Sarcopenia: how to measure, when and why

L3-SMI as a predictor of overall survival in oesophageal cancer patients receiving PD-1 inhibitors combined with chemotherapy

BACKGROUND

Programmed death ligand-1 (PD-1), as an immunotherapy target, has been increasingly used in tumour therapies. But as reactions and outcomes to PD-1 inhibitors combined with chemotherapy vary individually, it is primarily important to identify an ideal indicator for predicting the therapeutic effectiveness in individual patients. Oesophageal cancer (EC) patients often have difficulty eating due to tumour blockage of the oesophagus, leading to malnutrition and muscle loss. Sarcopenia is one of the influencing factors for poor prognosis in tumour patients, but its role in PD-1 inhibitors combined with chemotherapy of EC patients is not fully clarified. In this study, we aimed to explore the prognostic significance of Sarcopenia measured by CT in EC patients treated with PD-1 antibody combined with chemotherapy.

METHODS

The third lumbar skeletal muscle mass index (L3-SMI) was obtained from 83 EC patients before and 3 months after administration of PD-1 inhibitors combined with chemotherapy using conventional CT scans.

RESULTS

Baseline L3-SMI and 3-month L3-SMI values were found not suitable for predicting the overall survival (OS) of EC patients (p = 0.32 & p = 0.055). Longitudinal change in L3-SMI (ΔL3-SMI) during PD-1 inhibitors combined with chemotherapy was identified as a relevant marker of OS in univariable analysis (HR: 0.98, 95% CI: 0.96-1.00, p = 0.042) and multivariable analysis (HR: 0.96, 95% CI: 0.93-0.99, p = 0.02). L3-SMI-positive patients generally had better OS (p = 0.041).

CONCLUSION

Excessive muscle loss rather than muscle loss before and after administration of PD-1 inhibitors combined with chemotherapy is an important prognostic factor for therapeutic outcomes and OS in EC patients.

Preoperative CT-derived sarcopenia as a predictor of postoperative complications in patients undergoing laparoscopic radical resection for non-metastatic colorectal cancer: a retrospective study

PURPOSE

Sarcopenia is increasingly recognized as a risk factor for postoperative complications in gastrointestinal cancer surgery. This study aimed to assess the association between sarcopenia and postoperative complications following laparoscopic radical resection of non-metastatic colorectal cancer (CRC).

METHODS

In this retrospective study, 387 non-metastatic CRC patients undergoing laparoscopic radical resection were categorized into a sarcopenic group and a non-sarcopenic group based on preoperative skeletal muscle index (SMI, cm2/m2). Logistic regression analysis was performed to identify independent predictors for postoperative complications.

RESULTS

Sarcopenia was present in 156 (40.31%) patients. The incidence of postoperative complications was 32.3%, with a serious complication (Clavien-Dindo III-V) rate of 12.1%. Compared with non-sarcopenic patients, sarcopenic patients had significantly higher incidences of total complications (P < 0.001) and severe complications (P = 0.026). Multivariable analysis identified sarcopenia as an independent risk factor for total postoperative complications (OR = 3.42, 95%CI 1.85-6.31). Further analysis of specific types of postoperative complications revealed that anastomotic leakage (P = 0.001), surgical site infection (P = 0.002), and surgical site adverse events (P = 0.001) rates were higher in sarcopenic patients. In multivariable analysis, sarcopenia was independently associated with anastomotic leakage (OR = 3.36, 95%CI = 1.12-10.12) and surgical site adverse events (OR = 3.02, 95%CI = 1.55-5.90).

CONCLUSIONS

Preoperative CT-derived sarcopenia can predict postoperative complications in patients with non-metastatic CRC undergoing laparoscopic radical resection, particularly anastomotic leakage and surgical site adverse events.

Exploring the association between computed tomography (CT)-derived skeletal muscle mass and short- and long-term mortality in critically ill patients: a systematic review and meta-analysis

BACKGROUND

Low skeletal mass, often present at hospital admission, has been associated with poor prognoses.

AIM

To explore the association between computed tomography (CT)-derived skeletal muscle mass at the lumbar level and short- and long-term mortality in critically ill patients.

METHODS

Following PRISMA 2020 guidelines, we included studies on critically ill adults (≥ 18 years) hospitalized in intensive care units (ICU) that measured CT-derived skeletal muscle mass at the lumbar vertebral level within ± 7 days of ICU admission. The primary outcome was mortality, categorized as short-term (including ICU, hospital, 28- and 30-day mortality) and long-term (> 30 days) mortality. MEDLINE and Embase databases were searched without date restrictions. Study screening was performed using Rayyan, data extraction was guided by a custom-designed tool, and quality assessment was performed using the JBI Cohort Study Checklist. A meta-analysis was conducted, focusing on studies that reported short- and long-term mortality among patients with preserved and reduced skeletal muscle. A prevalence meta-analysis was also performed for studies that reported the size of subgroups with low muscle mass.

RESULTS

Out of 1248 unique records, 35 studies met the inclusion criteria, involving 9366 participants. The majority were retrospective, single-centre studies conducted on four continents and included heterogeneous populations such as patients with sepsis, COVID-19 and trauma. Sample sizes ranged from 36 to 939, with a wide age range, from 40 to 70 s, and a predominance of male patients (62%). Skeletal mass was most commonly reported as skeletal muscle index at the third lumbar vertebra. Studies reported mainly short-term mortality on day 28 or 30. Long-term mortality, measured at 90 days, 6 months, and 1 year, was evaluated in 11 studies. Meta-analyses revealed that low skeletal muscle mass area and index were significantly associated with increased risks of both short (OR = 2.33, CI 1.90-2.87, I2 = 41.39%)-and long-term mortality (OR = 2.67, CI 1.45-4.92, I2 = 62.24%). The overall prevalence of low muscle mass was 42% (CI 34-49%, I2 = 98.2%).

CONCLUSIONS

CT-assessed skeletal muscle mass at the lumbar level on admission to ICU is associated with both short- and long-term mortality. It may serve as a prognostic marker in critically ill patients. Standardized protocols for measuring and defining low skeletal muscle mass in this population are essential to improve comparability across studies.

Assessment of Sarcopenia Using Rectus Femoris Ultrasound in Emergency Patients-A Cross-Sectional Study

Background: Sarcopenia is a progressive muscle disorder commonly associated with aging and chronic diseases. It has been linked to worse clinical outcomes and increased vulnerability during acute illness. However, its prevalence in emergency department (ED) populations remains underexplored. This study aimed to evaluate the presence of sarcopenia among ED patients using ultrasound, determine its relationship with underlying comorbidities, and assess its association with in-hospital complications. Methods: We conducted a prospective, observational, cross-sectional study at the Infanta Cristina University Hospital (Madrid, Spain) from January to May 2024. A total of 150 patients aged 18 years and older who presented to the ED were assessed for sarcopenia using rectus femoris ultrasound. Sociodemographic, clinical, and laboratory variables were collected. A multivariate logistic regression model was used to identify independent predictors of in-hospital complications. Patients were followed for 30 days to evaluate outcomes. Comparisons were made between diagnostic groups and sarcopenia indices. Results: The mean age of the cohort was 70.7 years (SD 18.15), and 52% were male. Neurological diseases were associated with the highest degree of sarcopenia (mean Y-axis: 0.93 cm), followed by digestive (1.05 cm), hematological (1.05 cm), and cardiovascular diseases (1.08 cm). Patients who developed in-hospital complications had lower mean muscle thickness values compared to those without complications (1.08 cm vs. 1.24 cm; p < 0.05). Sarcopenia was significantly correlated with the presence of comorbidities and poor clinical outcomes. Conclusions: These findings support the integration of sarcopenia screening protocols into emergency care and highlight the need for studies exploring early nutritional or rehabilitation interventions targeted at high-risk patients.

Effect of the Finger-ring Test, compared with the standard test, as a predictor of sarcopenia in older adult patients: A systematic review and meta-analysis

AIM

The Finger-ring Test is valued for its simplicity and cost-effectiveness. This has prompted a systematic literature review to evaluate the effectiveness of the Finger-ring Test in the assessment of sarcopenia.

METHODS

Research studies in various online databases were accessed and perused, including PubMed, Web of Science, Scopus, Ovid, Embase, Medline and the Cochrane Database to identify relevant observational studies without any language restriction from database access to July 2024. To avoid missing any relevant matches, searches targeted specific words typically associated with the Finger-ring Test, such as Yubu-wakka Test and the Finger-circle Test. The research quality was evaluated using the ROBINS-E tool. A meta-analysis was performed using the SPSS software version 29. The review protocol was registered on PROSPERO, with the assigned ID CRD42024593561.

RESULTS

From a total of 286 studies, only four studies met the inclusion criteria. From a total of 2754 participants, the mean age of the participants was 68.35 ± 2.57 years. The pooled association of each group of the Finger-ring Test with sarcopenia showed the bigger group (OR 2.47; 95% CI 1.42-4.28; I2 = 64%), just fit group (OR 0.30; 95% CI 0.13-0.67; I2 = 75%) and the smaller group (OR 0.16; 95% CI 0.08-0.32; I2 = 62%).

CONCLUSIONS

This systematic review shows that the Finger-ring Test offers a practical method to identify older adults at risk of sarcopenia. These outcomes might serve as valuable indicators for creating public health initiatives in both the prevention and the management of sarcopenia. Geriatr Gerontol Int 2025; 25: 730-737.

Quantification of Skeletal Muscle at the First Lumbar Level for Prognosis in Amyotrophic Lateral Sclerosis

BACKGROUND

Skeletal muscle parameters at the first lumbar vertebra (L1) level on computed tomography (CT) are common indicators for muscle mass. However, their relationship with the severity and prognosis of amyotrophic lateral sclerosis (ALS) patients remains unclear.

METHODS

This cohort study included ALS patients who underwent chest CT scans between January 2018 and January 2022 and healthy controls (HCs) matched for gender and age. Overall survival (OS) was determined from the date of chest CT to death, tracheal intubation or 1 January 2024. Using ImageJ software, skeletal muscle area and density (L1 SMA/SMD), skeletal muscle index (L1 SMI), paraspinal muscle area and density (L1 PMA/PMD) and subcutaneous fat area and density (L1 SFA/SFD) at L1 were quantified. The relationships between the quantified muscle parameters and both King's clinical stages and the Revised ALS Functional Rating Scale (ALSFRS-R) were analysed. The Cox proportional hazard model was used to evaluate the hazard ratio (HR) of skeletal muscle parameters as risk factors for outcome events, and to construct a nomogram.

RESULTS

Muscle parameters in ALS patients (n = 102; 36.27% female; mean age, 60.85 ± 10.58 years) were significantly lower compared with HCs (p < 0.001). L1 SMD (p = 0.047) and L1 PMD (p = 0.003) both differed significantly across the King's clinical stages. ALSFRS-R scores correlated with L1 SMA (r = 0.35, p < 0.001), L1 SMI (r = 0.34, p < 0.001), L1 PMA (r = 0.27, p = 0.007) and L1 PMD (r = 0.27, p = 0.007). Multivariate Cox regression analysis revealed that L1 SMA (HR = 0.96, 95% confidence interval [CI] = 0.94-0.98, p = 0.001), L1 SMD (HR = 0.92, 95% CI = 0.88-0.96, p < 0.001) and L1 PMA (HR = 1.06, 95% CI = 1.01-1.11, p = 0.022) significantly influenced ALS survival, with area under the curves (AUCs) of 0.687 and 0.851 for 1- and 3-year OS prediction. The consistency index (C-index) for the nomogram was 0.72 (95% CI = 0.641-0.793).

CONCLUSIONS

Skeletal muscle parameters at L1 level on CT are significantly associated with clinical severity and prognosis in ALS.

TRIAL REGISTRATION

Chinese Clinical Trial Registration Center: ChiCTR230078702.

Dynamic shear wave elastography for the flexor digitorum superficialis: The correlation with physical performance in hospitalized older adults

Shear wave elastography (SWE) can quantify muscle stiffness to reflect the muscle quality, and we explored the application of SWE in assessing physical performance. In this work, a total of 98 older adults, including 55 men and 43 women, were recruited in this cross-sectional study. Short physical performance battery (SPPB) and time-up-and-go (TUG) test were used to evaluate physical performance, and a dynamic SWE imaging for the flexor digitorum superficialis in the process of using grip strength meter was documented. The peak strength and peak shear wave velocities (SWV) were recorded, and the ratio of peak SWV to peak strength was defined as the standardized muscle contractive stiffness. For men, the peak SWV was negatively correlated to SPPB scores (r = -0.351 to -0.448, all P < 0.01) and positively correlated to TUG time (r = 0.299-0.369, all P < 0.05), and the standardized muscle contractive stiffness was significantly negatively correlated to SPPB scores (r = -0.501 to -0.532, all P < 0.01) and positively correlated to TUG time (r = 0.424-0.462, all P < 0.01). For women, the peak SWV was not correlated to physical performance, and the standardized muscle contractive stiffness was correlated to the TUG time (r = 0.312 for Cmax and 0.310 for Cmean, both P < 0.05). Those participants with decreased physical performance had significant higher standardized muscle contractive stiffness in both men and women (all P < 0.05). We proved that SWE can be applied in evaluating muscle function and the flexor digitorum superficialis contractive stiffness standardized by grip strength can be a potential indicator.

Equations for Assessing Body Composition by Ultrasound in Older Adults: A Narrative Review

As individuals age, physiological changes in body composition occur, potentially contributing to adverse health outcomes in the elderly population. Various methods are used to assess body composition, but gold-standard techniques often involve technical complexity, high costs, and lack of portability. Alternative methods that are portable, relatively low-cost, and technically simpler are necessary for clinical use. Due to its portability, safety, and lower cost compared with gold-standard equipment, B-mode ultrasound has been suggested as a potential method for body composition assessment. This narrative review aimed to identify and discuss equations developed using ultrasound to assess body composition in older adults. An electronic search was conducted in the MEDLINE/PubMed, Web of Science, Scopus, and Google Scholar databases in September 2023 and updated in April 2025. The search terms used were ultrasound, body composition, muscle, fat, older adults, aging, and equation. To date, no standardized cut-off points have been established to define low muscle mass or a high body fat percentage using ultrasound in older adults. Further research is needed to determine the validity and applicability of this technique in comparison with gold standard methods, as well as among the different types of ultrasound devices (A-mode and B-mode). Caution is warranted when selecting predictive equations for assessing body composition in clinical practice in older adults, as several factors related to equipment and the population assessed must be taken into account.

Chest CT-determined sarcopenia is associated with poorer functional outcomes in osteoarthritis patients undergoing total knee arthroplasty: a retrospective cohort study

Sarcopenia diagnosed via opportunistic computed tomography (CT) is linked to poor postoperative outcomes. This study aimed to investigate the association between chest CT-diagnosed sarcopenia and post-total knee arthroplasty (TKA) functional outcomes. This single-center retrospective cohort study included 158 knee osteoarthritis (KOA) patients who underwent primary TKA between January 2021 and June 2022. Sarcopenia was defined using skeletal muscle index values derived from chest CT images at the T12 vertebral level. Sociodemographic, clinical, and perioperative data were collected, and functional outcomes were assessed via the Hospital for Special Surgery (HSS) score at 6 months postoperatively. Univariate and multivariate analyses identified independent risk factors for poorer postoperative functional outcomes in KOA patients undergoing TKA. The prevalence of sarcopenia in the cohort was 48.7%. At 6 months after TKA, sarcopenic patients had significantly lower HSS scores (P < 0.05). Advanced age (P = 0.025), higher body mass index (P = 0.027), sarcopenia (P = 0.020), and higher postoperative pain scores (P < 0.001) were independently associated with poorer functional outcomes. The results indicate that chest CT-determined sarcopenia is prevalent among KOA patients undergoing TKA and is significantly associated with poorer functional outcomes.

Update on the detection of frailty in older adults: a multicenter cohort machine learning-based study protocol

BACKGROUND

This study aims to investigate the relationship between muscle activation variables assessed via ultrasound and the comprehensive assessment of geriatric patients, as well as to analyze ultrasound images to determine their correlation with morbimortality factors in frail patients.

METHODS

The present cohort study will be conducted in 500 older adults diagnosed with frailty. A multicenter study will be conducted among the day care centers and nursing homes. This will be achieved through the evaluation of frail older adults via instrumental and functional tests, along with specific ultrasound images to study sarcopenia and nutrition, followed by a detailed analysis of the correlation between all collected variables.

DISCUSSION

This study aims to investigate the correlation between ultrasound-assessed muscle activation variables and the overall health of geriatric patients. It addresses the limitations of previous research by including a large sample size of 500 patients and measuring various muscle parameters beyond thickness. Additionally, it aims to analyze ultrasound images to identify markers associated with higher risk of complications in frail patients. The study involves frail older adults undergoing functional tests and specific ultrasound examinations. A comprehensive analysis of functional, ultrasound, and nutritional variables will be conducted to understand their correlation with overall health and risk of complications in frail older patients.

TRIAL REGISTRATION

The study was approved by the Research Ethics Committee of the Hospital Universitario Puerta de Hierro, Madrid, Spain (Act nº 18/2023). In addition, the study was registered with https://clinicaltrials.gov/ (NCT06218121).

Role of Pectoralis Muscle Analysis in Breast Magnetic Resonance Imaging for Body Composition Evaluation Before and After Neoadjuvant Chemotherapy for Breast Cancer

Background: sarcopenia is a physical condition characterized by the loss of muscle mass and strength; it is associated with worse outcomes in oncological diseases and is recognized as an independent predictor of poor survival. The aim of our work is to evaluate the correlation between the pectoralis muscles area (PMA) calculated in breast MRI examinations and the body composition parameters assessed in CT examinations, in order to identify a threshold useful for diagnosing sarcopenia in breast cancer patients who are candidates for neoadjuvant chemotherapy (NACT), so as to be able to provide the correct nutritional counselling. Methods: we included 116 patients with non-metastatic breast cancer, who were studied with MRI before and after NACT, in the 2018-2023 period. All patients were categorized according to age, weight, height, and BMI. Using MRI scans, both before and after treatment, we measured the PMA at the level of the sternal angle of Louis and evaluated the changes caused by NACT, and we performed the same procedure for CT body composition parameters. Results: the ROC we calculated describes the ability of the PMA to discriminate sarcopenic patients from non-sarcopenic ones, identifying an optimal cut-off of 20.55, which achieves a specificity of 92%. The variations in PMA after NACT showed a strong, statistically significant association with the variations in all CT body composition parameters. Conclusions: these results introduce the possibility of also assessing body composition in breast MRI. The novelty in this study is to have estimated, on the basis of these correlations, a cut-off value that reflects the skeletal muscle index threshold for the definition of sarcopenia that is usually used.

Unraveling the Metabolic Pathways Between Metabolic-Associated Fatty Liver Disease (MAFLD) and Sarcopenia

Metabolic-Associated Fatty Liver Disease (MAFLD) is a public health concern that is constantly expanding, with a fast-growing prevalence, and it affects about a quarter of the world's population. This condition is a significant risk factor for cardiovascular, hepatic, and oncologic diseases, such as hypertension, hepatoma, and atherosclerosis. Sarcopenia was long considered to be an aging-related syndrome, but today, it is acknowledged to be secondarily related to chronic diseases such as metabolic syndrome, cardiovascular conditions, and liver diseases, among other comorbidities associated with insulin resistance and chronic inflammation, besides inactivity and poor nutrition. The physiopathology involving MAFLD and sarcopenia has still not been solved. Inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance seem to be some of the keys to this relationship since this hormone target is mainly the skeletal muscle. This review aimed to comprehensively discuss the main metabolic and physiological pathways involved in these conditions. MAFLD and sarcopenia are interconnected by a complex network of pathophysiological mechanisms, such as insulin resistance, skeletal muscle tissue production capacity, chronic inflammatory state, oxidative stress, and mitochondrial dysfunction, which are the main contributors to this relationship. In addition, in a clinical analysis, patients with sarcopenia and MAFLD manifest more severe hepatitis fibrosis when compared to patients with only MAFLD. These patients, with both disorders, also present clinical improvement in their MAFLD when treated for sarcopenia, reinforcing the association between them. Lifestyle changes accompanied by non-pharmacological interventions, such as dietary therapy and increased physical activity, undoubtedly improve this scenario.

Impact of Sarcopenia on Mortality in Patients Undergoing TAVI: A Follow-Up Study

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe aortic stenosis who are deemed inoperable. However, sarcopenia may be a determining factor in their survival. The aim of our study is to assess the impact of sarcopenia, evaluated by computed tomography (CT), on mortality in this patient population. Methods: Patients with severe aortic stenosis undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis was performed, and correlations between body composition parameters at the T12 and L3 vertebral levels were assessed. Results: Our sample comprised 97 subjects. Time to mortality was associated with diabetes mellitus (p = 0.050), atrial fibrillation (p = 0.02), and respiratory disease (p = 0.03). Interestingly, sarcopenia (p = 0.039) and normal-density muscle area (p = 0.025) were also associated with time to mortality, with the association between sarcopenia and time to mortality becoming stronger after adjusting for covariates (p < 0.001). The correlation between different body composition parameters at the T12 and L3 vertebral levels was substantial and statistically significant. Conclusions: The use of CT to assess sarcopenia in patients with severe aortic stenosis undergoing TAVI is highly valuable and can predict time to mortality. Sarcopenia should be considered as a relevant parameter in the comprehensive evaluation of these patients.

Normative data for age-specific skeletal muscle area based on computed tomography in Korean population

BACKGROUND

Sarcopenia, a progressive loss of muscle mass and function, increases health risks in older adults, especially in rapidly ageing populations like Korea. Computed tomography (CT) imaging at the third lumbar vertebra (L3) level is a gold standard for assessing skeletal muscle area (SMA) and indices (SMIs), yet age- and sex-specific reference values are limited. This multicentre study aimed to establish these values for improved sarcopenia diagnosis.

METHODS

We conducted a retrospective study with 2637 healthy Korean adults (1366 men, 1271 women) aged 20 and older, using abdominal CT scans from routine health check-ups at four centres. SMA and SMIs were measured at L3, and T-scores were calculated by comparing participants' values with a healthy young reference group (ages 20-39). Sarcopenia was classified into Classes I and II using standardised cutoffs.

RESULTS

An age-related SMA decline was observed in both sexes, with a more significant reduction in men. Sarcopenia prevalence was higher in men based on the SMA index, while SMA/body mass index (BMI) was more sensitive in women. Class I sarcopenia ranged from 10.1% to 21.3% in men and 10.6% to 23.6% in women, with Class II prevalence between 1.0% and 5.5% in men and 1.3% and 8.3% in women.

CONCLUSION

This study establishes CT-based reference values for SMA and SMIs, supporting early sarcopenia detection, with the SMA/BMI index proving valuable for both men and women.

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

BACKGROUND

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

RESEARCH QUESTION

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

A systematic review on the prognostic role of radiologically-proven sarcopenia on the clinical outcomes of patients with acute pancreatitis

BACKGROUND

Sarcopenia is a known risk factor for poor prognosis in chronic pancreatitis, however the impact of sarcopenia in acute pancreatitis (AP) is unknown. This systematic review examines the prognostic impact of sarcopenia on clinical outcomes in patients with acute pancreatitis.

METHODS

A systematic literature of Medline, EMBASE, Cochrane, and the World Health Organisation International Clinical Trials Registry Platform was undertaken to identify articles relating to sarcopenia, AP, and computed tomography imaging. Data collected was related to studies' demographic population, presence of sarcopenia, sarcopenia assessment methodology, obesity, pancreatitis severity, and short- and long-term complications of AP.

RESULTS

A total of four out of 114 unique peer-review articles were included in this review, encompassing 947 patients in total. Of the analysable data, 200 patients had sarcopenia and 640 did not. There was marked heterogeneity in the determination of the presence of sarcopenia between studies. No significant association was found between sarcopenia and pancreatic necrosis, organ failure, venous thromboembolism, recurrent acute pancreatitis, or mortality.

CONCLUSION

Sarcopenia remains highly prevalent in patients suffering from acute pancreatitis. There is insufficient evidence to suggest sarcopenia is associated with poorer outcomes in patients with acute pancreatitis. More high-powered studies are required to further characterise the impact of sarcopenia on patients with acute pancreatitis.

New research progress of sarcopenia in surgically resectable malignant tumor diseases

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

MRI-based radiomics to determine the role of thigh muscle quality in the development of knee osteoarthritis: A discovery and validation study

INTRODUCTION

Although the reduced muscle quality is common in elderly people, its role in the development of knee osteoarthritis (OA) remains unclear. Magnetic Resonance Imaging (MRI) is considered the gold standard imaging modality to assess muscle quality, which might holistically capture the underlying pathology.

OBJECTIVES

This study aimed to apply MRI-based radiomics to assess the quality of thigh muscles comprehensively, and examine its prediction performance for incident knee OA.

METHODS

The participants at risk of knee OA during the 48-month visit were selected from a multicenter cohort and analyzed using a nested case-control design. Cases were matched 1:1 to controls according to age, sex, and contralateral knee status. A multitask framework was developed to comprehensively evaluate thigh muscle quality by calculating conventional quantitative markers and radiomic features. Baseline collected thigh and knee MRI scans were respectively used for discovery and validation procedures. In each procedure, three (cross-sectional area [CSA], intramuscular adipose tissue [intra-MAT] CSA, and radiomic signature score [Rad-score]) imaging models of each muscle group (extensors, flexors, and auxiliaries) were trained and tested. The prediction performance of each muscle Rad-score was compared with conventional markers respectively. Furthermore, the incremental predictive value of clinical characteristics for Rad-score model was investigated.

RESULTS

448 participants (mean age 61 years, 63 % female) were identified and split into training (314 [70.1 %]) and testing (134 [29.9 %]) cohorts. In the discovery procedure, the extensors Rad-score provided superior prediction performance than extensors CSA and intra-MAT CSA (area under the curve [AUC] 0.832 [95 % CI 0.765-0.899] vs 0.595 [0.498-0.692] and 0.600 [0.503-0.697] in testing cohort; all p < 0.001). Contrarily, the performances of the Rad-score and conventional markers of flexors were relatively poor, as were those of the auxiliaries. Extensors Rad-score also outperformed auxiliaries Rad-score, flexors Rad-score, and the clinical model (AUC 0.832 [0.765-0.899] vs 0.687 [0.597-0.777], 0.634 [0.541-0.728], and 0.577 [0.483-0.671] in testing cohort; all p < 0.001). Unexpectedly, the integration of other radiomic signatures and clinical characteristics showed comparable net benefit in decision curve analysis when compared with extensors Rad-score alone. Similar findings were obtained in the validation procedure.

CONCLUSION

MRI-based radiomics could enable comprehensive assessment of muscle quality and allow exact prediction of incident knee OA, which helps uncover the precursory role of reduced extensors quality in developing knee OA. The radiomic signature from extensors would be an alternative indicator for future diagnosis and treatment in knee OA.

Prognostic impact of low muscle mass on clinical outcomes in patients who undergo lung transplant

BACKGROUND

Low muscle mass (LMM) is recognized as a poor prognostic factor in various chronic lung diseases. However, its prognostic impact on recipients of lung transplants remains inconclusive.

METHODS

We retrospectively analyzed patients who underwent lung transplantation at a tertiary referral center in South Korea. Pretransplant skeletal muscle mass was quantified at the L1 vertebral level by computed tomography scans of the chest using a commercially available body composition analysis software. Patients were classified into LMM and non-LMM group using a threshold for LMM that had been previously validated in the South Korean population. We then evaluated the prognostic impact of preoperative LMM on clinical outcomes after lung transplantation.

RESULTS

A total of 107 patients were included in this analysis, of whom 44 (41.1%) were classified into the LMM group. The median follow-up duration was 958 days posttransplantation. A preoperative LMM was identified as an independent factor associated with a greater risk of overall mortality (adjusted hazard ratio, 2.15; 95% confidence interval, 1.07-4.34). In addition, patients with LMM had a greater risk of developing primary graft dysfunction (adjusted odds ratio, 3.56; 95% confidence interval, 1.25-10.18). At the 1-year follow-up, 37.5% of the patients with baseline LMM had recovered and were reclassified into the non-LMM group, and this improvement was found to mitigate the negative impact of preoperative LMM.

CONCLUSIONS

Pretransplant LMM was significantly associated with poor clinical outcomes in recipients of lung transplants. These findings highlight the importance of maintaining adequate muscle mass during the waiting period for lung transplantation.

The Intersection of Sarcopenia and Musculoskeletal Pain: Addressing Interconnected Challenges in Aging Care

The global aging population faces a growing prevalence of sarcopenia and musculoskeletal (MSK) pain, two interrelated conditions that diminish physical function, quality of life, and independence in older adults. Sarcopenia, characterized by the loss of muscle strength, mass, and function, often coexists with MSK pain, with emerging evidence suggesting that each condition may contribute to the progression of the other. This perspective explores the bidirectional relationship between sarcopenia and MSK pain, highlighting shared mechanisms, including inactivity, cellular aging, chronic inflammation, gender-related hormonal changes, and psychosocial factors such as depression and social isolation, which underlie the mutual exacerbation between conditions. Through a multidisciplinary framework, the article emphasizes integrating care across specialties to address these interconnected conditions. Practical approaches, including comprehensive screening protocols, tailored resistance exercise, and nutritional support, are discussed alongside innovative hybrid care models combining in-person and telemedicine systems to enhance accessibility and continuity of care. A call to action is presented for clinicians, policymakers, and researchers to adopt collaborative strategies, prioritize investment in integrated healthcare, and bridge critical knowledge gaps. By reframing care delivery and advancing multidisciplinary efforts, this perspective aims to effectively address the complex challenges posed by the intersection of sarcopenia and MSK pain in older adults.

A predictive nomogram based on triglyceride glucose index to body mass index ratio for low appendicular skeletal muscle mass

The aim of this study was to investigate risk factors, develop, and assess the predictive nomogram for low appendicular skeletal muscle mass index (ASMI) in middle-aged and elderly populations. A total of 3,209 inpatients were divided into a Training Set (n = 2,407) and a Validation Set (n = 802). A nomogram was developed using R software for internal validation, and external validation was performed using the Validation Set. Gender (male), age, height, weight, triglyceride levels, alanine aminotransferase levels, alcohol consumption, and the triglyceride-glucose index to body-mass index ratio (TyG/BMI) were identified as predictors for the nomogram of low ASMI. In the Training Set, Q1-Q4 subgroups were performed for TyG/BMI, and logistic regression analysis showed that a TyG/BMI ratio greater than 0.37 was significantly associated with an increased risk of developing low ASMI (P < 0.001), with an area under the receiver operating characteristic curve (AUC) of 0.879 for the nomogram. In the Validation Set, the nomogram also demonstrated excellent calibration and discrimination, with an AUC of 0.881. Decision curve analysis (DCA) indicated excellent clinical utility of the nomogram. The study innovatively used TyG/BMI to predict low ASMI, which can reduce the impact of obesity on the diagnosis of sarcopenia. The nomogram can be effectively used to screen for possible sarcopenia in community settings. Due to the cross-sectional study design and unable to obtain complete data on the assessment of muscle strength, the predictive efficacy of our nomogram model requires further confirmation through external validation by large, multicenter prospective studies on sarcopenia population.

Effects of the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls score on postoperative clinical outcomes following colorectal cancer surgery: a retrospective study

BACKGROUND/OBJECTIVES

Sarcopenia has known negative effects on clinical and oncological outcomes in patients with colorectal cancer (CRC). The use of the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire to determine the effects of sarcopenia on postoperative complications of CRC has not been reported to date. Therefore, this study aimed to investigate the relationship of SARC-F score with clinicopathologic outcomes after CRC surgery.

SUBJECTS/METHODS

We retrospectively included 285 patients who completed SARC-F questionnaires before CRC surgery between July 2019 and March 2022. Patients with an SARC-F score ≥4 (total score: 10) were classified in the high SARC-F group.

RESULTS

Overall, 34 (11.9%) patients had high SARC-F scores. These patients were older (76.9 ± 8.5 vs. 64.5 ± 11.4 years, p < 0.001) and had a higher preoperative CRP (2.5 ± 3.9 vs. 0.8 ± 1.6 mg/L, p = 0.019), lower body mass index (21.7 ± 3.4 vs. 24.0 ± 3.8 kg/m2, p = 0.001), and higher pan-immune-inflammation value (632.3 ± 615.5 vs. 388.9 ± 413.8, p = 0.031). More postoperative complications were noted in the high SARC-F group than in the low SARC-F group (58.8% vs. 35.6%, p = 0.009). High SARC-F scores were significantly associated with higher nodal stage, higher number of harvested lymph nodes, and larger tumor size. Univariate and multivariate analyses revealed high SARC-F score and operation time as independent risk factors associated with postoperative complications (odds ratio, 2.212/1.922; 95% confidence interval, 1.021-4.792/1.163-3.175; p = 0.044/0.011, respectively).

CONCLUSIONS

Preoperative SARC-F score was an independent risk factor associated with postoperative complications following colorectal cancer surgery.

Opportunistic prognostication by computerized tomography (CT) in the emergency department: analysis on 1920 patients and creation of a simple and fast scoring system

PURPOSE

To use simple CT measurements of musculoskeletal and cardiovascular systems to create a CT-based score to predict mortality in patients admitted to the Emergency Department (ED).

METHODS

The study received IRB approval. Non-contrast abdominal CT of > 18 year old patients admitted to the ER between January 2019 and January 2020 were evaluated by a team of twelve radiologists to calculate: (1) diameter of the infrarenal aorta in millimeter; (2) cross sectional area and composition (Hounsfield units) of the psoas muscle at the third lumbar vertebra (LV); (3) bone density, as quantified at the first lumbar vertebra (LV); (4) presence or absence of dilated abdominal aorta. Thirty-day all-cause mortality (ACM) was determined through hospital and electronic records.

RESULTS

N = 1920 unique patients were evaluated. The mean age was 65 ± 19 years and 46% were female. Death occurred in 7.9% of patients by 30 days from admission. The derivation dataset comprised 1462 patients. At multivariable analysis, age (OR 1.02, 95% CI: 1.007-1.04, p = 0.005), psoas cross sectional area (OR 0.99, 95% CI: 0.997-0.999, p < 0.001) and density (OR 0.96, 95% CI: 0.95-0.98, p < 0.001), and dilated infrarenal aorta (OR 1.85, 95% CI: 1-3.28, p = 0.04) were predictors of the outcome. We accordingly derived a 4-item risk score. In the derivation dataset, the score yielded moderate-high discrimination, with an AUC of 0.73 and excellent diagnostic agreement. In the validation dataset (N = 458), discrimination was high (AUC = 0.83).

CONCLUSION

Simple measurements gathered during a standard CT may allow determining the risk of mortality in the heterogeneous patient population admitted to the ED in a cost- and time-effective manner.

Deep learning-quantified body composition from positron emission tomography/computed tomography and cardiovascular outcomes: a multicentre study

BACKGROUND AND AIMS

Positron emission tomography (PET)/computed tomography (CT) myocardial perfusion imaging (MPI) is a vital diagnostic tool, especially in patients with cardiometabolic syndrome. Low-dose CT scans are routinely performed with PET for attenuation correction and potentially contain valuable data about body tissue composition. Deep learning and image processing were combined to automatically quantify skeletal muscle (SM), bone and adipose tissue from these scans and then evaluate their associations with death or myocardial infarction (MI).

METHODS

In PET MPI from three sites, deep learning quantified SM, bone, epicardial adipose tissue (EAT), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue (IMAT). Sex-specific thresholds for abnormal values were established. Associations with death or MI were evaluated using unadjusted and multivariable models adjusted for clinical and imaging factors.

RESULTS

This study included 10 085 patients, with median age 68 (interquartile range 59-76) and 5767 (57%) male. Body tissue segmentations were completed in 102 ± 4 s. Higher VAT density was associated with an increased risk of death or MI in both unadjusted [hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.37-1.43] and adjusted (HR 1.24, 95% CI 1.19-1.28) analyses, with similar findings for IMAT, SAT, and EAT. Patients with elevated VAT density and reduced myocardial flow reserve had a significantly increased risk of death or MI (adjusted HR 2.49, 95% CI 2.23-2.77).

CONCLUSIONS

Volumetric body tissue composition can be obtained rapidly and automatically from standard cardiac PET/CT. This new information provides a detailed, quantitative assessment of sarcopenia and cardiometabolic health for physicians.

Dipalmitoylphosphatidylcholine Lipid Vesicles for Delivering HMB, NMN, and L-Leucine in Sarcopenia Therapy

Sarcopenia, characterized by the degeneration of skeletal muscle tissue, has emerged as a significant concern in recent years. This increased awareness stems from advances in research focusing on elderly patients, which have revealed correlations between aging mechanisms and muscle degeneration, beyond the mere fact that tissues age and deteriorate over time. Consequently, the present study aims to address sarcopenia by developing and evaluating DPPC lipid vesicles that encapsulate three distinct drugs: HMB, NMN, and L-Leucine. These drugs are specifically selected for their properties, which facilitate effective interaction with the affected muscle tissue, thereby promoting desired therapeutic effects. Preliminary physicochemical analyses indicate the successful formation of spherical lipid vesicles, characterized by nanometric dimensions and stable membrane integrity. The biological investigations aimed to highlight the potential of DPPC lipid vesicles encapsulating HMB, NMN, and L-Leucine to alleviate sarcopenia-induced cytotoxicity and oxidative stress. Through a comparative evaluation of the three drug formulations, we demonstrate that drug-loaded DPPC vesicles effectively mitigate oxidative damage, preserve mitochondrial function, and maintain cytoskeletal integrity in H2O2-induced C2C12 myotubes, with HMB-loaded vesicles showing the strongest protective effects against muscle degeneration. These findings underscore the therapeutic potential of DPPC-based controlled release systems for sarcopenia treatment and highlight the need for further investigations into their mechanistic role in muscle preservation.

Low creatinine to cystatin C ratio is associated with lower muscle volumes and poorer gait speeds in the longitudinal Integrated Women's Health Program cohort

OBJECTIVE

Little is known about the longitudinal associations between creatinine-cystatin C ratios (CCR) with muscle volume and function during the menopausal transition. We investigated the longitudinal relationship of baseline CCR, with muscle volumes measured by magnetic resonance imaging (MRI), and objectively measured muscle strength and physical performance after 6.6-year follow-up.

METHODS

Participants from the Integrated Women's Health Programme (IWHP) cohort (n = 891, baseline mean age 56.2 ± 6.0) who attended both baseline and follow-up visits underwent objectively measured muscle strength and physical performance assessments and MRI. Creatinine to cystatin C ratio was calculated as (creatinine [mg/dL] / cystatin C [mg/L]) and low CCR were those in the lowest tertile (CCR < 8.16). Multivariable regression analyses were used to determine the associations of baseline CCR with muscle volumes and function 6.6 years later.

RESULTS

Baseline low CCR was associated with lower MRI-measured muscle volumes and poorer physical function 6.6 years later. Compared to high CCR group, mean fat-free thigh muscle volume of the low CCR group was 0.350 L lower (95% CI, 0.183-0.518) after adjustment for covariates. Similarly, the low CCR group was associated with 0.029 m/s slower (95% CI, 0.006-0.053) slower mean usual gait and 0.049 m/s slower (95% CI, 0.020-0.078) mean narrow gait speeds. CCR was not associated with handgrip strength and repeated chair stands and one-leg stand tests.

CONCLUSION

Low CCR at baseline was associated with lower fat-free muscle volumes and poorer gait speeds 6.6 years later. The potential of CCR as a predictive biomarker for adverse events related to sarcopenia in midlife women merits further investigation.

Impact of Preoperative CT-Measured Sarcopenia on Clinical, Pathological, and Oncological Outcomes After Elective Rectal Cancer Surgery

Background: Patients with rectal cancer may be exposed to a loss of muscle strength and quality. This study aimed to assess the role of preoperative CT-based sarcopenia on postoperative clinical, pathological, and oncological outcomes after rectal cancer surgery. Methods: This retrospective monocentric study included patients who underwent elective oncologic resection for rectal adenocarcinoma between 01/2014 and 03/2022. The skeletal muscle index (SMI) was measured using CT at the third lumbar vertebral level, and sarcopenia was defined based on pre-established sex-specific cut-offs. Patients with sarcopenia were compared to those without sarcopenia in terms of outcomes. A Cox proportional hazard regression analysis was used to determine the independent prognostic factors of disease-free survival (DFS) and overall survival (OS). Results: A total of 208 patients were included, and 123 (59%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (66 vs. 61 years, p = 0.003), had lower BMI (24 vs. 28 kg/m2, p < 0.001), and were mainly men (76 vs. 48%, p < 0.001). There was no difference in overall and major complication rates between the sarcopenia and non-sarcopenia group (43 vs. 37%, p = 0.389, and 17 vs. 17%, p = 1.000, respectively). Preoperative and postoperative features related to rectal surgery were comparable. The only predictive factor impacting OS was R1/R2 resection (HR 4.915, 95% CI, 1.141-11.282, p < 0.001), while sarcopenia (HR 2.013, 95% CI 0.972-4.173, p = 0.050) and T3/T4 status (HR 2.108, 95% CI 1.058-4.203, p = 0.034) were independently associated with DFS. Conclusions: A majority of patients undergoing rectal cancer surgery had preoperative CT-based sarcopenia. In this cohort, sarcopenia had no impact on postoperative morbidity and OS but was independently associated with DFS.

Ultrasound Beyond Joints: A Review of Extra-Articular Applications in Rheumatology

PURPOSE OF REVIEW

This review highlights key ultrasound applications for evaluating extra-articular involvement in rheumatic diseases, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. It explores recent advances, emerging areas of assessment, and future research directions. Additionally, the review examines current limitations in the routine use of ultrasound for these purposes and considers the potential of new technologies, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, to enhance the early detection and monitoring of extra-articular manifestations in rheumatic diseases.

RECENT FINDINGS

Extra-articular manifestations in patients with rheumatic diseases are crucial for diagnosis, management (including treatment strategies), and prognosis, making accurate assessment essential. Growing evidence supports the role of ultrasound in assessing these manifestations for diagnosis, monitoring, and gaining insights into disease pathogenesis. Recent studies emphasize the significant utility of ultrasound in evaluating extra-articular involvement across various organ systems, including the lungs, vessels, salivary glands, muscles, nerves, skin, and nails. Technological advances, such as shear-wave elastography, contrast-enhanced ultrasound, and artificial intelligence, are expanding the scope and precision of ultrasound applications. Despite its potential, challenges such as operator dependency, lack of standardized protocols, and the need for specialized training hinder its widespread adoption. Ultrasound is a non-invasive, cost-effective, and radiation-free imaging modality with high diagnostic accuracy, making it a valuable tool for assessing extra-articular manifestations in rheumatic diseases. Emerging technologies may further enhance its clinical utility. However, efforts to standardize techniques and improve accessibility are necessary to optimize its integration into routine practice.

Prevalence and Risk of Sarcopenia in Patients with Chronic Pancreatitis: Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Sarcopenia is a condition marked by a continuous decline in skeletal muscle strength and volume, often leading to significant health complications. According to several articles, sarcopenia is highly prevalent in chronic pancreatitis (CP) due to exocrine pancreatic insufficiency. The aim of this meta-analysis was to determine the pooled prevalence and risk of sarcopenia among CP patients.

METHODS

The search process adhered to the PRISMA 2020 guidelines and was registered in PROSPERO under the identification number CRD42025637059. The search was conducted in the following databases: MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, and the Russian Science Citation Index (RSCI). It covered studies published between 1 January 1985 and 20 December 2024. Only studies published in English or Russian with detailed comprehensive statistics and adult CP were included. Studies with specific patient populations affecting data objectivity were excluded. Sensitivity analyses were conducted (first, only studies with more than 50 CP patients were considered. Second, the analysis was restricted to full articles, excluding abstracts from conferences).

RESULTS

In total, 16 studies with 1556 participants (1398 CP patients and 158 controls) met the criteria. The pooled prevalence of sarcopenia was 39.117% (95% CI: 28.891-49.852) in CP patients and 7.745% (95% CI: 2.154-42.622) in the control group. An association was found between sarcopenia and CP using the fixed-effects model when compared to the control group (RR = 2.194, 95% CI: 1.502-3.203).

CONCLUSIONS

Sarcopenia is underdiagnosed in CP patients despite its significant clinical impact. Management strategies, including pancreatic enzyme replacement therapy, nutritional support, and resistance training show potential in the treatment of this state. Further research is needed to establish standardized diagnostic criteria and unified treatment approaches. Early detection and comprehensive care are essential to improving outcomes in CP patients with sarcopenia.

An Analysis of the Efficacy of Deep Learning-Based Pectoralis Muscle Segmentation in Chest CT for Sarcopenia Diagnosis

Sarcopenia is the loss of skeletal muscle function and mass and is a poor prognostic factor. This condition is typically diagnosed by measuring skeletal muscle mass at the L3 level. Chest computed tomography (CT) scans do not include the L3 level. We aimed to determine if these scans can be used to diagnose sarcopenia and thus guide patient management and treatment decisions. This study compared the ResNet-UNet, Recurrent Residual UNet, and UNet3 + models for segmenting and measuring the pectoralis muscle area in chest CT images. A total of 4932 chest CT images were collected from 1644 patients, and additional abdominal CT data were collected from 294 patients. The performance of the models was evaluated using the dice similarity coefficient (DSC), accuracy, sensitivity, and specificity. Furthermore, the correlation between the segmented pectoralis and L3 muscle areas was compared using linear regression analysis. All three models demonstrated a high segmentation performance, with the UNet3 + model achieving the best performance (DSC 0.95 ± 0.03). Pearson correlation coefficient between the pectoralis and L3 muscle areas showed a significant positive correlation (r = 0.65). The correlation coefficient between the transformed pectoralis and L3 muscle areas showed a stronger positive correlation in both univariate analysis using only muscle area (r = 0.74) and multivariate analysis considering sex, weight, age, and muscle area (r = 0.83). Segmentation of the pectoralis muscle area using artificial intelligence (AI) on chest CT was highly accurate, and the measured values showed a strong correlation with the L3 muscle area. Chest CT using AI technology could play a significant role in the diagnosis of sarcopenia.

Computed Tomography-Based Sarcopenia and Pancreatic Cancer Survival-A Comprehensive Meta-Analysis Exploring the Influence of Definition Criteria, Prevalence, and Treatment Intention

Background: Sarcopenia has been associated with poor outcomes in pancreatic cancer (PC). However, published results are heterogeneous in terms of study design, oncological outcomes, and sarcopenia measurements. This meta-analysis aims to evaluate the impact of computed tomography (CT)-based sarcopenia on overall survival (OS) and progression-free survival (PFS) in patients with PC, considering potential confounders such as the CT-based method and thresholds used to define sarcopenia, as well as treatment intention. Methods: We systematically searched databases for observational studies reporting hazard ratios (HRs) for OS and PFS in PC patients stratified by CT-based sarcopenia status. Random-effects models were used to calculate pooled crude and adjusted HRs (cHRs and aHRs, respectively), with subgroup analyses based on sarcopenia measurement methods, cutoff values, sarcopenia prevalence, and treatment intention. Heterogeneity was assessed using the I2 and τ2 statistics, and publication bias was evaluated using funnel plots and Egger's test. Results: Data from 48 studies were included. Sarcopenia was significantly associated with worse OS (pooled cHR = 1.58, 95% CI: 1.38-1.82; pooled aHR = 1.39, 95% CI: 1.16-1.66) and worse PFS (pooled cHR = 1.55, 95% CI: 1.29-1.86; pooled aHR = 1.31, 95% CI: 1.11-1.55). Subgroup analyses revealed significantly different, stronger associations in studies using stricter sarcopenia cutoffs (<50 cm2/m2 for males) and in patients undergoing curative treatments. Heterogeneity was substantial across analyses (I2 > 67%), but with generally low τ2 values (0.01-0.25). Egger's test indicated potential publication bias for OS (p < 0.001), but no significant bias was observed for PFS (p = 0.576). Conclusions: Sarcopenia determined by CT is an independent predictor of poor OS and PFS in PC, but this association varies depending on the cutoff used for its definition as well as on the treatment intention. Therefore, its routine assessment in clinical practice could provide valuable prognostic information, but future research should focus on standardizing sarcopenia assessment methods.

Cognitive Risk Stratification Score in Middle-aged and Older Adults with Type 2 Diabetes: a Cross-Sectional Study

CONTEXT

Cognitive impairment (CI) affects approximately 45% of middle-aged and older adults with Type 2 Diabetes Mellitus (T2DM) globally. Although formal comprehensive neuropsychological tests are the gold standard for diagnosing CI, they are often time-intensive and may not be feasible in primary care.

OBJECTIVE

This study aimed to develop and validate a novel Risk Stratification Score (RSS) to rapidly and comprehensively predict CI risk among middle-aged and older adults with T2DM, offering a streamlined alternative in clinical practice.

METHODS

A cross-sectional study was conducted from July 2023 to February 2024 in a primary care polyclinic in Singapore's western region. Participants aged between 40 and 85 diagnosed with T2DM (n=150) were included in a convenience sampling. The primary outcome was CI status and assessed using formal neuropsychological tests, which including Montreal Cognitive Assessment (MoCA).

RESULTS

CI was identified in 49.3% of participants (n=74). The RSS, incorporating the MoCA, Diastolic Blood Pressure (DBP), and Short Physical Performance Battery (SPPB), demonstrated excellent discrimination, achieving an area under the ROC curve of 0.802 (p < 0.001). With an optimal cutoff of 0.3, the model showed a sensitivity of 63.5% and specificity of 86.8%, effectively differentiating high- and low-risk CI groups.

CONCLUSION

RSS in clinical practice, exemplified by the Integrated Metabolic Cognitive Risk Stratification Pathway (imCRSP), is a promising tool for rapid CI risk assessment in primary care. Its robust predictive accuracy and ease of use support its application for early intervention in middle-aged and older adults with T2DM. Future studies should validate its use longitudinally and across diverse populations to enhance generalizability.

Relationship between 10 repetition maximum for chest press, leg press, and muscle mass measured using bioelectrical impedance analysis in healthy young adults

[Purpose] This study aimed to examine the relationship between bioelectrical impedance analysis measurements and 10 repetition maximum for chest press and leg press, and to develop a regression model to determine if bioelectrical impedance analysis can predict 10 repetition maximum in healthy young adults. [Participants and Methods] Ninety-four healthy adults participated in the study. Correlations between 10 repetition maximum and bioelectrical impedance analysis measurements were calculated, and simple linear regression was performed using bioelectrical impedance analysis measurements as independent variables to develop 10 repetition maximum prediction models. [Results] Significant correlations were found between 10 repetition maximum and bioelectrical impedance analysis measurements. The regression models for 10 repetition maximum for chest press based on upper limb muscle mass, skeletal muscle mass, and skeletal muscle mass index were Y=16.40X-13.27, Y=3.81X-36.78, and Y=20.51X-81.27, respectively. The regression models for 10 repetition maximum for leg press based on lower limb muscle mass, skeletal muscle mass, and skeletal muscle mass index were Y=12.60X-3.21, Y=8.09X-24.39, and Y=43.68X-119.60, respectively. [Conclusion] These findings may contribute to developing a safe and efficient method for measuring 10 repetition maximum, which can be useful in resistance training prescriptions.

Sarcopenia in trauma patients: A systematic review and meta-analysis

Sarcopenia is associated with poor prognosis and mortality following injury. This systematic review and meta-analysis aimed to analyze diagnostic criteria for sarcopenia, as well as to assess its prevalence and impact on health outcomes among trauma patients. We conducted a literature search on MEDLINE, EMBASE, and the Cochrane Library from inception to June 2023. A total of 27 studies were included, involving 8692 individuals (55.5 % men) with a mean age ranging from 42.2 to 80.5 years. The pooled prevalence of sarcopenia in trauma patients was 36.0 % [95 % confidence interval (CI): 29.1-43.0 %, I2 = 97.8 %], with a 39.3 % prevalence (95 % CI: 31.0-48.5 %, I2 = 96.8 %) in men and a 39.0 % prevalence (95 % CI: 31.4-46.2 %, I2 = 94.4 %) in women. Trauma patients with sarcopenia were more prone to complications [risk ratio (RR): 1.16, 95 % CI: 1.03-1.31, I2 = 45.8 %] and less able to discharge independently (RR: 0.74, 95 % CI: 0.63-0.86, I2 = 33.3 %). The risk of death in trauma patients with sarcopenia was higher than in non-sarcopenic patients [hazard ratio (HR): 1.64, 95 % CI: 1.31-2.04]. Sarcopenia is commonly present in trauma patients and has a negative impact on prognosis. Early assessment and interventions for sarcopenia should be conducted in trauma patients.

Body Composition in Primary Hyperparathyroidism: A Potential Contributor to Weakness and Fatigue

BACKGROUND

Primary hyperparathyroidism (PHPT) patients commonly report weakness and fatigue, though the underlying mechanisms are uncertain. Our purpose is to determine whether CT-derived muscle and adipose tissue metrics are associated with weakness and fatigue in PHPT patients.

METHODS

For this retrospective study, cross-sectional muscle and adipose tissue metrics were derived from CTs in PHPT patients undergoing preoperative imaging within 1 year of parathyroid surgery. Skeletal muscle index (SMI) and visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio were calculated based on a single CT image at the level of the L3 vertebra. Established sex-specific SMI thresholds were used to define sarcopenia. Demographic and clinical data were collected from the electronic health record. When available, postoperative CT images were analyzed to assess for changes in body composition pre- and post-parathyroidectomy.

RESULTS

The cohort comprised 53 PHPT patients (38 females, 15 males, mean age 61.4 years), of whom 24 (45%) reported weakness, 43 (81%) reported fatigue, and 31 (58%) met CT-based criteria for sarcopenia. Lower SMI was significantly associated with preoperative weakness in females but not males. For both weakness and fatigue, VAT/SAT ratios were higher in symptomatic females and lower in symptomatic males than their asymptomatic counterparts, though these differences were not statistically significant. In patients with postoperative CTs (n = 23), no significant changes in CT metrics were observed after parathyroidectomy.

DISCUSSION

In females but not males with PHPT, subjective preoperative weakness was significantly associated with lower SMI. Effects of parathyroid hormone on skeletal muscle and visceral adiposity may differ by sex.

Innovative equipment for lower limb muscle strength measurement: Design and application in sarcopenia screening

BACKGROUND

Grip Strength has been established as a practical and efficient method for screening and diagnosing sarcopenia. It is recognized that with advancing age, there is a more significant decline in lower limb muscle mass compared to the upper limb. However, due to the inherent complexity of assessing lower limb muscle strength compared to measuring Grip Strength, these assessments have not been universally adopted for sarcopenia screening.

METHODS

We measured the Forefoot Strength, Heel Strength, Knee Extension Strength, and Hip Extension Strength in 98 participants using portable equipment designed for lower limb muscle strength assessment. We compared the efficacy of using lower limb muscle strength cutoff values with grip strength for the screening of sarcopenia.

FINDINGS

The optimal cutoff values for screening sarcopenia in males using Knee Extension Strength and Hip Extension Strength were 140.1 N and 121.7 N, respectively, while for females they were 91.6 N and 90.4 N, respectively. In binary logistic regression models adjusted for age and body weight, Knee Extension Strength and Hip Extension Strength were found to be associated with sarcopenia in both males and females. Moreover, the efficacy of sarcopenia screening using Knee Extension Strength or Hip Extension Strength cutoff values was superior to that of grip strength alone, and the combination of Knee Extension Strength and Hip Extension Strength cutoff values yielded the best results for sarcopenia screening.

INTERPRETATION

Measurements of Knee Extension Strength and Hip Extension Strength may potentially serve as a promising method for sarcopenia screening.

Low Muscle Mass in the Internal Medicine Ward: Prevalence and Survival Implications

BACKGROUND

Low muscle mass is common in hospitalized patients. It is associated with adverse clinical outcomes. Reported prevalence varies widely due to non-universally accepted diagnostic criteria and the heterogeneity of the populations studied. Non-surgical ill patients are underrepresented in the literature.

AIMS

To estimate the prevalence of low muscle index and its impact on survival in patients admitted to an internal medicine unit.

METHODS

We prospectively enrolled patients with abdominal CT scans on admission to the Internal Medicine ward. We assessed muscle mass index (L3MI) at the level of the L3 lumbar vertebra. The primary outcome was to estimate the prevalence of low muscle mass on admission. Secondary outcomes were to determine the relationship of low L3MI with hospital mortality, length of stay, nosocomial infections, and hospital readmission.

RESULTS

One hundred and seven patients were included. The prevalence of low L3MI was 46.7%. An L3MI of 46.3 cm2/m2 in men and 40.9 cm2/m2 in women predicted death at one year with a sensitivity of 66% and a specificity of 78% (AUC = 0.62 [95% CI 0.38-0.86]) and 69 and 66% (AUC of 0.63 [95% IC 0.47-0.78]), respectively. In-hospital mortality, death at 60, 90, and 360 d, and hospital readmission were significantly higher in patients with low L3MI.

CONCLUSION

Almost half of the patients admitted to an internal medicine ward have low muscle mass index. The cutoff point of 40.9 cm2/m2 in females and 46.3 cm2/m2 in males predicts relevant clinical variables. We established the better L3MI cutoff value to predict 12-month mortality.

The impact of preoperative skeletal muscle loss on the completion of S-1 adjuvant chemotherapy for gastric cancer

PURPOSE

Body weight loss after surgery for gastric cancer is related to S-1 compliance and it also affects the prognosis. However, it is unclear whether the preoperative skeletal muscle mass affects S-1 completion for gastric cancer. We investigated the impact of preoperative skeletal muscle mass loss on the completion of S-1 adjuvant chemotherapy for gastric cancer.

METHODS

We retrospectively analyzed data from 53 patients who underwent curative gastrectomy followed by adjuvant S-1 monotherapy for pStage II-III gastric cancer between 2012 and 2021 at our hospital. The psoas muscle mass index (PMI) was used as the index for preoperative skeletal muscle mass.

RESULTS

Thirty-six patients completed S-1 treatment and 17 discontinued treatment. The patients who completed S-1 treatment had a longer overall survival than those who discontinued treatment (log-rank test, p = 0.043). According to a univariate analysis, the patients in the discontinuation group had a significantly lower preoperative body mass index (< 22.9 kg/m2, p = 0.005) and a higher rate of adverse events (grade 2 or higher, p < 0.001) than those in the completion group. According to a multivariate analysis, preoperative PMI (HR 3.563, p = 0.030) was an independent predictive factor for S-1 completion.

CONCLUSION

Preoperative skeletal muscle loss might therefore prevent the completion of adjuvant chemotherapy S-1 in patients with gastric cancer.

Dental Functional Status as a Possible Risk Factor of Sarcopenia: A Computed Tomography-Based Study

BACKGROUND

Functional dentition may be associated with sarcopenia by affecting chewing activity.

OBJECTIVES

The objective of this study is to determine the sarcopenia status of participants using computed tomography (CT)-based data and to investigate the association of sarcopenia with functional dentition, as well as denture condition.

METHODS

The study included 309 patients. The number of teeth was recorded. Functional dentition was evaluated based on the following parameters: (1) ≥ 1 tooth in the maxilla and mandible; (2) ≥ 10 teeth in each arch; (3) the presence of 12 anterior teeth; (4) 3-4 premolar posterior occlusal pairs (POPs) and (5) ≥ 1 molar POP bilaterally. The denture condition was also evaluated. CT-based assessment of sarcopenia was performed via measurement of the psoas muscle area at the level of the L3 vertebra and its hounsfield unit (HU) radiodensity on non-contrast-enhanced images. HU average calculation (HUAC), which is an imaging marker of sarcopenia, was performed. Gender-specific quartiles were then generated, and the lowest quartile of HUAC scores within each gender group was set as the cut-off point.

RESULTS

A total of 76 (24.5%) of the patients had sarcopenia, and 233 (75.5%) did not have sarcopenia. The mean number of teeth in the sarcopenia group was 17.12 ± 8.39, compared to 22.24 ± 6.72 in those without sarcopenia (p < 0.001). The relationship between functional dentition and sarcopenia was also significant. There was a positive relationship between ill-fitting dentures and sarcopenia (p < 0.001).

CONCLUSIONS

This unique perspective of the study contributes to the existing knowledge regarding the role of tooth loss in sarcopenia, highlighting the importance of functional occlusion.

CT-based sarcopenia assessment: Predicting outcomes in acute infection patients

In this retrospective cohort study, we investigated the prognostic value of sarcopenia evaluated by Computed Tomography (CT)-based indices for adverse hospitalization outcomes in patients with acute infections. We analyzed data from 225 patients admitted to the hospital for acute infections between 2019 and 2020. Patients who had undergone an abdominal CT scan either up to 1 month before or within the first 3 days of hospitalization were included. CT image analysis was used to evaluate skeletal muscle mass (by skeletal muscle index (SMI)) and muscle quality (by psoas muscle density, pMD). Low pMD was associated with higher in-hospital mortality (31% vs 11.4% p < 0.001) as well as higher longer-term mortality rates (p = 0.008 for 30 days and <0.001 for 90- and 1-year mortality). Low pMD remained an independent poor prognostic factor after controlling for confounders, with an adjusted odds ratio (aOR) of 2.74, (95% CI 1.33-5.67, p = 0.006) for 1-year mortality, and aOR of 2.61, (95% CI 1.23-5.55) for a prolonged hospital stay. Low SMI was associated with adverse outcomes, although this association was not independent after controlling for confounders. Notably, patients with both low SMI and pMD exhibited the poorest hospitalization outcomes: aOR for 1-year mortality 5.015 (95% CI 1.767-14.23, p = 0.002), and prolonged length of stay aOR 3.197, (95% CI 1.159-8.821, p = 0.025). CT-based muscle indices serve as independent prognostic factors in medical patients admitted with acute infection. Incorporating radiological assessments of sarcopenia into routine care for hospitalized patients with acute infection may enable risk stratification and early intervention in reversible conditions.

Understanding the Complexity of Hypertension with Sarcopenia by Scientometric Analysis

Objective

The scientometric analysis was aim to focus on recent studies and clarify new research directions on hypertension with sarcopenia. We hope to provide comprehensive insights or actionable recommendations for clinicians or policymakers.

Methods

The Web of Science Core Collection database (WoSCC) from 2004 to 2023 for analysis was used. And VOSviewer, CiteSpace, and Origin software were utilized for scientometric analyses.

Results

The United States was the primary contributor to 1,994 studies on hypertension with sarcopenia. The University of São Paulo emerged as the most prolific institution, with Morrell Nicholas W. being the most influential scholar and Cruz-Jentoft A.J. being the most co-cited author. PLoS One was the most prolific journal, whereas Circulation was the most relevant journal. Research has focused not only on physiological, biochemical, and cell biological mechanisms but also on sarcopenia associated with other diseases and involved in various fields, highlighting the complexity of the area and the need for integrative treatment. Keyword analysis revealed that, in addition to hypertension and sarcopenia, other topics such as obesity, pulmonary hypertension, old age, metabolic syndrome, inflammation, hypoxia, exercise, insulin resistance, and revascularization attracted attention. In recent years, COVID-19, mitochondria, handgrip strength, etc. have been hot topics, but aging, skeletal muscle, weight loss, diabetes, obesity, metabolic syndrome, insulin resistance, heart failure, mitochondria, mortality, exercise, and physical activity seems to bridge hypertension and sarcopenia research.

Conclusion

This study highlights the distribution of fields, the structure of knowledge and the evolution of major research topics related to hypertension in patients with sarcopenia. Identifying keyword hotspots enhanced the comprehension of occurrence, development, and future research trends related to the topic.

Sarcopenia as a Predictor of Mortality in a Cohort of Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

BACKGROUND AND AIMS

Despite technical advances, endoscopic retrograde cholangiopancreatography (ERCP) is associated with complications and potentially lethal outcomes. Sarcopenia, a complex syndrome mainly associated with aging, has been recognized as a predictor of poor surgical outcomes. Thus far, the impact of sarcopenia on ERCP remains unknown. The present study evaluates the role of sarcopenia as a predictor of ERCP-related outcomes in a cohort of elderly patients.

METHODS

Patients who underwent ERCP between June 2019 and January 2023 were retrospectively included. Demographic and procedure-associated data were collected. Sarcopenia was assessed using the skeletal muscle index (SMI) measured from a single axial slice through the L3 vertebra on a CT scan. ERCP-related outcomes were recorded. Univariate and multivariate analyses were used to assess the correlation between sarcopenia and procedural outcomes.

RESULTS

In total, 256 patients were enrolled, of whom 30 (11.7%) were sarcopenic. Cardiopulmonary complications of ERCP occurred in 3.5%. Sarcopenia was associated with higher 30-day and 12-month post-ERCP mortality (OR 3.45, p = 0.03; OR 3.87, p = 0.004) and longer hospitalization time (7 vs. 11 days, p = 0.003).

CONCLUSIONS

SMI is an easy and objective index of sarcopenia that could be used to predict ERCP outcomes. Indeed, sarcopenia was independently associated with prolonged hospitalization and increased mortality in a retrospective cohort of elderly patients.

Frailty and Sarcopenia Assessment in Patients with Advanced Chronic Liver Disease in a Tertiary Center in Romania

Background/Objectives: Sarcopenia and frailty are both multidimensional and interrelated problems for patients with cirrhosis and require prompt assessment and appropriate management because of their impact on disease outcomes. Our purpose is to identify the prevalence of sarcopenia and frailty in patients with advanced liver disease. Furtherksdnvk more, our purpose is to explore the association between sarcopenia, frailty, and various complications and the impact of these conditions on short- and long-term hospital survival rates. Methods: A prospective, observational, unicentric study was conducted in an emergency university hospital in Romania between January 2021 and December 2023 that included patients with advanced liver diseases. The patients with sarcopenia and frailty were selected using measurements of handgrip strength (HGS), Short Physical Performance Battery (SPPB), liver frailty index (LFI), and skeletal muscle index (SMI). Patients were divided into four groups based on the presence of sarcopenia and/or frailty. Results: This study included 128 patients. Younger patients associated with both sarcopenia and frailty (55.76 ± 10.46 years). Most males were without sarcopenia and frailty (63.93%) compared to those with both sarcopenia and frailty (36.07%). The Child-Pugh score C was identified in the majority of those with both sarcopenia and frailty (69.70%). Higher values for MELD-Na scores were obtained in the group with sarcopenia and frailty (25.45 ± 6.924). Biomarkers like albumin, sodium, C-reactive protein, bilirubin, and platelets were statistically significant as mortality predictors in all four groups. Patients with both sarcopenia and frailty presented more often with encephalopathy and spontaneous bacterial peritonitis. Survival rates in the short and long term were lower for the patients who associated both sarcopenia and frailty compared to those without sarcopenia and frailty. Conclusions: The presence of sarcopenia and frailty significantly impacts outcomes in patients with decompensated advanced liver disease. When both conditions coexist in the same patient, they markedly increase in-hospital mortality, as well as short- and long-term survival rates.

Rectus Femoris Muscle Segmentation on Ultrasound Images of Older Adults Using Automatic Segment Anything Model, nnU-Net and U-Net-A Prospective Study of Hong Kong Community Cohort

Sarcopenia is characterized by a degeneration of muscle mass and strength that incurs impaired mobility, posing grievous impacts on the quality of life and well-being of older adults worldwide. In 2018, a new international consensus was formulated to incorporate ultrasound imaging of the rectus femoris (RF) muscle for early sarcopenia assessment. Nonetheless, current clinical RF muscle identification and delineation procedures are manual, subjective, inaccurate, and challenging. Thus, developing an effective AI-empowered RF segmentation model to streamline downstream sarcopenia assessment is highly desirable. Yet, this area of research readily goes unnoticed compared to other disciplines, and relevant research is desperately wanted, especially in comparison among traditional, classic, and cutting-edge segmentation networks. This study evaluated an emerging Automatic Segment Anything Model (AutoSAM) compared to the U-Net and nnU-Net models for RF segmentation on ultrasound images. We prospectively analyzed ultrasound images of 257 older adults (aged > 65) in a community setting from Hong Kong's District Elderly Community Centers. Three models were developed on a training set (n = 219) and independently evaluated on a testing set (n = 38) in aspects of DICE, Intersection-over-Union, Hausdorff Distance (HD), accuracy, precision, recall, as well as stability. The results indicated that the AutoSAM achieved the best segmentation agreement in all the evaluating metrics, consistently outperforming the U-Net and nnU-Net models. The results offered an effective state-of-the-art RF muscle segmentation tool for sarcopenia assessment in the future.

Effect of Preoperative Body Composition on Postoperative Anastomotic Leakage in Oncological Ivor Lewis Esophagectomy-A Retrospective Cohort Study

BACKGROUND

Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery.

METHODS

In this cohort study, we analyzed patients' body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo-Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients.

RESULTS

From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = -0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%).

CONCLUSIONS

Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans.

Wearable Fabric System for Sarcopenia Detection

Sarcopenia has been a serious concern in the context of an increasingly aging global population. Existing detection methods for sarcopenia are severely constrained by cumbersome devices, the necessity for specialized personnel, and controlled experimental environments. In this study, we developed an innovative wearable fabric system based on conductive fabric and flexible sensor array. This fabric system demonstrates remarkable pressure-sensing capabilities, with a high sensitivity of 18.8 kPa-1 and extraordinary stability. It also exhibits excellent flexibility for wearable applications. By interacting with different parts of the human body, it facilitates the monitoring of various physiological activities, such as pulse dynamics, finger movements, speaking, and ambulation. Moreover, this fabric system can be seamlessly integrated into sole to track critical indicators of sarcopenia patients, such as walking speed and gait. Clinical evaluations have shown that this fabric system can effectively detect variations in indicators relevant to sarcopenia patients, proving that it offers a straightforward and promising approach for the diagnosis and assessment of sarcopenia.

Sarcopenia-associated factors and their bone mineral density levels in middle-aged and elderly male type 2 diabetes patients

BACKGROUND

Chronic hyperglycemia can damage the microcirculation, which impairs the function of various organs and tissues and predisposes individuals to chronic complications. Sarcopenia (SP) is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes. In particular, diabetic patients are at higher risk of SP because of insulin resistance, chronic inflammation, and decreased physical activity.

AIM

To identify SP-associated factors in middle-aged and elderly male type 2 diabetes mellitus (T2DM) patients and their correlation with bone mineral density (BMD).

METHODS

A retrospective analysis was conducted on 196 middle-aged and elderly male T2DM inpatients in the First Affiliated Hospital of Chongqing Medical University between June 2021 and June 2023, with 60 concurrent healthy individuals as the control group. Differences in general information, blood biochemistry, glycosylated hemoglobin, muscle strength, and detection rate of SP were compared between groups. The BMD, appendicular skeletal muscle (ASM), and fat mass, as well as grip strength and gait speed, were determined for each patient, and the ASM index (ASMI) was counted. The quantitative data were subjected to correlation and logistic regression analyses to identify risk factors for SP.

RESULTS

Fifty-one of the 196 middle-aged and elderly male T2DM patients were diagnosed with SP, which accounted for 26.02%. The middle-aged and elderly T2DM patients with SP exhibited a longer diabetes mellitus (DM) course and a lower body mass index (BMI) and 25(OH)D3 compared with the non-SP patients. The T2DM + SP patients exhibited lower BMI, ASM, ASMI, left- and right-hand grip strength, gait speed, and muscle and fat mass of the upper and lower limbs compared with the diabetic non-SP patients. The femoral neck, total hip, and lumbar spine L1-4 BMD were markedly lower in T2DM + SP patients compared with those in the non-SP diabetics. Long-term DM course, low BMI, and low BMD of the femoral neck, lumbar spine L1-4, and total hip were identified as risk factors for the development of SP.

CONCLUSION

T2DM patients are at risk for SP; however, measures can be taken to prevent the related risk factors.

Radiomic-based biomarkers: Transforming age and body composition metrics into personalized age-informed indices

Chronological age has been the standard for quantifying the aging process. While it is simple to quantify it cannot fully discern the biological variability of aging between individuals. The growing body of interest in this variability of human aging has led to the introduction of new biomarkers to operationalize biological age. The inclusion of body composition may provide additional value to biological aging as a prediction and estimation factor of individual health outcomes. Diagnostic images based on radiomic techniques such as Computed Tomography contain an untapped wealth of patient-specific data that remain inaccessible to healthcare providers. These images are beneficial for collecting information from body composition that adds precision and granularity when compared to traditional measures. This information can subsequently be aggregated to construct models for changes in the human body associated with aging. In addition, aging leads to a natural decline in the best parameter of drug dosing in older adults, glomerular filtration rate. Since the conventional models of kidney function are correlated with age and body composition, the radiomic biomarkers representing age-related changes in body composition may also serve as potential new imaging biomarkers of kidney function for personalized dosing. Our review introduces potential radiomic biomarkers as measures of body composition change targeting the aging processes. As a functional example, we have hypothesized an age-related model of radiomics as a covariate of kidney function to improve personalized dosing. Future research focusing on evaluating this hypothesis in human subject studies is acknowledged.

[Sonography of muscles : Rheumatology-Neurology-Geriatrics-Sports medicine-Orthopedics]

Muscle sonography is used in rheumatology, neurology, geriatrics, sports medicine and orthopedics. Muscular atrophy with fatty and connective tissue degeneration can be visualized and must be interpreted in conjunction with the sonographic findings of the supplying nerves. Sonography is becoming increasingly more important for the early diagnosis of sarcopenia in rheumatology, geriatrics and osteology. Even if its significance has not yet been conclusively clarified, many publications confirm the high reliability of the method. Sonography can ideally be used in addition to magnetic resonance imaging (MRI) in the diagnostics of myositis as it can speed up the diagnosis, muscle groups that were not imaged by MRI can also be assessed sonographically and all muscle groups can be examined during the course of the procedure. Sonography also helps to make a quick and uncomplicated diagnosis of many sports injuries in addition to MRI and is therefore the basis for a targeted therapeutic approach.