A path model of sarcopenia on bone mass loss in elderly subjects

Sarcopenia: recent advances for detection, progression, and metabolic alterations along with therapeutic targets

Sarcopenia, a disorder marked by muscle loss and dysfunction, is a global health concern, particularly in aging populations. Sarcopenia is intricately related to various health conditions, including obesity, dysphagia, and frailty, which underscores the complexity. Despite recent advances in metabolomics and other omics data for early detection and treatment, the precise characterization and diagnosis of sarcopenia remains challenging. In the present review we provide an overview of the complex metabolic mechanisms that underlie sarcopenia, with particular emphasis on protein, lipid, carbohydrate, and bone metabolism. The review highlights the importance of leucine and other amino acids in promoting muscle protein synthesis and clarifies the critical role played by amino acid metabolism in preserving muscular health. In addition, the review provides insights regarding lipid metabolism on sarcopenia, with an emphasis on the effects of inflammation and insulin resistance. The development of sarcopenia is largely influenced by insulin resistance, especially with regard to glucose metabolism. Overall, the review emphasizes the complex relationship between bone and muscle health by highlighting the interaction between sarcopenia and bone metabolism. Furthermore, the review outlines various therapeutic approaches and potential biomarkers for diagnosing sarcopenia. These include pharmacological strategies such as hormone replacement therapy and anabolic steroids as well as lifestyle modifications such as exercise, nutrition, and dietary changes.

The association of lipid metabolism and sarcopenia among older patients: a cross-sectional study

Sarcopenia has become a heavy disease burden among the elderly. Lipid metabolism was reported to be involved in many degenerative diseases. This study aims to investigate the association between dysregulated lipid metabolism and sarcopenia in geriatric inpatients. This cross-sectional study included 303 patients aged ≥ 60, of which 151 were diagnosed with sarcopenia. The level of total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), homocysteine (HCY), BMI, and fat percentage, were compared between sarcopenia and non-sarcopenia patients. The Spearman correlation coefficient was used to estimate the association between sarcopenia and the level of lipid metabolism. To determine risk factors related to sarcopenia, a multivariate logistic regression analysis was carried out. Risk prediction models were constructed based on all possible data through principal component analysis (PCA), Logistic Regression (LR), Support Vector Machine (SVM), k-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGboost). We observed rising prevalence of sarcopenia with increasing age, decreasing BMI, and fat percentage (p < 0.001, Cochran Armitage test). Multivariate logistic regression analysis revealed sarcopenia's risk factors, including older age, male sex, lower levels of BMI, TC, and TG, and higher levels of LDL and HCY (p < 0.05). The sarcopenia risk prediction model showed the risk prediction value of sarcopenia, with the highest area under the receiver operating curve (AUC) of 0.775. Our study provided thorough insight into the risk factors associated with sarcopenia. It demonstrated that an increase in lipid metabolism-related parameters (BMI, TG, TC), within normal reference ranges, may be protective against sarcopenia. The present study can illuminate the direction and significance of lipid metabolism-related factors in preventing sarcopenia.

The effects of community-based exercise modalities and volume on musculoskeletal health and functions in elderly people

The effects of different muscle loading exercise (MLEX) modes and volume on musculoskeletal health is not well-studied in older populations. Aim: Therefore, this study aimed to compare the effects of community-based MLEX modalities and volume on musculoskeletal health in elderly people. Methods: Elderly men (n = 86) and women (n = 170), age 50-82 years old, were assigned to the sedentary (SE, n = 60), muscle strengthening exercise (MSE, n = 71), aerobic exercise (AE, n = 62) and Tai Chi exercise (TCE, n = 63) groups, based on > 2 years of exercise history. Exercise volume was compared between "Minimum" ("Min" < 60 min/week), "Low" (60-120 min/week). "Moderate" (121-239 min/week) and "High" (240-720 min/week) volumes. Results: All three modes of MLEX were associated with lower percentage of body fat (BF%) and higher percentage of lean body mass (LBM%, p = 0.003 main effect of group, and p = 0.002 main effect of volume for both BF% and LBM%), but not with higher bone mineral density (BMD, total body, lumbar spine, total hip and neck of femur), than SE. TCE had a distinct advantage in trunk flexibility (p = 0.007 with MSE, p = 0.02 with AE, and p = 0.01 with SE), and both TCE (p = 0.03) and AE (p = 0.03) performed better than SE in the one-leg stand balance test. Isometric strength and throwing speed and peak power with a 2 kg power ball were higher in the MLEX than SE groups (p = 0.01), in the ranking order of MSE, AE and TCE. However, there was no difference in handgrip strength performance between the MLEX groups, which performed better than the SE participants. Accumulating >120 min/week of MLEX can promote body composition health and muscle functions, but 60 min/week of MSE alone may have equal or better outcomes in these parameters. Conclusion: Community-based MLEX classes may be used to mitigate age-related chronic disease that are associated with body composition and muscular functions.

Discovering the Physio-Pathological Mechanisms of Interaction between Bone Mineral Density, Muscle Mass, and Visceral Adipose Tissue in Female Older Adults through Structural Equation Modeling

This study aims to examine the relation between visceral adipose tissue (VAT), as a proxy for metabolically unhealthy obesity, muscle, as a proxy for muscle quality and sarcopenia, and bone, as a proxy for bone mineral density and osteoporosis. Other variables, such metabolic syndrome, nutritional status, number of diseases, kidney and liver function and inflammation were assessed as direct or indirect effects. This study used structural equation modeling (SEM) in a sample of 713 older women (mean age 82.1 ± 6.3). The results indicate a positive statistically significant association between bone and muscle mass (β = 0.195, <0.001) and nutritional status and muscle mass (β = 0.139, p < 0.001), but negative association between age with muscle mass (β = −0.509, p < 0.001) and nutritional status (estimates: −2.264, p < 0.001). A negative association between VAT and muscle mass was also reported (β = −1.88, p < 0.001). A negative statistically significant association was reported between bone mineral density and functional status (β = −1.081, p < 0.001), and a positive association between functional status and muscle mass (β = 9.000, p < 0.001). In addition, functional status was positively statistically associated with cognitive performance (β = 0.032, p < 0.001). The SEM method demonstrates that the VAT, muscle mass and bone mineral density are associated, but the form of the relation is different in relation to different factors, such as nutritional status, mental and functional status, age, and number of pathologies, having different impacts on metabolic outcomes. SEM is a feasible technique for understanding the complex mechanisms of frailty in the elderly.

The Role of Sympathetic Nerves in Osteoporosis: A Narrative Review

Osteoporosis, a systemic bone disease, is characterized by decreased bone density due to various reasons, destructed bone microstructure, and increased bone fragility. The incidence of osteoporosis is very high among the elderly, and patients with osteoporosis are prone to suffer from spine fractures and hip fractures, which cause great harm to patients. Meanwhile, osteoporosis is mainly treated with anti-osteoporosis drugs that have side effects. Therefore, the development of new treatment modalities has a significant clinical impact. Sympathetic nerves play an important role in various physiological activities and the regulation of osteoporosis as well. Therefore, the role of sympathetic nerves in osteoporosis was reviewed, aiming to provide information for future targeting of sympathetic nerves in osteoporosis.

Association between Osteoporosis and Meniere's Disease: Two Longitudinal Follow-Up Cohort Studies

A high rate of Meniere's disease (MD) in patients with osteoporosis has been suggested. This research intended to estimate the bidirectional association of MD with osteoporosis. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort 2002-2019 was examined. In study I, 9529 patients with MD and 38,116 control I participants were analyzed for a previous history of osteoporosis. In study II, 65,858 patients with osteoporosis and 65,858 control II participants were analyzed for a previous history of MD. Stratified Cox proportional hazard models were applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MD for osteoporosis in study I and of osteoporosis for MD in study II. The rate of a prior history of osteoporosis was 13.3% for the MD group and 11.3% for the control I group. The patients with MD had a 1.12 times higher HR for previous osteoporosis (95% CI = 1.04-1.20). In study II, the rate or a prior history of MD was 3.7% for patients with osteoporosis and 2.0% for the control II group. The patients with osteoporosis had a 1.50 times higher HR for previous MD (95% CI = 1.40-1.61). Most subgroups according to age, sex, and comorbid conditions demonstrated consistent bidirectional associations between MD and osteoporosis. Adult patients with MD had a greater risk of osteoporosis. In addition, adult patients with osteoporosis also showed a higher risk of MD.

The prevalence and risk factors of sarcopenia in rheumatoid arthritis patients: A systematic review and meta-regression analysis

BACKGROUND

Sarcopenia is an ever-increasingly recognized entity in aging or chronically-ill individuals. A recent surge of researches came out on sarcopenia in rheumatoid arthritis (RA). However, the results varied widely. We tried to assess the prevalence of and associated factors with sarcopenia in patients with RA.

METHODS

We searched the investigations dealing with the prevalence of and associated factors with sarcopenia in RA from PubMed, EMBASE, CENTRAL, EBSCOhost, Airiti Library, CEPS, CNKI and J-STAGE from the inception to January 11, 2020. Effects regarding prevalence and associated factors were extracted and evaluated by random-effects model. Sensitivity analysis was also performed.

RESULTS

Seventeen studies containing 3,140 RA subjects were identified. After exclusion of outliers, the pooled prevalence of sarcopenia was 31%. Neither ongoing-study districts nor diagnostic modalities affected prevalence significantly. Any associated factors being mentioned in at least two publications were analyzed, yielding functional limitation (Steinbrocker stage III/IV), high CRP and RF seropositivity as the significant risk factors. Based on disease durations, we carried out meta-regression and found DAS28 and HAQ are predictive models. There was no alteration in the interpretation of results from sensitivity analysis after removal of any studies skewed in sampling distribution.

CONCLUSIONS

The prevalence of sarcopenia in patients with RA is high, compared to that in general counterparts. Disease duration rather than age, residing area or diagnostic modalities influences sarcopenia development; DAS28 and HAQ predict occurrence. High index of suspicion to facilitate early detection of sarcopenia in RA patients is important.

Creatinine to Cystatin C Ratio as a Marker of Bone Property in Older Adults: The J-SHIPP Study

OBJECTIVES

To clarify whether serum creatinine to cystatin C ratio (CCR), a marker of muscle mass and muscle function may be used as a simple marker of bone property.

DESIGN

A cross-sectional analysis.

SETTING

A general population-based observation study.

PARTICIPANTS

1,606 middle-aged to elderly (≥50 years, mean age: 66.9 ± 7.5 years old) men (n = 642) and post-menopausal women (n = 964).

MEASUREMENT

Speed of sound (SOS) at the calcaneal bone was used as a surrogate marker of bone mineral density. The cross-sectional area of the muscle at the mid-thigh was measured using computed tomography.

RESULTS

There was significant linear correlation between the quartiles of CCR and SOS (Q1: 1,495 ± 25, Q2: 1,499 ± 24, Q3: 1,507 ± 26, Q4: 1,511 ± 25 m/sec; P < 0.001) even in a sex-separated analysis. This association was independent of major covariates (Q1: β = -0.126, P < 0.001; Q2: β = -0.096, P = 0.001; Q3: β = -0.022; P = 0.412, Q4: reference) and the mid-thigh muscle mass, while creatinine alone or eGFR did not show clear association with SOS.

CONCLUSION

The CCR may be used as a simple marker of bone property independently of muscle mass in a general population with preserved renal function.

Bone mineral density and trabecular bone score in Chinese subjects with sarcopenia

Background

As the general population is aging worldwide, the incidence of sarcopenia and osteoporosis is also rapidly increasing. Studies have found the link between sarcopenia and osteoporosis, but the relationship between sarcopenia and osteoporosis, especially bone microarchitecture, remains unclear.

Aims

To investigate the relationship between components of sarcopenia (muscle mass, handgrip strength, and gait speed) and components of osteoporosis [bone mass measured by bone mineral density (BMD) and bone microarchitecture measured by trabecular bone score (TBS)] in Chinese subjects.

Methods

318 Chinese men and 203 Chinese women were included in our study. Muscle mass and BMD were measured by dual-energy X-ray absorptiometry (DXA). TBS iNsight^® software was used for TBS. Jamar hydraulic hand dynamometer was used to assess muscle strength, and gait speed was used to assess physical performance.

Results

We found that the relative appendicular skeletal muscle mass (RASM) in both genders and handgrip strength in women correlated positively with TBS, RASM in men and handgrip strength in women correlated positively with BMDs. In the multiple linear regression model, RASM was positively associated with TBS in both genders, but no significant association was observed between RASM and BMDs. Interestingly, handgrip strength showed positive association with all evaluated BMDs and TBS in women, but not in men. Women with sarcopenia had lower TBS and BMDs at all evaluated sites. Men with sarcopenia had lower BMDs only at femur neck and total hip.

Conclusions

The reduction of muscle mass and strength was significantly associated with decreased bone mass and deteriorated bone microarchitecture. More importantly, low muscle mass is an independent risk factor for bone microarchitecture in Chinese subjects.

Osteosarcopenic Visceral Obesity and Osteosarcopenic Subcutaneous Obesity, Two New Phenotypes of Sarcopenia: Prevalence, Metabolic Profile, and Risk Factors

Background

The main criticism of the definition of “osteosarcopenic obesity” (OSO) is the lack of division between subcutaneous and visceral fat. This study describes the prevalence, metabolic profile, and risk factors of two new phenotypes of sarcopenia: osteosarcopenic visceral obesity (OSVAT) and osteosarcopenic subcutaneous obesity (OSSAT).

Methods

A standardized geriatric assessment was performed by anthropometric and biochemical measures. Dual-energy X-ray absorptiometry (DXA) was used to assess body composition, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), osteoporosis, and sarcopenia.

Results

A sample of 801 subjects were assessed (247 men; 554 women). The prevalence of osteosarcopenic obesity (OSO) was 6.79%; OSSAT and OSOVAT were, respectively, 2.22% and 4.56%. OSVAT (versus the others) showed a higher level of inflammation (CRP and ESR, p < 0.05), bilirubin (p < 0.05), and risk of fractures (FRAX index over 15%, p < 0.001). Subjects with OSSAT did not show any significant risk factors associated to obesity.

Conclusions

The osteosarcopenic visceral obesity phenotype (OSVAT) seems to be associated with a higher risk of fractures, inflammation, and a worse metabolic profile. These conditions in OSVAT cohort are associated with an increase of visceral adipose tissue, while patients with OSSAT seem to benefit related to the “obesity paradox”.

Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review" found on pages 33-41, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the geriatric syndrome of sarcopenia. 2. Identify the outcome of the sarcopenia studies. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Sarcopenia is an important geriatric syndrome with high prevalence rates and one of the most common causes of reductions in mobility, quality of life, and increasing dependency on care. The current study examined the relationship between sarcopenia and nutritional status in adults 60 and older. A systematic literature search was conducted, and data from 33 publications were included. The currently available literature indicates that sarcopenia is correlated with poor nutritional status (e.g., low body mass index, unfavorable nutritional risk screening results, decreased nutritional laboratory parameters, anorexia). Comparison of the studies' results were complicated by the lack of a generally accepted definition for sarcopenia, as well as the use of many different instruments to detect sarcopenia. The co-occurrence of malnutrition and sarcopenia is of great relevance. Future scientific work should focus on the formation of consistent definitions and instruments for the detection of sarcopenia to improve data comparisons. [Journal of Gerontological Nursing, 42(7), 33-41.].

Sarcopenia and sarcopenic obesity in comparison: prevalence, metabolic profile, and key differences. A cross-sectional study in Italian hospitalized elderly

BACKGROUND

The aim of this study is to identify the prevalence, assess the metabolic profile, and key differences (versus healthy) in a cohort of subjects with sarcopenia (S) and in sarcopenic obesity (SO) hospitalized elderly.

METHODS

A standardized comprehensive geriatric assessment was performed. We enrolled 639 elderly subjects (196 men, 443 women) with a mean age of 80.90 ± 7.77 years. Analysis of variance and a multinomial logistic regression analysis adjusting for covariates were used to assess the differences between groups.

RESULTS

The prevalence of (S) was 12.42% in women and 23.47% in men. (SO) was 8.13% in women and 22.45% in men. Data showed that either groups had a functional impairment (Barthel index < 50 points). (S) had the mean value of erythrocyte sedimentation rate (ESR) (>15 mm/h), CPR (>0.50 mg/dl) homocysteine (>12 micromol/l), and hemoglobin (<12 g/dl). Ferritin level over the range (>145 mcg/dl) was detected in either cohort (due to inflammation). (SO) had glycemia (>110 mg/dl). Key differences in (S) cohort (versus healthy) were a reduction in functional impairment (p < 0.001), an increase in white blood cell (p < 0.01), a decrease in iron level (p < 0.05), in electrolytes balance (Na: p < 0.01 and Cl: p < 0.01), and tyroid function (TSH: p < 0.001). In addition, (S) had higher state of inflammation (erythrocyte sedimentation rate: p < 0.05 and C-reactive protein: p < 0.01), and an increase of risk of fractures (FRAX: OR 1.07; p < 0.001), risk of malnutrition (mini nutritional assessment: p < 0.001), and risk of edema (extra cellular water: p < 0.001). In (SO) cohort, an increase in white blood cell (p < 0.001) and erythrocyte sedimentation rate (p < 0.05) was observed.

CONCLUSIONS

(S) subjects appears more vulnerable than (SO). Sarcopenia is closely linked to an increase in the risk of hip-femur fractures, inflammation, edema, and malnutrition. The (SO) subjects seem to benefit from the "obesity paradox."

Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review

Background

Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. The aim of this systematic review is to gather all the relevant studies that measured HGS to diagnose sarcopenia and frailty and to identify the differences between the protocols used.

Methods

A systematic review was carried out following the recommendations of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed and Web of Science were systematically searched, until August 16, 2016. The evidence regarding HGS measurement protocols used to diagnose sarcopenia and frailty was summarised and the most recent protocols regarding the procedure were compared.

Results

From the described search 4393 articles were identified. Seventy-two studies were included in this systematic review, in which 37 referred to sarcopenia articles, 33 to frailty and two evaluated both conditions. Most studies presented limited information regarding the protocols used.

Conclusions

The majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.

Beyond Body Mass Index. Is the Body Cell Mass Index (BCMI) a useful prognostic factor to describe nutritional, inflammation and muscle mass status in hospitalized elderly?: Body Cell Mass Index links in elderly

BACKGROUND & AIM

The aim of this study was to establish the effectiveness of Body Cell Mass Index (BCMI) as a prognostic index of (mal)nutrition, inflammation and muscle mass status in the elderly.

METHODS

A cross-sectional observational study has been conducted on 114 elderly patients (80 women and 34 men), with mean age equal to 81.07 ± 6.18 years. We performed a multivariate regression model by Structural Equation Modelling (SEM) framework. We detected the effects over a Mini Nutritional Assessment (MNA) stratification, by performing a multi-group multivariate regression model (via SEM) in two MNA nutritional strata, less and bigger (or equal) than 17.

RESULTS

BCMI had a significant effect on albumin (β = +0.062, P = 0.001), adjusting for the other predictors of the model as Body Mass Index (BMI), age, sex, fat mass and cognitive condition. An analogous result is maintained in MNA<17 stratum. BMI has confirmed to be a solid prognostic factor for both free fat mass (FFM) (β = +0.480, P < 0.001) and Skeletal Muscle Index (SMI) (β = +0.265, P < 0.001), assessed by DXA. BCMI also returned suggestive evidences (0.05 < P < 0.10) for both the effect on FFM and on SMI in overall sample.

CONCLUSIONS

The main result of this study is that the BCMI, compared to BMI, proved to be significantly related to an important marker as albumin in geriatric population. Then, assessing the BCMI could be a valuable, inexpensive, easy to perform tool to investigate the inflammation status of elderly patients.

Osteosarcopenic obesity in women: impact, prevalence, and management challenges

Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs.

Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools

BACKGROUND

The aim of this study was to evaluate the performance of Edmonton Frail Scale (EFS) on frailty assessment in association with multi-dimensional conditions assessed with specific screening tools and to explore the prevalence of frailty by gender.

METHODS

We enrolled 366 hospitalised patients (women\men: 251\115), mean age 81.5 years. The EFS was given to the patients to evaluate their frailty. Then we collected data concerning cognitive status through Mini-Mental State Examination (MMSE), health status (evaluated with the number of diseases), functional independence (Barthel Index and Activities Daily Living; BI, ADL, IADL), use of drugs (counting of drugs taken every day), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), Skeletal Muscle Index of sarcopenia (SMI), osteoporosis and functionality (Handgrip strength).

RESULTS

According with the EFS, the 19.7% of subjects were classified as non frail, 66.4% as apparently vulnerable and 13.9% with severe frailty. The EFS scores were associated with cognition (MMSE: β = 0.980; p < 0.01), functional independence (ADL: β = -0.512; p < 0.00); (IADL: β = -0.338; p < 0.01); use of medications (β = 0.110; p < 0.01); nutrition (MNA: β = -0.413; p < 0.01); mood (GDS: β = -0.324; p < 0.01); functional performance (Handgrip: β = -0.114, p < 0.01) (BI: β = -0.037; p < 0.01), but not with number of comorbidities (β = 0.108; p = 0.052). In osteoporotic patients versus not-osteoporotic patients the mean EFS score did not differ between groups (women: p = 0.365; men: p = 0.088), whereas in Sarcopenic versus not-Sarcopenic patients, there was a significant differences in women: p < 0.05.

CONCLUSIONS

This study suggests that measuring frailty with EFS is helpful and performance tool for stratifying the state of fragility in a group of institutionalized elderly. As matter of facts the EFS has been shown to be associated with several geriatric conditions such independence, drugs assumption, mood, mental, functional and nutritional status.

Sex-specific differences in risk factors for sarcopenia amongst community-dwelling older adults

With considerable variation including potential sex-specific differential rate of skeletal muscle loss, identifying modifiable factors for sarcopenia will be pivotal to guide targeted interventions. This study seeks to identify clinical and biological correlates of sarcopenia in community-dwelling older adults, with emphasis on the role of anabolic and catabolic stimuli, and special reference to gender specificity. In this cross-sectional study involving 200 community-dwelling and functionally independent older adults aged ≥50 years, sarcopenia was defined using the Asian Working Group for Sarcopenia criteria. Comorbidities, cognitive and functional performance, physical activity and nutritional status were routinely assessed. Biochemical parameters included haematological indices, lipid panel, vitamin D level, anabolic hormones [insulin-like growth factor-1 (IGF-1), free testosterone (males only)] and catabolic markers [inflammatory markers (interleukin-6, C-reactive protein) and myostatin]. Multiple logistic regression was performed to identify independent predictors for sarcopenia. Age was associated with sarcopenia in both genders. Malnutrition conferred significantly higher odds for sarcopenia in women (OR = 5.71, 95% CI 1.13-28.84.44, p = 0.035) while higher but acceptable range serum triglyceride was protective in men (OR = 0.05, 95% CI 0.00-0.52, p = 0.012). Higher serum myostatin independently associated with higher odds for sarcopenia in men (OR = 1.11, 95% CI 1.00-1.24, p = 0.041). Serum IGF-1 was significantly lower amongst female sarcopenic subjects, with demonstrable trend for protective effect against sarcopenia in multiple regression models, such that each 1 ng/ml increase in IGF-1 was associated with 1% decline in odds of sarcopenia in women (p = 0.095). Our findings support differential pathophysiological mechanisms for sarcopenia that, if corroborated, may have clinical utility in guiding sex-specific targeted interventions for community-dwelling older adults.

Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men

OBJECTIVE

Analyze the influence of sarcopenia in bone health of elderly men.

SUBJECTS AND METHODS

This cross-sectional study evaluated 198 men aged over 60 years. Body composition was measured by dual energy X-ray absorptiometry. The BMD was measured at the femoral neck, total hip, lumbar spine and 33% radius. The diagnosis of abnormal BMD was defined for men who presented densitometric diagnosis of osteopenia or osteoporosis defined by T-score of femoral neck, total hip and lumbar spine. The pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People.

RESULTS

The group diagnosed with normal BMD, compared to the group of abnormal BMD, have significantly higher body weight, body mass index, grip strength, lean mass, fat mass, and relative appendicular skeletal muscle mass (RASM). However, after multiple linear regression analysis, we found that only the RASM, lean mass, and handgrip strength in the dominant hand influenced the variability of the BMD after adjustment for age and weight. Regression analyzes showed a positive association between greater appendicular lean mass and a smaller number of elderly patients with abnormal BMD diagnostic. The regression analyzes showed that elderly men diagnosed with pre-sarcopenia and sarcopenia had more abnormal BMD than non-sarcopenic elderly men.

CONCLUSION

We concluded that pre-sarcopenia and sarcopenia were associated with abnormal BMD. The lean mass, compared to fat mass, has a greater positive influence on the BMD of elderly men. This result suggests the importance of the increase in lean mass for the bone health of elderly men.

Association between muscle mass and adipo-metabolic profile: a cross-sectional study in older subjects

Background

Sarcopenia, the decrease in muscle mass and function, may lead to various negative health outcomes in elderly. The association among sarcopenia with adiposity and metabolic markers has rarely been studied in the elderly population, with controversial results. The aim of this study is to evaluate this relationship in older subjects.

Methods

A cross-sectional study was conducted in 290 elderly patients, focusing on the possible association between muscle mass loss, assessed by relative skeletal muscle mass (RSMM), and an adipo-metabolic profile (AMP) defined by adiposity and metabolic biochemical markers. Measurements of body composition were assessed by dual energy X-ray absorptiometry. Biochemical parameters, such as albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, C-reactive protein, and homocysteine and its related markers (folate and vitamin B12) were measured. Using canonical correlation analysis and structural equation modeling, an individual score of AMP was created and correlated with RSMM.

Results

The AMP–RSMM correlation was equal to +0.642 (95% confidence interval, +0.512 to +0.773; P<0.001). Hence, a negative association between sarcopenia severity and adiposity/metabolic biochemical markers was highlighted.

Conclusion

This study contained a novel way to examine the relationship between the variables of interest based on a composite index of adiposity and metabolic conditions. Results shed light on the orientation and magnitude of adiposity and metabolic markers in preventing muscle mass loss. There might be a protective effect of adiposity, compatible with the “obesity paradox.”