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Oranchuk DJ, Bodkin SG, Boncella KL, Harris-Love MO. Exploring the associations between skeletal muscle echogenicity and physical function in aging adults: A systematic review with meta-analyses. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:820-840. [PMID: 38754733 PMCID: PMC11336328 DOI: 10.1016/j.jshs.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/18/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Assessment and quantification of skeletal muscle within the aging population is vital for diagnosis, treatment, and injury/disease prevention. The clinical availability of assessing muscle quality through diagnostic ultrasound presents an opportunity to be utilized as a screening tool for function-limiting diseases. However, relationships between muscle echogenicity and clinical functional assessments require authoritative analysis. Thus, we aimed to (a) synthesize the literature to assess the relationships between skeletal muscle echogenicity and physical function in older adults (≥60 years), (b) perform pooled analyses of relationships between skeletal muscle echogenicity and physical function, and (c) perform sub-analyses to determine between-muscle relationships. METHODS CINAHL, Embase, MEDLINE, PubMed, and Web of Science databases were systematically searched to identify articles relating skeletal muscle echogenicity to physical function in older adults. Risk-of-bias assessments were conducted along with funnel plot examination. Meta-analyses with and without sub-analyses for individual muscles were performed utilizing Fisher's Z transformation for the most common measures of physical function. Fisher's Z was back-transformed to Pearson's r for interpretation. RESULTS Fifty-one articles (n = 5095, female = ∼2759, male = ∼2301, 72.5 ± 5.8 years, mean ± SD (1 study did not provide sex descriptors)) were extracted for review, with previously unpublished data obtained from the authors of 13 studies. The rectus femoris (n = 34) and isometric knee extension strength (n = 22) were the most accessed muscle and physical qualities, respectively. The relationship between quadriceps echogenicity and knee extensor strength was moderate (n = 2924, r = -0.36 (95% confidence interval: -0.38 to -0.32), p < 0.001), with all other meta-analyses (grip strength, walking speed, sit-to-stand, timed up-and-go) resulting in slightly weaker correlations (r: -0.34 to -0.23, all p < 0.001). Sub-analyses determined minimal differences in predictive ability between muscle groups, although combining muscles (e.g., rectus femoris + vastus lateralis) often resulted in stronger correlations with maximal strength. CONCLUSION While correlations are modest, the affordable, portable, and noninvasive ultrasonic assessment of muscle quality is a consistent predictor of physical function in older adults. Minimal between-muscle differences suggest that echogenicity estimates of muscle quality are systemic. Therefore, practitioners may be able to scan a single muscle to estimate full-body skeletal muscle quality/composition, while researchers should consider combining multiple muscles to strengthen the model.
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Affiliation(s)
- Dustin J Oranchuk
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Stephan G Bodkin
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Katie L Boncella
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael O Harris-Love
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Kremer WM, Schwarz A, Schepers M, Labenz C, Hahn F, Sivanathan V, Düber C, Galle PR, Sprinzl MF. Evaluation of Sonographic Muscle Measurement Using Established Muscle Markers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39258324 DOI: 10.1002/jum.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/08/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Loss of muscle quantity and function is associated with frailty and reduced quality of life. Sonography is a simple option to quantify muscle mass, which could be included into routine diagnostic workup. This study was designed to prospectively evaluate sonographic measurement and to compare it with established measurements of muscle quantity and function. METHODS Between March 2020 and May 2022, 723 patients were enrolled in the study. Psoas muscle area index (PMAI) and psoas muscle thickness height index (PMTI) were quantified. Thigh muscle thickness indices (TMTI) were either measured without compression (fTMTI) or under compression (cTMTI). Variation coefficient (VC) as well as intra- and inter-observer reliability were analyzed. The reliability and reproducibility of the sonographic morphometry were assessed using two examiners. Sonographic morphometry was compared with established measurements of muscle using computed tomography and hand grip strength, respectively. RESULTS In 156 patients, sonographic indices were compared with corresponding CT indices. Of the 723 patients included, sonographic indices were compared with hand strength in 429 patients. Interobserver and intraobserver variability showed better results for the femur indices than for the psoas indices (correlation coefficient: 0.8697/0.9118 vs 0.7502/0.7319). Psoas muscle indices correlated best with the reference standard of the SMI. The optimal cut-off for each muscle index for determining muscle loss according to the SMI and hand grip strength was calculated. CONCLUSION Sonography can simplify muscle measurement and should be used in the future. Sonographic muscle indices have the potential to simplify evaluation, especially in risk groups such as patients with liver cirrhosis or other wasting disorders.
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Affiliation(s)
- Wolfgang Maximilian Kremer
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Alexander Schwarz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Markus Schepers
- Institute of Medical Biometry, Epidemiology and Informatics of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Felix Hahn
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter Robert Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin Franz Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Re R, Scano A, Amata O, Spinelli L, Tomba A, Brambilla C, Frizziero A, Caserta AV, Cubeddu R, Torricelli A, Contini D. A personalized clinical assessment: multi-sensor approach for understanding musculoskeletal health in the frail population. Biomed Eng Online 2024; 23:91. [PMID: 39252062 PMCID: PMC11382456 DOI: 10.1186/s12938-024-01287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Sarcopenia is a muscle disorder causing a progressive reduction of muscle mass and strength, but the mechanism of its manifestation is still partially unknown. The three main parameters to assess are: muscle strength, muscle volume or quality and low physical performance. There is not a definitive approach to assess the musculoskeletal condition of frail population and often the available tests to be performed in those clinical bedridden patients is reduced because of physical impairments. In this paper, we propose a novel instrumental multi-domain and non-invasive approach during a well-defined protocol of measurements for overcoming these limitations. A group of 28 bedridden elder people, subjected to surgery after hip fracture, was asked to perform voluntary isometric contractions at the 80% of their maximum voluntary contraction with the non-injured leg. The sensor employed before and/or during the exercise were: ultrasound to determine the muscle architecture (vastus lateralis); force acquisition with a load cell placed on the chair, giving an indication of the muscle strength; surface electromyography (EMG) for monitoring muscular electrical activity; time-domain (TD) near-infrared spectroscopy (NIRS) for evaluating muscle oxidative metabolism. RESULTS A personalized "report card" for each subject was created. It includes: the force diagram (both instantaneous and cumulative, expected and measured); the EMG-force diagram for a comparison between EMG derived median frequency and measured force; two graphs related to the hemodynamic parameters for muscle oxidative metabolism evaluation, i.e., oxy-, deoxy-, total-hemoglobin and tissue oxygen saturation for the whole exercise period. A table with the absolute values of the previous hemodynamic parameters during the rest and the ultrasound related parameters are also included. CONCLUSIONS In this work, we present the union of protocols, multi-domain sensors and parameters for the evaluation of the musculoskeletal condition. The novelties are the use of sensors of different nature, i.e., force, electrical and optical, together with a new way to visualize and combine the results, by means of a concise, exhaustive and personalized medical report card for each patient. This assessment, totally non-invasive, is focused on a bedridden population, but can be extended to the monitoring of rehabilitation progresses or of the training of athletes.
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Affiliation(s)
- R Re
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy.
- Istituto di Fotonica e Nanotecnologie (IFN), National Research Council (CNR), Piazza Leonardo da Vinci, 32, 20133, Milan, Italy.
| | - A Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), 20133, Milan, Italy
| | - O Amata
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - L Spinelli
- Istituto di Fotonica e Nanotecnologie (IFN), National Research Council (CNR), Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
| | - A Tomba
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - C Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian National Research Council (CNR), 20133, Milan, Italy
| | - A Frizziero
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122, Milan, Italy
| | - A V Caserta
- Department of Rehabilitation, Azienda Socio Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - R Cubeddu
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
| | - A Torricelli
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
- Istituto di Fotonica e Nanotecnologie (IFN), National Research Council (CNR), Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
| | - D Contini
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
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Marín Baselga R, Teigell-Muñoz FJ, Porcel JM, Ramos Lázaro J, García Rubio S. Ultrasound for body composition assessment: a narrative review. Intern Emerg Med 2024:10.1007/s11739-024-03756-8. [PMID: 39240412 DOI: 10.1007/s11739-024-03756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
Ultrasound has become an increasingly valuable tool for the assessment of body composition, offering several applications and indications in clinical practice. Ultrasound allows bedside evaluation of muscle mass, fat compartments, and extravascular water, providing a cost-effective, portable, and accessible alternative to traditional methods, such as Dual-energy X-ray Absorptiometry (DEXA), Bioelectrical Impedance Analysis (BIA), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). It is particularly useful in evaluating conditions, such as malnutrition, sarcopenia, and sarcopenic obesity, which require poor muscle mass to establish a diagnosis. The potential uses of ultrasound in body composition assessment include measurement of muscle thickness, cross-sectional area, pennation angle, and echo-intensity, which are indicative of muscle health. Additionally, ultrasound can be used to evaluate various fat compartments, including visceral, subcutaneous, and ectopic fat, which are important for understanding metabolic health and cardiovascular risk. However, the widespread adoption of ultrasound is challenged by the lack of standardized measurements and the absence of ultrasound measures in the validated diagnostic criteria. This article reviews the current applications of ultrasound in body composition assessment, highlighting the recent advancements and the correlation between ultrasound parameters and clinical outcomes. It discusses the advantages of ultrasound while also addressing its limitations, such as the need for standardized protocols and cut-off points. By providing a comprehensive update based on recent publications, this article aims to enhance the clinical utility of ultrasound in assessing and monitoring body composition and pave the way for future research in this field.
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Affiliation(s)
| | | | - José M Porcel
- Internal Medicine Department, Hospital Universitario Arnau Vilanova, IRBLleida, Lleida, Spain
| | - Javier Ramos Lázaro
- Internal Medicine Department, Hospital Universitario de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Samuel García Rubio
- Internal Medicine Department, Hospital Santa Marina, ISS BioBizkaia, Bilbao, Spain.
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Solla-Suarez P, Avanzas P, Encuentra-Sopena M, Almendárez M, Álvarez-Abella Á, Álvarez-Velasco R, Domingo-Lavandera F, Boga J, Coto-Montes A, de la Tassa CM, Gutiérrez-Rodríguez J. Prognostic impact of muscle ultrasound-guided diagnosis of sarcopenia in older adults with severe aortic stenosis. Eur Geriatr Med 2024:10.1007/s41999-024-01042-6. [PMID: 39227556 DOI: 10.1007/s41999-024-01042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Muscle ultrasound is increasingly popular thanks to its advantages over other techniques. However, its usefulness in the diagnosis of sarcopenia in older adults with aortic stenosis (AS) has not been studied to date. OBJECTIVES to analyze the prevalence of sarcopenia using muscle ultrasound and its impact on the health outcomes in older patients with AS. METHODS The single-center FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry was used to study patients over 75 years with severe AS susceptible to valve replacement. Sarcopenia was suspected in those individuals with diminished grip strength, and the diagnosis was confirmed in the presence of reduced ultrasound quadriceps muscle thickness, following the recommendations of the EWGSOP2 (European-Working-Group-on-Sarcopenia-in-Older-People). The primary composite endpoint was urgent hospital admission and mortality of cardiac cause 6 months after the diagnosis. RESULTS Of the 150 patients studied, 55.3% were females, and only 17.3% were frail; the mean age was 83.4 years. Sarcopenia was diagnosed in 42 patients (28%). The overall survival rate at 6 months was 92%. The primary endpoint was recorded in 23.2% of the cases and was more frequent in the sarcopenic patients (33.3%) than in the non-sarcopenic individuals (17.6%) (p = 0.01). The regression analysis found that sarcopenia was associated with an increased risk of the primary endpoint (HR: 2.25; 95% CI 1.19-4.45; p = 0.02), adjusting for potential confounding factors. CONCLUSIONS The incidence of serious cardiac complications in older patients with sarcopenia and severe AS is significant. The present study describes a noninvasive, ultrasound-guided diagnostic technique that may prove efficient in its predictive capacity.
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Affiliation(s)
- Pablo Solla-Suarez
- Geriatrics Department, Geriatrics Clinical Management Area, Monte Naranco Hospital-Central University Hospital of Asturias, Avenida Doctores Fernández Vega, 107, 33012, Oviedo, Asturias, Spain.
- Health Research Institute of Asturias, ISPA, Oviedo, Spain.
| | - Pablo Avanzas
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- Cardiology Department, Cardiac Area, Central University Hospital of Asturias, Oviedo, Spain
- University of Oviedo, UOV, Oviedo, Spain
| | - Marta Encuentra-Sopena
- Geriatrics Department, Geriatrics Clinical Management Area, Monte Naranco Hospital-Central University Hospital of Asturias, Avenida Doctores Fernández Vega, 107, 33012, Oviedo, Asturias, Spain
| | - Marcel Almendárez
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- Cardiology Department, Cardiac Area, Central University Hospital of Asturias, Oviedo, Spain
| | - Áurea Álvarez-Abella
- Geriatrics Department, Geriatrics Clinical Management Area, Monte Naranco Hospital-Central University Hospital of Asturias, Avenida Doctores Fernández Vega, 107, 33012, Oviedo, Asturias, Spain
| | - Rut Álvarez-Velasco
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- Cardiology Department, Cardiac Area, Central University Hospital of Asturias, Oviedo, Spain
| | - Fe Domingo-Lavandera
- Geriatrics Department, Geriatrics Clinical Management Area, Monte Naranco Hospital-Central University Hospital of Asturias, Avenida Doctores Fernández Vega, 107, 33012, Oviedo, Asturias, Spain
| | - José Boga
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- Microbiology Department, Central University Hospital of Asturias, Oviedo, Spain
| | - Ana Coto-Montes
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- University of Oviedo, UOV, Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - César Morís de la Tassa
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
- Cardiology Department, Cardiac Area, Central University Hospital of Asturias, Oviedo, Spain
- University of Oviedo, UOV, Oviedo, Spain
| | - José Gutiérrez-Rodríguez
- Geriatrics Department, Geriatrics Clinical Management Area, Monte Naranco Hospital-Central University Hospital of Asturias, Avenida Doctores Fernández Vega, 107, 33012, Oviedo, Asturias, Spain
- Health Research Institute of Asturias, ISPA, Oviedo, Spain
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Wang Z, Xu Z, Zhong H, Zheng X, Yan L, Lyu G. Establishment and Validation of a Predictive Model for Sarcopenia Based on 2-D Ultrasound and Shear Wave Elastography in the Medial Gastrocnemius Muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1299-1307. [PMID: 38969525 DOI: 10.1016/j.ultrasmedbio.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To develop and validate a predictive model for sarcopenia. METHODS A total of 240 subjects who visited our hospital between August 2021 and May 2023 were randomly divided by time of entry into a training set containing 2/3 of patients and a validation set containing 1/3 of patients. The muscle thickness (MT), echo intensity (EI), and shear wave velocity (SWV) of the medial gastrocnemius muscle were measured. Indicators that were meaningful in the univariate analysis in the training set were included in a binary logistic regression to derive a regression model, and the model was evaluated using a consistency index, calibration plot, and clinical validity curve. Diagnostic efficacy and clinical applicability were compared between the model and unifactorial indicators. RESULTS Four meaningful variables, age, body mass index (BMI), MT, and SWV, were screened into the predictive model. The model was Logit Y = 21.292 + 0.065 × Age - 0.411 × BMI - 0.524 × MT - 3.072 × SWV. The model was well differentiated with an internally validated C-index of 0.924 and an external validation C-index of 0.914. The calibration plot predicted probabilities against actual probabilities showed excellent agreement. The specificity, sensitivity, and Youden's index of the model were 73.80%, 97.40%, and 71.20%, respectively, when using the diagnostic cut-off value of >0.279 for sarcopenia. The logistic model had higher diagnostic efficacy (p < 0.001) and higher net clinical benefit (p < 0.001) over the same threshold range compared to indicators. CONCLUSION The logistic model of sarcopenia has been justified to have good discriminatory, calibrated, and clinical validity, and has higher diagnostic value than indicators.
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Affiliation(s)
- Zecheng Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China; Department of Ultrasound, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Zhenhong Xu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Huohu Zhong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xinying Zheng
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Lisheng Yan
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China; Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China.
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Yang X, Zhang B, Liu Y, Lv Q, Guo J. Automatic Quantitative Assessment of Muscle Strength Based on Deep Learning and Ultrasound. ULTRASONIC IMAGING 2024; 46:211-219. [PMID: 38881032 DOI: 10.1177/01617346241255590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Skeletal muscle is a vital organ that promotes human movement and maintains posture. Accurate assessment of muscle strength is helpful to provide valuable insights for athletes' rehabilitation and strength training. However, traditional techniques rely heavily on the operator's expertise, which may affect the accuracy of the results. In this study, we propose an automated method to evaluate muscle strength using ultrasound and deep learning techniques. B-mode ultrasound data of biceps brachii of multiple athletes at different strength levels were collected and then used to train our deep learning model. To evaluate the effectiveness of this method, this study tested the contraction of the biceps brachii under different force levels. The classification accuracy of this method for grade 4 and grade 6 muscle strength reached 98% and 96%, respectively, and the overall average accuracy was 93% and 87%, respectively. The experimental results confirm that the innovative methods in this paper can accurately and effectively evaluate and classify muscle strength.
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Affiliation(s)
- Xiao Yang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Beilei Zhang
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Ying Liu
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Qian Lv
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
| | - Jianzhong Guo
- Key Laboratory of Ultrasound of Shaanxi Province, School of Physics and Information Technology, Shaanxi Normal University, Xi'an, China
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Enciu VT, Ologeanu PM, Fierbinteanu-Braticevici C. Ultrasound Assessment of Sarcopenia in Alcoholic Liver Disease. Diagnostics (Basel) 2024; 14:1891. [PMID: 39272674 PMCID: PMC11394590 DOI: 10.3390/diagnostics14171891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Malnutrition frequently affects patients with alcoholic liver disease (ALD), with important impacts on disease prognosis. Sarcopenia, the clinical phenotype of malnutrition characterized by skeletal muscle loss, is the major component responsible for adverse events in this population. The aim of this study is to assess the use of ultrasound (US) skeletal muscle performance in stratifying ALD disease severity. We recruited 43 patients with ALD and divided them into two groups: alcoholic hepatitis (AH) and alcoholic cirrhosis (AC). We evaluated disease-specific clinical and biological parameters and their relation to US Rectus Femoris muscle (RFM) measurements, including RFM thickness, stiffness (RFMS) and echogenicity (RFE). A thirty-seconds chairs stand test (30sCST) was used as the sarcopenia surrogate test. RMF thickness correlated with platelet count and serum albumin (p < 0.001). Both RFM and RFMS correlated with disease severity (p < 0.001) and 30sCST (p < 0.001, p = 0.002). Patients with AH had more severe US muscle abnormalities compared to AC (RFMS 1.78 m/s vs. 1.35 m/s, p = 0.001) and the highest prevalence of RFE (χ2 = 8.652, p = 0.003). Rectus Femoris US assessment could represent a reliable tool in the diagnosis and severity stratification of ALD-induced sarcopenia.
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Affiliation(s)
- Vlad-Teodor Enciu
- Internal Medicine II and Gastroenterology Department, Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Emergency University Hospital, 050098 Bucharest, Romania
| | - Priscila Madalina Ologeanu
- Internal Medicine II and Gastroenterology Department, Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Emergency University Hospital, 050098 Bucharest, Romania
| | - Carmen Fierbinteanu-Braticevici
- Internal Medicine II and Gastroenterology Department, Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Emergency University Hospital, 050098 Bucharest, Romania
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du Pisanie JL, Ramakrishnan V, Patel V, Commander C, Yu H. MRI paraspinous skeletal muscle enhancement: A potential imaging biomarker for assessing clinical liver cirrhosis severity. PLoS One 2024; 19:e0308520. [PMID: 39172893 PMCID: PMC11340957 DOI: 10.1371/journal.pone.0308520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE To evaluate for correlation between MRI paraspinous muscle (PSM) enhancement and clinical measures of cirrhosis severity (CMCS) utilizing established imaging biomarkers of sarcopenia as comparison. MATERIALS AND METHODS Retrospective evaluation of 224 patients (mean age 59.6± 9.7 years, 135 males and 89 females) with liver cirrhosis who underwent contrast-enhanced MRI between August 2021 and August 2022 was performed. Assessed variables included: body mass index (BMI), varices and ascites present on imaging (VPI and API), albumin, total bilirubin (Tbili), international normalized ratio (INR), creatinine, MELD score, as well as history of paracentesis (PH), spontaneous bacterial peritonitis, and variceal bleed (VBH). These variables were compared to PSM skeletal muscle index (SMI), PSM signal fat fractions (sFF), and PSM contrast enhancement fraction (CEFR) calculated on arterial (CEFR-ART), portal venous (CEFR-PV), and delayed (CEFR-DEL) phases collected on MRI. RESULTS Patients with MELD>17, PH, and VPI had lower PSM CEFR-ART (0.06vs. 0.11, p = 0.01; 0.07vs. 0.11, p = 0.01; and 0.09vs. 0.13, p = 0.03, respectively). PSM CEFR-ART correlated negatively with MELD. Patients with MELD>17 and PH had lower PSM CEFR-PV (0.16vs. 0.23, p = 0.02; 0.18 vs. 0.23, p = 0.01, respectively). PSM CEFR-PV correlated positively with albumin and negatively with Tbili, INR, and MELD. PSM CEFR-DEL correlated negatively with Tbili and MELD. Patients with API, PH, and VBH had lower PSM SMI (4.68vs. 5.59, p<0.001; 4.37vs. 5.48, p<0.001; 4.78vs. 5.35, p = 0.04, respectively). PSM SMI correlated negatively with Tbili and positively with BMI. PSM sFF correlated positively with BMI, PSM CEFR-PV, and PSM CEFR-DEL. CONCLUSION PSM CEFR is significantly reduced on MRI in patients with clinical manifestations of severe liver cirrhosis. Further investigation into PSM CEFR's usefulness as an imaging biomarker for evaluating liver disease severity is warranted.
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Affiliation(s)
- Johannes L. du Pisanie
- Department of Radiology, Interventional Radiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Venkateswaran Ramakrishnan
- Department of Radiology, Interventional Radiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Vedang Patel
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Clayton Commander
- Department of Radiology, Interventional Radiology, Baptist Health, Jacksonville, Florida, United States of America
| | - Hyeon Yu
- Department of Radiology, Interventional Radiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
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10
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Yik V, Kok SSX, Chean E, Lam YE, Chua WT, Tan WJ, Foo FJ, Ng JL, Su SS, Chong CXZ, Aw DKL, Khoo NAX, Wischmeyer PE, Molinger J, Wong S, Ong LWL, Koh FHX. Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)-A Pilot Study. Nutrients 2024; 16:2768. [PMID: 39203903 PMCID: PMC11357450 DOI: 10.3390/nu16162768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has been proposed as a useful point-of-care diagnostic tool to assess muscle quality, but no validated cut-offs for sarcopenia have been reported. Using novel automated artificial intelligence (AI) software to interpret ultrasound images may assist in mitigating the operator-dependent nature of the modality. Our study aims to evaluate the fidelity of AI-aided ultrasound as a reliable and reproducible modality to assess muscle quality and diagnose sarcopenia in surgical patients. Methods: Thirty-six adult participants from an outpatient clinic were recruited for this prospective cohort study. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Ultrasonography of the rectus femoris muscle was performed, and images were analyzed by an AI software (MuscleSound® (Version 5.69.0)) to derive muscle parameters including intramuscular adipose tissue (IMAT) as a proxy of muscle quality. A receiver operative characteristic (ROC) curve was used to assess the predictive capability of IMAT and its derivatives, with area under the curve (AUC) as a measure of overall diagnostic accuracy. To evaluate consistency between ultrasound users of different experience, intra- and inter-rater reliability of muscle ultrasound parameters was analyzed in a separate cohort using intraclass correlation coefficients (ICC) and Bland-Altman plots. Results: The median age was 69.5 years (range: 26-87), and the prevalence of sarcopenia in the cohort was 30.6%. The ROC curve plotted with IMAT index (IMAT% divided by muscle area) yielded an AUC of 0.727 (95% CI: 0.551-0.904). An optimal cut-off point of 4.827%/cm2 for IMAT index was determined with a Youden's Index of 0.498. We also demonstrated that IMAT index has excellent intra-rater reliability (ICC = 0.938, CI: 0.905-0.961) and good inter-rater reliability (ICC = 0.776, CI: 0.627-0.866). In Bland-Altman plots, the limits of agreement were from -1.489 to 1.566 and -2.107 to 4.562, respectively. Discussion: IMAT index obtained via ultrasound has the potential to act as a point-of-care evaluation for sarcopenia screening and diagnosis, with good intra- and inter-rater reliability. The proposed IMAT index cut-off maximizes sensitivity for case finding, supporting its use as an easily implementable point-of-care test in the community for sarcopenia screening. Further research incorporating other ultrasound parameters of muscle quality may provide the basis for a more robust diagnostic tool to help predict surgical risk and outcomes.
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Affiliation(s)
- Vanessa Yik
- Duke-NUS Medical School, Singapore 169857, Singapore;
| | - Shawn Shi Xian Kok
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Esther Chean
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Yi-En Lam
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Wei-Tian Chua
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Winson Jianhong Tan
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Fung Joon Foo
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Jia Lin Ng
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Sharmini Sivarajah Su
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Cheryl Xi-Zi Chong
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Darius Kang-Lie Aw
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | | | - Paul E. Wischmeyer
- Department of Anesthesia, Duke University Medical Center, Durham, NC 27710, USA
| | - Jeroen Molinger
- Department of Anesthesia, Human Pharmacology and Physiology Lab (HPPL), Duke University Medical Center, Durham, NC 27710, USA
- Department of Intensive Care Adults, Erasmus Medical Center University, 3015 GD Rotterdam, The Netherlands
| | - Steven Wong
- Department of Radiology, Sengkang General Hospital, Singapore 544886, Singapore
| | - Lester Wei-Lin Ong
- Department of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | - Frederick Hong-Xiang Koh
- Duke-NUS Medical School, Singapore 169857, Singapore;
- Department of Colorectal Surgery, Sengkang General Hospital, Singapore 544886, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
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11
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Gehlen M, Schwarz-Eywill M, Mahn K, Pfeiffer A, Bauer JM, Maier A. [Sonography of muscles : Rheumatology-Neurology-Geriatrics-Sports medicine-Orthopedics]. Z Rheumatol 2024:10.1007/s00393-024-01541-8. [PMID: 39143255 DOI: 10.1007/s00393-024-01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 08/16/2024]
Abstract
Muscle sonography is used in rheumatology, neurology, geriatrics, sports medicine and orthopedics. Muscular atrophy with fatty and connective tissue degeneration can be visualized and must be interpreted in conjunction with the sonographic findings of the supplying nerves. Sonography is becoming increasingly more important for the early diagnosis of sarcopenia in rheumatology, geriatrics and osteology. Even if its significance has not yet been conclusively clarified, many publications confirm the high reliability of the method. Sonography can ideally be used in addition to magnetic resonance imaging (MRI) in the diagnostics of myositis as it can speed up the diagnosis, muscle groups that were not imaged by MRI can also be assessed sonographically and all muscle groups can be examined during the course of the procedure. Sonography also helps to make a quick and uncomplicated diagnosis of many sports injuries in addition to MRI and is therefore the basis for a targeted therapeutic approach.
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Affiliation(s)
- Martin Gehlen
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland.
| | - Michael Schwarz-Eywill
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Karin Mahn
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Andreas Pfeiffer
- Abteilung für Neurologie, St. Josefs-Hospital Cloppenburg, Cloppenburg, Deutschland
| | - Jürgen M Bauer
- Abteilung für Akutgeriatrie, Mitglied der EWGSOP2, Bethanien Krankenhaus Heidelberg, Heidelberg, Deutschland
| | - Anna Maier
- Abteilung für Rheumatologie, Interdisziplinäres Ultraschallzentrum & Ausbildungsabteilung Sonographie DEGUM, Nordwestdeutsches Rheumazentrum, St. Josef Stift, Sendenhorst, Deutschland
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12
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Zhang XY, Yang Y. The value of multi-modal ultrasound in the assessment of sarcopenia in maintenance hemodialysis patients. Rev Clin Esp 2024; 224:437-444. [PMID: 38849074 DOI: 10.1016/j.rceng.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients. METHODS MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients. RESULTS The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511-0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV(P < 0.05), with a cut-off value of 0.69. CONCLUSIONS Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.
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Affiliation(s)
- X Y Zhang
- Chongqing Hospital of Traditional Chinese Medicine, China
| | - Y Yang
- Chongqing Hospital of Traditional Chinese Medicine, China.
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13
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Phillip JG, Minet LR, Smedemark SA, Ryg J, Andersen-Ranberg K, Brockhattingen KK. Comparative analysis of hand-held and stationary ultrasound for detection of sarcopenia in acutely hospitalised older adults-a validity and reliability study. Eur Geriatr Med 2024; 15:1017-1022. [PMID: 39031330 PMCID: PMC11377503 DOI: 10.1007/s41999-024-01021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND AND PURPOSE Sarcopenia is a growing health concern among geriatric patients. Early diagnostics is importance to intervene and better muscle status and thus physical function. Ultrasound can be a valuable tool for patient-near diagnostics of sarcopenia. In recent time, ultrasound devices have evolved from larger stationary devices to minor hand-held devices that are more portable. However, the literature lacks research comparing quality of the different devices. The purpose of this study was to compare hand-held ultrasound (HH-US) to stationary ultrasound (S-US) in muscle assessment for detection of sarcopenia in acutely hospitalized older adults. METHODS A cross-sectional study using a convenience sample of acutely admitted older patients examined with both HH-US and S-US within a single session by the same examiner. Image analysis was performed using ImageJ, and was conducted by two raters: Rater 2 an experienced US examiner and Rater 1 an US examiner who received training from Rater 2. The Ultrasound sarcopenia index (USI) was used for evaluating sarcopenia. Validity and reliability of HH-US were analyzed using Cohen's Kappa and Student's t-test. RESULTS 21 participants (mean age 83.4 years, 52% female). Results showed "substantial" intra-rater reliability (κ = 0.77 for Rater 1) and 'near-perfect' validity (κ = 0.92 for Rater 2). Inter-rater comparisons revealed no significant differences (p < 0.05). CONCLUSION HH-US is a potential method for detection of sarcopenia in acutely hospitalized older adults.
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Affiliation(s)
- Jeppe Grabov Phillip
- Department of Geriatric Medicine, Odense University Hospital, Svendborg, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lisbeth Rosenbek Minet
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Siri Aas Smedemark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Kittelmann Brockhattingen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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14
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Ileri I, Eren F, Neselioglu S, Hafızoglu M, Karaduman D, Atbas C, Sahiner Z, Dikmeer A, Balcı C, Dogu BB, Cankurtaran M, Erel O, Halil MG. The role of thiol-disulfide homeostasis and ischemia-modified albumin in osteosarcopenia. Ir J Med Sci 2024; 193:2109-2114. [PMID: 38512402 DOI: 10.1007/s11845-024-03667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Oxidative stress results from an imbalance between the induction of reactive oxygen species and the ability of cells to metabolize them. Numerous markers can be used to assess the level of oxidative stress. Thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) are some of them. The aim of this study is to investigate the role of TDH and IMA, which are indicators of oxidative stress, in older patients with osteosarcopenia (OS). METHODS The study was conducted cross-sectionally in a geriatrics outpatient clinic. Patients who applied to the outpatient clinic for three months were included in the study. Patients with acute infection, delirium, malignancy, severe liver, heart or kidney dysfunction and who did not give their consent for the study were excluded from the study. The study was conducted with 136 patients. Sarcopenia was diagnosed according to muscle ultrasonography (USG) and handgrip strength (HGS) results. Osteopenia/osteoporosis was diagnosed according to bone mineral densitometry (BMD) results. The combination of osteopenia/osteoporosis and sarcopenia was accepted as OS. RESULTS Native thiol, total thiol value and nativethiol /totalthiol*100 values were significantly lower in the group with OS (respectively; value = 265 ± 53.8 standard deviation (SD) μmol/L, p = ≤ 0.001; value = 295.33 ± 55.77 SD μmol/L, p = 0.001; value = 90.06 (2.8) interquartile ranges (IQR), p = 0.033). Disulfide/native thiol*100 and disulfide/total thiol*100 values were significantly higher in the group with OS (respectively; value = 5.5 (1.7) IQR, p = 0.033; value = 4.97 (1.4) IQR, p = 0.034). CONCLUSION In our study, the role of oxidative stress in OS was demonstrated by using TDH as an oxidative stress parameter.
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Affiliation(s)
- Ibrahim Ileri
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Funda Eren
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Salim Neselioglu
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Merve Hafızoglu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Didem Karaduman
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cansu Atbas
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Sahiner
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ayse Dikmeer
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burcu Balam Dogu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozcan Erel
- Department of Clinical Biochemistry, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Meltem Gülhan Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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15
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Dong B, Yu D, Zhang H, Li P, Li Y, Li C, Li J. Association between preoperative sarcopenia and postoperative delirium in older patients undergoing gastrointestinal cancer surgery. Front Aging Neurosci 2024; 16:1416569. [PMID: 39144259 PMCID: PMC11322050 DOI: 10.3389/fnagi.2024.1416569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
Background Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Methods Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. Results One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Conclusion Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chong Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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16
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Zanotelli A, Rossi AP, Del Monte L, Vantini G, Stabile G, Urbani S, Giani A, Zoico E, Babbanini A, Fantin F, Zamboni M, Mazzali G. The Role of Combined Muscle Ultrasound and Bioimpedentiometry Parameters for Sarcopenia Diagnosis in a Population of Hospitalized Older Adults. Nutrients 2024; 16:2429. [PMID: 39125310 PMCID: PMC11313821 DOI: 10.3390/nu16152429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. METHODS A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. RESULTS Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. CONCLUSIONS The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects.
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Affiliation(s)
- Alfredo Zanotelli
- Section of Geriatric Medicine, Ospedale Santa Maria del Carmine, 38068 Rovereto, Italy;
| | - Andrea P. Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, 31100 Treviso, Italy
| | - Letizia Del Monte
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gianluca Vantini
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Giovanni Stabile
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Anna Giani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Elena Zoico
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Alessio Babbanini
- Division of Geriatrics, Department of Medicine, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy;
| | - Francesco Fantin
- Division of Geriatrics, University of Trento, 38100 Trento, Italy;
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
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17
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Alamoudi NH, Aldisi D, El-Sharkawy MS, Abulmeaty MMA. Handheld Ultrasound Parameters of Lower Limb Muscles versus Bioelectrical Impedance Analysis Parameters for Skeletal Muscle Assessments in Arabic Female Adults. Diagnostics (Basel) 2024; 14:1582. [PMID: 39125458 PMCID: PMC11311980 DOI: 10.3390/diagnostics14151582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Ultrasound (US) is a promising tool for skeletal muscle assessment; however, US studies have scarcely focused on Arabic populations. This study examined the association of handheld US indicators and bioelectrical impedance analysis (BIA) parameters in healthy Arabic females. A cross-sectional study was conducted on 60 healthy Arabic females whose muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris (RF) were measured alongside their MT and pennation angle (PA) of the medial gastrocnemius (MG) muscle (both muscles on the dominant side). Anthropometric and body composition analyses quantified fat-free mass (FFM) and appendicular skeletal muscle mass (ASMM). Muscle strength was assessed using a handgrip dynamometer, and physical activity levels were recorded with the Global Physical Activity Questionnaire (GPAQ). The CSA of the RF and the MT of both the RF and MG correlated significantly with FFM and ASMM. The PA of MG showed no significant correlations with ASMM, FFM, or handgrip strength. The CSA of RF was significantly correlated with handgrip strength (r = 0.313, p = 0.015), while the PA of MG correlated positively with GPAQ score (r = 0.346, p = 0.007). The CSA of RF significantly predicted both ASMM (β = 0.883, p = 0.0002) and FFM (β = 1.935, p = 0.0001). In conclusion, handheld US parameters, especially the RF's CSA, correlate with and can predict BIA-based FFM and ASMM in healthy females.
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Affiliation(s)
- Nada H. Alamoudi
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (N.H.A.); (D.A.)
| | - Dara Aldisi
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (N.H.A.); (D.A.)
| | - Mohamed S. El-Sharkawy
- Radiology and Medical Imaging Department, King Saud University, Riyadh 11922, Saudi Arabia;
| | - Mahmoud M. A. Abulmeaty
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (N.H.A.); (D.A.)
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18
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Marco E, Pérez-Sáez MJ, Muñoz-Redondo E, Curbelo YG, Ramírez-Fuentes C, Meza-Valderrama D, Acuña-Pardo C, Muns MD, Vázquez-Ibar O, Chamoun BO, Faura-Vendrell A, Bach A, Crespo M, Pascual J. Phase Angle as Surrogate Marker of Muscle Weakness in Kidney Transplant Candidates Referred to Prehabilitation. Nutrients 2024; 16:2245. [PMID: 39064689 PMCID: PMC11280164 DOI: 10.3390/nu16142245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Phase angle (PhA), a marker of nutritional status obtained by bioelectrical impedance analysis (BIA), is associated with the integrity of cell membranes. Damage to muscle fiber membranes can impact muscle strength, which is related to adverse outcomes in adults with advanced chronic kidney disease (CKD). The main objective of this study was to determine the usefulness of the PhA in identifying muscle weakness in candidates for kidney transplants (KTs). Secondly, it aimed to examine the associations of PhA with other parameters of body composition, exercise performance, and muscle structure. Sensitivity, specificity, and area under the receiver operating characteristics curve were used to evaluate the PhA (index test) as a biomarker of muscle weakness. Muscle strength was estimated with maximal voluntary isometric contraction of the quadriceps (MVCI-Q) of the dominant side. Muscle weakness was defined as MVIC-Q < 40% of body weight. A total of 119 patients were evaluated (mean age 63.7 years, 75.6% men). A phase angle cut-off of 5.1° was identified to classify men with a higher likelihood of having low muscle strength in upper limbs (MVIC-Q 40% of their body weight). Male KT candidates with PhA < 5.1° had poorer exercise capacity, lower muscle strength, less muscle mass, and smaller muscle size. A PhA < 5.1° was significantly associated with an eight-fold higher muscle weakness risk (OR = 8.2, 95%CI 2.3-29.2) in a binary regression model adjusted by age, frailty, and hydration status. Remarkably, PhA is an easily obtainable objective parameter in CKD patients, requiring no volitional effort from the individual. The associations of PhA with aerobic capacity, physical activity, muscle mass, and muscle size underscore its clinical relevance and potential utility in the comprehensive evaluation of these patients.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr. Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Yulibeth G. Curbelo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Cindry Ramírez-Fuentes
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Panama City 0819, Panama
| | - Carolina Acuña-Pardo
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain; (E.M.-R.); (Y.G.C.); (C.R.-F.); (C.A.-P.)
| | - Mª Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain;
| | - Olga Vázquez-Ibar
- Department of Geriatrics, Centre-Fòrum Hospital del Mar, 08019 Barcelona, Spain;
| | - Betty Odette Chamoun
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Faura-Vendrell
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Anna Bach
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, 08003 Barcelona, Spain; (M.J.P.-S.); (B.O.C.); (A.F.-V.); (A.B.); (M.C.)
| | - Julio Pascual
- Department of Nephrology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
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Reinoso-Párraga PP, González-Montalvo JI, Menéndez-Colino R, Perkisas S, Rivera-Deras I, Garmendia-Prieto B, Arain SJ, Tung-Chen Y, Vilches-Moraga A. Usefulness of point of care ultrasound in older adults: a multicentre study across different geriatric care settings in Spain and the United Kingdom. Age Ageing 2024; 53:afae165. [PMID: 39051145 DOI: 10.1093/ageing/afae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/29/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Point of care ultrasound (POCUS) is an imaging technique performed bedside. To date, few published studies have reported the usefulness of multiorgan POCUS in Geriatrics. The objective of this study was to describe the utility of multiorgan POCUS in the care of older adults admitted to geriatric care settings. METHODOLOGY Observational retrospective study of patients admitted to geriatric settings in Spain and UK. Multiorgan POCUS was performed when there was a specific clinical suspicion or unexplained torpid clinical course despite physical examination and complementary tests. A geriatrician with a certificate degree in comprehensive ultrasound and long-standing experience in POCUS carried out POCUS. All patients underwent multiorgan POCUS in a cephalo-caudal manner. RESULTS Out of 368 patients admitted to geriatric units, 29% met the inclusion criteria. Average age was 85.9 years (SD ± 6.1). POCUS identified 235 clinically significant findings (2.2 per patient). Findings were classified as 37.9% confirmed diagnosis, 16.6% ruled out diagnosis, 14.9% unsuspected relevant diagnoses and 30.6% clinical follow-ups. POCUS findings led to changes in pharmacological and non-pharmacological treatment in 66.3 and 69.2% respectively, resulted in completion or avoidance of invasive procedures in 17.8 and 15.9%, respectively, facilitating early referrals to other specialities in 14.9% and avoiding transfers in 25.2% of patients. CONCLUSION Multiorgan POCUS is a tool that aids in the assessment and treatment of patients receiving care in geriatrics units. These results show the usefulness of POCUS in the management of older adults and suggest its inclusion in any curriculum of Geriatric Medicine speciality training.
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Affiliation(s)
- Paola Pastora Reinoso-Párraga
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González-Montalvo
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine. Universidad Autónoma de, Madrid, Spain
| | - Rocío Menéndez-Colino
- Department of Geriatrics, La Paz University Hospital, Madrid, Spain
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine. Universidad Autónoma de, Madrid, Spain
| | - Stany Perkisas
- University Centre for Geriatrics ZNA (Ziekenhuis Netwerk Antwerpen) University of Antwerp, Antwerp, Belgium
| | | | - Blanca Garmendia-Prieto
- Department of Geriatrics, Cruz Roja University Hospital, Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
| | | | - Yale Tung-Chen
- Research Institute La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
- Department of Internal Medicine. La Paz University Hospital, Madrid, Spain
| | - Arturo Vilches-Moraga
- Department of Geriatrics and Long-term Care, Hamad Medical Corporation, Doha, Qatar
- School of Medicine, Bolton University, Bolton, UK
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20
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Güner M, Girgin S, Ceylan S, Özcan B, Öztürk Y, Okyar Baş A, Koca M, Balcı C, Doğu BB, Cankurtaran M, Yıldırım T, Halil M. The Role of Muscle Ultrasonography to Diagnose Malnutrition and Sarcopenia in Maintenance Hemodialysis. J Ren Nutr 2024; 34:330-336. [PMID: 38128851 DOI: 10.1053/j.jrn.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sarcopenia and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia in patients undergoing MHD and investigate the role of muscle ultrasound (US) parameters to predict sarcopenia and malnutrition. METHODS A total of 45 patients who have undertaken MHD for more than 6 months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF). RESULTS The prevalence of probable and confirmed sarcopenia was 51.1% (n = 23) and 35.6% (n = 16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n = 14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (P = .046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61 cm2, respectively (P < .05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; P = .011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; P = .017). CONCLUSION RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.
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Affiliation(s)
- Merve Güner
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye.
| | - Sinem Girgin
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Serdar Ceylan
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Berşan Özcan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Yelda Öztürk
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Arzu Okyar Baş
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Meltem Koca
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Cafer Balcı
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Burcu Balam Doğu
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Mustafa Cankurtaran
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Tolga Yıldırım
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
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21
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Rodriguez C, Mota JD, Palmer TB, Heymsfield SB, Tinsley GM. Skeletal muscle estimation: A review of techniques and their applications. Clin Physiol Funct Imaging 2024; 44:261-284. [PMID: 38426639 DOI: 10.1111/cpf.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
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Affiliation(s)
- Christian Rodriguez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Jacob D Mota
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Ty B Palmer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Steven B Heymsfield
- Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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22
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Simó-Servat A, Ibarra M, Libran M, Escobar L, Perea V, Quirós C, Puig-Jové C, Barahona MJ. Prospective Study to Evaluate Rectus Femoris Muscle Ultrasound for Body Composition Analysis in Patients Undergoing Bariatric Surgery. J Clin Med 2024; 13:3763. [PMID: 38999329 PMCID: PMC11242698 DOI: 10.3390/jcm13133763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Bariatric surgery (BS) has a significant impact on body composition (BC) and consequently may affect established sarcopenic obesity (SO) in candidate patients. The aim of this study was to assess the utility of muscle ultrasound (MUS) of rectus femoris thickness (RFT) for the evaluation of BC and skeletal muscle function in patients undergoing BS compared to bioimpedance analysis (BIA), dual-energy X-ray absorptiometry (DEXA) and dynamometry. On the other hand, we aimed to demonstrate how MUS of RFT correlates with quality of life (QoL) in this population, likely due to its ability to detect regional quadriceps muscle sarcopenia compared to the other mentioned methods. Methods: This was a prospective pilot study that included 77 participants (64.9% female, mean age: 53.2 ± 8.67 years) who underwent BS. Handgrip strength was measured using a dynamometer, fat-free mass index (iFFM) was assessed by BIA, appendicular muscle index (AMI) was calculated using DEXA, and RFT was measured by MUS. Moreover, homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. All these measurements were conducted 1 month prior to BS and at the 12-month follow-up. QoL was assessed using the Moorehead-Ardelt questionnaire. Results: The mean BMI decreased by 12.95 ± 3.56 kg/m2 (p = 0.001). Firstly, we observed a positive correlation pre-surgery between HOMA and RFT (r = 0.27, p = 0.02), iFFM (r = 0.36, p = 0.001), AMI (r = 0.31, p = 0.01) and dynamometer readings (r = 0.26, p = 0.02). In addition, we found a correlation between RFT and iFFM (pre-surgery: r = 0.31, p = 0.01; post-surgery: r = 0.25, p = 0.05) and between RFT and lower-extremity AMI post-surgery (r = 0.27, p = 0.04). Secondly, we observed significant reductions in iFFM, AMI and RFT (p = 0.001), but not in dynamometer readings (p = 0.94). Finally, a tendency to a positive correlation between QoL questionnaire and RFT post-surgery results (r = 0.23, p = 0.079) was observed. Conclusions: Our results suggest that RFT measured by MUS is useful for evaluating SO and for the follow-up of these patients after BS. Moreover, RFT can provide relevant information about regional sarcopenia and probably has an accurate correlation with QoL in comparison with the other methods.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Montse Ibarra
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Mireia Libran
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Lilian Escobar
- Department of General Surgery, Hospital Universitari MútuaTerrassa, 08221 Terrassa, Spain;
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Carlos Puig-Jové
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Maria-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
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23
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Catikkas NM, Safer VB, Bas S, Gunay DS, Durak A, Utku IK, Safer U. Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:608-618. [PMID: 38600828 DOI: 10.1002/jcu.23688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIMS There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM). METHODS We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM. RESULTS We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022). CONCLUSION Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.
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Affiliation(s)
- Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Suleyman Bas
- Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Deniz Sevindik Gunay
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Ayfer Durak
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Irem Kirac Utku
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Umut Safer
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
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24
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Zhu S, Garofalo J, Abuhantash M, McRae S, MacDonald P, Longstaffe R, Ogborn D. Functional Performance and Tendon Morphology After Operative or Nonoperative Treatment of Achilles Tendon Ruptures. Int J Sports Phys Ther 2024; 19:670-680. [PMID: 38835984 PMCID: PMC11144663 DOI: 10.26603/001c.117549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/03/2024] [Indexed: 06/06/2024] Open
Abstract
Background While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon (AT) ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping. Hypothesis/Purpose The purpose of this study was to determine if functional performance including strength, jumping, and hopping outcomes differed between OM and NOM of acute ATR. The secondary objective was to assess the degree of association between AT morphology and performance outcomes. Study Design Retrospective cohort with a single prospective evaluation. Methods All patients were treated at an institutional secondary care center. Eligible participants (n=12 OM; 12 NOM) who were treated with OM or NOM of ATR within three weeks of injury were evaluated a minimum 20 months following ATR. AT length, thickness and gastrocnemius muscle thickness were assessed with B-mode ultrasound. Isokinetic plantar flexor strength, hop tests and countermovement and drop jumps were completed. Two-way ANOVAS were completed on all tests with unilateral values, independent t-tests were used for bilateral outcomes, and linear regressions were completed to assess the relationship between normalized AT length and performance. Results Affected limb AT was elongated and thickened (p\<0.01), gastrocnemius was atrophied (p\< 0.01) and angle-specific plantar flexor torque was reduced at 120°/s when measured at 20° plantar flexion (p = 0.028). Single leg drop vertical jump was higher in OM (p = 0.015) with no difference for hop and jump tests. AT length was related to plantar flexor torque but had no relationship with hopping performance. Conclusions Hop test performance was maintained despite plantarflexion weakness, gastrocnemius atrophy, and AT elongation. This may be the result of compensatory movement patterns. AT length holds limited explanatory power in plantar flexor strength, although this relationship should be evaluated further. Level of Evidence Level III.
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Affiliation(s)
- Sophie Zhu
- Department of Surgery, Orthopedic SectionUniversity of Manitoba
| | | | | | | | - Peter MacDonald
- Department of Surgery, Orthopedic SectionUniversity of Manitoba
- Pan Am Clinic
| | - Rob Longstaffe
- Department of Surgery, Orthopedic SectionUniversity of Manitoba
- Pan Am Clinic
| | - Dan Ogborn
- Department of Surgery, Orthopedic SectionUniversity of Manitoba
- Pan Am Clinic Foundation
- Faculty of Kinesiology and Recreation ManagementUniversity of Manitoba
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25
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Staempfli JS, Kistler-Fischbacher M, Gewiess J, Bastian JD, Eggimann AK. The Validity of Muscle Ultrasound in the Diagnostic Workup of Sarcopenia Among Older Adults: A Scoping Review. Clin Interv Aging 2024; 19:993-1003. [PMID: 38831963 PMCID: PMC11146336 DOI: 10.2147/cia.s463917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Muscle ultrasound has emerged as a promising method in the diagnostic work-up of sarcopenia. The objective of this scoping review was to explore the validity of muscle ultrasound against the latest sarcopenia definitions among older adults. Methods We adhered to the PRISMA guidelines for scoping reviews. A systematic search of databases was performed by two independent reviewers. All articles comparing the performance of ultrasound to an internationally acknowledged sarcopenia definition among older adults (≥60 years) and published between 2019/01/01 (the year updated sarcopenia definitions were introduced) and 2023/11/15 were included. Data were extracted and collated by muscle and muscle parameters. Results Out of 2290 articles screened, six studies comprising 24 validity tests among a total of 1619 older adults (mean age 74.1 years, 52.2% female) were included. The validity tests investigated the rectus femoris (n = 7), biceps brachii (n = 5), gastrocnemius medialis (n = 4), tibialis anterior (n = 4), soleus (n = 3), and rectus abdominis (n = 1). The parameter muscle thickness (MT) (n = 14) was most commonly measured. The latest European and Asian sarcopenia definitions (EWGSOP2, AWGS2) were applied as reference standards in four validity tests each. None of the studies used the Sarcopenia Definition and Outcome Consortium (SDOC) criteria. The highest area under the curve AUC (0.92, 95% confidence interval [CI] 0.89-0.94) was found for the muscle thickness of the rectus femoris muscle. Due to substantial heterogeneity among the studies, pooling of data using a meta-analytic approach was not feasible. Conclusion Limited number of studies have examined the validity of muscle ultrasound for diagnosing sarcopenia based on recent definitions among older adults. Thereby, muscle thickness of the rectus femoris showed promising results regarding validity. Further studies are needed to investigate the validity of key muscles and to validate muscle ultrasound among older hospitalized patients.
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Affiliation(s)
| | - Melanie Kistler-Fischbacher
- Centre on Aging and Mobility, Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - Jan Gewiess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Anna K Eggimann
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, 3010, Switzerland
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Yau DKW, Griffith JF, Underwood MJ, Joynt GM, Lee A. Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study. Perioper Med (Lond) 2024; 13:45. [PMID: 38783315 PMCID: PMC11112902 DOI: 10.1186/s13741-024-00401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Malcolm John Underwood
- Cardiovascular Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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de Luis Roman D, García Almeida JM, Bellido Guerrero D, Guzmán Rolo G, Martín A, Primo Martín D, García-Delgado Y, Guirado-Peláez P, Palmas F, Tejera Pérez C, García Olivares M, Maíz Jiménez M, Bretón Lesmes I, Alzás Teomiro CM, Guardia Baena JM, Calles Romero LA, Prior-Sánchez I, García-Luna PP, González Pacheco M, Martínez-Olmos MÁ, Alabadí B, Alcántara-Aragón V, Palma Milla S, Martín Folgueras T, Micó García A, Molina-Baena B, Rendón Barragán H, Rodríguez de Vera Gómez P, Riestra Fernández M, Jiménez Portilla A, López-Gómez JJ, Pérez Martín N, Montero Madrid N, Zabalegui Eguinoa A, Porca Fernández C, Tapia Guerrero MJ, Ruiz Aguado M, Velasco Gimeno C, Herrera Martínez AD, Novo Rodríguez M, Iglesias Hernández NC, de Damas Medina M, González Navarro I, Vílchez López FJ, Fernández-Pombo A, Olveira G. Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk. Nutrients 2024; 16:1552. [PMID: 38892486 PMCID: PMC11174631 DOI: 10.3390/nu16111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.
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Affiliation(s)
- Daniel de Luis Roman
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - José Manuel García Almeida
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
| | - Diego Bellido Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
| | - Germán Guzmán Rolo
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - Andrea Martín
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - David Primo Martín
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Yaiza García-Delgado
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
| | - Fiorella Palmas
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Tejera Pérez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
| | - María García Olivares
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Surgery, Malaga University, 29010 Malaga, Spain
| | - María Maíz Jiménez
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
| | - Irene Bretón Lesmes
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | | | - Juan Manuel Guardia Baena
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | - Laura A. Calles Romero
- Endocrinology and Nutrition Service, Basurto University Hospital, 48903 Bilbao, Spain; (L.A.C.R.); (N.C.I.H.)
| | | | - Pedro Pablo García-Luna
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - María González Pacheco
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Miguel Ángel Martínez-Olmos
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
- Molecular Endocrinology Research Group, Health Research Institute of Santiago de Compostela-IDIS, 15706 Santiago de Compostela, Spain
- CIBERObn, National Health Institute Carlos III, 28031 Madrid, Spain
| | - Blanca Alabadí
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain;
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Valeria Alcántara-Aragón
- Endocrinology and Nutrition Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Samara Palma Milla
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Service, University Hospital of La Paz, 28046 Madrid, Spain;
| | - Tomás Martín Folgueras
- Endocrinology and Nutrition Service, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Andrea Micó García
- Endocrinology and Nutrition Service, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Begoña Molina-Baena
- Deparment of Endocrinology and Nutrition, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain;
| | - Henry Rendón Barragán
- Endocrinology and Nutrition, FEA Endocrinology and Nutrition, Navarra University Hospital, 31008 Pamplona, Spain;
| | | | - María Riestra Fernández
- Endocrinology Service, Cabueñes University Hospital, 33394 Gijón, Spain;
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Ana Jiménez Portilla
- Endocrinology and Nutrition Service, Consorci Hospital General Universitari de València, 46014 Valencia, Spain;
| | - Juan J. López-Gómez
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Nuria Pérez Martín
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Natalia Montero Madrid
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
| | - Alba Zabalegui Eguinoa
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Porca Fernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
- Professor Novoa Santos Foundation, 15405 A Coruña, Spain
| | - María José Tapia Guerrero
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Marta Ruiz Aguado
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
- i+12 Research Institute, 28041 Madrid, Spain
| | - Cristina Velasco Gimeno
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | - Aura D Herrera Martínez
- Reina Sofía University Hospital, 14004 Córdoba, Spain; (C.M.A.T.); (A.D.H.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - María Novo Rodríguez
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | | | - María de Damas Medina
- Endocrinology Service, Complejo Hospitalario de Jaén, 23007 Jaén, Spain; (I.P.-S.); (M.d.D.M.)
| | - Irene González Navarro
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - Francisco Javier Vílchez López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
| | - Gabriel Olveira
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
- CIBER of Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, 28029 Madrid, Spain
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Prell T, Grimm A, Axer H. Uncovering sarcopenia and frailty in older adults by using muscle ultrasound-A narrative review. Front Med (Lausanne) 2024; 11:1333205. [PMID: 38828232 PMCID: PMC11140070 DOI: 10.3389/fmed.2024.1333205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Muscle ultrasound is a valuable non-invasive and cost-effective method in assessing muscle mass and structure, both of which are significant indicators for the development of sarcopenia and frailty in elderly individuals. Sarcopenia refers to the loss of muscle mass and strength that occurs with age, whereas frailty is a complex geriatric syndrome characterized by reduced physical function and an increased susceptibility to negative health outcomes. Both conditions are prevalent in older adults and are associated with higher risks of falls, disability, and mortality. By measuring muscle size and structure and several other ultrasound parameters, including muscle thickness, cross-sectional area, echogenicity (brightness in the ultrasound image), pennation angle, and fascicle length ultrasound can assist in identifying sarcopenia and frailty in older adults. In addition, ultrasound can be used to evaluate muscle function such as muscle contraction and stiffness, which may also be affected in sarcopenia and frailty. Therefore, muscle ultrasound could lead to better identification and tracking of sarcopenia and frailty. Such advancements could result in the implementation of earlier interventions to prevent or treat these conditions, resulting in an overall improvement in the health and quality of life of the elderly population. This narrative review describes the benefits and challenges when using ultra-sound for the evaluation of frailty and sarcopenia.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
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Besora-Moreno M, Llauradó E, Jiménez-ten Hoevel C, Sepúlveda C, Queral J, Bernal G, Pérez-Merino L, Martinez-Hervas S, Alabadi B, Ortega Y, Valls RM, Solà R, Pedret A. New Perspectives for Low Muscle Mass Quantity/Quality Assessment in Probable Sarcopenic Older Adults: An Exploratory Analysis Study. Nutrients 2024; 16:1496. [PMID: 38794734 PMCID: PMC11123861 DOI: 10.3390/nu16101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Low muscle mass quantity/quality is needed to confirm sarcopenia diagnosis; however, no validated cut-off points exist. This study aimed to determine the diagnostic accuracy of sarcopenia through muscle mass quantity/quality parameters, using the bioimpedance analysis (BIA), isokinetic, and ultrasound tools in probable sarcopenic community-dwelling older adults (≥60 years). Also, it aimed to suggest possible new cut-off points to confirm sarcopenia diagnosis. METHODS A cross-sectional exploratory analysis study was performed with probable sarcopenic and non-sarcopenic older adults. BIA, isokinetic, and ultrasound parameters were evaluated. The protocol was registered on ClinicalTrials.gov (NCT05485402). RESULTS A total of 50 individuals were included, 38 with probable sarcopenia (69.63 ± 4.14 years; 7 men and 31 women) and 12 non-sarcopenic (67.58 ± 4.54 years; 7 men and 5 women). The phase angle (cut-off: 5.10° men, p = 0.003; 4.95° women, p < 0.001), peak torque (cut-off: 66.75 Newtons-meters (N-m) men, p < 0.001; 48.35 N-m women, p < 0.001), total work (cut-off: 64.00 Joules (J) men, p = 0.007; 54.70 J women, p = 0.001), and mean power (cut-off: 87.8 Watts (W) men, p = 0.003; 48.95 W women, p = 0.008) in leg extension, as well as the the forearm muscle thickness (cut-off: 1.41 cm (cm) men, p = 0.017; 0.94 cm women, p = 0.041), had great diagnostic accuracy in both sexes. CONCLUSIONS The phase angle, peak torque, total work, and mean power in leg extension, as well as forearm muscle thickness, had great diagnostic accuracy in regard to sarcopenia, and the suggested cut-off points could lead to the confirmation of sarcopenia diagnosis, but more studies are needed to confirm this.
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Affiliation(s)
- Maria Besora-Moreno
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Claudia Jiménez-ten Hoevel
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Cristina Sepúlveda
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Judit Queral
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
| | - Glòria Bernal
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Laura Pérez-Merino
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain; (S.M.-H.); (B.A.)
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Blanca Alabadi
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain; (S.M.-H.); (B.A.)
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Yolanda Ortega
- Institut Universitari d’Investigació en Atenció Primària-IDIAP Jordi Gol, 43202 Tarragona, Spain;
- Primary Care Centre Salou, Institut Català de la Salut, 43840 Tarragona, Spain
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
- Institut Investigació Sanitària Pere i Virgili (ISPV), 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain; (G.B.); (L.P.-M.)
| | - Anna Pedret
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (M.B.-M.); (C.J.-t.H.); (C.S.); (J.Q.); (R.M.V.); (A.P.)
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Barry DJ, Farragher JB, Betik AC, Fyfe JJ, Convit L, Cooke MB. Investigating the effects of synbiotic supplementation on functional movement, strength and muscle health in older Australians: a study protocol for a double-blind, randomized, placebo-controlled trial. Trials 2024; 25:307. [PMID: 38715143 PMCID: PMC11077830 DOI: 10.1186/s13063-024-08130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Aging has been associated with a progressive loss of skeletal muscle quality, quantity and strength, which may result in a condition known as sarcopenia, leading to a decline in physical performance, loss of independence and reduced quality of life. While the cause of impaired physical functioning observed in elderly populations appears to be multifactorial, recent evidence suggests that age-associated alterations in gut microbiota could be a contributing factor. The primary objective will be to assess the effects of a dietary synbiotic formulation on sarcopenia-related functional outcomes such as handgrip strength, gait speed and physical performance within older individuals living independently. The secondary objective will be to examine associations between changes in gut microbiota composition, functional performance and lean muscle mass. METHODS Seventy-four elderly (60-85 years) participants will be randomized in a double-blind, placebo-controlled fashion to either an intervention or control group. The intervention group (n = 37) will receive oral synbiotic formulation daily for 16 weeks. The control group (n = 37) will receive placebo. Assessments of physical performance (including Short Physical Performance Battery, handgrip strength and timed up-and-go tests) and muscle ultrasonography will be performed at 4 time points (baseline and weeks 8, 16 and 20). Likewise, body composition via bioelectric impedance analysis and blood and stool samples will be collected at each time point. Dual-energy X-ray absorptiometry will be performed at baseline and week 16. The primary outcomes will be between-group changes in physical performance from baseline to 16 weeks. Secondary outcomes include changes in body composition, muscle mass and architecture, fecal microbiota composition and diversity, and fecal and plasma metabolomics. DISCUSSION Gut-modulating supplements appear to be effective in modifying gut microbiota composition in healthy older adults. However, it is unclear whether these changes translate into functional and/or health improvements. In the present study, we will investigate the effects of a synbiotic formulation on measures of physical performance, strength and muscle health in healthy older populations. TRIAL REGISTRATION This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000652774) in May 2022.
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Affiliation(s)
- David J Barry
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Joshua B Farragher
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew C Betik
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jackson J Fyfe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Lilia Convit
- Centre for Sports Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Matthew B Cooke
- Sport, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.
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Hafızoğlu M, Yıldırım HK, Okyar Baş A, Karaduman D, Şahiner Z, Doğu BB, Halil MG, Cankurtaran M, Balcı C. Role of muscle ultrasound in frailty assessment in older adults with type 2 diabetes mellitus. BMC Geriatr 2024; 24:397. [PMID: 38704521 PMCID: PMC11069196 DOI: 10.1186/s12877-024-05008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that is characterized by increased vulnerability to intrinsic and extrinsic stressors due to decreased biologic reserves. Muscle ultrasound (US) is a valid and reliable method for assessing muscle quantity in older adults. The study aims to examine the relationship between frailty definitions and US-derived muscle parameters. METHODS We conducted a cross-sectional study with type 2 diabetes mellitus outpatients in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment. For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed. Muscle US measurements included Gastrocnemius Medialis (GM) muscle thickness, GM fascicle length, GM pennation angle, Rectus Femoris (RF) muscle thickness, Rectus Femoris cross-sectional area (RFCSA), Rectus Abdominis (RA) muscle thickness, External Oblique (EO) muscle thickness, Internal Oblique (IO) muscle thickness, and Transverse Abdominis (TA) muscle thickness. RESULTS In all, 373 participants were included in the study. The median age of participants was 72.7 ± 5.9 years, and 64.6% of them were female. According to the FFP, 18.2% of the participants were living with frailty, 56% of them were pre-frail; 57.4% of them were living with frailty according to the CFS; 25.2% of them were living with frailty, and 20.6% of them were pre-frail according to the EFS. The FFP, CFS, and EFS scores were related to muscle thickness of GM, RF, and RA, fascicle length of GM, and pennation angle of GM and RFCSA. Particularly, GM pennation angle, RF muscle thickness, and RFCSA were associated with an increased risk of frailty. Besides muscle thickness of GM, RF, and RA, fascicle length of GM, pennation angle of GM, and RFCSA were significant for predicting the presence of frailty. CONCLUSIONS US-derived regional muscle measurements are associated with frailty definitions (in both physical, cumulative deficit, and multidimensional models) in a diabetic geriatric population.
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Affiliation(s)
- Merve Hafızoğlu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Hatice Kübra Yıldırım
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Karaduman
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Şahiner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Schillebeeckx F, Duyck J, Plessers A, Agostini A, Vander Poorten S, Hanssen B, Desloovere K, Verheyden G, Peers K. Defining tibial anterior muscle morphology in first-ever chronic stroke patients using three-dimensional freehand ultrasound. Top Stroke Rehabil 2024:1-14. [PMID: 38563275 DOI: 10.1080/10749357.2024.2333184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Drop foot is common post-stroke, elevating fall risks and mobility limitations. It is caused by weakness and lack of control of the tibialis anterior muscle (TA), for which various rehabilitation treatments are used. A reliable objective estimate of changes in TA muscle morphology and composition can enhance treatment optimization. OBJECTIVES We aimed to ascertain 3D freehand ultrasound (3DfUS) reliability in measuring TA muscle volume, length, and echo intensity in stroke patients and healthy controls and its validity by comparing these features across legs, between patients and controls, and between clinical subgroups (i.e. patients with and without ankle contracture, spastic muscle overactivity, and foot dorsiflexor paresis). METHODS We included 9 stroke patients and 9 healthy controls to define reliability and 26 stroke patients and 28 healthy controls to define validity. For reliability, data were collected and processed by 2 different operators and processors. For inter- and intra-rater reliability, intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were used. For validity, Wilcoxon-Signed-Ranked and Mann-Whitney U tests were used for comparisons between groups and subgroups. RESULTS All measurements showed good to excellent inter- and intra-rater reliability (ICC: 0.816 to 0.997, SEM: 0.5% to 7.8%). Comparison analyses revealed no differences in muscle features among legs, groups, or subgroups. CONCLUSION While the 3DfUS is a reliable method to define TA morphology and composition, its clinical validity needs further investigation into factors influencing muscle property changes across various age groups and post-stroke time points. MESH TERMS Stroke; Skeletal muscle morphology; muscle composition; 3D freehand ultrasonography, Anterior Tibial Muscle.
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Affiliation(s)
- Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
| | - Julien Duyck
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
| | - Anouk Plessers
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
| | - Adele Agostini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Sandor Vander Poorten
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
| | - Britta Hanssen
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium
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Güner M, Girgin S, Yıldırım T, Okyar Baş A, Ceylan S, Öztürk Y, Koca M, Balcı C, Doğu BB, Cankurtaran M, Halil MG. Decreased abdominal wall muscle mass defined by muscle ultrasound is associated with malnutrition according to Global Leadership Initiative on Malnutrition criteria in renal transplant recipients: A cross-sectional study. JPEN J Parenter Enteral Nutr 2024; 48:329-336. [PMID: 38367017 DOI: 10.1002/jpen.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Changed body composition with increased fat content and decreased muscle mass is seen in renal transplantation recipients (RTRs). Increased fat mass might mask underlying muscle mass loss; measuring low body mass index and weight reduction alone may not be sensitive enough to diagnose malnutrition in RTRs. We aimed to determine the prevalence of malnutrition in stable RTRs using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess the use of muscle ultrasonography (US) to compare the performance of various muscle US measurements in the diagnosis of reduced muscle mass. METHODS Ninety-one patients who had renal transplantation >6 months ago were enrolled in the study. GLIM criteria were performed for all patients, but not those at risk of malnutrition. Bioelectrical impedance analysis and muscle US were performed to identify reduced muscle mass. RESULTS The prevalence of malnutrition according to GLIM criteria was 25.3% (n = 23). All muscle US measurements were lower in the malnourished group than the well-nourished group; however, the malnourished group had substantially lower muscle thicknesses in abdominal muscles, specifically the external oblique (EO) and internal oblique (IO) muscles, than the well-nourished group (P = 0.001 and P = 0.007, respectively). There was a significant association between malnutrition and EO (odds ratio [OR] = 0.338, 95% CI = 0.163-0.699; P = 0.003) and IO (OR = 0.620, 95% CI = 0.427-0.900; P = 0.012) regardless of age and sex. CONCLUSION One in four RTRs experience malnutrition. Muscle US could be used effectively for the diagnosis of reduced muscle mass and malnutrition in RTRs according to GLIM criteria.
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Affiliation(s)
- Merve Güner
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Girgin
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Ceylan
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Öztürk
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Benatti de Oliveira G, Vilar Fernandes L, Summer Chen X, Drumond Andrade FC, Scarlazzari Costa L, Junqueira Vasques AC, Pires Corona L. Intra- and inter-rater reliability of muscle and fat thickness measurements obtained using portable ultrasonography in older adults. Clin Nutr ESPEN 2024; 60:65-72. [PMID: 38479941 DOI: 10.1016/j.clnesp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Ultrasonography (US) is a promising tool for assessing body composition, offering accuracy and accessibility. However, technician skills and equipment characteristics can impact measurement reliability. We aimed to evaluate the intra- and inter-rater reliability of two evaluators using A-mode Portable Ultrasound to measure muscle and fat thickness in Brazilian older adults. METHODS Quantitative cross-sectional study carried out with 150 community-dwelling older adults of Campinas-SP-Brazil, recruited in a retirement preparation program and a geriatric outpatient care unit. Scans of nine anatomical points were performed using the portable ultrasound in A-mode (BodyMetrix Pro System BX2000; Livermore, CA), with 6 scans per location and 3 measurements taken by each evaluator. After the selection and analysis of the generated images, muscle and fat thickness were measured. Reliability estimates between measures of the same evaluator (intra-rater) and between evaluators (inter-rater) were assessed using intraclass correlation coefficients (ICC), and differences within and between technicians were assessed using one-way ANOVA. Analyses were carried out for the overall sample and stratified by sex and by nutritional status. RESULTS Excellent ICC values (>0.90) were found for subcutaneous fat thickness in intra- and inter-rater reliability analyses. The lowest ICC values were observed for deep abdominal fat thickness measured by evaluator 1 (ICC = 0.90) and evaluator 2 (ICC = 0.87), as well as in the inter-rater analysis (ICC = 0.85). Muscle thickness measurements had satisfactory ICC values for triceps, biceps, anterior thigh, and calf, ranging from moderate to good (ICC 0.50-0.90). CONCLUSION A portable A-mode ultrasound demonstrates excellent reliability among both intra- and inter-raters for assessing fat thickness but only moderate for muscle thickness in older adults. Hence, this could prompt inquiries regarding the sole reliance on this tool for quantifying muscle mass and examining sarcopenia in older adults. To our knowledge, this study represents the first assessment of reliability for a portable A-mode ultrasound device conducted with older adults.
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Affiliation(s)
| | | | - Xiayu Summer Chen
- School of Social Work, University of Illinois at Urbana-Champaign, United States
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Ben-Menachem E, Ashes C, Lepar G, Deacon J, Glavan N, Molan V, Watson A. Smaller rectus femoris size measured by ultrasound is associated with poorer outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1115-1122.e5. [PMID: 35995604 DOI: 10.1016/j.jtcvs.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery. METHODS A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA. RESULTS One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm2 (1.41 cm2), and range of 0.71 to 8.77 cm2. When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA. CONCLUSIONS Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures. TRIAL REGISTRY NUMBER ACTRN12620000678998.
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Affiliation(s)
- Erez Ben-Menachem
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; Notre Dame School of Medicine, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.
| | - Catherine Ashes
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Gila Lepar
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - James Deacon
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Nicole Glavan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Veronique Molan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Alasdair Watson
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
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Di Lenarda L, Buoite Stella A, Ratti C, Ruggiero L, Bernard M, Cavarzerani LP, Canton G, Murena L. Assessing Muscle Mass in the Orthopedic Clinical Setting: Application of the Ultrasound Sarcopenia Index in Elderly Subjects with a Recent Femoral Fracture. Nutrients 2024; 16:711. [PMID: 38474844 PMCID: PMC10934151 DOI: 10.3390/nu16050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Sarcopenia poses a risk factor for falls, disability, mortality, and unfavorable postoperative outcomes. Recently, the Ultrasound Sarcopenia Index (USI) has been validated to assess muscle mass, and this study aimed to apply the USI in the clinical setting. METHODS This prospective observational study included 108 patients aged >65 years, hospitalized for proximal femoral traumatic fracture. Patients were divided into two groups based on anamnestic data: patients with independent walking (IW) and patients requiring walking aid (WA) before admission. All the participants received an ultrasound examination. Other parameters evaluated were handgrip strength, limb circumferences, nutrition (MNA), and activity of daily living (ADL) scores. RESULTS Fifty-six IW patients (83 ± 6 y; 38 females) and 52 WA patients (87 ± 7 y; 44 females) were recruited. The USI was significantly higher in the IW group compared to the WA group (p = 0.013, Cohen's d = 0.489). Significant correlations were found between the USI and other sarcopenia-associated parameters, such as handgrip strength, MNA, ADLs, other muscle ultrasound parameters, and limb circumferences. CONCLUSION The application of the USI in the orthopedic surgery setting is feasible and might support the diagnosis of sarcopenia when combined with other measures of strength and function.
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Affiliation(s)
- Luca Di Lenarda
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Alex Buoite Stella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Chiara Ratti
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Luca Ruggiero
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Monica Bernard
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
| | - Luisa Priscamaria Cavarzerani
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Gianluca Canton
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (L.D.L.); (C.R.); (L.R.); (M.B.); (G.C.); (L.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
- Single-Cycle Master’s Degree Course in Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
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Psenicka O, Brutvan T, Kratky J, Krizova J. Muscle Dysfunction and Functional Status in COVID-19 Patients during Illness and after Hospital Discharge. Biomedicines 2024; 12:460. [PMID: 38398063 PMCID: PMC10887156 DOI: 10.3390/biomedicines12020460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND COVID-19 pneumonia is associated with SIRS and hypercatabolism. The aim of this study was to determine muscle loss during the acute phase of COVID-19 pneumonia and evaluate long-term sequelae in discharged patients. METHODS A total of 16 patients with COVID-19 pneumonia and respiratory insufficiency were included in the study. Selected parameters (weight, BMI, LBM = lean body mass, albumin, CRP, NLR = neutrophil-to-lymphocyte ratio, ultrasound measured thickness of rectus femoris muscle = US RF and rectus femoris + vastus intermedius = US RF + VI, handgrip strength, quality of life = EQ-5D questionnaire, and activities of daily living = Barthel's ADLs) were recorded on admission, discharge, and 1, 3, and 6 months after discharge. RESULTS The most significant changes were between hospital admission and discharge: US RF and RF + VI (-1.28 ± 1.97 mm, p = 0.046; -1.76 ± 2.94 mm, p = 0.05), EQ-5D score (14.6 ± 19.2, p = 0.02), and ADLs (17.1 ± 22.6; p = 0.02). There was a significant positive correlation between US RF + VI and handgrip strength (p = 0.014) and a negative correlation between weight and Barthel index (p = 0.012). There was an association between muscle function with an EQ-5D score and ADLs during outpatient check-ups, most noticeably between handgrip strength, US RF+VI, and ADLs (p = 0.08; p = 0.1, respectively). Conclusions: In patients with COVID-19 pneumonia, there is a significant reduction of health-related quality of life, impaired even 6 months after hospital discharge, influenced mainly by muscle loss. During the hospital stay, there was a significant muscle mass reduction. Ultrasound measurement of thigh muscle thickness may be a useful method to monitor muscle loss.
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Affiliation(s)
- Otakar Psenicka
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Tomas Brutvan
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Jan Kratky
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
| | - Jarmila Krizova
- 3rd Department of Internal Medicine, General University Hospital, 120 00 Prague, Czech Republic; (T.B.); (J.K.); (J.K.)
- 1st Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
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Chang CY, Lenchik L, Blankemeier L, Chaudhari AS, Boutin RD. Biomarkers of Body Composition. Semin Musculoskelet Radiol 2024; 28:78-91. [PMID: 38330972 DOI: 10.1055/s-0043-1776430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The importance and impact of imaging biomarkers has been increasing over the past few decades. We review the relevant clinical and imaging terminology needed to understand the clinical and research applications of body composition. Imaging biomarkers of bone, muscle, and fat tissues obtained with dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasonography are described.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Louis Blankemeier
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Akshay S Chaudhari
- Department of Radiology and of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, California
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Wang D, Zhang G, Yu Y, Zhang Z. Imaging of Sarcopenia in Type 2 Diabetes Mellitus. Clin Interv Aging 2024; 19:141-151. [PMID: 38292460 PMCID: PMC10826713 DOI: 10.2147/cia.s443572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Sarcopenia is an age-related condition characterized by the loss of skeletal muscle mass, muscular strength, and muscle function. In older adults, type 2 diabetes mellitus (T2DM) constitutes a significant health burden. Skeletal muscle damage and deterioration have emerged as novel chronic complications in patients with diabetes, often linked to their increased longevity. Diabetic sarcopenia has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Nevertheless, effectively managing metabolic disorders in patients with T2DM through appropriate therapeutic interventions could potentially mitigate the risk of sarcopenia. Utilizing imaging technologies holds substantial clinical significance in the early detection of skeletal muscle mass alterations associated with sarcopenia. Such detection is pivotal for arresting disease progression and preserving patients' quality of life. These imaging modalities offer reproducible and consistent patterns over time, as they all provide varying degrees of quantitative data. This review primarily delves into the application of dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound for both qualitative and quantitative assessments of muscle mass in patients with T2DM. It also juxtaposes the merits and limitations of these four techniques. By understanding the nuances of each method, clinicians can discern how best to apply them in diverse clinical scenarios.
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Affiliation(s)
- Dingyue Wang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Gaosen Zhang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Yana Yu
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
| | - Zhen Zhang
- Department of Ultrasound, the First Affiliated Hospital China Medical University, Shenyang City, Liaoning Province, 110001, People’s Republic of China
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Yang Q, Zhang C, Zhang Z, Su B. Muscle ultrasound to diagnose sarcopenia in chronic kidney disease: a systematic review and bayesian bivariate meta-analysis. BMC Nephrol 2024; 25:12. [PMID: 38178026 PMCID: PMC10768384 DOI: 10.1186/s12882-023-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for sarcopenia among chronic kidney disease (CKD) populations. BACKGROUND Sarcopenia has become a worldwide health issue, especially for CKD patients. Conventional techniques of muscle mass assessment often prove limited, thus prompts increasing interest in ultrasound suitability. METHODS We searched the Cochrane Library, PubMed and Embase for literature published up to June 2023. Ultrasound diagnosis of sarcopenia in CKD patients was included. Two independent investigators used the Quality Assessment Tool for Diagnosis Accuracy Studies (QUADAS-2) to assess the quality. We extracted valuable information from eligible studies. Using a Bayesian bivariate model, we pooled sensitivity and specificity values and summary receiver operating characteristic (SROC) curves. RESULTS Five articles, involving 428 participants at various stages of CKD were included. Three studies diagnosed by the cross-sectional area (CSA) of the rectus femoris, while two others by muscle thickness (MT) and shear wave elastography (SWE) from the same muscle, separately. Overall, CSA or SWE had a pooled sensitivity of 0.95 (95% CrI, 0.80, 1.00), and the specificity was 0.73 (95% CrI, 0.55, 0.88) for diagnosing sarcopenia in CKD patients. CONCLUSIONS Ultrasound measurements of CSA and SWE were more sensitive for diagnosing sarcopenia in the CKD population than in the general population. Ultrasound assessment from a single peripheral skeletal muscle site may serve as a rapid screening tool for identifying sarcopenic individuals within the CKD population, if a specific cut-off value could be determined.
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Affiliation(s)
- Qinbo Yang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chen Zhang
- West China Hospital, West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Zhuyun Zhang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Med+ Biomaterial Institute of West China Hospital/West China School of Medicine, Sichuan University, Guoxue Alley No. 37, Chengdu, Sichuan Province, 610041, Chengdu, China.
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Tai MF, Bvalani R, Nkhalema B, Mbale E, Chetcuti K, Iroh Tam PY. Ultrasound assessment of malnutrition in infancy: a pilot case-control study. BMC Pediatr 2024; 24:2. [PMID: 38172699 PMCID: PMC10763116 DOI: 10.1186/s12887-023-04479-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed at determining the intra- and inter-rater reliability in ultrasound body composition measurements and investigating the differences between malnourished and non-malnourished infants. Sonographic images for measurements of fat and muscle thickness were compared between 9 malnourished and 9 non-malnourished hospitalized infants. The mean of fat and muscle thickness sums were 12.44 ± 7.58 mm and 28.98 ± 7.18 mm, respectively. The intra- and inter-rater intraclass correlation coefficient were above 0.9 for both measurements, indicating high intra- and inter-rater reliability. Compared to non-malnourished infants, malnourished infants have 45% of fat thickness sum and 71% of muscle thickness sum. Ultrasound measurements of body composition in infants were different between hospitalized malnourished and non-malnourished infants. This approach has the potential to be utilized more broadly, from assessing the nutritional status of critically ill infants in intensive care units to screening for malnutrition in high-risk infant populations.
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Affiliation(s)
- Meng-Fan Tai
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Research Programme, Blantyre, Malawi
- Current affiliation: Department of Paediatrics, Taipei Tzu Chi Hospital, New Taipei City, Taiwan
| | - Ruth Bvalani
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bazwell Nkhalema
- Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Karen Chetcuti
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Radiology, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Research Programme, Blantyre, Malawi.
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.
- Kamuzu University of Health Sciences, Blantyre, Malawi.
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Malawi-Liverpool Wellcome Research Programme, Queen Elizabeth Central Hospital, Kamuzu University of Health Sciences, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
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Lima J, Foletto E, Cardoso RCB, Garbelotto C, Frenzel AP, Carneiro JU, Carpes LS, Barbosa-Silva TG, Gonzalez MC, Silva FM. Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings. Clin Nutr 2024; 43:95-110. [PMID: 38016244 DOI: 10.1016/j.clnu.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
AIMS This scoping review aimed to identify, explore, and map the objectives, methodological aspects, and results of studies that used ultrasound (US) to assess skeletal muscle (SM) in critically ill patients. METHODS A scoping review was conducted according to the Joanna Briggs Institute's methodology. All studies that evaluated SM parameters from the US in patients admitted to the intensive care unit (ICU) were considered eligible. We categorized muscle thickness and cross-sectional area as parameters for assessing SM quantity, while echogenicity, fascicle length, and pennation angle analysis were used to evaluate muscle "quality" (composition/architecture). A literature search was conducted using four databases for articles published until December 2022. Independent reviewers selected the studies and extracted data. Descriptive statistics were calculated to present the results. RESULTS A total of 107 studies were included, the majority of which were prospective cohort studies (59.8 %) conducted in general ICUs (49.5 %). The most frequent objective of the studies was to evaluate SM quantity depletion during the ICU stay (25.2 %), followed by determining whether a specific intervention would modify SM (21.5 %). Most studies performed serial SM evaluations (76.1 %). The rectus femoris muscle thickness was evaluated in most studies (67.9 %), followed by the rectus femoris cross-sectional area (54.3 %) and the vastus intermedius muscle thickness (40.2 %). The studies demonstrated the feasibility and reproducibility of US for SM evaluation, especially related to quantitative parameters. Most studies (70.3 %) reported significant SM quantity depletion during hospitalization. However, the accuracy of the US in measuring SM varied across the studies. CONCLUSIONS The lack of detailed description and standardization in the protocols adopted by the studies included in this scoping review precludes the translation of the evidence related to US for SM assessment into clinical practice.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Estéfani Foletto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Rafaella C B Cardoso
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Charlles Garbelotto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas Brazil
| | - Juliana U Carneiro
- Multiprofessional Residency Program: Intensive Care. Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Larissa S Carpes
- Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre Brazil
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas Brazil
| | | | - Flávia M Silva
- Nutrition Department and Nutrition Science Graduate Program. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre Brazil.
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Rossi AP, Babbanini A, Del Monte L, Vantini G, Stabile G, Urbani S, Fantin F, Zoico E, Zamboni M, Mazzali G. The Role of Ultrasound Muscle Parameters for Myosteatosis and Myofibrosis Measurement in Young, Older, and Obese Subjects. J Am Med Dir Assoc 2024; 25:91-97. [PMID: 37330218 DOI: 10.1016/j.jamda.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The aim of the study was to compare quantitative and qualitative ultrasound parameters between healthy young adults and post-acute hospitalized older adults with and without physical disability, as well as between normal weight and overweight/obese persons. DESIGN Cross-sectional observational study. SETTING AND PARTICIPANTS A total of 120 individuals were recruited: 24 healthy young adults, 24 normal weight and 24 overweight/obese community-dwelling adults, and 48 post-acute hospitalized older adults with different degrees of functional autonomy. METHODS The rectus femoris cross-sectional area (CSA), subcutaneous adipose tissue (SCAT) thickness, echogenicity, strain elastography, and compressibility were measured with ultrasound echography. RESULTS Post-acute older adults with a good level of autonomy showed higher echogenicity, a higher compressibility index and elastometry strain, and lower rectus femoris thickness and CSA as compared with young persons. Post-acute individuals with physical disability showed lower echogenicity and a greater stiffness compared with their still autonomous counterparts. Normal weight individuals showed lower stiffness as evaluated with elastometry and a lower SCAT thickness, as compared with individuals with age-matched overweight or obesity. From multiple regression analyses, using CSA as an independent variable, an inverse association with female sex and age was observed, explaining 16% and 51% of variance. Echogenicity was directly associated with age (34% of variance) and with the Barthel index (6% of variance). Elastometry showed association with age and body mass index (BMI), 30% and 16% of variance, respectively. Considering compressibility as a dependent variable, a direct association with age and an inverse association with BMI were observed, with 5% and 11% of variance respectively. CONCLUSIONS AND IMPLICATIONS Muscle mass decreases with age and with physical disability. Echogenicity, which increases with age and disability level, seems to be associated with myofibrosis. Conversely, elastometry seems useful in the characterization of muscle quality in overweight or obese individuals and as a reliable indirect measure of myosteatosis.
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Affiliation(s)
- Andrea P Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, Treviso, Italy.
| | - Alessio Babbanini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Letizia Del Monte
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Gianluca Vantini
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Giovanni Stabile
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Francesco Fantin
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Elena Zoico
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Division of Geriatrics, Department of Surgery, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, Verona, Italy
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López Jiménez E, Neira Álvarez M, Menéndez Colino R, Checa López M, Grau Jiménez C, Pérez Rodríguez P, Vasquez Brolen B, Arias Muñana E, Ramírez Martín R, Alonso Bouzón C, Amor Andrés MS, Bermejo Boixareu C, Brañas F, Alcantud Ibáñez M, Alcantud Córcoles R, Cortés Zamora EB, Gómez Jiménez E, Romero Rizos L, Avendaño Céspedes A, Hernández Socorro CR, Abizanda P. Muscle mass loss measured with portable ultrasound in hospitalized older adults: The ECOSARC study. J Nutr Health Aging 2024; 28:100010. [PMID: 38267149 DOI: 10.1016/j.jnha.2023.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The main objective was to analyze the evolution of muscle of the Quadriceps Rectus Femoris (QRF) between admission and discharge, in older adults hospitalized with an acute medical disease in Acute Geriatric Units (AGUs). DESIGN Prospective multicentric observational cohort study. SETTING Seven AGUs from University Hospitals in Spain. PARTICIPANTS Hospitalized adults ≥ 70 years old, able to ambulate and without severe dementia. MEASUREMENTS Ultrasound measurements of QRF were acquired at 2/3 distal between anterior-superior iliac spine and patella in both legs by trained Geriatricians. Ultrasound Chison model ECO2 was used. QRF area, thickness, edema, echogenicity, and fasciculations were measured. RESULTS From the complete sample (n = 143), in 45 (31.5%) participants, ultrasound images were classified as non-valid by an expert radiologist. Mean age was 87.8 (SD 5.4). Mean hospital stay 7.6 days (SD 4.3). From those with valid images, 36 (49.3%), 2 (2.7%), and 35 (47.9%) presented a decrease, equal values, or an increase in QRF area from baseline to discharge, respectively, and 37 (50.0%), 2 (2.7%), and 35 (47.3%) presented a decrease, equal values, or an increase in QRF thickness, respectively. 26 (35.6%) presented a decrease in more than 0.2 cm2 of QRF area, and 23 (31.1%) a decrease in more than 0.1 cm of QRF thickness. Only 4 (5.4%) patients presented new edema, while 13 (17.6%) worsened echogenicity. CONCLUSION One third of older adults develop significant muscle loss during a hospitalization for acute medical diseases. TRIAL REGISTRATION NUMBER NCT05113758.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Fátima Brañas
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Rubén Alcantud Córcoles
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Belén Cortés Zamora
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Gómez Jiménez
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Luis Romero Rizos
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | - Almudena Avendaño Céspedes
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | - Pedro Abizanda
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain.
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Dams K, De Meyer GR, Jacobs R, Schepens T, Perkisas S, Moorkens G, Jorens P. Combined ultrasound of m. quadriceps and diaphragm to determine the occurrence of sarcopenia and prolonged ventilation in a COVID-19 ICU cohort: The COVID-SARCUS trial. Nutrition 2024; 117:112250. [PMID: 37918311 DOI: 10.1016/j.nut.2023.112250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/29/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine the development of sarcopenia in a COVID-19 intensive care unit population by sequential quadriceps and diaphragm ultrasound and its relationship with hospital outcomes. METHODS We assessed muscle thickness, cross-sectional area, fascicle length, pennation angle, and echo intensity within 48 h after intubation, at days 5 and 10 and at discharge from the intensive care unit in 30 critically ill patients with confirmed COVID-19. RESULTS A different evolution of muscle thickness of the diaphragm and m. rectus femoris was observed; the changes between the two muscles were not correlated (Pearson's χ2 3.91, P = 0.419). The difference in muscle thickness was linked to the outcome for both m. rectus femoris and diaphragm, with the best survival seen in the group with stable muscle thickness. The greatest loss of muscle thickness occurred between days 5 and 10. The echo intensity was higher in the patients with increased muscle thickness, who also had a worse prognosis. There was a correlation between cross-sectional area on day 5 and handgrip strength (r = 0.290, P = 0.010). Only 31% of patients were able to return to their preadmission residence without any additional rehabilitation. CONCLUSIONS Muscle atrophy and decline in muscle strength appear in the earliest stages after admission to the intensive care unit and are related to functional outcome.
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Affiliation(s)
- Karolien Dams
- Intensive Care Department, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Sciences, Antwerp, Belgium.
| | - Gregory Ra De Meyer
- Intensive Care Department, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Sciences, Antwerp, Belgium; Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium
| | - Rita Jacobs
- Intensive Care Department, Antwerp University Hospital, Edegem, Belgium
| | - Tom Schepens
- Intensive Care Department, Antwerp University Hospital, Edegem, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Stany Perkisas
- University Centre of Geriatrics, University of Antwerp, Antwerp, Belgium
| | - Greta Moorkens
- Department of Internal Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Philippe Jorens
- Intensive Care Department, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Sciences, Antwerp, Belgium
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Márquez Mesa E, Suárez Llanos JP, Afonso Martín PM, Negrín CB, García Ascanio M, González González S, Llorente Gómez de Segura I. Influence of the Results of Control of Intakes, Proteins and Anthropometry Nutritional Screening, Sarcopenia and Body Composition on the Clinical Evolution of Hospitalized Patients. Nutrients 2023; 16:14. [PMID: 38201844 PMCID: PMC10780303 DOI: 10.3390/nu16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Hospital malnutrition and sarcopenia are common in inpatients and are associated with worse prognosis. Our objective is to determine the association of the positivity of CIPA (Control of Intakes, Proteins and Anthropometry) nutrition screening tool and sarcopenia and evaluate its prognostic implications (length of stay, readmissions and mortality) as well as different components of body composition. (2) Methodology: Cross-sectional single-center study and prospective six months follow-up for prognostic variables. On admission, CIPA and EWGSOP2 criteria were assessed. (3) Results: Four hundred inpatients, a median of 65.71 years old and 83.6% with high comorbidity, were evaluated. In total, 34.8% had positive CIPA and 19.3% sarcopenia. Positive CIPA and sarcopenia had worse results in body composition (fat mass (FM), fat-free mass (FFM) and appendicular skeletal muscle mass index (ASMI)) and dynamometry. Positive CIPA is significantly associated with worse prognosis (mortality (OR = 1.99), readmissions (OR = 1.86) and length of stay (B = 0.19)). Positive CIPA and sarcopenia combined are associated with a tendency to higher mortality (OR = 2.1, p = 0.088). Low hand grip strength (HGS) is significantly related to a higher length of stay (B = -0.12). (4) Conclusions: In hospitalized patients, malnutrition independently and combined with sarcopenia is associated with a worse prognosis but not body composition. Low HGS is related to a higher length of stay.
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Affiliation(s)
- Elena Márquez Mesa
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
| | - José Pablo Suárez Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
| | | | - Carla Brito Negrín
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - María García Ascanio
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - Samuel González González
- Faculty of Health Sciences, University of La Laguna, Calle Padre Herrera, 38200 La Laguna, Spain
| | - Ignacio Llorente Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, 38010 Santa Cruz de Tenerife, Spain; (J.P.S.L.)
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Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
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Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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García Almeida JM, Bellido D, De Luis D, Guzmán Rolo G, Olveira G. Protocol for a prospective cohort study on the feasibility of application of nutritional ultrasound in the diagnosis and follow-up of patients with nutritional risk at hospital discharge: study on body composition and function (DRECO). BMJ Open 2023; 13:e074945. [PMID: 38070895 PMCID: PMC10729227 DOI: 10.1136/bmjopen-2023-074945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Nutritional ultrasound (US) is an emerging technique in clinical nutrition for the morphological and structural study of muscle mass. Currently, all definitions of malnutrition include the measurement of muscle mass; however, there is no single way to assess it. It is necessary to develop new techniques to identify muscle involvement in malnutrition that are valid, standardised, reliable, accurate and profitable. OBJECTIVE To value the new muscle US techniques aimed to measure muscle and functional status, to make a more accurate diagnosis and a better prediction of complications and morbidity and mortality in patients at nutritional risk. PRIMARY OUTCOME to assess the feasibility of US or muscle US techniques in both nutritional diagnosis and follow-up in a nutritional intervention programme. METHODS AND ANALYSIS Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) is a prospective, multicentre (25 Spanish hospitals), uncontrolled clinical study in standard clinical practice to value the usefulness of nutritional US (muscle US) in the nutritional diagnosis and follow-up, over 3-6 months, after standard nutritional clinical practice intervention and physical activity, to control their disease-related malnutrition. 1000 patients are expected to be included in. DISCUSSION This study will standardise nutritional US measures. It will validate and define specific cut-off values for nutritional US and correlate it with already well-known nutritional tools such as Subjective Global Assessment or Global Leadership Initiative on Malnutrition criteria. Thus, muscle US will become not only a tool to diagnose malnutrition, but it will also be integrated in the daily practice to evaluate nutritional interventions. ETHICS AND DISSEMINATION All DRECO study materials have been approved by each of the IRB/IEC of all the sites enrolled (either approval of the own IRB/IEC or validating the approval of the IRB/IEC of another hospital). The study has been registered with ClinicalTrials.gov, on 27 June 2022. The results from this study will be presented at scientific conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05433831.
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Affiliation(s)
| | - Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, A Coruña, Spain
| | - Daniel De Luis
- Department of Endocrinology and Nutrition, Valladolid University Hospital, Valladolid, Spain
| | | | - Gabriel Olveira
- Endocrinology and Nutrition Service, Regional University Hospital of Málaga. Málaga Biomedical Research Institute - BIONAND Platform, Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, Málaga, Spain
- CIBER of Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, Málaga, Spain
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49
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Marín-Baselga R, Sanz-Ortega C, Platero-Dueñas L, Sorriguieta-Torre R, Palma-Milla S, Tung-Chen Y. Nutritional assessment by ultrasound of the rectus femoris and preperitoneal adipose tissue as predictors of hospitalized patient complications. Rev Clin Esp 2023; 223:640-646. [PMID: 37865334 DOI: 10.1016/j.rceng.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/11/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Malnutrition and sarcopenia are associated with increased risk of adverse events and worse outcome in hospitalised patients. Ultrasonography is a useful tool in the assessment of body composition. PATIENTS AND METHODS Twenty-three patients admitted to a hospital ward were recruited. Ultrasonographic variables of muscle tissue and adipose tissue were collected, as well as their variation during admission. These were correlated with anthropometric, clinical and analytical data. RESULTS We observed a correlation of ultrasound measurements with length of hospitalisation (maximum preperitoneal fat -0.585, rectus femoris thickness - RF -0.539, RF area -0.540), frailty (RF -0.599) and dependency (RF 0.628). RF contractile capacity correlated with reported weekly exercise (0.642). CONCLUSION RF and preperitoneal fat thickness correlate with the number of days of admission and functional capacity, emerging as prognostic variables.
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Affiliation(s)
- R Marín-Baselga
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - C Sanz-Ortega
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Platero-Dueñas
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | | | - S Palma-Milla
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición Hospital Universitario La Paz, Madrid, Spain
| | - Y Tung-Chen
- Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain.
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50
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Baş H, Okyar Baş A, Ceylan S, Güner M, Koca M, Hafızoğlu M, Şahiner Z, Öztürk Y, Balcı C, Doğu BB, Cankurtaran M, Halil MG. Lower gastrocnemius muscle stiffness, derived from elastography, is an independent factor for falls in older adults. Aging Clin Exp Res 2023; 35:2979-2986. [PMID: 37907664 DOI: 10.1007/s40520-023-02605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND AIMS It is well known that components of sarcopenia (i.e., decreased muscle strength and mass) are related to falls in older adults. However, the possible effects of changes in muscle quality on falls have not been identified. This study aimed to evaluate the changes in muscle quality reflected by muscle stiffness derived from shear-wave elastography (SWE) and its association with falls in older adults. METHODS A total of 101 geriatric outpatients were included in the study. Assessments of physical performance, muscle strength (handgrip strength), muscle mass (muscle ultrasonography and bioelectrical impedance analysis), and muscle stiffness of the medial head of gastrocnemius (GCM) in relaxation and passive stretching were performed. The history of falls in the previous year was questioned and recorded. RESULTS The median (25-75 percentiles) age of participants was 73 (69-77) years, and 66.3% (n = 67) were female. According to fall history, participants were divided into non-fallers and fallers groups, and 72 (71.3%) and 29 (28.7%) participants were in each group, respectively. The median muscle stiffness of (Emean) the GCM in passive stretching was significantly lower in the fallers group (p < 0.001), and it was significantly correlated with the number of falls in the previous year (r: - 0.274, p: 0.010). In regression analyses, the Emean value of GCM in passive stretching was significantly associated with falls independent of confounders (OR: 0.944, 95% CI 0.90-0.98, p = 0.010). DISCUSSION AND CONCLUSION This is the first study to reveal the relationship between falls and SWE-defined lower GCM stiffness independently of muscle mass and strength.
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Affiliation(s)
- Hakan Baş
- Department of Radiology, Ankara Gazi Mustafa Kemal Occupational and Environmental Diseases Hospital, Yenimahalle, Ankara, Turkey.
| | - Arzu Okyar Baş
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Serdar Ceylan
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Merve Güner
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Koca
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Merve Hafızoğlu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Zeynep Şahiner
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Öztürk
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Cafer Balcı
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Balam Doğu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Meltem Gülhan Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
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