Which is the best alternative to estimate muscle mass for sarcopenia diagnosis when DXA is unavailable?

Exploring influencing factors and predictive analysis of sarcopenia in the Chinese population using the body composition analyzer

OBJECTIVE

Employing body composition analysis, this study aims to examine the influencing factors and conduct predictive analysis regarding sarcopenia incidence in the middle-aged and elderly population in China.

METHODS

This study recruited inpatients from the General Medicine Department of Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, as the subjects for a single-center retrospective study. Diagnosis was conducted according to the 2019 criteria from the Asian Working Group for Sarcopenia. Binary logistic regression analysis was utilized to identify factors influencing sarcopenia, and predictive modeling for sarcopenia occurrence was performed based on the area under the ROC curve (AUC).

RESULTS

This study comprised 1258 hospitalized patients, of whom 340 were diagnosed with sarcopenia and 918 were not, resulting in a prevalence of 27%. The baseline characteristics showed statistically significant differences between the two groups. Binary logistic regression analysis revealed that low protein, low total body water, low minerals, low basal metabolic rate, and age were risk factors for sarcopenia (OR > 1, P < 0.05). Conversely, being male, having a higher BMI, greater fat-free mass index, and a higher InBody score were identified as protective factors against sarcopenia (OR < 1, P < 0.05). The AUC values for predicting sarcopenia occurrence based on low protein, low total body water, low minerals, low basal metabolic rate, and age were 0.871, 0.846, 0.757, 0.645, and 0.649, respectively, indicating their significance as predictive indicators. Combining these five indicators into a new predictive model for sarcopenia yielded an area under the curve (AUC) value of 0.932, demonstrating excellent sensitivity and specificity concurrently.

CONCLUSION

The results of body composition analysis indicate that sarcopenia occurrence in the middle-aged and elderly population in China is associated with factors such as low protein, low total body water, low minerals, low basal metabolic rate, age, gender, BMI, fat-free mass index, and InBody score. The combination of specific body composition indicators facilitates the effective prediction of sarcopenia. Clinical practitioners should proactively identify the risk factors influencing sarcopenia, accurately predict.

Body composition and risk for sarcopenia in transgender women

OBJECTIVES

Body composition and strength of cisgender (cis) individuals are well established. However, those for transgender women (trans women) undergoing gender-affirming hormone therapy remain unclear. This study aimed to detect possible body composition and strength variations related to sarcopenia.

METHODS

This was a cross-sectional comparative study of 37 trans women, 34 cis men, and 34 cis women. Body composition was measured in all individuals by bioelectrical impedance analysis; prehensile strength by dynamometry was studied in trans women.

RESULTS

In this study, trans women had higher body mass index values than cis individuals (P < 0.01). Fat mass was 41% higher for trans women than cis men. Muscle mass (MM) was lower in trans women than cis men (-10%), and higher than cis women (24%). Bone mass was lower in trans women than cis men and higher in cis women (P < 0.01). Trans women's prehensile strengths were 25.26 kg for the right hand and 24.8 kg for the left. Appendicular skeletal muscle mass was 23.63 kg, and appendicular skeletal muscle mass index was 8.14 kg.

CONCLUSION

Trans women undergoing gender-affirming hormone therapy show a tendency to adapt body compartments to those of cis women with increased fat mass and reduced muscle mass. Prehensile strength in trans women was close to the cutoff points for sarcopenia risk. Nutrition, physical activity, strength, and body composition are important to avoid the possible risk for sarcopenia. More studies along these lines are necessary, especially in older adults.

Use of electrical bioimpedance in the assessment of sarcopenia in the older aldults: A scoping review

OBJECTIVE

to map and synthesize the main evidence on the use of bioelectrical impedance (BIA) and its variables in the assessment of sarcopenia in community-dwelling older adults.

METHODS

This is a scoping review carried out by searching for articles available in four databases: PUBMED, LILACS, Web of Science and CINAHL, with the following search strategy: Body Composition AND Sarcopenia AND ″electric impedance'' OR ″bioelectrical impedance analysis'' AND Aged.

RESULTS

A total of 27,660 older adults made up the sum of the samples of the included studies. Most studies included participants of both sexes (75.6%), used the variable skeletal and/or appendicular skeletal muscle mass (ASMM) (75.6%), followed by body fat (8.1%), and phase angle (8.1%) in the assessment of the body composition of subjects with sarcopenia.

CONCLUSION

The data from this research show that ASMM and phase angle are the main variables related to sarcopenia screening in community-dwelling older adults. Whereas total extracellular water/body water is still considered a confounding variable in the screening of sarcopenia in the elderly, but it can be considered useful regarding the health conditions of the elderly in the community.

Frontiers in sarcopenia: Advancements in diagnostics, molecular mechanisms, and therapeutic strategies

The onset of sarcopenia is intimately linked with aging, posing significant implications not only for individual patient quality of life but also for the broader societal healthcare framework. Early and accurate identification of sarcopenia and a comprehensive understanding of its mechanistic underpinnings and therapeutic targets paramount to addressing this condition effectively. This review endeavors to present a cohesive overview of recent advancements in sarcopenia research and diagnosis. We initially delve into the contemporary diagnostic criteria, specifically referencing the European Working Group on Sarcopenia in Older People (EWGSOP) 2 and Asian Working Group on Sarcopenia (AWGS) 2019 benchmarks. Additionally, we elucidate comprehensive assessment techniques for muscle strength, quantity, and physical performance, highlighting tools such as grip strength, chair stand test, dual-energy X-ray Absorptiometry (DEXA), bioelectrical impedance analysis (BIA), gait speed, and short physical performance battery (SPPB), while also discussing their inherent advantages and limitations. Such diagnostic advancements pave the way for early identification and unequivocal diagnosis of sarcopenia. Proceeding further, we provide a deep-dive into sarcopenia's pathogenesis, offering a thorough examination of associated signaling pathways like the Myostatin, AMP-activated protein kinase (AMPK), insulin/IGF-1 Signaling (IIS), and the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathways. Each pathway's role in sarcopenia mediation is detailed, underscoring potential therapeutic target avenues. From a mechanistic perspective, the review also underscores the pivotal role of mitochondrial dysfunction in sarcopenia, emphasizing elements such as mitochondrial oxidative overload, mitochondrial biogenesis, and mitophagy, and highlighting their therapeutic significance. At last, we capture recent strides made in sarcopenia treatment, ranging from nutritional and exercise interventions to potential pharmacological and supplementation strategies. In sum, this review meticulously synthesizes the latest scientific developments in sarcopenia, aiming to enhance diagnostic precision in clinical practice and provide comprehensive insights into refined mechanistic targets and innovative therapeutic interventions, ultimately contributing to optimized patient care and advancements in the field.

Sarcopenia and sarcopenic obesity among older adults in the nordic countries: a scoping review

BACKGROUND

Sarcopenia and sarcopenic obesity (SO) are age-related syndromes that may compromise physical and mental health among older adults. The Nordic countries differ from other regions on prevalence of disease, life-style behavior, and life expectancy, which may impact prevalence of sarcopenia and SO. Therefore, the aim of this study is to review the available evidence and gaps within this field in the Nordic countries.

METHODS

PubMed, Embase, and Web of science (WOS) were searched up to February 2023. In addition, grey literature and reference lists of included studies were searched. Two independent researcher assessed papers and extracted data.

RESULTS

Thirty-three studies out of 6,363 searched studies were included in this scoping review. Overall prevalence of sarcopenia varied from 0.9 to 58.5%. A wide prevalence range was still present for community-dwelling older adults when definition criteria and setting were considered. The prevalence of SO ranged from 4 to 11%, according to the only study on this field. Based on the included studies, potential risk factors for sarcopenia include malnutrition, low physical activity, specific diseases (e.g., diabetes), inflammation, polypharmacy, and aging, whereas increased levels of physical activity and improved dietary intake may reduce the risk of sarcopenia. The few available interventions for sarcopenia were mainly focused on resistance training with/without nutritional supplements (e.g., protein, vitamin D).

CONCLUSION

The findings of our study revealed inadequate research on SO but an increasing trend in the number of studies on sarcopenia. However, most of the included studies had descriptive cross-sectional design, small sample size, and applied different diagnostic criteria. Therefore, larger well-designed cohort studies that adhere to uniform recent guidelines are required to capture a full picture of these two age-related medical conditions in Nordic countries, and plan for prevention/treatment accordingly.

Ten tips on how to assess bone health in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical 'tips and tricks' for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate "real-time" monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.

Muscle mass evaluation in hospitalized patients: Comparison between doubly indirect methods

BACKGROUND

Loss of muscle mass (MM) in hospitalized patients has been associated with negative outcomes, thus, evaluating this biomarker is important to stratify risk. Although studies have been showing that calf circumference (CC) and bioelectrical impedance analysis (BIA) are valid for estimating MM in hospitalized patients, we do not know if they are associated. The aim of this study was to evaluate the associations between CC and BIA in hospitalized patients.

METHODS

A cross-sectional study, in hospitalized patients' post-acute cardiac event. We collected sociodemographic, clinical, and anthropometric data. CC measurement was adjusted according to the BMI. Spearman's correlations and associations between the methods were performed for the total sample, according to sex and stage of life (older adults or not).

RESULTS

We included 177 patients, mean age of 60.5 ± 12.4 years old, the majority males (75 %). Median BMI was 26.2 kg/m2 (23.8-29.2 kg/m2), most of them overweight (41.8 %). The median of CC was lower in females and older adults, and majority of the patients had low CC (87.6 %). Higher values of fat-free mass (FFM) by BIA were observed in males and younger adults, and 5.6 % presented low FFMI. We found a positive and moderate correlation between fat-free mass index (FFMI) and CC (rho = 0.532). Males had higher correlations (rho = 0.481). An increase of 1 kg in the FFM represented an increase of 1.16 cm (crude analysis) to 1.59 cm (adjusted analysis) in CC (p < 0.001). FFM explained 37 % in the variability of CC, and together with BMI, sex and age, explained 60 % in the variability.

CONCLUSIONS

Raw values of FFM obtained by BIA and CC presented a weak to moderate correlation in cardiac patients. Changes in one measure impact on the other one.

Evaluation of Multi-Frequency Bioelectrical Impedance Analysis against Dual-Energy X-ray Absorptiometry for Estimation of Low Muscle Mass in Older Hospitalized Patients

The accuracy of multi-frequency (MF) bioelectrical impedance analysis (BIA) to estimate low muscle mass in older hospitalized patients remains unclear. This study aimed to describe the ability of MF-BIA to identify low muscle mass as proposed by The Global Leadership Initiative on Malnutrition (GLIM) and The European Working Group on Sarcopenia in Older People (EWGSOP-2) and examine the association between muscle mass, dehydration, malnutrition, and poor appetite in older hospitalized patients. In this prospective exploratory cohort study, low muscle mass was estimated with MF-BIA against dual-energy X-ray absorptiometry (DXA) in 42 older hospitalized adults (≥65 years). The primary variable for muscle mass was appendicular skeletal muscle mass (ASM), and secondary variables were appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI). Cut-off values for low muscle mass were based on recommendations by GLIM and EWGSOP-2. MF-BIA was evaluated against DXA on the ability to estimate absolute values of muscle mass by mean bias, limits of agreement (LOA), and accuracy (5% and 10% levels). Agreement between MF-BIA and DXA to identify low muscle mass was evaluated with sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). The association between muscle mass, dehydration, malnutrition, and poor appetite was visually examined with boxplots. MF-BIA overestimated absolute values of ASM with a mean bias of 0.63 kg (CI: -0.20:1.46, LOA: -4.61:5.87). Agreement between MF-BIA and DXA measures of ASM showed a sensitivity of 86%, specificity of 94%, PPV of 75% and NPV of 97%. Boxplots indicate that ASM is lower in patients with malnutrition. This was not observed in patients with poor appetite. We observed a tendency toward higher ASM in patients with dehydration. Estimation of absolute ASM values with MF-BIA should be interpreted with caution, but MF-BIA might identify low muscle mass in older hospitalized patients.

Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study

BACKGROUND

Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction.

METHODS

Participants in this cross-sectional study were recruited from a HF outpatients' clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People.

RESULTS

A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30).

CONCLUSIONS

The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.

Defining and diagnosing sarcopenia: Is the glass now half full?

Low muscle mass and function exert a substantial negative impact on quality of life, health and ultimately survival, but their definition, identification and combination to define sarcopenia have suffered from lack of universal consensus. Methodological issues have also contributed to incomplete agreement, as different approaches, techniques and potential surrogate measures inevitably lead to partly different conclusions. As a consequence: 1) awareness of sarcopenia and implementation of diagnostic procedures in clinical practice have been limited; 2) patient identification and evaluation of therapeutic strategies is largely incomplete. Significant progress has however recently occurred after major diagnostic algorithms have been developed, with common features and promising perspectives for growing consensus. At the same time, the need for further refinement of the sarcopenia concept has emerged, to address its increasingly recognized clinical heterogeneity. This includes potential differential underlying mechanisms and clinical features for age- and disease-driven sarcopenia, and the emerging challenge of sarcopenia in persons with obesity. Here, we will review existing algorithms to diagnose sarcopenia, and major open methodological issues to assess skeletal muscle mass and function under different clinical conditions, in order to highlight similarities and differences. Potential for consensus on sarcopenia diagnosis as well as emerging new challenges will be discussed.

Bioelectrical impedance analysis in the BaSAlt cohort-study: the phase angle as an additional parameter for sarcopenia quantification among German nursing home residents?

PURPOSE

Sarcopenia is characterized by the loss of muscle mass, strength, and physical functioning. The bioelectrical impedance analysis (BIA) is a simplify method for the measurement of muscle quantity and quality. But there is a lack of evidence in the interpretation of the muscle quality parameter phase angle (PhA), which was recommended by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). We hypothesize that the PhA shows differences between sarcopenia categorized groups and can be used as an additional parameter for sarcopenia quantification among residents of nursing homes (NH).

METHODS

Based on EWGSOP2 specifications, 78 residents from five German NH was categorized into sarcopenia groups. Group comparisons with Kruskal-Wallis tests, Dunn-Bonferroni post-hoc-Tests, and correlations with Spearman coefficients were conducted with the muscle quality parameter PhA.

RESULTS

Significant group differences by Kruskal-Wallis test for PhA was detected (H = 8.150, p = 0.017). The Dunn-Bonferroni post-hoc-Test showed significant results by group comparison for "confirmed/ severe sarcopenia" (4.1° [3.1-5.0]) with "no sarcopenia" (4.6° [3.7-11.2]; p =0 .049) and "probable sarcopenia" (4.7° [3.4-13.5]; p = 0.016), respectively.

CONCLUSIONS

There is a limitation for differentiation in preliminary stage of sarcopenia among multimorbid NH residents by PhA. Moreover, further research for specific cut-off-values and the individual sarcopenia progression monitoring by PhA are needed.

TRIAL REGISTRATION

No. AZ A2.5.4-096_aa (Date of approval: July 2019).

The Prevalence and Agreement of Sarcopenic Obesity Using Different Definitions and Its Association with Mild Cognitive Impairment

BACKGROUND

The consistent definition of sarcopenic obesity (SO) is limited, its association with mild cognitive impairment (MCI) has not been clarified.

OBJECTIVE

This study aimed to evaluate the prevalence and agreement of SO using different definitions and the association between SO and MCI.

METHODS

SO was diagnosed by the co-existence of sarcopenia defined by the Asia Working Group for Sarcopenia (AWGS) and obesity by body mass index (BMI), visceral fat area (VFA), waist circumference (WC), or body fat percentage (BF%). Cohen's kappa was used to assess the agreement between the different definitions. The association between SO and MCI was assessed using multivariable logistic regression.

RESULTS

Among 2,451 participants, the prevalence of SO ranged from 1.7% to 8.0% under different definitions. SO defined by AWGS and BMI (AWGS+BMI) showed fair agreements with the other three criteria (κ ranged from 0.334 to 0.359). The other criteria showed good agreements with each other. The κ statistics were 0.882 for AWGS+VFA and AWGS+BF%, 0.852 for AWGS+VFA and AWGS+WC, and 0.804 for AWGS+BF% and AWGS+WC, respectively. When using different diagnoses of SO, compared with the health group, the adjusted ORs of MCI for SO were 1.96 (95% CI: 1.29-2.99, SO: AWGS+WC), 1.75 (95% CI: 1.14-2.68, SO: AWGS+VFA), 1.94 (95% CI: 1.29-2.93, SO: AWGS+BF%), and 1.45 (95% CI: 0.67-3.12, SO: AWGS+BMI), respectively.

CONCLUSION

Using different obesity indicators combined with AWGS to diagnose SO, BMI had lower prevalence and agreement compared with other three indicators. SO was associated with MCI under different methods (WC, VFA, or BF%).

The Effects of Fluid Hydration Status on Ultrasound Muscle Measurement in Hemodialysis Patients

OBJECTIVE

This study aimed to explore the effects of fluid hydration status on ultrasound muscle measurement in hemodialysis (HD) patients.

METHODS

Ultrasound muscle examination of the right rectus femoris and bioelectrical impedance analysis measurement of the right lower limb were performed in HD patients at the periods of predialysis and postdialysis. The correlations between the changes in the corresponding ultrasound and bioelectrical impedance analysis variables were analyzed.

RESULTS

A total of 50 patients on maintenance HD were included, with mean age of 52.6 ± 13.5 years. Patients were 40% female (n = 20), and average dialysis duration was 2.62 ± 2.42 years. Compared to predialysis, the measurements of cross-sectional area, muscle thickness, echo intensity (EI), and their percentage changes all decreased significantly after the HD procedure (P < .05). The change in EI and its percentage change were significantly correlated with changes in total body water, intracellular water, and extracellular water (P < .05).

CONCLUSIONS

The HD session may have significant effects on ultrasound muscle measurement. Both the indicators of muscle quantity (cross-sectional area and muscle thickness) and quality (EI) significantly decreased after HD, which may contribute to the change in fluid hydration status and the change in fluid composition.

Calf circumference has a positive correlation with physical performance among community-dwelling middle-aged, older women

Introduction

Sarcopenia and frailty are well-known public health problems in middle-aged and older people. Calf circumference (CC) is a representative anthropometric index that may be useful for screening sarcopenia. Physical performance, assessed by hand grip strength and gait speed, measures sarcopenia and frailty. This community-based, cross-sectional study was conducted in Guishan District, Taoyuan City, between April and October 2017 to investigate the relationship between CC and physical performance among community-dwelling middle-aged, older people in Taiwan and to evaluate potential sex differences. CC tends to be an efficient predictor of physical performance in community health screenings and outpatient clinics for community health examinations, where there is limited time for surveys.

Methods

A total of 1,308 volunteers aged 50-85 were recruited. Volunteers who declined to participate, those with recent cardiovascular disease, and those with an inability to complete an interview, physical performance examinations, and body composition measurements were excluded from the study. A total of 828 participants were enrolled in this study (237 men and 591 women). The statistical methods applied in this study were the Mann-Whitney U-test, independent two-sample t-test, Chi-square test, and multivariate logistic regression models.

Result and discussion

Significant differences were observed in age, waist circumference, appendicular skeletal mass index, calf circumference, hand grip strength, and income between men and women. No significant differences were observed between the men and women regarding body mass index, gait speed, exercise habits, or underlying disorders of diabetes mellitus, hypertension, or hyperlipidemia. Comparing across three different CC tertiles, we discovered significant differences in age, body mass index, waist circumference, appendicular skeletal muscle index, gait speed, and hand grip strength in both men and women. On multivariate logistic regression, after adjusting for age, appendicular skeletal mass index, body mass index, exercise habits, income levels, and CC were positively correlated with physical performance as measured by both gait speed (β = 0.15, p = 0.01) and hand grip strength (β = 0.25, p < 0.001) in women, compared to only hand grip strength (β = 0.41, p < 0.001) in men. Lower calf circumference is an independent risk factor for poor physical performance, especially among women.

The Contribution of Diet Therapy and Probiotics in the Treatment of Sarcopenia Induced by Prolonged Immobilization Caused by the COVID-19 Pandemic

The prolonged immobilization associated with COVID-19 infection and the restrictions imposed by the pandemic have determined major changes in physical activity and eating habits, with a negative impact on physical performance. This study monitored non-pharmacological interventions (diet therapy and probiotics) in managing sarcopenia for patients with recent SARS-CoV-2 history (14 days). A prospective study was performed on 200 patients (between December 2020−December 2021), with SPPB score < 9, randomly divided into: Group K—DP (93 patients) with dietary therapy (protein 1.2−1.5 g/kg) and probiotics for two months; and Group K—non-DP (107 patients) without diet therapy and probiotics. All patients were included in a specific physical training program (40 min), three sessions per week. Skeletal muscle index (SMI), serum albumin, and hemoglobin were determined. The SMI was initially low for both groups without significant statistical differences (6.5 ± 0.52 kg/m2 for Group K—non-DP vs. 6.7 ± 0.57 Kg/m2 for Group K—DP, p = 0.135). After two months, significant difference between initial and final SMI values was determined for Group K—DP (6.92 ± 0.50 kg/m2 vs. 6.77 ± 0.56 kg/m2, p = 0.048). In Group K—DP, at end of study, were more patients with normal SMI (n = 32 → N = 70) values (p < 0.001) and fewer sarcopenia patients (p < 0.001). The initial serum albumin means values in the two groups (Group K—non-DP, 4.17 ± 1.04 g/dL, and Group K—DP, 3.95 ± 0.98 g/dL) were not statistically significantly different (p = 0.122). The hemoglobin level improved significantly following a hyper protein diet enriched with pro-biotics (p = 0.003). Diet therapy, consisting of increased protein intake and specific probiotics and specific physical therapy, demonstrated superiority in improving the functional status of patients with recent COVID-19 infection.

Sex Difference in Cutoff and Prevalence of Sarcopenia among 300,090 Urban Korean Population: Association with Metabolic Syndrome

Background and Objectives: The study aimed to establish the threshold values and prevalence of sarcopenia and to investigate the association of sarcopenia with metabolic syndrome in an urban Korean population. Materials and Methods: The study included 300,090 adults who underwent anthropometric analyses by bioelectrical impedance analyzer. Sarcopenia was defined as: (1) class I, skeletal muscle mass index (SMI) within −1 to −2 standard deviations (SDs); (2) or class II, <−2 SD of SMI in a young population. Results: Low SMI threshold levels for class I and class II sarcopenia were 39.8 and 36.7% in men, and 35.5 and 32.3% in women. Among all age groups, the prevalence rates of sarcopenia were highest in the age group 80−89 years. Following adjustment for possible confounders including age, sex, height, metabolic and health behavioral factors, adjusted odds ratios (95% confidence intervals) for the risk of metabolic syndrome were 2.43 (2.33−2.54) for class I and 2.69 (2.49−2.91) for class II sarcopenia, compared with the normal reference. Sarcopenia was more strongly associated with metabolic syndrome in women than men (p for interaction < 0.01). The threshold values and prevalence of sarcopenia were demonstrated in a large Korean urban population. Conclusions: This study identified that sarcopenia was associated with increased risk of metabolic syndrome, showing itself to be significantly higher in women than men.

Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study

BACKGROUND

Sarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use with sarcopenia in a sample of Portuguese HF outpatients.

METHODS

In this cross-sectional study, a sample of 136 HF patients (median age: 59 years, 33.8% women) was recruited from an HF outpatients' clinic of a University Hospital in Portugal. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2. Clinical, nutritional, and dietary data were collected.

RESULTS

A total of 25 (18.4%) individuals were categorised as sarcopenic, ranging from 12.2% in younger (< 65 years) participants vs. 30.4% in older ones and from 3.3% in men vs. 47.8% in women. Severe sarcopenia accounted for 7.4% of the sample and sarcopenic obesity was identified in 5.1% of the individuals. A total of 65.4% of the participants were statin users. In multivariable analysis (n = 132, 25 sarcopenic), the use of statins was inversely associated with sarcopenia (OR = 0.03; 95% CI = 0.01, 0.30). Each additional age year was associated with a 9% increase in the likelihood of being sarcopenic (OR = 1.09; 95% CI = 1.01, 1.17), and each Kg.m^-2 increment in body mass index was associated with a 21% decrease in the likelihood of sarcopenia (OR = 0.79; 95% CI = 0.65, 0.96). The daily use of five or more medicines was also directly associated with sarcopenia (OR = 26.87; 95% CI = 2.01, 359.26). On the other hand, being a man and being physically active were inversely associated with sarcopenia (OR = 0.01; 95% CI = 0.00, 0.07 and OR = 0.09; 95% CI = 0.01, 0.65, respectively).

CONCLUSIONS

Contrary to what was expected, patients medicated with statins were less likely to be sarcopenic. Although this finding deserves further research, we hypothesise that this might be related to the pleiotropic effects of statins on endothelial function, contributing to better neuromuscular fitness.

Bio-Electrical Impedance Analysis: A Valid Assessment Tool for Diagnosis of Low Appendicular Lean Mass in Older Adults?

Background

The diagnosis of sarcopenia is essential for early treatment of sarcopenia in older adults, for which assessment of appendicular lean mass (ALM) is needed. Multi-frequency bio-electrical impedance analysis (MF-BIA) may be a valid assessment tool to assess ALM in older adults, but the evidences are limited. Therefore, we validated the BIA to diagnose low ALM in older adults.

Methods

ALM was assessed by a standing-posture 8 electrode MF-BIA (Tanita MC-780) in 202 community-dwelling older adults (age ≥ 55 years), and compared with dual-energy X-ray absorptiometry (DXA) (Hologic Inc., Marlborough, MA, United States; DXA). The validity for assessing the absolute values of ALM was evaluated by: (1) bias (mean difference), (2) percentage of accurate predictions (within 5% of DXA values), (3) the mean absolute error (MAE), and (4) limits of agreement (Bland–Altman analysis). The lowest quintile of ALM by DXA was used as proxy for low ALM (< 22.8 kg for men, < 16.1 kg for women). Sensitivity and specificity of diagnosing low ALM by BIA were assessed.

Results

The mean age of the subjects was 72.1 ± 6.4 years, with a BMI of 25.4 ± 3.6 kg/m², and 71% were women. BIA slightly underestimated ALM compared to DXA with a mean bias of −0.6 ± 1.2 kg. The percentage of accurate predictions was 54% with a MAE of 1.1 kg, and limits of agreement were −3.0 to + 1.8 kg. The sensitivity for ALM was 80%, indicating that 80% of subjects who were diagnosed as low ALM according to DXA were also diagnosed low ALM by BIA. The specificity was 90%, indicating that 90% of subjects who were diagnosed as normal ALM by DXA were also diagnosed as normal ALM by the BIA.

Conclusion

This comparison showed a poor validity of MF-BIA to assess the absolute values of ALM, but a reasonable sensitivity and specificity to recognize the community-dwelling older adults with the lowest muscle mass.

Current status of the assessment of sarcopenia, frailty, physical performance and functional status in chronic kidney disease patients

PURPOSE OF REVIEW

Low physical function, frailty, and sarcopenia are common complications of chronic kidney disease (CKD). In this article, we review the epidemiology and pathogenesis of low physical function, as well as its associations with adverse outcomes in CKD patients. Additionally, we present various traditional and novel methods for assessment of physical function in CKD patients.

RECENT FINDINGS

In nondialysis dependent (NDD) and dialysis-dependent CKD patients, the prevalence of low physical function, frailty, and sarcopenia are substantially higher than in the general population. The potential mechanisms of low physical function, frailty, and sarcopenia in CKD patients are due to various factors including underlying kidney disease, co-existing comorbidities, and certain therapeutic interventions utilized in CKD. Increasing evidence has also uncovered the ill effects of impaired physical function on clinical outcomes in CKD patients.

SUMMARY

Routine assessment of physical function is an under-utilized yet important component in the management of CKD patients. Future studies are needed to determine how prescription of exercise and increased daily physical activity can be tailored to optimize the health and well-being of NDD and dialysis-dependent CKD patients in pursuit of successful aging.