RESULTS The study group included 103 patients with RA (51 men) and 428 healthy control subjects. Among patients with RA, low muscle density was associated with higher disease activity, C-reactive protein and interleukin-6 levels, greater total and visceral fat area, lower ALMI Z scores, physical inactivity, and long-term use of glucocorticoids (>1 year). Patients with low ALMI Z scores had lower muscle density Z scores compared with reference participants with similarly low ALMI scores. Low muscle density was independently associated with lower muscle strength, higher HAQ scores, and lower SPPB scores, after adjustment for ALMI and FMI Z scores. CONCLUSION The low muscle density observed in patients with RA was associated with low muscle mass, excess adiposity, poor strength, and greater disability. Interventions to address poor muscle quality could potentially affect important functional outcomes.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania and University of Pennsylvania, Philadelphia
| | | | - Jin Long
- Stanford University, Palo Alto, California
| | - Babette Zemel
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Said Ibrahim
- Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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Effect of maternal weight during pregnancy on offspring muscle strength response to resistance training in late adulthood. Adv Med Sci 2018; 63:353-358. [PMID: 30099329 DOI: 10.1016/j.advms.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2018] [Accepted: 07/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Maternal obesity can unfavorably influence offspring body composition, muscle strength, and possibly muscle's adaptability to training, but the human studies are scarce. Therefore, we aimed to investigate the effect of maternal obesity on offspring muscle strength responses to resistance training intervention in elderly frail women. MATERIALS/METHODS Recruited participants were elderly frail women offspring of lean/normal weight mothers (n = 19, mean body mass index (BMI): 22.8 kg/m2, range: 19.9-24.5) or overweight/obese mothers (n = 16, mean BMI: 29.7 kg/m2, range: 28.2-34.2). Information on maternal BMI immediately prior to delivery was collected from the birth registers. All women participated in a 4-month supervised progressive resistance training intervention three times a week for 60 min. Predicted 1-RM of abdominal crunch, hip abduction, leg curl, leg press, seated row, and total strength were measured at baseline and after each month of training. RESULTS According to rANOVA, strength increased significantly in both groups (p for time <0.001), but no significant between the group difference were detected (p for time x group interaction > 0.072). On average, muscle strength of the women offspring of overweight/obese mothers tended to be lower than in women offspring of lean/normal weight mothers, but the only significant difference was found in leg curl (p = 0.006). No significant differences between the groups were found in relative strength changes from baseline to 4-months. CONCLUSIONS Muscle strength response to supervised resistance training is not modulated by maternal adiposity in late pregnancy in elderly frail female offspring.
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Smith GI, Commean PK, Reeds DN, Klein S, Mittendorfer B. Effect of Protein Supplementation During Diet-Induced Weight Loss on Muscle Mass and Strength: A Randomized Controlled Study. Obesity (Silver Spring) 2018; 26:854-861. [PMID: 29687650 PMCID: PMC5918424 DOI: 10.1002/oby.22169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE High protein (particularly leucine-rich whey protein) intake is recommended to mitigate the adverse effect of weight loss on muscle mass. The effectiveness of this approach is unknown. METHODS Seventy middle-aged (50-65 years old) postmenopausal women with obesity were randomized to (1) weight maintenance (WM), (2) weight loss and the recommended daily allowance for protein (0.8 g/kg/d) (WL group), or (3) weight loss plus whey protein supplementation (total protein: 1.2 g/kg/d) (WL-PS group). Thigh muscle volume and strength were assessed at baseline and after 5% and 10% weight loss in the weight-loss groups and after matched time periods (∼3 and 6 months, respectively) in the WM group. RESULTS A 5% weight loss caused a greater decrease in thigh muscle volume in the WL group than the WL-PS group (4.7% ± 0.7% vs. 2.8% ± 0.8%, respectively; P < 0.05). After 10% weight loss, there was no statistically significant difference in muscle mass loss in the two groups, and the total loss was small in both groups (5.5% ± 0.8% and 4.5% ± 0.7%, respectively). The dietary interventions did not affect muscle strength. CONCLUSIONS Whey protein supplementation during diet-induced weight loss does not have clinically important therapeutic effects on muscle mass or strength in middle-aged postmenopausal women with obesity.
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Affiliation(s)
- Gordon I Smith
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul K Commean
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dominic N Reeds
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bettina Mittendorfer
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
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Strasser EM, Hofmann M, Franzke B, Schober-Halper B, Oesen S, Jandrasits W, Graf A, Praschak M, Horvath-Mechtler B, Krammer C, Ploder M, Bachl N, Quittan M, Wagner KH, Wessner B. Strength training increases skeletal muscle quality but not muscle mass in old institutionalized adults: a randomized, multi-arm parallel and controlled intervention study. Eur J Phys Rehabil Med 2018. [PMID: 29517189 DOI: 10.23736/s1973-9087.18.04930-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Age related loss of skeletal muscle mass is accompanied by changes in muscle quality leading to impairment of functional status. AIM This study investigated the effect of resistance training and nutritional supply on muscle mass and muscle quality in very old institutionalized adults. DESIGN Prospective, randomized, multi-arm parallel and controlled intervention study. SETTING This study was conducted in five retirement care facilities. POPULATION This subgroup of the Vienna Active Ageing Study included 54 women and men (82.4±6.0 years) with impaired health status. Participants were randomly assigned either to elastic band resistance training (N.=16), training with nutritional supplementation (N.=21) or control group (N.=17). METHODS Health status was assessed at baseline with functional tests, cognitive status, nutritional status, sum of medications as well as sum of diseases. Skeletal muscle mass, determined by dual-energy X-ray absorptiometry, isokinetic knee extension and flexion force and handgrip strength were assessed at baseline and after 6 months. Muscle quality of lower extremities was defined as ratio of the extensor (MQ_LE (Ext.)) or flexor strength (MQ_LE (Flex.)) to lean leg mass. Muscle quality of upper extremity was defined as ratio of handgrip strength to lean arm mass. Follow-up examinations were performed after 12 and 18 months of intervention. RESULTS Muscle quality, but not muscle mass, showed significant correlations to functional tests at baseline (0.300 - 0.614, P<0.05). Resistance training significantly enhanced muscle quality of lower extremity after 6 months (MQ_LE (Ext.) +19.8%, MQ_LE (Flex.) +30.8%, P<0.05). Nutritional supplementation could not further increase the training effect. Participants with lower muscle quality at baseline benefit most from the training intervention. Skeletal muscle mass was not changed by any intervention. CONCLUSIONS Resistance training with elastic bands improved muscle quality in very old people. Additional nutritional supplementation was not able to further improve the effects obtained by training alone. CLINICAL REHABILITATION IMPACT Elastic band resistance training could be safely used to improve muscle quality even in old people with impaired health status. Weak and chronically ill participants benefit most from this training.
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Affiliation(s)
- Eva-Maria Strasser
- Institute for Physical Medicine and Rehabilitation/Karl Landsteiner Institute for Remobilisation and Functional Health, Kaiser Franz Joseph Hospital, Social Medical Center South, Vienna, Austria -
| | - Marlene Hofmann
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Bernhard Franzke
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Barbara Schober-Halper
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Stefan Oesen
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Waltraud Jandrasits
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Alexandra Graf
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Markus Praschak
- Institute for Physical Medicine and Rehabilitation/Karl Landsteiner Institute for Remobilisation and Functional Health, Kaiser Franz Joseph Hospital, Social Medical Center South, Vienna, Austria
| | - Barbara Horvath-Mechtler
- Institute of Radiology, Kaiser Franz Joseph Hospital, Social Medical Center South, Vienna, Austria
| | - Christine Krammer
- Institute of Radiology, Kaiser Franz Joseph Hospital, Social Medical Center South, Vienna, Austria
| | - Martin Ploder
- Department of Pediatric Surgery, Social Medical Center East, Donauspital, Vienna, Austria
| | - Norbert Bachl
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Michael Quittan
- Institute for Physical Medicine and Rehabilitation/Karl Landsteiner Institute for Remobilisation and Functional Health, Kaiser Franz Joseph Hospital, Social Medical Center South, Vienna, Austria
| | - Karl-Heinz Wagner
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Barbara Wessner
- Research Platform Active Ageing, University of Vienna, Vienna, Austria.,Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
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44
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Khoja SS, Moore CG, Goodpaster BH, Delitto A, Piva SR. Skeletal Muscle Fat and Its Association With Physical Function in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:333-342. [PMID: 28482146 DOI: 10.1002/acr.23278] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To characterize skeletal muscle fat (SMF), intermuscular adipose tissue (IMAT), and subcutaneous adipose tissue (SAT) in individuals with rheumatoid arthritis (RA), and assess the associations between these fat depots and physical function and physical activity. METHODS In a cross-sectional analysis from an RA cohort, SMF, IMAT, and SAT were measured using computed tomography imaging of the midthigh cross-sectional region. Physical function was measured using the Health Assessment Questionnaire (HAQ) and a battery of performance-based tests that included quadriceps muscle strength, gait speed, repeated chair-stands, stair ascent, and single-leg stance. Physical activity was assessed using an activity monitor. Associations between SMF, IMAT, and SAT and physical function and activity were assessed by multiple linear regression models adjusted for potential confounders such as age, sex, body mass index (BMI), muscle area, and muscle strength. RESULTS Sixty subjects with RA (82% female, mean ± SD age 59 ± 10 years, mean ± SD BMI 31.79 ± 7.16 kg/m2 ) were included. In the adjusted models, lower SMF was associated with greater gait speed, single-leg stance, quadriceps strength, and physical activity, and less disability (R2 Δ range 0.06-0.25; P < 0.05), whereas IMAT was not associated with physical function or physical activity and SAT was negatively associated with disability (HAQ) (R2 Δ = 0.13; P < 0.05) and weakly but positively associated with muscle strength (R2 Δ = 0.023; P < 0.05). CONCLUSION Fat infiltration within the muscle seems to independently contribute to low physical function and physical activity, contrary to IMAT or SAT accumulation. Longitudinal studies are necessary to confirm the impact of SMF on disability and health promotion in persons with RA.
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Affiliation(s)
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas Health Care System, Charlotte, North Carolina
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | | | - Sara R Piva
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Arnold WD, Taylor RS, Li J, Nagy JA, Sanchez B, Rutkove SB. Electrical impedance myography detects age-related muscle change in mice. PLoS One 2017; 12:e0185614. [PMID: 29049394 PMCID: PMC5648130 DOI: 10.1371/journal.pone.0185614] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/16/2017] [Indexed: 12/14/2022] Open
Abstract
Loss of muscle mass and strength represents one of the most significant contributors to impaired function in older adults. Convenient and non-invasive biomarkers are needed that can readily identify and track age-related muscle change. Previous data has suggested electrical impedance myography (EIM) has the potential to serve in this capacity. In this study we investigated how changes in EIM compared with other standard measures of muscle structure and function in aged compared with young mice. A total of 19 male mice aged approximately 25 months and 19 male mice aged 3 months underwent surface multifrequency EIM of the right gastrocnemius muscle using standard methods. Fore and hind limb grip strength, sciatic compound muscle action potential amplitude, and in-situ force of the gastrocnemius were also measured; after sacrifice, gastrocnemius myofiber size was assessed using standard histology. Spearman correlation coefficients were calculated to investigate the association between EIM and muscle characteristics. EIM in aged animals demonstrated significantly lower 50 kHz impedance phase (p<0.001) and reactance (p<0.01) values as well as reduced multifrequency parameters. In contrast, absolute gastrocnemius muscle mass was no different between young and aged mice (p = 0.58) but was reduced in aged mice after normalization to body mass (p<0.001). Median myofiber size in the aged mice was not different from that of young mice (p = 0.72). Aged mice showed reduced muscle function on the basis of normalized fore limb (p<0.001) and normalized hind limb (p<0.001) grip strength, as well as normalized gastrocnemius twitch (p<0.001) and normalized maximal isometric force (p<0.001). Sciatic compound muscle action potential amplitude was reduced in aged mice (p<0.05). EIM parameters showed good correlation with reduced standard physiological and electrophysiological measures of muscle health. Our study suggests that EIM is sensitive to aged-related muscle change and may represent a convenient and valuable method of quantifying loss of muscle health.
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Affiliation(s)
- W. David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Rebecca S. Taylor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Janice A. Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Matsuzawa R, Nozaki K, Tanaka S, Nakamura T, Maekawa E, Masuda T, Ako J, Miyaji K. Prognostic Value of Psoas Muscle Area and Density in Patients Who Undergo Cardiovascular Surgery. Can J Cardiol 2017; 33:1652-1659. [PMID: 29173605 DOI: 10.1016/j.cjca.2017.10.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Low skeletal muscle density, determined using computed tomography (CT), has yet to be examined in terms of muscle function and prognostic capability in patients who require open cardiovascular surgery. This study was performed to examine whether psoas muscle area and density, determined using CT, are associated with postoperative mortality in patients who undergo cardiovascular surgery. METHODS We reviewed the findings in 773 consecutive patients who underwent preoperative CT imaging, including the level of the third lumbar vertebra for clinical purposes. We measured grip strength, gait speed, and 6-minute walking distance to assess muscle function before hospital discharge. Skeletal muscle area was calculated from psoas muscle cross-sectional area (in squared centimeters) on preoperative CT images at the level of the third lumbar vertebra divided by the square of the patient's height in metres to give the skeletal muscle index (SMI). Skeletal muscle density determined by muscle attenuation (MA) was calculated by measuring the average Hounsfield units of the psoas muscle cross-sectional area. RESULTS The mean age of the study population was 65.0 ± 13.1 years, and 64.7% of the patients were male. Multivariate logistic regression analysis and multivariate Cox regression analysis showed that low MA, but not SMI, was significantly associated with muscle function, and all-cause mortality (P < 0.05). Kaplan-Meier analysis showed that low MA, but not low SMI, predicted mortality (P = 0.014). CONCLUSIONS Low skeletal muscle density, but not skeletal muscle area, predicted poorer muscle function and mortality in patients who undergo cardiac surgery.
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Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shinya Tanaka
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Nunes PR, Oliveira AA, Martins FM, Souza AP, Orsatti FL. Effect of resistance training volume on walking speed performance in postmenopausal women: A randomized controlled trial. Exp Gerontol 2017; 97:80-88. [DOI: 10.1016/j.exger.2017.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/14/2022]
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Abstract
Weight loss is the cornerstone of therapy for people with obesity because it can ameliorate or completely resolve the metabolic risk factors for diabetes, coronary artery disease, and obesity-associated cancers. The potential health benefits of diet-induced weight loss are thought to be compromised by the weight-loss-associated loss of lean body mass, which could increase the risk of sarcopenia (low muscle mass and impaired muscle function). The objective of this review is to provide an overview of what is known about weight-loss-induced muscle loss and its implications for overall physical function (e.g., ability to lift items, walk, and climb stairs). The currently available data in the literature show the following: 1) compared with persons with normal weight, those with obesity have more muscle mass but poor muscle quality; 2) diet-induced weight loss reduces muscle mass without adversely affecting muscle strength; 3) weight loss improves global physical function, most likely because of reduced fat mass; 4) high protein intake helps preserve lean body and muscle mass during weight loss but does not improve muscle strength and could have adverse effects on metabolic function; 5) both endurance- and resistance-type exercise help preserve muscle mass during weight loss, and resistance-type exercise also improves muscle strength. We therefore conclude that weight-loss therapy, including a hypocaloric diet with adequate (but not excessive) protein intake and increased physical activity (particularly resistance-type exercise), should be promoted to maintain muscle mass and improve muscle strength and physical function in persons with obesity.
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Affiliation(s)
| | | | - Bettina Mittendorfer
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO
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Topcu Y, Tufan F, Karan MA. Potential Confounders in Identification of Sarcopenia in Cirrhosis. Clin Gastroenterol Hepatol 2016; 14:1671-1672. [PMID: 27311617 DOI: 10.1016/j.cgh.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Yildiray Topcu
- Istanbul Faculty of Medicine, Department of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Fatih Tufan
- Istanbul Faculty of Medicine, Department of Geriatrics, Istanbul University, Istanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul Faculty of Medicine, Department of Geriatrics, Istanbul University, Istanbul, Turkey
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50
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Yoon JW, Jang HC. Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6). Diabetes Metab J 2016; 40:250-1. [PMID: 27352255 PMCID: PMC4929230 DOI: 10.4093/dmj.2016.40.3.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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