Association between Sarcopenia and Fall Risk According to the Muscle Mass Adjustment Method in Japanese Older Outpatients

Relationship between cardiorespiratory fitness and falls in older adults: A population-based study

AIM

The present study investigated the relationship between cardiorespiratory fitness (CRF) and episodes and severity of falls in older adults.

METHODS

This cross-sectional study drew on data from the Brazilian 2019 National Health Survey. The sample consisted of 18 991 older adults (aged ≥60 years). CRF was obtained through a non-exercise model for estimating VO2max, and the people were classified as low, moderate or high CRF. Logistic and multinomial regression models were used. Odds ratios (ORs) and their respective confidence intervals (95% CIs) were calculated.

RESULTS

Older adults with strong CRF are 29% (OR 0.69, 95% CI 0.52-0.92) less likely to suffer falls than those with poor CRF. High levels of CRF were also associated with non-severe falls. However, no associations were found between CRF and severe falls with fractures and medical intervention.

CONCLUSION

Although good CRF levels can reduce the chance of falls, this protection does not extend to falls with more severe consequences, such as fractures and the need to seek medical care. Geriatr Gerontol Int 2024; ••: ••-••.

Association between self-reported weight loss and new long-term care insurance certifications: A 9-year Japanese older adult cohort study

AIM

This cohort study aimed to assess weight loss associated with new long-term care insurance (LTCI) certifications over a 9-year period, accounting for the competing risk of death.

METHODS

We analyzed data from 3749 Japanese individuals aged ≥65 years in Kami Town, Hyogo Prefecture, Japan. Weight loss was assessed using the Kihon Checklist during the baseline survey. Data regarding LTCI certifications were collected until March 2022. Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) of 9-year LTCI certification because of weight loss, adjusted for confounding factors. To exclude the effect of competing risks, Fine-Gray regression was used to estimate subdistribution HRs. Subgroup analyses were carried out after the examination of potential interactions between subjective cognitive function, body mass index categories and weight loss.

RESULTS

The incidence rate of new LTCI certifications was 5.16 per 100 person-years overall - broken down into 7.02 for those with weight loss and 4.97 for those without. The adjusted HR for weight loss to new LTCI certifications was 1.35 (95% CI 1.15-1.59). Considering mortality as a competing risk, the adjusted subdistribution HR was 1.37 (95% CI 1.16-1.61). Conversely, no interaction was observed between weight loss and subjective cognitive function or body mass index categories.

CONCLUSIONS

Excluding the effect of mortality, weight loss was identified as a risk factor for new LTCI certifications. However, no interaction was observed between weight loss and subjective cognitive function or body mass index categories. Geriatr Gerontol Int 2024; 24: 1320-1327.

Diagnosis of sarcopenic obesity in Japan: Consensus statement of the Japanese Working Group on Sarcopenic Obesity

Sarcopenic obesity is the co-existence of obesity and sarcopenia in individuals aged 40-75 years. The Japanese Working Group on Sarcopenic Obesity has developed diagnostic criteria tailored for the Japanese population, considering their unique characteristics compared with European populations. Our algorithm consists of two steps: screening and diagnosis. The screening of obesity mandates using waist circumference and/or body mass index (BMI) based on national standards, while screening for sarcopenia involves the "finger ring test" in addition to the Asian Working Group for Sarcopenia 2019 criteria. The final diagnosis of sarcopenia involves handgrip strength for low muscle strength, the five-times chair stand test for low physical function, and limb skeletal muscle mass (corrected for BMI) for low muscle mass. Obesity is assessed by visceral fat area or body fat percentage. Sarcopenic obesity is then categorized into Stage I, with muscle weakness/loss of function, loss of muscle mass, and obesity; or Stage II, which includes complications. Further clinical validation is needed to refine the consensus and age range. Geriatr Gerontol Int 2024; 24: 997-1000.

Bidirectional Association between Sarcopenia and Depressive Symptoms among Chinese Middle- and Older-Aged Adults: Longitudinal Observational Study

BACKGROUND

The study aimed to examine the bidirectional relationship between sarcopenia and depressive symptoms in a national, community-based cohort study, despite the unclear temporal sequence demonstrated previously.

METHODS

Data were derived from four waves (2011 baseline and 2013, 2015, and 2018 follow-ups) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 17,708 participants aged 45 years or older who had baseline data on both sarcopenia status and depressive symptoms in 2011 were included in the study. For the two cohort analyses, a total of 8092 adults without depressive symptoms and 11,292 participants without sarcopenia in 2011 were included. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Depressive symptoms were defined as a score of 20 or higher on the 10-item Center for Epidemiologic Studies Depressive Scale (CES-D-10). Cox proportional hazard regression models were conducted to examine the risk of depressive symptoms and sarcopenia risk, while cross-lagged panel models were used to examine the temporal sequence between depressive symptoms and sarcopenia over time.

RESULTS

During a total of 48,305.1 person-years follow-up, 1262 cases of incident depressive symptoms were identified. Sarcopenia exhibited a dose-response relationship with a higher risk of depressive symptoms (HR = 1.7, 95%CI: 1.2-2.3 for sarcopenia, and HR = 1.5, 95%CI: 1.2-1.8 for possible sarcopenia, p trend < 0.001). In the second cohort analysis, 240 incident sarcopenia cases were identified over 39,621.1 person-years. Depressive symptoms (HR = 1.5, 95%CI: 1.2-2.0) are significantly associated with a higher risk of developing sarcopenia after multivariable adjustment (p < 0.001, Cross-lagged panel analyses demonstrated that depressive symptoms were associated with subsequent sarcopenia (β = 0.003, p < 0.001). Simultaneously, baseline sarcopenia was also associated with subsequent depressive symptoms (β = 0.428, p < 0.001).

CONCLUSION

This study identified a bidirectional relationship between depressive symptoms and sarcopenia. It seems more probable that baseline sarcopenia is associated with subsequent depressive symptoms in a stronger pattern than the reverse pathway. The interlinkage indicated that maintaining normal muscle mass and strength may serve as a crucial intervention strategy for alleviating mood disorders.

Epigenetic characterization of sarcopenia-associated genes based on machine learning and network screening

To screen characteristic genes related to sarcopenia by bioinformatics and machine learning, and to verify the accuracy of characteristic genes in the diagnosis of sarcopenia. Download myopia-related data sets from geo public database, find the differential genes through R language limma package after merging, STRING database to build protein interaction network, and do Go analysis and GSEA analysis to understand the functions and molecular signal pathways that may be affected by the differential genes. Further screen the characteristic genes through LASSO and SVM-RFE machine algorithms, make the ROC curve of the characteristic genes, and obtain the AUC value. 10 differential genes were obtained from the data set, including 7 upregulated genes and 3 downregulated genes. Eight characteristic genes were screened by a machine learning algorithm, and the AUC value of characteristic genes exceeded 0.7. In patients with sarcopenia, the expression of TPPP3, C1QA, LGR5, MYH8, and CDKN1A genes are upregulated, and the expression of SLC38A1, SERPINA5, and HOXB2 genes are downregulated. The above genes have high accuracy in the diagnosis of sarcopenia. The research results provide new ideas for the diagnosis and mechanism research of sarcopenia.

Multidisciplinary approach to sarcopenia: a narrative review

Sarcopenia is a condition in which muscle mass and strength are decreased and muscle function is impaired. It is an indicator of frailty and loss of independence in older adults. It is also associated with increased physical disability, which increases the risk of falls. As a multifactorial disease, sarcopenia is caused by a combination of factors including aging, hormonal changes, nutritional deficiencies, and physical inactivity. Understanding the underlying pathophysiology of sarcopenia and identifying its different causes is critical to developing effective prevention and treatment strategies. This review summarizes the pathophysiology, consequences, diagnostic methods, and multidisciplinary approaches to sarcopenia.

TT3, a More Practical Indicator for Evaluating the Relationship Between Sarcopenia and Thyroid Hormone in the Euthyroid Elderly Compared with FT3

BACKGROUND AND AIMS

Sarcopenia is a common disease in the elderly, and the thyroid hormone (TH) might participate in the pathogenesis of sarcopenia. However, the results of previous studies were not completely consistent. We performed this study to investigate the association between THs and sarcopenia in a Chinese elderly euthyroid population.

SUBJECTS AND METHODS

A total of 309 Chinese elderly euthyroid subjects with an average age of 85.19 ± 7.8 years were enrolled. Participants were divided into four groups (non-sarcopenia, possible sarcopenia, sarcopenia and serve sarcopenia) according to the consensus update of AWGS in 2019. Serum levels of TT3, FT3, TT4, FT4, TSH, rT3 and TBG were measured. Muscle mass was measured by multifrequency bioelectrical impedance analysis, hand grip (HG) was represented by spring-type dynamometer, and gait speed (GS) was determined by 6-metre walk test. The FRAIL scale was used to assess frailty.

RESULTS

Compared to the non-sarcopenia group, the sarcopenia group showed a significant increase in age and FRIAL score, while FT3 and TT3 levels decreased significantly. Partial correlation analysis (adjusted by age, gender and the scores of FRIAL scale) indicated that FT3, TT3 and TSH had significant positive correlations with HG, and there also was a significant positive correlation between TT3 and GS. In addition, after adjusting for age, gender, BMI, ALT, sCr, and score on the FRAIL scale, the multivariate linear regression analysis showed that TT3 was positively associated with muscle strength and negatively associated with sarcopenia risk.

CONCLUSION

There is an association between the low TT3 level and sarcopenia. Therefore, maintaining higher T3 concentrations within the normal range appears to be beneficial for sarcopenia in the elderly. In addition, due to the fluctuation of FT3, TT3 is a more stable and practical indicator to evaluate the relationship between sarcopenia and thyroid hormone in the elderly euthyroid population.

Prevalence of Sarcopenia in Older Patients in Rehabilitation Wards

The multidisciplinary assessment of hospitalized patients via validated scales and tools has become crucial in the early identification of sarcopenia. The objective of this study was to determine the prevalence of sarcopenia and its related factors in patients aged ≥65 years admitted to the neurological rehabilitation departments of cognitive motor disorders and functional motor rehabilitation at the IRCCS Hospital San Raffaele in Milan. Using the algorithm reported by the European Working Group on Sarcopenia in Older People (EWGSOP2), the prevalence of sarcopenia in patients was investigated from 2019-2020. Definite sarcopenia was detected in 161 of 336 recruited patients (47.9%). Age was significantly higher in sarcopenic patients than in those without sarcopenia (median 81 vs. 79 years, p < 0.001) and height, weight, and body mass index were lower (p < 0.001 for all). The malnutrition screening test (MUST) was higher but still negative in most sarcopenic patients (47.8% vs. 20.6%, p < 0.001). Patients with sarcopenia had significantly reduced life autonomy (by Barthel index, median 55 vs. 60 points, p < 0.001) and increased mental impairment (tested by MMSE and MOCA, p < 0.005 for both). In conclusion, sarcopenic patients were more cognitively impaired and less autonomous in their daily life, but the majority presented with a negative malnutrition screening test.

Combinations of Sarcopenia Diagnostic Criteria by Asian Working Group of Sarcopenia (AWGS) 2019 Guideline and Incident Adverse Health Outcomes in Community-Dwelling Older Adults

OBJECTIVES

This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes.

DESIGN

Longitudinal analyses of a cohort study.

SETTING AND PARTICIPANTS

We conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS).

METHODS

From the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years.

RESULTS

A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes.

CONCLUSIONS AND IMPLICATIONS

Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes.

The accuracy of body mass index and calf circumference values when assessing sarcopenia in a multi-ethnic cohort of middle-aged and older adults: West China health and aging trend study results

Objective

This analysis was designed to explore the utility of body mass index (BMI) and calf circumference (CC) values in the diagnosis of sarcopenia.

Methods

A cross-sectional analysis of community-dwelling adults ≥50 years old was conducted. An InBody 770 bioimpedance analysis (BIA) device was used for measuring muscle mass, a grip-strength dynamometer was used to assess muscle strength, and a 4 m gait speed (GS) analysis was used to gauge physical function. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used to define sarcopenia. The cut-off values for BMI and CC were based on the computed Younden's index values and AWGS 2019 criteria, respectively. The area under the ROC curves (AUC), specificity, sensitivity, and positive and negative predictive values (PPV and NPV) were calculated to establish the value of BMI and CC for the diagnosis of sarcopenia.

Results

In total, the data of 4177 participants ≥50 years of age were analyzed. These included 2668 (63.9%) females and 1509 (36.1%) males. Of these participants, 946 (22.6%) met the criteria for sarcopenia, including 408 (27%) males and 538 (20.2%) females. The sensitivity, specificity, and NPVs obtained when using BMI and CC values to predict sarcopenia were as follows: 84.03%/65.51%/0.90 and 74.76%/83.51%/0.87, respectively, in males; 87.36%/64.12%/0.94 and 78.25%/82.09%/0.93, in females. The respective AUC values for BMI and CC in males were 0.83 (0.80-0.85) and 0.85 (0.83-0.88), while in females they were 0.85 (0.83-0.87) and 0.88 (0.87-0.90).

Conclusions

These data suggest that BMI and CC can both serve as accurate predictors of sarcopenic incidence in a multi-ethnic population ≥50 years of age. The specificity values for BMI were relatively low in both males and females, however, underscoring the relative advantages of measuring CC when assessing individual sarcopenia risk.

Association between Regional Body Muscle Mass and Non-Alcoholic Fatty Liver Disease: An Observational Study Using Data from the REACTION Study

Background and aims: Regional muscle distribution is associated with abdominal obesity and metabolic syndrome. However, the relationship between muscle distribution and nonalcoholic fatty liver disease (NAFLD) remains unclear. This study was to determine the relationship between regional muscle distribution and the risk and severity of NAFLD. Methods: This cross-sectional study ultimately included 3161 participants. NAFLD diagnosed by ultrasonography was classified into three groups (non, mild, and moderate/severe). We estimated the regional body muscle mass (lower limbs, upper limbs, extremities, and trunk) through multifrequency bioelectrical impedance analysis (BIA). The relative muscle mass was defined as the muscle mass adjusted for the body mass index (BMI). Results: NAFLD participants accounted for 29.9% (945) of the study's population. Individuals with a higher lower limb, extremity, and trunk muscle mass had a lower risk of NAFLD (p < 0.001). Patients with moderate/severe NAFLD had a lower muscle mass of the lower limbs and trunk than patients with mild NAFLD (p < 0.001), while the muscle mass of the upper limbs and extremities did not differ significantly between the two groups. Moreover, similar results were found for both sexes and among different age groups. Conclusions: A higher muscle mass of the lower limbs, extremities, and trunk was negatively associated with the risk of NAFLD. A lower muscle mass of the limbs and trunk was inversely associated with the severity of NAFLD. This study provides a new theoretical basis for the development of individualized exercise prescriptions for the prevention of NAFLD in non-NAFLD patients.

Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study

Aim

The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients.

Methods

Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020.

Results

In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020.

Conclusion

This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.