Fall and Fracture Risk in Sarcopenia and Dynapenia With and Without Obesity: the Role of Lifestyle Interventions

Association between sarcopenic obesity and knee osteoarthritis: A narrative review

Sarcopenia and obesity have been studied independently as risk factors for knee osteoarthritis. However, there is now research interest in investigating whether the co-existence of sarcopenia and obesity (sarcopenic obesity) within the same individual significantly increases the risk of knee osteoarthritis, compared to sarcopenia or obesity alone. This review synthesises current literature to explore the association between sarcopenic obesity and knee osteoarthritis, emphasising both the clinical evidence and existing gaps. We highlight the challenges and progress in defining sarcopenic obesity and discuss the impact that the lack of a consensus definition of sarcopenic obesity has on comparing outcomes of studies investigating the relationship between sarcopenic obesity and knee OA. We offer methodological insights to guide future studies investigating whether sarcopenic obesity increases the risk of knee osteoarthritis above and beyond the risk associated with each condition on its own. The implications for clinical practice are discussed, including the need to incorporate effective resistance exercise into weight loss programs for individuals with sarcopenic obesity. This is critical as a general weight loss program alone among individuals with sarcopenic obesity can include substantial loss of muscle mass, potentially predisposing patients to further functional decline.

Links among Obesity, Type 2 Diabetes Mellitus, and Osteoporosis: Bone as a Target

Obesity, type 2 diabetes mellitus (T2DM) and osteoporosis are serious diseases with an ever-increasing incidence that quite often coexist, especially in the elderly. Individuals with obesity and T2DM have impaired bone quality and an elevated risk of fragility fractures, despite higher and/or unchanged bone mineral density (BMD). The effect of obesity on fracture risk is site-specific, with reduced risk for several fractures (e.g., hip, pelvis, and wrist) and increased risk for others (e.g., humerus, ankle, upper leg, elbow, vertebrae, and rib). Patients with T2DM have a greater risk of hip, upper leg, foot, humerus, and total fractures. A chronic pro-inflammatory state, increased risk of falls, secondary complications, and pharmacotherapy can contribute to the pathophysiology of aforementioned fractures. Bisphosphonates and denosumab significantly reduced the risk of vertebral fractures in patients with both obesity and T2DM. Teriparatide significantly lowered non-vertebral fracture risk in T2DM subjects. It is important to recognize elevated fracture risk and osteoporosis in obese and T2DM patients, as they are currently considered low risk and tend to be underdiagnosed and undertreated. The implementation of better diagnostic tools, including trabecular bone score, lumbar spine BMD/body mass index (BMI) ratio, and microRNAs to predict bone fragility, could improve fracture prevention in this patient group.

Immediate fall prevention: the missing key to a comprehensive solution for falling hazard in older adults

The world is witnessing an unprecedented demographic shift due to increased life expectancy and declining birth rates. By 2050, 20% of the global population will be over 60, presenting significant challenges like a shortage of caregivers, maintaining health and independence, and funding extended retirement. The technology that caters to the needs of older adults and their caregivers is the most promising candidate to tackle these issues. Although multiple companies and startups offer various aging solutions, preventive technology, which could prevent trauma, is not a big part of it. Trauma is the leading cause of morbidity, disability, and mortality in older adults, and statistics constitute traumatic fall accidents as its leading cause. Therefore, an immediate preventive technology that anticipates an accident on time and prevents it must be the first response to this hazard category to decrease the gap between life expectancy and the health/wellness expectancy of older adults. The article outlines the challenges of the upcoming aging crisis and introduces falls as one major challenge. After that, falls and their mechanisms are investigated, highlighting the cognitive functions and their relation to falls. Moreover, since understanding predictive cognitive mechanisms is critical to an effective prediction-interception design, they are discussed in more detail, signifying the role of cognitive decline in balance maintenance. Furthermore, the landscape of available solutions for falling and its shortcomings is inspected. Finally, immediate fall prevention, the missing part of a wholesome solution, and its barriers are introduced, and some promising methodologies are proposed.

Obesity, diabetes and risk of bone fragility: How BMAT behavior is affected by metabolic disturbances and its influence on bone health

PURPOSE

Osteoporosis is a metabolic bone disease characterized by decreased bone strength and mass, which predisposes patients to fractures and is associated with high morbidity and mortality. Like osteoporosis, obesity and diabetes are systemic metabolic diseases associated with modifiable risk factors and lifestyle, and their prevalence is increasing. They are related to decreased quality of life, functional loss and increased mortality, generating high costs for health systems and representing a worldwide public health problem. Growing evidence reinforces the role of bone marrow adipose tissue (BMAT) as an influential factor in the bone microenvironment and systemic metabolism. Given the impact of obesity and diabetes on metabolism and their possible effect on the bone microenvironment, changes in BMAT behavior may explain the risk of developing osteoporosis in the presence of these comorbidities.

METHODS

This study reviewed the scientific literature on the behavior of BMAT in pathological metabolic conditions, such as obesity and diabetes, and its potential involvement in the pathogenesis of bone fragility.

RESULTS

Published data strongly suggest a relationship between increased BMAT adiposity and the risk of bone fragility in the context of obesity and diabetes.

CONCLUSION

By secreting a broad range of factors, BMAT modulates the bone microenvironment and metabolism, ultimately affecting skeletal health. A better understanding of the relationship between BMAT expansion and metabolic disturbances observed in diabetic and obese patients will help to identify regulatory pathways and new targets for the treatment of bone-related diseases, with BMAT as a potential therapeutic target.

Indices of sarcopenic obesity are important predictors of finite element analysis-derived bone strength in older adults with obesity

Background

The expanding population of older adults with obesity is a public health challenge, in part, because of the increased risk of fractures despite normal or high bone mineral density. Potential factors predisposing to fractures in this group include sarcopenia associated with obesity and impaired bone quality. We aimed to determine the contribution of sarcopenic obesity (SO) indices to bone strength as assessed by microfinite element analysis (μFEA) of high-resolution peripheral quantitative computed tomography (HR-pQCT).

Methods

One-hundred eighty-nine older (age ≥ 65 years) adults with obesity (BMI ≥ 30 kg/m2) participated in lifestyle intervention trials at our medical center. All underwent baseline measurements of bone strength (failure load and stiffness) using μFEA from HR-pQCT of the distal radius and tibia. In addition, SO indices [appendicular lean mass/weight (ALM/W) and percent body fat (FM%)] by dual-energy X-ray absorptiometry and handgrip strength (HGS) by dynamometry were assessed. SO was diagnosed and staged based on the 2022 ESPEN and EASO expert consensus statement.

Results

Both ALM/W and HGS were positively correlated explaining 28% to 36% of the variance in failure load and stiffness at the distal radius and tibia (all p < 0.001). In contrast, FM% was negatively correlated explaining 22% to 31% of the variance in failure load and stiffness at the distal radius and tibia (all p < 0.001). The associations of SO indices with failure load and stiffness remained significant after controlling for age, sex, race/ethnicity, diabetes, and 25-OH vitamin D (ALM/W: R 2 = 0.301 to 0.448, HGS: R 2 = 0.346 to 0.472, FM%: R 2 = 0.299 to 0.432) (p < 0.001 to 0.011). SO was diagnosed in 75/189 (40%) participants with 66/75 (88%) having functional or metabolic complications (stage II). Participants with SO had lower failure load and stiffness at the distal radius than participants with no SO (both p < 0.05).

Conclusion

These findings demonstrate that lower muscle mass and strength and higher fat mass may impair bone quality. Therefore, interventions that focus on preserving muscle mass and strength while reducing fat mass may be important to decrease fracture risk when older adults with obesity undertake lifestyle intervention therapy.

Recent Advances in Nutraceuticals for the Treatment of Sarcopenic Obesity

Sarcopenic obesity, low muscle mass, and high body fat are growing health concerns in the aging population. This review highlights the need for standardized criteria and explores nutraceuticals as potential therapeutic agents. Sarcopenic obesity is associated with insulin resistance, inflammation, hormonal changes, and reduced physical activity. These factors lead to impaired muscle activity, intramuscular fat accumulation, and reduced protein synthesis, resulting in muscle catabolism and increased fat mass. Myostatin and irisin are myokines that regulate muscle synthesis and energy expenditure, respectively. Nutritional supplementation with vitamin D and calcium is recommended for increasing muscle mass and reducing body fat content. Testosterone therapy decreases fat mass and improves muscle strength. Vitamin K, specifically menaquinone-4 (MK-4), improves mitochondrial function and reduces muscle damage. Irisin is a hormone secreted during exercise that enhances oxidative metabolism, prevents insulin resistance and obesity, and improves bone quality. Low-glycemic-index diets and green cardamom are potential methods for managing sarcopenic obesity. In conclusion, along with exercise and dietary support, nutraceuticals, such as vitamin D, calcium, vitamin K, and natural agonists of irisin or testosterone, can serve as promising future therapeutic alternatives.

Habitual physical activity and sedentary behavior as predictors of dynapenia in older adults: a cross-sectional study

BACKGROUND

Dynapenia is a risk factor of mortality. Therefore, the development of low-cost and easy-to-apply tools is essential to optimize the health surveillance actions of older people.

OBJECTIVES

To compare the time spent on habitual physical activity (HPA) and sedentary behavior (SB) among dynapenic and non-dynapenic older adults and ascertain the predictive ability of these behaviors on outcome.

DESIGN AND SETTING

A cross-sectional population epidemiological survey was conducted involving 208 older adults.

METHODS

HPA and SB were quantified using the International Physical Activity Questionnaire, and dynapenia was identified by handgrip strength (women: 18.37 kgf; men: 26.75 kgf).

RESULTS

The prevalence was 24.50%. In both sexes, dynapenic individuals reported a HPA median time of 70.00 minutes/week (min/wk), while non-dynapenic women and men reported HPA median times of 240.00 and 280.00 min/wk, respectively (P < 0.05). For SB among dynapenic individuals, a median of 388.75 min/day was observed in women and 428.57 min/d in men. In contrast, non-dynapenic women and men had 291.42 and 274.28 min/day in SB (P < 0.05), respectively. The best cutoff HPA to discriminate the outcome was 150.00 min/wk in women (sensitivity: 73.30%; specificity: 60.67%) and 140.00 min/wk in men (sensitivity, 71.43%; specificity, 61.54%). The best cutoff SB was 381.43 min/day in women (sensitivity, 53.30%; specificity, 84.80%) and 351.43 min/day in men (sensitivity, 71.43%; specificity, 73.85%).

CONCLUSION

Older individuals with dynapenia spent less time on HPA and more time in SB. Furthermore, HPA was found to be a better discriminator of dynapenic individuals, and SB better discriminated non-dynapenic individuals.

Prevalence of dynapenia and overlap with disability, depression, and executive dysfunction

OBJECTIVE

This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion.

METHODS

This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls.

RESULTS

A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions.

CONCLUSIONS

Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

Global prevalence of osteosarcopenic obesity amongst middle aged and older adults: a systematic review and meta-analysis

PURPOSE

Osteosarcopenic obesity syndrome (OSO) is a recently recognized disorder encompassing osteopenia/osteoporosis, sarcopenia, and obesity. However, evidence in pooling knowledge regarding the prevalence of OSO worldwide is scarce. Hence, this review aimed to determine the pooled prevalence of OSO in middle-aged and older adults.

METHODS

We conducted systematic searches in Scopus, Embase, PubMed Central, MEDLINE, ScienceDirect, and Google Scholar from inception until October 2022. We evaluated the quality of the included studies using the Newcastle-Ottawa scale. The meta-analysis results using a random-effects model included the pooled prevalence and 95% confidence intervals (CIs).

RESULTS

We included 20 studies with a total of 23,909 participants. Most of the studies were of good quality. The final pooled prevalence of OSO in middle-aged and older adults worldwide was 8% (95% CI: 6%-11%; n = 20). Females (pooled prevalence = 9%; 95% CI:7%-12%; n = 17) had a higher burden of OSO than males (pooled prevalence = 5%; 95% CI:3%-8%; n = 11). We also found that the burden was higher among studies reporting OSO prevalence only in the elderly population (pooled prevalence = 13%; 95% CI: 9%-17%). The asymmetric nature of the funnel plot indicates the presence of publication bias. Additional sensitivity analysis did not reveal any significant variation in the pooled effect size estimation.

CONCLUSION

Approximately one in ten middle-aged and older adults suffer from OSO. The burden was highest among females and older adults. Diagnostic and intervention packages targeting such patients should be developed and implemented in high-risk settings.

Effects of 12 weeks of Tai Chi on neuromuscular responses and postural control in elderly patients with sarcopenia: a randomized controlled trial

Objective

To explore the effect of 12 weeks of Tai Chi on neuromuscular responses and postural control in elderly patients with sarcopenia.

Methods

One hundred and twenty-four elderly patients with sarcopenia from ZheJiang Hospital and surrounding communities were selected, however, 64 were later disqualified. Sixty elderly patients with sarcopenia were randomly assigned to the Tai Chi group (n = 30) and the control group (n = 30). Both groups received 45-min health education sessions once every 2 weeks for 12 weeks, and the Tai Chi group engaged in 40-min simplified eight-style Tai Chi exercise sessions 3 times per week for 12 weeks. Two assessors who had received professional training and were unaware of the intervention allocation assessed the subjects within 3 days prior to the intervention and within 3 days after completion of the intervention. They chose the unstable platform provided by the dynamic stability test module in ProKin 254 to evaluate the patient's postural control ability. Meanwhile, surface EMG was utilized to assess the neuromuscular response during this period.

Results

After 12 weeks of intervention, the Tai Chi group showed a significant decrease in neuromuscular response times of the rectus femoris, semitendinosus, anterior tibialis, and gastrocnemius and overall stability index (OSI) compared to before the intervention (p < 0.05), while there was no significant difference in the control group for these indicators before and after intervention (p > 0.05). In addition, these indicators in the Tai Chi group were significantly lower than those in the control group (p < 0.05). The changes in neuromuscular response times of the rectus femoris, semitendinosus, anterior tibialis, and gastrocnemius were positively correlated with the changes in OSI (p < 0.05) in the Tai Chi group, but there were no significant correlations between changes in neuromuscular response times of the aforementioned muscles and changes in OSI in the control group (p < 0.05).

Conclusion

Twelve-weeks of Tai Chi exercise can improve the neuromuscular response of the lower extremities in elderly patients with sarcopenia, shorten their neuromuscular response time when balance is endangered, enhance their dynamic posture control ability, and ultimately reduce the risk of falls.

Influencing factors of weak grip strength and fall: a study based on the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Fall is a major cause of mortality and cause a significant burden on the healthcare system and economic system. Weak grip strength signifies impaired function. Older people with weak grip strength are at a higher risk of death. China has the largest ageing population in the world today. This study aims to analyze the factors contributing to weak grip strength and fall among Chinese.

METHODS

This study analyzed data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). To identify the risk factors of fall and weak grip strength, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) regression model.

RESULTS

In the LASSO regression model, all the risk factors were not shrunken. In the stepwise logistic regression model, adjusted for gender, age, grip strength, depression, and chronic disease, we found that female (aOR = 1.376, 95% CI = 1.243-1.523; P < 0.001), history of ischemic stroke (aOR = 1.786, 95% CI = 1.263-2.524; P = 0.001), depression (aOR = 1.559, 95% CI = 1.396-1.742; P < 0.001), weak grip strength (aOR = 1.285, 95% CI = 1.105-1.494; P = 0.001), older age (aOR = 1.227, 95% CI = 1.163-1.294; P < 0.001), rheumatoid arthritis (aOR = 1.410, 95% CI = 1.270-1.560; P < 0.001), history of kidney disease (aOR = 1.383, 95% CI = 1.136-1.682; P = 0.001) were factors associated with fall significantly. After further adjusting, we found the risk factors of weak grip strength included symptomatic knee osteoarthritis (aOR = 1.755, 95% CI 1.158-2.661; P = 0.008), living in rural area (aOR = 2.056, 95% CI 1.290-3.277; P = 0.002), depression (aOR = 1.523, 95% CI 1.116-2.078; P = 0.008), older age (aOR = 2.116, 95% CI 1.801-2.486; P < 0.001).

CONCLUSION

From the study, we found that older age and depression were risk factors of weak grip strength and fall. Weak grip strength was a risk factor of fall. Female, ischemic stroke, kidney disease, rheumatoid arthritis were risk factors of fall; living in rural area and symptomatic knee osteoarthritis were risk factors of weak grip strength.

Dynapenia in all-cause mortality and its relationship with sedentary behavior in community-dwelling older adults

The aim of the present study was to investigate the relationship of dynapenia combined with sedentary behavior (SB) on the risk of mortality in older adults living in a Brazilian community. A total of 322 participants aged ≥ 60 years from the ELSIA (Longitudinal Study of Elderly Health in Alcobaça) prospective cohort were included. Dynapenia was diagnosed when the handgrip strength was < 27 ​kg for men and < 16 ​kg for women. The exposure time to SB was assessed considering the total time spent sitting during one day in the week and one day on the weekend. When combined with dynapenia, we derived the construction of four groups: best behavior (absence of dynapenia and low SB), intermediate behavior (absence of dynapenia and high SB; presence of dynapenia and low SB) and worst behavior (presence of dynapenia and high SB). Mortality was assessed by the follow-up time until death and/or censorship. During the 5-year follow-up of the study, 55 participants progressed to death. In the adjusted models, the dynapenia and the time spent exposed to SB were analyzed in a combined way, the older adults with worse behavior (high SB and dynapenia) had higher risk ratios for mortality (hazard ratio 2.46; 95% confidence interval 1.01-5.97) than the best behavior group. Older adults with dynapenia are at greater risk for all-cause mortality, which is aggravated by the addition of longer exposure to SB.

Effect of Body Mass Index on Femur Fracture Location: A Retrospective Database Study

OBJECTIVES

Use a large database design and multivariable analyses to assess the associations between body mass index (BMI) and femur fracture patterns after controlling for other risk factors.

DESIGN

Retrospective cohort study.

SETTING

National insurance claims database of patient records from 2010 to 2018.

PATIENTS/PARTICIPANTS

Patients with femur fracture diagnoses were identified. Patients with multiple fractures within 1 week (polytrauma patients), patients without a BMI diagnosis code within 6 months of fracture, and patients with multiple BMI diagnosis codes (implying a substantial change in weight) were excluded.

INTERVENTION

N/A.

MAIN OUTCOME MEASUREMENTS

Patients were divided into groups based on fracture location: proximal (OTA/AO 31), shaft (OTA/AO 32), or distal (OTA/AO 33). The distribution of femur fractures was compared across BMI categories.

RESULTS

A total of 57,042 patients with femur fracture were identified: 45,586 proximal fractures, 4216 shaft fractures, and 7240 distal fractures. Patients with BMI &lt;29.9 have increased odds ( P &lt; 0.0001) of proximal fracture and decreased odds ( P &lt; 0.0001) of shaft or distal fractures. Patients with BMI &gt;30.0 have decreased odds ( P &lt; 0.0001) of proximal fracture and increased odds ( P &lt; 0.0001) of distal fractures.

CONCLUSIONS

Increasing BMI is associated with a decreased proportion of proximal femur fractures and a corresponding increase in the proportion of shaft and distal fractures. Regression analyses determined that age, sex, osteoporosis, diabetes, and tobacco use are not the cause of this trend.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Characteristics of sarcopenia subjects in arterial pulse spectrum analysis

Aims

Sarcopenia is significantly associated with the number of cardiovascular and metabolic diseases, however, the underlying pathophysiological processes are largely unknown. This study performed harmonic index of finger photoplethysmography (PPG) waveforms with the aims of distinguishing different arterial pulse waveform signals between sarcopenia, presarcopenia, dynapenia, and healthy subjects.

Methods

Sixty-eight subjects were enrolled and obtained 1-min PPG signals, then were assigned to four age-matched groups: control, dynapenia, presarcopenia, and sarcopenia which definition according to Asian Working Group for Sarcopenia (AWGS): 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Harmonics 1-10 of the PPG waveform were obtained and calculated each of the amplitude proportions (C _n ), standard deviations (SD _n ), coefficients of variations (CV _n ), and vascular elasticity index (VEI) for to evaluating the blood-pressure harmonic variability.

Results

The prevalence of sarcopenia in women gender (8 out of 9, 88.9%, p = 0.046) and osteoporosis in dynapenia (7 out of 16, 43.8%, p = 0.005) were significant higher. Among the four groups, compared with control, dynapenia, and presarcopenia, sarcopenia had largest SD _n -values for harmonics 1, 2, 3, and 5 (ratio 1, 2, 3, 5 = 0.354, 0.209, 0.137, 0.074); whereas sarcopenia had largest coefficients of variations (CV _n ) values for harmonics 1, 2, 3 and 10 (ratio 1, 2, 3, 10 = 0.263, 0.310, 0.402, 0.791). Besides, the Δ odds ratio of ratio 3, 4,and 6 tertile values were significantly increased in sarcopenia and possible sarcopenia group compared with control group. Subjects with sarcopenia had significantly higher VEI in mean, SD, and CV of the PPG waveform (mean = 2.332, SD = 1.479, CV = 0.634, p = 0.007) among the groups and the results of binary logistic regression analysis in the tertiles met statistical significance between the sarcopenia and non-sarcopenia groups whether adjusted or unadjusted (adjusted odds ratio 6.956, p = 0.030, unadjusted odds ratio 3.937, p = 0.039).

Conclusions

The elasticity of vessels among sarcopenia groups in lower-frequency components of harmonic ratio in which we defined as VEI showed a significantly highest VEI mean, SD, and CV in sarcopenia indicates the poorer elasticity of the arteries. The present findings showed finger PPG waveform measurements may be useful for early detection of vascular diseases with patients with sarcopenia in a non-invasive and easy-to-perform technique which may expand the clinical applicability in the future.

Severity of underweight and risk of fracture: a Korean nationwide population-based cohort study

Underweight is an important modifiable risk factor for fractures. However, there have been few large cohort studies regarding the relationship between underweight and fracture in the general population. We investigated the risk of fracture development according to underweight severity in a large population cohort. This nationwide cohort study included 2,896,320 people aged ≥ 40 years who underwent national health checkups in 2009 and were followed up to identify the incidence of fracture until December 31, 2018. After applying the exclusion criteria that included overweight and obese individuals, the study population was divided according to body mass index (BMI) into normal weight (18.5 ≤ BMI < 23.0), mild underweight (17.5 ≤ BMI < 18.5), moderate underweight (16.5 ≤ BMI < 17.5), and severe underweight (BMI < 16.5) groups. Cox proportional hazards regression analyses were performed to calculate the hazard ratios for risk of fracture according to underweight severity. Severely underweight participants had a 28% increased fracture risk (adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.20-1.37) compared with those of normal weight. In addition, fracture risk was increased by 14% in individuals with moderate underweight (adjusted HR 1.14, 95% CI 1.08-1.19) and 9% in those with mild underweight (adjusted HR 1.09, 95% CI 1.06-1.13). The severity of underweight was significantly associated with risk of fracture.

Gender and education inequalities in dynapenia-free life expectancy: ELSI-Brazil

OBJECTIVE

To estimate the dynapenia-free life expectancy among community-dwelling older Brazilian adults and evaluate gender-related and educational differences.

METHODS

This is a cross-sectional study. The data were obtained from the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil - Brazilian Longitudinal Study of Aging), conducted from 2015 to 2016 in Brazil. Dynapenia is defined as low muscle strength (< 27kg for men and < 16kg for women), measured with a handgrip dynamometer. The dynapenia-free life expectancy was estimated using the Sullivan method based on the standard period life table and dynapenia prevalence, stratified by age groups, gender, and schooling.

RESULTS

A total of 8,827 participants, aged 50 and over (53.3% women), were investigated. The prevalence of dynapenia was 17.7% among men and 18.5% among women. The women live longer and with more years free of dynapenia than men. Those in the higher education category (four or more years) presented an advantage in the dynapenia-free life expectancy estimates.

CONCLUSIONS

The results of this study suggest the substantial impact of dynapenia on longer dynapenia-free life expectancy among older people. Understanding dynapenia prevalence and dynapenia-free life expectancy could assist in predicting care needs, as well as targeting efforts to delay the onset of complications related to it at older ages. Without the implementation of policy regarding dynapenia prevention, inequalities in health due to gender and socioeconomic status may continue to increase.

Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: the BELL pragmatic controlled trial

The Ballistic Exercise of the Lower Limb (BELL) trial examined the efficacy and safety of a pragmatic hardstyle kettlebell training program in older adults. Insufficiently active men and women aged 59–79 years, were recruited to a 6-month repeated measures study, involving 3-months usual activity and 3-months progressive hardstyle kettlebell training. Health-related physical fitness outcomes included: grip strength [GS], 6-min walk distance [6MWD], resting heart rate [HR], stair-climb [SC], leg extensor strength [LES], hip extensor strength [HES], Sit-To-Stand [STS], vertical jump [CMVJ], five-times floor transfer [5xFT], 1RM deadlift, body composition (DXA), attendance, and adverse events. Sixteen males (68.8 ± 4.6 yrs, 176.2 ± 7.8 cm, 90.7 ± 11.0 kg, 29.2 ± 2.6 kg/m²) and sixteen females (68.6 ± 4.7 yrs, 163.9 ± 5.4 cm, 70.4 ± 12.7 kg, 26.3 ± 4.9 kg/m²) were recruited. Compliance with the supervised exercise program was very high (91.5%). Kettlebell training increased GS (R: MD = 7.1 kg 95% CI [4.9, 9.3], L: MD = 6.3 kg 95% CI [4.1, 8.4]), 6MWD (41.7 m, 95% CI [17.9, 65.5]), 1RM (16.2 kg, 95% CI [2.4, 30.0]), 30 s STS (3.3 reps, 95% CI [0.9, 5.7]), LES (R: MD = 61.6 N, 95% CI [4.4, 118.8]), HES (L: MD = 21.0 N,95% CI [4.2,37.8]), appendicular skeletal lean mass (MD = 0.65 kg, 95% CI [0.08, 1.22]), self-reported health change (17.1%, 95% CI [4.4, 29.8]) and decreased SC time (2.7 s, 95% CI [0.2, 5.2]), 5xFT time (6.0 s, 95% CI [2.2, 9.8]) and resting HR (7.4 bpm, 95% CI [0.7, 14.1]). There were four non-serious adverse events. Mean individual training load for group training sessions during the trial was 100,977 ± 9,050 kg. High-intensity hardstyle kettlebell training was well tolerated and improved grip strength and measures of health-related physical fitness in insufficiently active older adults.

Trial registration: Prospectively registered: 20/08/2019, Australian New Zealand Clinical Trials Registry (ACTRN12619001177145).

Prevalence and diagnostic agreement of sarcopenic obesity with different definitions among Chinese community-dwelling older adults

OBJECTIVE

this retrospective study aims to compare the prevalence and diagnostic agreement of sarcopenic obesity (SO) using different obesity diagnostic methods among Chinese community-dwelling older adults.

METHODS

SO was diagnosed with sarcopenia and obesity diagnostic methods. Sarcopenia was defined using the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019). Four widely used indicators were used to define obesity: body mass index (BMI), waist circumference (WC), percent of body fat (PBF) and visceral fat area (VFA). Cohen's kappa was used to analyse the diagnosis agreement of SO between different diagnostic methods.

RESULTS

a total of 1,050 participants were included, including 347 men (71.3 ± 7.4 years) and 703 women (69.9 ± 7.5 years). The prevalence of sarcopenia was 25% in total participants, there was no difference between men (24.2%) and women (25.5%), (P = 0.705). With different obesity diagnostic methods, the obesity prevalence ranged from 4.1 to 42.2%, the SO prevalence was 0.1-7.9%. The diagnosis agreement of SO was poor-to-moderate (κ ranged from -0.002 to 0.682). Among the four diagnostic methods, AWGS combined with BMI had the poorest agreement (κ = -0.002 with other methods), AWGS combined with VFA had the best agreement (κ = 0.641 and 0.682 with AWGS combined with PBF and with AWGS combined with WC, respectively).

CONCLUSION

the prevalence of SO vary considerably and the diagnostic agreement is poor-to-moderate with non-uniform diagnostic methods. BMI has the lowest sensitivity, whereas VFA has the highest sensitivity in diagnosis of SO, and VFA has a relatively good diagnostic agreement with other diagnostic methods.

The Influence of Obesity, Ovariectomy, and Greenshell Mussel Supplementation on Bone Mineral Density in Rats

Obesity is considered to impair long-term health by disturbing multiple physiological functions. However, it remains a controversial issue as to whether obesity has beneficial or detrimental effects on bone health in postmenopausal women. The aims of this study were to investigate the relationships between obesity and bone mineral density (BMD) under conditions of ovarian hormone deficiency in an animal model and to evaluate the potential health benefits of Greenshell mussel (GSM) on bone health. A total of 144 adult female Sprague-Dawley rats were fed from age 12 weeks on one of four diets (normal [ND]; ND + GSM; high fat/high sugar [HF/HS]; HF/HS + GSM; n = 36 per diet). At age 20 weeks, after a dual-energy X-ray absorptiometry (DXA) scan, 12 of the rats on each diet underwent ovariectomy (OVX) and the remaining rats were left intact. Twelve of the intact rats in each diet group were culled at age 26 weeks (short-term cohort). The remaining rats were culled at age 48 weeks (long-term cohort). Rats were DXA scanned before cull, then various fat pads were dissected. The results revealed that HF/HS rats and OVX rats dramatically increased body weight and fat deposition in correlation with leptin. In the long-term cohort, vertebral spine BMD rapidly declined after OVX. At termination, the OVX rats had decreased plasma bone turnover markers of CTX-1 and TRAP when compared with sham rats. Significantly higher BMD was found in OVX rats fed the HF/HS diet compared with ND, but this difference was not recapitulated in intact rats. BMD of right femur was significantly increased 5% to 10% by GSM in the short-term cohort. The data demonstrated that obesity can be beneficial by increasing BMD in OVX rats, and this may extrapolate to postmenopausal women as adipocyte-produced estrogen may slightly compensate for the reduction in ovarian hormones. Finally, the data showed that GSM may be beneficial to bone health by increasing BMD accrual. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Dynapenic abdominal obesity and the effect on long-term gait speed and falls in older adults

BACKGROUND

Although both dynapenia and abdominal obesity have negative impact on physical function and health, few prospective studies evaluate the association of dynapenic abdominal obesity (D/AO) with gait speed and falls. Our aim was to examine the combined effect of low muscle strength and abdominal obesity on long-term gait speed and falls in older adults.

METHODS

We used longitudinal data from the English Longitudinal Study of Ageing (ELSA), including 4987 individuals aged 60 years and over. Grip strength and waist circumference were measured at baseline. Gait speed and fall events (falls, recurrent falls, and fall-related injury) were evaluated during a 14-year follow-up. The study population were divided into nondynapenic nonabdominal obesity (ND/NAO), nondynapenic abdominal obesity (ND/AO), dynapenic nonabdominal obesity (D/NAO), and D/AO, according to the sex-specific grip strength (<16 kg for women and <26 kg for men) and waist circumference (>88 cm for women and >102 cm for men). We used generalized estimating equation (GEE) model with gait speed as the outcome and cox proportional hazards models with fall events as the outcome.

RESULTS

GEE model showed that gait speed decreased during the 14-year follow-up in all groups (all P_time < 0.001). Participants with ND/AO, D/NAO, and D/AO at baseline exhibited a worse gait speed than those with ND/NAO (all P_group < 0.001). No significant difference in the rate of gait speed decline between four groups was found (P_group×time = 0.062). Cox regression analysis showed that D/NAO and D/AO highly predicted falls, and the hazard ratio (HR) was 1.181 (95% CI: 1.002, 1.392) for D/NAO and 1.195 (95% CI: 1.006, 1.421) for D/AO. D/AO was the unique condition associated with recurrent falls and fall-related injury, and the HRs were 1.276 (95% CI: 1.018, 1.599) and 1.348 (95% CI: 1.066, 1.704), respectively.

CONCLUSION

Dynapenia abdominal obesity, determined by low grip strength and high waist circumference, exhibits worse gait speed and increases the risk of fall events in older adults. Effort to maintain the mobility should focus on improving muscle strength and reducing excess body fat.

Lower Lean Mass Is Associated with Greater Arterial Stiffness in Patients with Lower Extremity Artery Disease

Background: Arterial stiffness is independently associated with lower extremity artery disease (LEAD). Although obesity is already known as an independent cardiovascular risk factor, it was found that, paradoxically, in patients diagnosed with cardiovascular disease, an increase in body mass index (BMI) was associated with a decrease in mortality. However, the underlying mechanism of this paradoxical association remain uncertain. In this study, we firstly hypothesize that arterial stiffness correlates with body mass; secondly, the underlying mechanism of the association for patients with LEAD is individual body composition, in particular, lean mass. Methods: The present study was performed as a single-center, prospective, observational analysis. A total of 412 patients with current or previously diagnosed LEAD (Rutherford Classification 2–4) were included, the cfPWV and AIx were measured as indices of arterial stiffness, and a body composition assessment was performed. Results: In male patients, there was a significantly negative correlation between the AIx and lean mass coefficient (p = 0.004, 95% CI: −0.28 (−0.48–0.09)). Conclusion: For patients with peripheral arterial disease, our data show that lower lean mass in male patients is associated with increased arterial stiffness as measured by the AIx. Therefore, progressive resistance training may be beneficial for the reduction in arterial stiffness in PAD patients in secondary prevention.

Pelvic region bone density, soft tissue mass, and injury frequency in female professional ballet dancers and soccer athletes

We recently observed a high prevalence of low pelvic bone mineral density (BMD) in female professional ballet performers. Because this population is susceptible to musculoskeletal overuse injuries, we aimed to determine which regions of the pelvis may be at greatest risk compared to general population females (GENPOP) as well as professional female soccer players (SOCCER, a comparison to other elite athletes regularly subjected to high degrees of loading). Three groups of age-matched females [(GENPOP; n = 38, 27±1yrs), (BALLET; single company, n = 36, 26±3yrs), (SOCCER; single NWSL® club, n = 34, 25±1yrs)] consented to have their BMD and body composition assessed (DEXA, GE®). In addition to soft tissue and total and regional BMD analyses, a segmental analysis of the pelvis was performed to determine site-specific BMD for the iliac fossa, iliac fossa/iliac crest/ilium combined, pubic bone, ischium, and sacrum. A mixed-model ANOVA followed by a Tukey's post-hoc test was used to compare the groups (Type-I error; α = 0.05). The BALLET group had lower pelvic BMD for all measures (Avg.%Diff. = 15%-27%, p<0.001) compared to the SOCCER group and for the ischium (Avg.%Diff.= 8%; p=0.007) and sacrum (Avg.%Diff. ​= ​7%; p = 0.028) compared to the GENPOP group. The BALLET group had lower lean mass for all measures compared to the other groups (Avg.%Diff. = 12%-18%; p < 0.01). Professional ballet performers exhibit reduced pelvic region soft tissue and site-specific BMD not previously detected using standard DEXA analyses. These findings highlight which pelvic regions may benefit from preventative strength training and/or nutritional interventions.

Body composition of women with and without dynapenia defined by different cut-off points

ABSTRACT Objective To compare body composition of postmenopausal women with and without dynapenia, defined by different cut-off points. Methods Body composition was assessed by electrical bioimpedance and the nutritional status by the body mass index. Dynapenia was diagnosed according to handgrip strength, using the following cut-off points: handgrip strength <16kgf and <20 kgf. Results A total of 171 women (50 to 92 years of age) participated in the investigation. The mean age of non-dynapenic and dynapenic women (handgrip strength <20kgf) was 69.4±8.2 and 74.5±8.2 years, respectively. The mean age of women with dynapenia (handgrip strength <16kgf) was 75.0±10.1 years and non-dynapenic women, 71.1±8.2 years. It was found that dynapenic women, with handgrip strength <20 and <16kgf, had an average of 2.38 and 2.47kg less muscle mass respectively, when compared to non-dynapenic women (p<0.05). However, there was no difference in muscle mass between the different dynapenic groups. Non-dynapenic women (handgrip strength ≥20kgf) had more total (3.55kg) and central fat (1.47kg) (p<0.05). Conclusion Dynapenic women, diagnosed considering both cutoff points, had less total and segmental muscle mass compared to non-dynapenic women. In addition, dynapenic women with handgrip strength <20kgf had lower total and trunk adiposity.

Can physical activity levels and relationships with energy expenditure change the clinical aspects of sarcopenia and perceptions of falls among elderly women? Observational cross-sectional study

BACKGROUND

Physical activity (PA) is an effective strategy for managing sarcopenia in the elderly, but few studies have addressed PA levels regarding age-related changes.

OBJECTIVE

To ascertain the effects of elderly women's PA levels on sarcopenia, physical performance, handgrip strength and perception of the risk of falling, and their relationship with energy expenditure.

DESIGN AND SETTING

Observational cross-sectional study conducted in the southern region of the city of São Paulo, Brazil.

METHODS

Forty-seven elderly women were evaluated and divided into three groups: low PA (n = 13); moderate PA (n = 16); and high PA (n = 18). Their PA levels were investigated through the International Physical Activity Questionnaire (IPAQ); sarcopenia index, through dual-energy radiological absorptiometry; physical performance through the Timed Up & Go test; handgrip strength, using a digital dynamometer; and perception of the risk of falling, through the Fall Risk Awareness Questionnaire.

RESULTS

High PA level indicated higher skeletal muscle mass index, physical performance and IPAQ score, compared with low and moderate PA levels. Multiple linear regression analysis showed that higher IPAQ energy expenditure at high and moderate PA levels was a good predictor of higher physical performance and increased perception of the risk of falling.

CONCLUSION

Elderly women classified as having high PA level showed improvements in sarcopenia, handgrip strength, physical performance and perception of the risk of falling. The IPAQ energy expenditure of the elderly women with high and moderate PA levels was a good predictor of physical performance and improved perception of the risk of falling.

Prevalence and Trends in Low Bone Density, Osteopenia and Osteoporosis in U.S. Adults With Non-Alcoholic Fatty Liver Disease, 2005-2014

BACKGROUND & AIMS

Non-alcoholic fatty liver disease (NAFLD) is suggested to be associated with bone mineral density (BMD) alterations; however, this has not been ascertained. The current study aimed to investigate the changes in BMD and the prevalence of osteopenia/osteoporosis in US adults with or without NAFLD and to evaluate their association.

METHODS

The study was conducted based on data collected from the U.S. National Health and Nutrition Examination Survey (NHANES) during the period 2005-2014. A total of 13 837 and 6 177 participants aged > 20 years were eligible for conducting the Hepatic Steatosis Index (HSI) and the US Fatty Liver Index (USFLI) analysis, respectively.

RESULTS

From 2005-2014, a downward trend in femoral neck BMD was observed in subjects with NAFLD aged ≥ 40. After adjustment for potential confounders, an upward shift occurred in the prevalence of osteopenia/osteoporosis at the femoral neck in adults aged ≥ 40, particularly in women ≥ 60 years old and men below the age of 60. Moreover, a negative association was found between BMD and NAFLD markers (USFLI, HSI), whereas NAFLD with advanced fibrosis was positively associated with the prevalence of spine fractures.

CONCLUSIONS

There was a trend toward lower BMD and higher prevalence of osteopenia/osteoporosis at the femoral neck in US adults with NAFLD aged ≥ 40 years during the period of 2005-2014. NAFLD with advanced fibrosis was positively associated with a higher risk of spine fracture. More research is required to fully investigate the mechanism and consequence of poor bone health in NAFLD patients and consider optimum management of osteopenia/osteoporosis for this population.

Incidence and predictors of fractures in older adults with and without obesity defined by body mass index versus body fat percentage

PURPOSE

The aim of this study was to determine and compare risk factors associated with incident fractures in older adults with and without obesity, defined by both body mass index (BMI) and body fat percentage.

METHODS

1,099 older adults (mean ± standard deviation age = 63.0 ± 7.5) years, participated in this prospective cohort study. Obesity status at baseline was defined by BMI (≥30 kg/m²) obtained by anthropometry and body fat percentage (≥30% for men and ≥40% for women) assessed by dual-energy X-ray absorptiometry (DXA). Total hip and lumbar spine areal bone mineral density (aBMD) were assessed by DXA up to five years. Incident fractures were self-reported up to 10 years.

RESULTS

Prevalence of obesity was 28% according to BMI and 43% according to body fat percentage. Obese older adults by BMI, but not body fat percentage, had significantly higher aBMD at the total hip and spine compared with non-obese (both p-value<0.05). Obese older adults by body fat percentage had significantly higher likelihood of all incident fractures (OR: 1.71; CI:1.08, 2.71) and non-vertebral fractures (OR: 1.88; CI:1.16, 3.04) compared with non-obese after adjusting for confounders. Conversely, obese older adults by BMI had a significantly lower likelihood (OR: 0.54; CI:0.31, 0.94) of non-vertebral fractures although this was no longer significant after adjustment for total hip aBMD (all p-value > 0.05). Mediation analysis confirmed that aBMD meditated the effects of BMI, but not body fat percentage, on all incident fractures. Higher baseline falls risk score was the only consistent predictor of increased likelihood of incident fracture in obese individuals only, according to both BMI and body fat percentage (both p-value<0.05).

CONCLUSIONS

Obesity defined by body fat percentage is associated with increased likelihood of incident fractures in community-dwelling older adults, whereas those who are obese according to BMI have reduced likelihood of incident fracture which appears to be explained by higher aBMD. Falls risk assessment may improve identification of obese older adults at increased risk of incident fractures.

Are the Relationships of Lean Mass and Fat Mass With Bone Microarchitecture Causal or Due to Familial Confounders? A Novel Study of Adult Female Twin Pairs

It is not known whether the relationships of lean mass (LM) and fat mass (FM) with bone microarchitecture and geometry are causal and/or are because of confounders, including familial confounders arising from genetic and environment effects shared by relatives. We tested the hypotheses that: (i) LM is associated with cortical bone traits, (ii) FM is associated with trabecular bone traits, and (iii) these relationships of LM and FM with bone microarchitecture and geometry have a causal component. Total body composition was quantified for 98 monozygotic (MZ) and 54 dizygotic (DZ) white female twin pairs aged 31 to 77 years. Microarchitecture at the distal tibia and distal radius was quantified using HRpQCT and StrAx software. We applied the Inference about Causation through Examination of FAmiliaL CONfounding (ICE FALCON) method. Within‐individuals, distal tibia total bone area, cortical area, cortical thickness, and trabecular number were positively associated with LM (standardized regression coefficient (β) = 0.13 to 0.43; all p < 0.05); porosity of the inner transitional zone (ITZ) was negatively associated with LM (β = −0.22; p < 0.01). Trabecular number was positively associated with FM (β = 0.40; p < 0.001), and trabecular thickness was negatively associated with FM (β = −0.27; p < 0.001). For porosity of ITZ and trabecular number, the cross‐pair cross‐trait association with LM was significant before and after adjustment for the within‐individual association with LM (all ps < 0.05). For trabecular number, the cross‐pair cross‐trait association with FM was significant before and after adjustment for the within‐individual association with FM (p < 0.01). There were no significant changes in these cross‐pair cross‐trait associations after adjustment for the within‐individual association (p = 0.06 to 0.99). Similar results were found for distal radius measures. We conclude that there was no evidence that the relationships of LM and FM with bone microarchitecture and geometry are causal; they must in part due to by familial confounders affecting both bone architecture and body composition. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Comparison of clinical risk factors for incident fracture in obese and non-obese community-dwelling older men

BACKGROUND

Obese older adults have higher bone mineral density (BMD), but other characteristics of obesity may predispose these individuals to fracture. We aimed to compare clinical risk factors for incident fracture in obese and non-obese older men.

METHODS

Body mass index (BMI) and body fat percentage were assessed at baseline by anthropometry and dual-energy X-ray absorptiometry, respectively, in 1625 community-dwelling men aged ≥70 years. Categories for non-obese and obese were <30 kg/m²and ≥30 kg/m² for BMI, and <30% and ≥30% for body fat percentage. Sociodemographic, medical, physical function and blood biochemistry parameters were collected at baseline. Self-reported incident fractures of any type and cause (excluding pathological fractures and fractures of hands, fingers, feet, toes and the skull) were confirmed by radiographic reports and recorded up to 9 years. Hip fractures were followed for 14 years using data linkage.

RESULTS

Prevalence of obesity was 27% according to BMI and 44% according to body fat percentage. There were no differences in incidence of any fracture between non-obese and obese men by BMI (10.7 vs 9.3%, respectively; P > 0.05) or body fat percentage (10.2 vs 10.6%, respectively; P > 0.05). Significant interactions were observed demonstrating that dementia increased hazard for incident any and hip fracture in non-obese men (adjusted hazard ratio 7.08; 95% CI 3.27-15.36 and 8.36; 3.13-22.31, respectively) but not obese men. Past-year falls increased hazard for any fracture in obese men (2.86; 95% CI 1.60-5.10) but not non-obese men while higher luteinizing hormone concentrations reduced hazard for hip fracture in obese men (0.91; 0.85-0.97 per IU/L) but not non-obese men.

CONCLUSIONS

In community-dwelling older men, obesity does not protect against incident fracture. Assessments of falls history and gonadotrophin levels, in addition to established clinical risk factors for fracture, may contribute to improvements in fracture prediction in obese older men.

Midlife falls are associated with increased risk of mortality in women: Findings from the National Health and Nutrition Examination Survey III

OBJECTIVES

Falls are a public health concern for older adults but are also common among midlife adults. However, the consequences of falls occurring during midlife are not well understood.

METHODS

This investigation assessed the relationship between falls and mortality among midlife adults using survey data from the Third National Health and Nutrition Examination Survey (n = 1,295), linked to the National Death Index. The relationship between recurrent falls (≥2 falls) in the past year and 10-year death rate was assessed using survey-weighted Cox regression.

RESULTS

Nearly 20 % of adults who died within 10 years of their interview date were recurrent fallers at the time of interview. For women only, recurrent fallers had more than 4-fold increased hazard of death within 10 years compared to non-recurrent fallers (HR = 4.41; 95 % CI:2.24,8.68).

CONCLUSIONS

Findings suggest that midlife women are particularly vulnerable to adverse outcomes following recurrent falls. Fall prevention efforts should include efforts targeted at midlife women.

Obesity, dynapenia, and their combination: Implications for bone mineral density in Brazilian adults-the Pró-Saúde study

OBJECTIVES

This study aimed to evaluate bone mineral density (BMD) in the presence or absence of dynapenia or obesity in Brazilian adults.

METHODS

This is a cross-sectional study conducted in 502 adults (age: 33-81 y; 51% women) participating in the Pró-Saúde study, a cohort of civil servants at the university campuses in Rio de Janeiro, Brazil. Body composition and BMD were determined by dual energy x-ray absorptiometry. Handgrip strength was measured using a dynamometer. According to measures of handgrip strength (≤19 kg for women; ≤32 kg for men) and fat mass (>30% for men; >40% for women), participants were classified into four groups: non-obese non-dynapenic, obese non-dynapenic, non-obese dynapenic, and obese dynapenic. The association between BMD at each specific bone site and obesity, dynapenia, and their interaction was evaluated using a general linear model.

RESULTS

The prevalence of dynapenic obesity was 14% in men and 15.2% in women. Dynapenia alone was not associated with BMD at any site in either men nor women. Obesity and dynapenia interacted to influence BMD in women (P < 0.05). Total body, lumbar spine, and femoral neck BMD were higher by 6.3%, 9.3%, and 10.4%, respectively, in dynapenic obese women compared with their non-obese counterparts (P < 0.05). In men, obesity, dynapenia, and their combination were not associated with BMD at any site.

CONCLUSIONS

Our results suggest that dynapenia, obesity, and their combination may affect BMD in a sex-dependent manner. In the presence of dynapenia, fat mass appears to exert a protective effect on BMD in women, but not in men.

Does Lower Lean Body Mass Mediate the Relationship Between Falls and Higher Body Mass Index in Asian Older Persons?

The current evidence on the relationship between a higher body mass index (BMI) and falls in older adults is conflicting. This study, therefore, evaluated the relationship between BMI and falls and explored underlying mechanisms for this relationship. Data from 1,340 individuals from the Malaysian Elders Longitudinal Research study, obtained through home-based computer-assisted interviews and followed by hospital-based health checks, were utilized. A history of the presence of falls in the previous 12 months was obtained. The presence of at least one fall in the past 12 months was associated with a higher BMI (odds ratio = 1.03, 95% confidence interval [1.01, 1.06]). The relationship between a higher BMI and falls was, however, attenuated by a lower percentage of lean body mass, which accounted for 69% of the total effect of BMI on the risk of falls. Future studies should now investigate this aforementioned relationship prospectively.

An exploration of the knowledge structure in studies on old people physical activities in Journal of Exercise Rehabilitation: by semantic network analysis

Physical activity, a key component of maintaining health, is becoming an essential alternative in reducing medical expenses for the old people. This research was intended to analyze 51 research papers published in the Journal of Exercise Rehabilitation (JER) through semantic network analysis. The subjects of the study were the keywords that the authors of each paper used in journal search sites from 2013 to 2019. The present researcher analyzed the frequency, density, and centrality of the keywords of the indicators through semantic network analysis and then visualized them on the basis of findings using UCINET6 and the NetDraw program. Also, the researcher classified the hidden clusters by CONCOR (Convergence of iterated Correlations) analysis, which is a kind of cluster analysis. As a result, it was found that the keyword with the highest frequency was “exercise,” followed by “cognition, “physicalactivity,” “old-women,” “Korean,” “fall,” and “training.” It was also found that most of the high-frequency keywords, such as “exercise,” “cognition,” “old-women,” “program” and “depression” had high centrality. These keywords were classified into four clusters: (a) mental health research, (b) physical health research, (c) social behavior research, and (d) leisure efficacy research. This suggests that the old people-related research papers published in the JER have derived effective methods of maintaining physical and mental health using scientific exercise programs, and especially address the effects of exercise intervention for old women.

Exploring the Association between Vascular Dysfunction and Skeletal Muscle Mass, Strength and Function in Healthy Adults: A Systematic Review

Background: The prevalence of vascular dysfunction increases with advancing age, as does the loss of muscle mass, strength and function. This systematic review explores the association between vascular dysfunction and skeletal muscle health in healthy adults. Methods: EMBASE and MEDLINE were searched for cross-sectional and randomized controlled studies between January 2009 and April 2019, with 33 out of 1246 studies included based on predefined criteria. Assessments of muscular health included muscle mass, strength and function. Macrovascular function assessment included arterial stiffness (pulse wave velocity or augmentation index), carotid intima-media thickness, and flow-mediated dilation. Microvascular health assessment included capillary density or microvascular flow (contrast enhanced ultrasound). Results: All 33 studies demonstrated a significant association between vascular function and skeletal muscle health. Significant negative associations were reported between vascular dysfunction and -muscle strength (10 studies); -mass (9 studies); and -function (5 studies). Nine studies reported positive correlations between muscle mass and microvascular health. Conclusions: Multiple studies have revealed an association between vascular status and skeletal muscle health in healthy adults. This review points to the importance of screening for muscle health in adults with vascular dysfunction with a view to initiating early nutrition and exercise interventions to ameliorate functional decline over time.

A nationwide study on prevalence and factors associated with dynapenia in older adults: ELSI-Brazil

This study aimed to assess the prevalence and factors associated with dynapenia in a nationally representative sample of Brazilians aged 50 years and older. A cross-sectional study was performed with baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Dynapenia was defined as low muscle strength (< 27kg for men and < 16kg for women). Explanatory variables were sociodemographic characteristics, health conditions, health behaviors and physical performance. Analyses were based on multivariate logistic regression and population attributable fractions. Among the 8,396 participants, the prevalence of dynapenia was 17.2% (16.6% among men and 17.7% among women); for those aged 65 years and older, the prevalence was 28.2% (29.1% and 27.5% among men and women, respectively). Dynapenia was positively associated with age, low gait speed, limitations in performing two or more basic daily activities, falls and self-reported chronic diseases; and negatively associated with education level, physical activity and body mass index (overweight/obese, OR = 0.26). Prevalence of dynapenia is high in Brazilian older adults. Educational skills and physical activity improvement present greater potential to reduce dynapenia in this population.

Kettlebell training in clinical practice: a scoping review

BACKGROUND

A scoping review of scientific literature on the effects of kettlebell training. There are no authoritative guidelines or recommendations for using kettlebells within a primary care setting. Our review objectives were to identify the extent, range and nature of the available evidence, to report on the types of evidence currently available to inform clinical practice, to synthesise key concepts, and identify gaps in the research knowledge base.

METHODS

Following the PRISMA-ScR Checklist, we conducted a search of 10 electronic databases from inception to 1 February 2019. There were no exclusions in searching for publications. A single reviewer screened the literature and abstracted data from relevant publications. Articles were grouped and charted by concepts and themes relevant to primary care, and narratively synthesised. Effect sizes from longitudinal studies were identified or calculated, and randomised controlled trials assessed for methodological quality.

RESULTS

Eight hundred and twenty-nine records were identified to 1 February 2019. Four hundred and ninety-six were screened and 170 assessed for eligibility. Ninety-nine publications met the inclusion criteria. Effect sizes were typically trivial to small. One trial used a pragmatic hardstyle training program among healthy college-age participants. Two trials reported the effects of kettlebell training in clinical conditions. Thirty-three studies explicitly used 'hardstyle' techniques and 4 investigated kettlebell sport. Also included were 6 reviews, 22 clinical/expert opinions and 3 case reports of injury. Two reviewers independently evaluated studies using a modified Downs & Black checklist.

CONCLUSIONS

A small number of longitudinal studies, which are largely underpowered and of low methodological quality, provide the evidence-informed therapist with little guidance to inform the therapeutic prescription of kettlebells within primary care. Confidence in reported effects is low to very low. The strength of recommendation for kettlebell training improving measures of physical function is weak, based on the current body of literature. Further research on reported effects is warranted, with inclusion of clinical populations and investigations of musculoskeletal conditions common to primary care. There is a need for an externally valid, standardised approach to the training and testing of kettlebell interventions, which better informs the therapeutic use of kettlebells in primary care.

Examining the association between vestibular function and lower extremity circumference in an aged population

AIM

To explore the association between vestibular dysfunction and specific anthropometric parameters.

METHODS

The results from 2420 participants of the 1999-2004 National Health and Nutrition Examination Survey were included for the evaluation of vestibular dysfunction using the Romberg test of standing balance and anthropometric measurements, including waist circumference, thigh circumference, calf circumference (CC), waist-to-thigh ratio (WTR) and waist-to-calf ratio (WCR). Passing the balance test was defined as participants keeping their balance for 30 s while in the standing position with their eyes closed. Multivariable logistic regression models were the main statistical tools in the present study.

RESULTS

The mean age of the participants was approximately 65 years, and half of the study participants were men. The full adjusted odds ratio of vestibular dysfunction for the CC, thigh circumference, WCR and WTR was 0.941 (95% confidence interval [CI], 0.894-0.992), 0.948 (95% CI 0.912-0.986), 1.856 (95% CI 1.087-3.170) and 2.516 (95% CI 1.235-5.126), respectively. Higher waist circumference along with lower thigh circumference and CC were observed in the participants in the higher WTR and WCR quartiles. Furthermore, a dose-response relationship between vestibular dysfunction and anthropometric ratios was detected.

DISCUSSION

The present study showed that individuals with lower CC and thigh circumference or higher WCR and WTR exhibited higher odds of having vestibular dysfunction. Geriatr Gerontol Int 2019; 19: 622-627.

Definition of Respiratory Sarcopenia With Peak Expiratory Flow Rate

OBJECTIVES

Respiratory muscle strength decreases with advancing age, and respiratory muscle dysfunction may indicate respiratory sarcopenia. However, there is no consensus regarding the definition of respiratory sarcopenia. We aimed to create a definition of respiratory sarcopenia based on the peak expiratory flow rate (PEFR).

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Community-based study including 681 community-dwelling older people.

METHODS

Body composition, spirometry, grip strength, and walking speed were measured. Participants reported comorbidities and long-term insurance certification. Conventional sarcopenia was defined using skeletal muscle mass, grip strength, and walking speed adjusted for the Japanese population. Receiver operating characteristic (ROC) curve analysis of the cut-off values of PEFR for conventional sarcopenia and long-term care insurance certification were performed for both sexes without airway obstruction. In the ROC curve analysis, potential cut-off values were lowest quartile, lowest quintiles, and the standard deviation of PEFR. Multiple logistic regression analysis was performed with respiratory sarcopenia as a dependent variable defined by each cut-off value and other variants as independent variables.

RESULTS

The ROC curve analysis for conventional sarcopenia and long-term care insurance certification showed significance for both sexes, and we determined cut-off values from those results. The multiple logistic regression model using PEFR values 1 standard deviation below the mean had the highest accuracy; thus, we accepted these cut-off values (4.40 L/s for men, 3.21 L/s for women) for the definition of respiratory sarcopenia.

CONCLUSIONS/IMPLICATIONS

The definition of respiratory sarcopenia based on PEFR was useful and correlated with conventional sarcopenia and long-term care insurance certification among community-dwelling older people. In this study, respiratory sarcopenia was determined by PEFR alone. Other parameters may need to be considered.

Analysis of bone mass and its relationship with body composition in school-aged children and adolescents based on stage of puberty and site specificity: A retrospective case-control study

The aim of this study was to better understand the relationship of bone mass with body composition based on different stages of puberty and to illuminate the contribution of site-specific fat mass and lean mass (FM and LM) compared with bone mass in school-aged children and adolescents in Chongqing, China.A total of 1179 healthy subjects of both sexes were recruited. Bone mineral content (BMC), bone mineral density (BMD), bone area, and both FM and LM were measured by dual-energy X-ray absorptiometry (DXA). The fat mass and lean mass indexes (FMI and LMI, respectively) were calculated as the FM (kg) and LM (kg) divided by the height in meters squared, respectively.Most of the bone mass indicators were significantly higher for postpubertal boys than for girls at the same stage (P < .001). The proportion of subjects with normal bone mass increased, while the proportion of subjects with osteopenia and osteoporosis decreased with increased body weight regardless of gender and puberty stage (P < .01). FM and LM were significantly positively related to bone mass regardless of gender and puberty stage (P < .0001). FMI and LMI were significantly positively related to bone mass in most conditions (P < .05 and P < .0001, respectively). Four components of the FM and LM were linearly and significantly associated with BMD and BMC for TB and TBHL. Among them, the head fat mass and head lean mass showed the greatest statistical contribution.In the process of assessing bone status, we recommend measuring fat and lean masses, including the fat and lean masses of the head.

Vitamin D supplementation and muscle strength in pre-sarcopenic elderly Lebanese people: a randomized controlled trial

Previous studies have shown that improving vitamin D status among the elderly may lead to an improvement in muscle mass and muscle strength. In our study, vitamin D supplementation showed significant improvements in vitamin D concentrations as well as appendicular muscle mass in pre-sarcopenic older Lebanese people. However, we found no significant effect on muscle strength.

INTRODUCTION

Improving vitamin D status might improve muscle function and muscle mass that lead to sarcopenia in older subjects. The aim of this randomized, controlled, double-blind study was to examine the effect of vitamin D supplementation on handgrip strength and appendicular skeletal muscle mass in pre-sarcopenic older Lebanese subjects. We also examined whether this effect differs in normal vs. obese subjects.

METHODS

Participants (n = 128; 62 men and 66 women) deficient in vitamin D (25(OH)D = 12.92 ± 4.3 ng/ml) were recruited from Saint Charles Hospital, Beirut, Lebanon. The participants were given a supplement of 10,000 IU of cholecalciferol (vitamin D group; n = 64) to be taken three times a week or a placebo tablet (placebo group; n = 64) for 6 months. One hundred fifteen subjects completed the study: 59 had normal weight, while 56 were obese. Strength and functional assessment and biochemical analysis were performed at the start and after 6 months.

RESULTS

Compared to placebo, the vitamin D supplemented group showed significant improvements in appendicular skeletal muscle mass (ASMM) (P < 0.001) but not in handgrip strength (P = 0.2901). ANCOVA for ASMM adjusting for obesity and including the interaction between obesity and vitamin D showed a significant interaction. The increase in ASMM with vitamin D in normal-weight subjects was higher than that of obese subjects (B = 35.09 vs. B = 2.19).

CONCLUSION

Treatment with vitamin D showed beneficial effects on appendicular muscle mass in pre-sarcopenic older Lebanese men and women. However, it had no effect on muscle strength relative to placebo. This trial was registered at isrctn.org as ISRCTN16665940.

Functional resistance training can increase strength, knee torque ratio, and functional performance in elderly women

Functional resistance training can increase strength, knee torque ratio, and functional performance in elderly women. The aim of the present study was to understand the effects of closed kinetic chain exercises with constant load on muscular strength, the knee torque conventional ratio (hamstring:quadriceps - H:Q), and functional capacity in the elderly. Nine untrained healthy elderly women participated in experimental resistance training. Ten-repetition maximum (10RM) for the deadlift, isokinetic maximum voluntary concentric contraction, and functional capacity were assessed before and after the 7-week resistance-training program. Magnitude based inference analysis was used to examine the differences in muscle strength and functional performance. Therefore, the smallest worthwhile change was calculated and 90% confidence intervals were also determined to characterize muscle strength and functional performance. The analysis demonstrated an increase in the deadlift and knee flexor torque (60o/sec) after the experimental intervention. Furthermore, stair ascent, knee extensor torque (120o/sec), knee flexor torque (120o/sec), and knee ratio (60o/sec) also presented a positive effect in the same training period. Conversely, knee extensor torque (60o/sec), and knee ratio (120o/sec) did not show conclusive responses. In conclusion, resistance training with functional closed kinetic chain exercises and constant volume load (i.e., 65% of 1-repetition maximum) can increase deadlift 10RM, isokinetic concentric torque, the conventional H:Q ratio, and stair ascent performance in elderly women.

Musculoskeletal health of Indigenous Australians

INTRODUCTION

Research on non-communicable diseases (NCD) in Indigenous Australians has mostly focused on diabetes mellitus and chronic kidney or cardiovascular disease. Osteoporosis, characterised by low bone mass and structural deterioration of bone tissue, and sarcopenia, the age-related loss of muscle mass and strength, often co-exist with these common NCDs-the combination of which will disproportionately increase bone fragility and fracture risk and negatively influence cortical and trabecular bone. Furthermore, the social gradient of NCDs, including osteoporosis and fracture, is well-documented, meaning that specific population groups are likely to be at greater risk of poorer health outcomes: Indigenous Australians are one such group.

PURPOSE

This review summarises the findings reported in the literature regarding the muscle and bone health of Indigenous Australians.

FINDINGS

There are limited data regarding the musculoskeletal health of Indigenous Australians; however, areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) is reported to be greater at the hip compared to non-Indigenous Australians. Falls are the leading cause of injury-related hospitalisations in older Australians, particularly Indigenous Australians, with a great proportion suffering from fall-related fractures. Despite sparse data, it appears that Indigenous men and women have a substantially higher risk of hip fracture at a much younger age compared to non-Indigenous Australians.

CONCLUSION

Data on more detailed musculoskeletal health outcomes are required in Indigenous Australians to better understand fracture risk and to formulate evidence-based strategies for fracture prevention and to minimise the risk of falls.

The obesity paradox and osteoporosis

Overweight and obesity according to the definition of the WHO are considered as an abnormal or excessive fat accumulation that may impair health. Studies comparing fracture incidence in obese and non-obese individuals have demonstrated that obesity, defined on the basis of body mass index (BMI), is associated with increased risk of fracture at some sites but seems to be protective at others. The results of the studies are influenced by the distribution of BMI in the population studied; for example, in cohorts with a low prevalence of obesity, a predilection for certain fracture sites in obese individuals becomes difficult to detect, whereas, in populations with a high prevalence of obesity, previously unreported associations may emerge. Furthermore, obesity can bring with itself many complications (Type 2 diabetes mellitus, vitamin D deficiency, and motor disability) which, in the long run, can have a definite influence in terms of overall risk and quality of life, as well. This is a narrative review focusing on the relationship between bone metabolism and overweight/obesity and dealing with the fundamental dilemma of a disease (obesity) apparently associated with improved values of bone mineral density, part of a complicated relationship which revolves around obesity called "the obesity paradox".

Assistive technologies to overcome sarcopenia in ageing

Sarcopenia is an age-related decline in skeletal muscle mass and function that results in disability and loss of independence. It affects up to 30% of older adults. Exercise (particularly progressive resistance training) and nutrition are key strategies in preventing and reversing declines in muscle mass, strength and power during ageing, but many sarcopenic older adults fail to meet recommended levels of both physical activity and dietary nutrient intake. Assistive technology (AT) describes devices or systems used to maintain or improve physical functioning. These may help sarcopenic older adults to maintain independence, and also to achieve adequate physical activity and nutrition. There is a paucity of research exploring the use of AT in sarcopenic patients, but there is evidence that AT, including walking aids, may reduce functional decline in other populations with disability. Newer technologies, such as interactive and virtual reality games, as well as wearable devices and smartphone applications, smart homes, 3D printed foods, exoskeletons and robotics, and neuromuscular electrical stimulation also hold promise for improving engagement in physical activity and nutrition behaviours to prevent further functional declines. While AT may be beneficial for sarcopenic patients, clinicians should be aware of its potential limitations. In particular, there are high rates of patient abandonment of AT, which may be minimised by appropriate training and monitoring of use. Clinicians should preferentially prescribe AT devices which promote physical activity. Further research is required in sarcopenic populations to identify strategies for effective use of current and emerging AT devices.

Associations of sarcopenic obesity with the metabolic syndrome and insulin resistance over five years in older men: The Concord Health and Ageing in Men Project

PURPOSE

Previous cross-sectional studies investigating associations of sarcopenic obesity with metabolic syndrome (MetS) and insulin resistance have not utilised consensus definitions of sarcopenia. We aimed to determine associations of sarcopenic obesity with MetS and insulin resistance over five years in community-dwelling older men.

METHODS

1231 men aged ≥70 years had appendicular lean mass (ALM) and body fat percentage assessed by dual-energy X-ray absorptiometry and hand grip strength and gait speed tests. Sarcopenia was defined as low ALM/height (m²) and low hand grip strength or gait speed (European Working Group definition); obesity was defined as body fat percentage ≥30%. MetS was assessed at baseline and 5-years later. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was assessed at 5-years only.

RESULTS

Men with sarcopenic obesity (odds ratio, 95% CI: 2.07, 1.21-3.55) and non-sarcopenic obesity (4.19, 3.16-5.57) had higher MetS likelihood than those with non-sarcopenic non-obesity at baseline. Higher gait speed predicted lower odds for prevalent MetS (0.45, 0.21-0.96 per m/s). Higher body fat predicted increased odds for prevalent and incident MetS (1.14, 1.11-1.17 and 1.11, 1.02-1.20 per kg, respectively) and deleterious 5-year changes in MetS fasting glucose, high-density lipoprotein cholesterol and triglycerides (all P < 0.05). Compared with non-sarcopenic non-obesity, estimated marginal means for HOMA-IR at 5-years were higher in non-sarcopenic obesity only (1.0, 0.8-1.1 vs 1.3, 1.2-1.5; P < 0.001). Similar results were observed when sarcopenic obesity was defined by waist circumference.

CONCLUSIONS

Sarcopenic obesity does not appear to confer greater risk for incident MetS or insulin resistance than obesity alone in community-dwelling older men.

Is elevated body mass index protective against cervical spine injury in adults?

PURPOSE

Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma.

MATERIALS AND METHODS

Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period.

RESULTS

A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18-25) patients, 6.2% for overweight/obese (BMI 25-35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18-25 as a reference group, females with BMI > 25-35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41-0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26-0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12-4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46-0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups.

CONCLUSION

An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.

Physical Therapy Considerations for Chronic Kidney Disease and Secondary Sarcopenia

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance. Given the consequences of both low muscle mass and low bone mineral density, appropriate and timely physical therapy is important for fall risk assessment and intervention to minimize the susceptibility to bone fracture. While strength training has been studied less frequently than aerobic training for the management of secondary CKD conditions, evidence suggests that this patient population benefits from participation in strength training programs. However, the provision of a formal exercise prescription by a health care professional, along with formal implementation of an exercise program, may need to be more fully integrated into the standard plan of care for individuals with CKD.