Higher malnutrition risk is related to increased intramuscular adipose tissue of the quadriceps in older inpatients: A cross-sectional study

Association between quadriceps muscle thickness or echo intensity, malnutrition, and activities of daily living in an integrated medical and long-term care facility: A cross-sectional study

BACKGROUND &AIMS

Malnutrition and physical function impairment are prevalent concerns in long-term care facilities. This study investigated the relationship between quadriceps muscle thickness (QMT) or echo intensity (QEI), nutritional status, and activities of daily living (ADL) in residents of an Integrated Facility for Medical and Long-term Care (IFMLC) in Japan.

METHODS

Using a cross-sectional design, 126 residents (86 women, median age 89 years) at an IFMLC were assessed. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria including disease burden/inflammation, while ADL status was evaluated using the Barthel Index (BI). QMT and QEI, indicative of muscle mass and intramuscular adipose tissue, were measured by ultrasound. Multivariate logistic and linear regression analyses were conducted to explore the association of QMT or QEI with malnutrition and ADL.

RESULTS

62 residents (49%) were in the lower QMT group and 63 residents (50%) were in the upper QEI group. The prevalence of severe malnutrition in the lower QMT group was significantly higher than that in the upper QMT group. Moreover, the lower QMT group had significantly lower BI points than the upper QMT group. The upper QEI group had significantly lower BI points than the lower QEI group. lower QMT was associated with severe malnutrition (odds ratio 3.170; 95% CI 1.238 to 8.725; P = 0.016). Furthermore, both lower QMT (B = -12.520; 95% CI -17.069 to -7.973; P < 0.001) and upper QEI (B = -7.598; 95% CI -12.565 to -2.631; P = 0.003) showed an independent correlation with lower BI scores.

CONCLUSION

This study found a relationship between lower QMT correlated with severe malnutrition and poor ADL, while higher QEI is associated with poor ADL.

Prevalence and prognostic significance of malnutrition in patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair

BACKGROUND

Malnutrition is associated with poor prognosis in several cardiovascular diseases; however, its role in patients with secondary mitral regurgitation (SMR) is poorly known.

AIMS

To evaluate the impact of nutritional status, assessed using different scores, on clinical outcomes in patients with SMR undergoing transcatheter edge-to-edge repair (TEER) in a real-world setting.

METHODS

A total of 658 patients with SMR and complete nutritional data were identified from the MIVNUT registry. Nutritional status has been assessed using controlling nutritional status index (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) scores. Outcomes of interest were all-cause mortality and all-cause mortality or heart failure (HF) hospitalization.

RESULTS

Any malnutrition grade was observed in 79.4%, 16.7%, and 47.9% of patients by using CONUT, PNI, and GNRI, respectively, while moderate to severe malnutrition was noted in 24.7%, 16.7%, and 25.6% of patients, respectively. At a median follow-up of 2.2 years, 212 patients (32.2%) died. Moderate-severe malnutrition was associated with a higher rate of all-cause mortality (HR: 2.46 [95% CI: 1.69-3.58], HR: 2.18 [95% CI: 1.46-3.26], HR: 1.97 [95% CI: 1.41-2.74] for CONUT, PNI, and GNRI scores, respectively). The combined secondary endpoint of all-cause mortality and HF rehospitalization occurred in 306 patients (46.5%). Patients with moderate-severe malnutrition had a higher risk of the composite endpoint (HR: 1.56 [95% CI: 1.20-2.28], HR: 1.55 [95% CI: 1.01-2.19], HR: 1.36 [95% CI: 1.02-1.80] for CONUT, PNI, and GNRI scores, respectively). After adjustment for multiple confounders, moderate-severe malnutrition remained independently associated with clinical outcomes.

CONCLUSIONS

Moderate-severe malnutrition was common in patients with SMR undergoing TEER. It was independently associated with poor prognosis regardless of the different scores used.

Association between muscle quality and nutritional status among community-dwelling older adults: A cross-sectional study

Background: Decline in muscle quality is associated with poorer health in community-dwelling older adults. Although there is evidence that malnutrition is associated with the decline of muscle quality in older adults, few analyses have considered important factors related to muscle quality. Aim: The purpose of this study was to determine the relationship between muscle quality and nutritional status in community-dwelling older adults, taking into account muscle mass, muscle strength, and amount of physical activity. Methods: This was a cross-sectional study. Data were obtained from a health checkup program in Japan. Participants were older adults aged ≥65 years living in the community who participated in the health checkup program. The data collected were echo intensity, scores on the Global Leadership Initiative on Malnutrition criteria, skeletal muscle mass, grip strength, physical activity level, and demographic data. Multiple regression analysis was used to examine the association between muscle quality and nutritional status. Results: Data were analyzed for 50 participants (mean age 77.62 years, standard deviation 6.16 years, 78.0% women). Multiple regression analysis showed that nutritional status affected muscle quality even when various factors were taken into account (B = 6.95, β = 0.31, p = 0.04, 95% confidence interval: 0.01-0.62). Conclusion: The observed association suggests that providing nutritional support for older adults living in the community may be a useful strategy to maintain muscle quality.

Increase in protein intake is related to decreasing intramuscular adipose tissue of the quadriceps in older inpatients: A longitudinal study

BACKGROUND & AIM

Several randomized controlled trials indicated that an increase in protein intake decreases intramuscular adipose tissue of the thigh in mobility-limited or pre-frail older persons and stroke patients. However, whether the increase in protein intake in older inpatients is related to decreasing intramuscular adipose tissue remains unclear. The aim of this study was to examine the longitudinal relationship between intramuscular adipose tissue of the quadriceps and protein intake in older inpatients.

METHODS

This longitudinal study included 193 older inpatients (aged ≥65 years) (median [IQR] age: 83.0 [77.0-88.0]). The primary outcomes were changes in intramuscular adipose tissue of the quadriceps and protein intake. Intramuscular adipose tissue and muscle mass of the quadriceps were examined using ultrasound images (i.e., quadriceps echo intensity and thickness). The changes in quadriceps echo intensity and protein intake were calculated by subtracting the quadriceps echo intensity and protein intake at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in protein intake was independently and significantly related to changes in quadriceps echo intensity and thickness.

RESULTS

Quadriceps echo intensity at discharge (81.3 ± 20.6 [a.u.]) was significantly lower than at admission (84.0 ± 20.5 [a.u.]). Protein intake at discharge (1.2 [1.0-1.4] g/kg/day) was significantly higher than at admission (1.2 [0.9-1.4] g/kg/day). Change in protein intake was negatively and significantly related to the change in quadriceps echo intensity. In contrast, change in protein intake was not independently and significantly related to change in quadriceps thickness.

CONCLUSIONS

Our results indicate that an increase in protein intake is related to a decrease in intramuscular adipose tissue of the quadriceps in older inpatients. Nutritional intervention for increasing protein intake in older inpatients may be essential for decreasing intramuscular adipose tissue of the quadriceps.

Association of Regional Muscle Thickness and Echo Intensity with Muscle Volume, Intramuscular Adipose Tissue, and Strength of the Quadriceps Femoris

Purpose

This study aimed to investigate the association of muscle thickness (MT) and echo intensity (EI) obtained at different regions along the muscle length with muscle volume (MV), intramuscular adipose tissue (IntraMAT), and muscle strength of the quadriceps femoris (QF).

Patients and Methods

A total of 135 community-dwelling adults (64 men and 71 women) participated in the study. Ultrasound scanning of the rectus femoris (RF) and vastus intermedius (VI) was performed at three locations (from mid- to distal thigh). The MT of the RF and VI and EI of the RF were measured. MRI-derived MV, IntraMAT, and muscle strength of the QF were measured.

Results

The correlation between RF-MT and RF-MV weakened as scanning approached the distal thigh, and the difference between the coefficients for the scanning locations was significant for women. However, the correlation of VI-MT with VI-MV and that of the combined MT of RF and VI with the MV of the whole QF and muscle strength were comparable among the scanning locations for both sexes. The correlation of RF-EI with the IntraMAT of the RF and the whole QF and muscle strength was also comparable among the scanning locations for both sexes.

Conclusion

The results of this study suggest that ultrasound measurements at the distal thigh can predict MV, IntraMAT, and muscle strength of the QF to the same degree as those at the mid-thigh.

Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation

Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.

Association of medial gastrocnemius adiposity with poststroke severe malnutrition and functional performance of activities of daily living in older patients: A prospective analysis

BACKGROUND

Relationships among medial gastrocnemius intramuscular adipose tissue, nutrition status, and functional outcomes of patients after a stroke are unknown. This study was conducted to determine the relationship between nutrition status and gastrocnemius intramuscular adipose tissue and whether medial gastrocnemius intramuscular adipose tissue affects functional outcomes of older patients after a stroke.

METHODS

This prospective cohort study included 217 patients with stroke. Nutrition status was evaluated by the Global Leadership Initiative on Malnutrition. The medial gastrocnemius intramuscular adipose tissue was assessed using ultrasound echographic intensity. Multivariate linear regression analysis was used to determine the relationship between nutrition status at admission and medial gastrocnemius intramuscular adipose tissue. Furthermore, we examined the influence of medial gastrocnemius intramuscular adipose tissue on the Functional Independence Measure (FIM)-motor score at discharge and FIM-motor efficiency, which indicates FIM-motor changes during the hospital stay.

RESULTS

Severe malnutrition had a positive influence on medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side (β = 0.175; P = 0.044). Additionally, the medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side was negatively correlated with the FIM-motor score at discharge (β = -0.102; P = 0.005) and FIM-motor efficiency (β = -0.273; P = 0.005).

CONCLUSIONS

This study clarified the factors that contribute to a higher medial gastrocnemius intramuscular adipose tissue content on the nonparalyzed side and the effect of the higher adipose tissue content on functional outcomes.

Longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different activities of daily living levels

BACKGROUND & AIMS

Whether there is a longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps at different activities of daily living (ADL) levels remains unclear. This study aimed to examine the longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different ADL levels.

METHODS

This prospective cohort study was hospital-based and included 198 inpatients aged ≥65 years. Ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The changes in quadriceps thickness and echo intensity were calculated by subtracting these baseline values from these values at discharge. ADL were assessed at admission using the Barthel Index (BI). The participants were divided into the low BI (BI score <60) and high BI (BI score ≥60) groups in accordance with the BI score. Multiple regression analysis was performed to examine whether the change in quadriceps echo intensity was independently and significantly related to change in quadriceps thickness, even after adjusting for confounding factors in the total participants and high and low BI groups.

RESULTS

The number of the high and low BI groups were 54 and 144. Change in quadriceps echo intensity was independently and significantly related to changes in quadriceps thickness of the total participants (β = -0.53, p < 0.01) and low BI (β = - 0.51, p < 0.01) and high BI (β = -0.70, p < 0.01) groups.

CONCLUSIONS

The results of this study indicate that there is a longitudinal negative relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients regardless of ADL level. Intramuscular adipose tissue may be an important contributing factor for muscle mass.

Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients

OBJECTIVES

This study aimed to examine whether the decrease in muscular echo-intensity of the quadriceps by ultrasound in older inpatients is related to the improvement of gait independence than the increase of muscle thickness.

DESIGN

Longitudinal study.

SETTING

Hospital-based study.

PARTICIPANTS

This study included 171 inpatients aged ≥ 65 years (median age: 84.0 [77.0-88.0], 56.1% female). Patients who were able to walk independently at hospital admission were excluded from the study.

MEASUREMENTS

Improvement of gait independence during hospital stay was assessed using the change in Functional Independence Measure (FIM) gait score (i.e., FIM gait score at hospital discharge minus FIM gait score at hospital admission) and FIM gait score at hospital discharge. Muscular echo-intensity and muscle thickness of the quadriceps were assessed at hospital admission and discharge using ultrasound images, respectively. Muscular echo-intensity has been shown to be mainly related to intramuscular adipose tissue. Multiple linear regression analysis was performed to identify the factors independently associated with the change in FIM gait score and FIM gait score at discharge.

RESULTS

Change in quadriceps echo-intensity was independently and significantly associated with the change in FIM gait score (β = -0.22, p = 0.017) and FIM gait score at hospital discharge (β = -0.21, p = 0.017). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in FIM gait score (β = 0.16, p = 0.050) and FIM gait score at hospital discharge (β = 0.15, p = 0.050).

CONCLUSIONS

Our study indicates that a decrease in muscular echo-intensity of the quadriceps by ultrasound is more related to the improvement of gait independence than an increase of muscle thickness in older inpatients. Intervention for intramuscular adipose tissue of the quadriceps may be important for improving gait independence in older inpatients.

Higher malnutrition risk in older inpatients who are referred to the department of rehabilitation is related to increase of intramuscular adipose tissue: A prospective study

BACKGROUND & AIMS

A recent cross-sectional study reported that a higher intramuscular adipose tissue of the quadriceps is related to higher malnutrition risk in older inpatients. However, a longitudinal relationship between them in older inpatients remains unclear. This study aimed to examine the relationship between the malnutrition risk at hospital admission and change in quadriceps intramuscular adipose tissue induced during the hospital stay in older inpatients.

METHODS

The inclusion criteria in this longitudinal study were older patients (aged ≥65 years) who were referred to the department of rehabilitation. Patients who died during a hospital stay, who underwent thigh amputation, and who had a hospital stay of <3 days or a lack of data were excluded from the study. Malnutrition risk at post-acute hospital admission was assessed using Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at hospital admission and discharge using echo intensity and muscle thickness on ultrasound images. The changes in quadriceps echo intensity and thickness were calculated by subtracting these baseline values from these values at discharge. Multiple regression analysis was performed to examine whether GNRI at admission is independently and significantly related to the quadriceps echo intensity and thickness at discharge and changes in quadriceps echo intensity and thickness. The independent variables were GNRI, age, sex, days from onset disease, disease, quadriceps echo intensity or thickness at admission, and change in quadriceps thickness.

RESULTS

This study included 200 inpatients (median [interquartile range] age: 83.0 [77.0-88.0], 57.0% female). GNRI at admission was significantly and independently related to quadriceps echo intensity at discharge (β = -0.136, p = 0.008) and change in quadriceps echo intensity (β = -0.177, p = 0.008). In contrast, GNRI was not significantly and independently related to quadriceps thickness at discharge (β = 0.087, p = 0.158) and change in quadriceps thickness (β = 0.133, p = 0.158).

CONCLUSIONS

Our results suggest that a higher malnutrition risk at post-acute hospital admission in older inpatients is related to an increase of intramuscular adipose tissue of the quadriceps during the hospital stay. Malnutrition risk at hospital admission in older inpatients is considered to be a predictor for an increase of intramuscular adipose tissue of the quadriceps during a hospital stay.

Usefulness of Muscle Ultrasonography in the Nutritional Assessment of Adult Patients with Cystic Fibrosis

Background: Muscle ultrasonography of the quadriceps rectus femoris (QRF) is a technique on the rise in the assessment of muscle mass in application of nutritional assessment. The aim of the present study is to assess the usefulness of muscle ultrasonography in patients with cystic fibrosis, comparing the results with other body composition techniques such as anthropometry, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), and handgrip strength (HGS). At the same time, we intend to assess the possible association with the nutritional and respiratory status. Methods: This was a prospective observational study in adult patients with cystic fibrosis in a clinically stable situation. Muscle ultrasonography of the QRF was performed, and the results were compared with other measures of body composition: anthropometry, BIA, and DXA. HGS was used to assess muscle function. Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 48 patients were included, with a mean age of 34.1 ± 8.8 years. In total, 24 patients were men, and 24 patients were women. Mean BMI was 22.5 ± 3.8 kg/m2. Mean muscular area rectus anterior (MARA) was 4.09 ± 1.5 cm2, and mean muscular circumference rectus was 8.86 ± 1.61 cm. A positive correlation was observed between the MARA and fat-free mass index (FFMI) determined by anthropometry (r = 0.747; p < 0.001), BIA (r = 0.780; p < 0.001), and DXA (r = 0.678; p < 0.001), as well as muscle function (HGS: r = 0.790; p < 0.001) and respiratory parameters (FEV1; r = 0.445, p = 0.005; FVC: r = 0.376, p = 0.02; FEV1/FVC: r = 0.344, p = 0.037). A total of 25 patients (52.1%) were diagnosed with malnutrition according to GLIM criteria. Differences were observed when comparing the MARA based on the diagnosis of malnutrition (4.75 ± 1.65 cm2 in normo-nourished vs. 3.37 ± 1.04 in malnourished; p = 0.014). Conclusions: In adults with cystic fibrosis, the measurements collected by muscle ultrasound of the QRF correlate adequately with body composition techniques such as anthropometry, BIA, DXA, and handgrip strength. Muscle ultrasound measurements, particularly the MARA, are related to the nutritional status and respiratory function of these patients.

Influence of ultrasound focus depth on the association between echo intensity and intramuscular adipose tissue

INTRODUCTION/AIMS

Attenuation of the US wave is a serious limitation of echo intensity (EI) on B-mode ultrasound (US). The aim of this study was to determine if the focus depth of US images influences the depth-dependent attenuation of EI and the relationship between EI and intramuscular adipose tissues (IntraMAT).

METHODS

The rectus femoris (RF) and vastus intermedius (VI) of the right thigh were studied in 135 adults (92 older, 43 younger). The EI on US images was measured at three focus depth conditions: top of the image, center of the RF, and center of the VI. The depth of the region of interest (ROI) was measured. Using water and fat images based on the two-point Dixon technique with 3.0 T MRI scanner, IntraMAT was calculated.

RESULTS

The correlation between EI and IntraMAT was stronger in the focus RF and VI conditions than in the focus top condition and stronger for RF than for VI. The depth of the ROI influenced the IntraMAT-adjusted residual EI more in the focus top condition than in the focus RF and VI conditions, and influenced VI more strongly than it did RF.

DISCUSSION

This study showed that by mitigating EI attenuation, EI with a focus depth adjusted to the ROI reflected IntraMAT more accurately than that without adjustment. However, it may not completely prevent the potential influence of depth-dependent attenuation of EI, especially for deeper muscles such as the VI. This article is protected by copyright. All rights reserved.

Relationship between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients

BACKGROUND

In 2021, the International Society of Physical and Rehabilitation Medicine (ISPRM) special interest group on sarcopenia included the quadriceps thickness assessed with ultrasound image as an indicator of muscle mass in the diagnosis criteria of sarcopenia. If quadriceps echo intensity of older inpatients is to be a strong predictor of quadriceps thickness, muscle quality of the quadriceps may be estimated by the muscle mass when diagnosing sarcopenia using the criteria of ISPRM.

OBJECTIVE

This study aimed to examine the association between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients.

METHODS

This cross-sectional study included 399 inpatients aged ≥ 65 years. Primary outcomes were muscle mass and fraction of intramuscular adipose tissue of the quadriceps. Images were acquired using a B-mode ultrasound. Muscle mass and fraction of intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. A multiple regression analysis (forced entry method) was performed to confirm whether quadriceps echo intensity was related to quadriceps thickness even after adjusting for other factors.

RESULTS

In the multiple regression analyses for both male and female models, quadriceps echo intensity (male: β = - 0.537, p < 0.001; female: β = - 0.438, p < 0.001), Geriatric Nutritional Risk Index (male: β = 0.236, p < 0.001; female: β = 0.213, p < 0.001), and subcutaneous fat thickness of the thigh (male: β = 0.197, p < 0.001; female: β = 0.248, p < 0.001) were independently and significantly associated with quadriceps thickness.

CONCLUSIONS

Our results show that there is a negative and significant association between muscle mass and fraction of intramuscular adipose tissue in older inpatients. Muscle quality of the quadriceps in older inpatients may be estimated to some extent by the muscle mass.

Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality

OBJECTIVES

This study aimed to examine the relationship between muscle mass, intramuscular adipose tissue, and body mass index (BMI) in older inpatients.

DESIGN

Cross-sectional study.

SETTING

Hospital-based study.

PARTICIPANTS

This study included 413 inpatients aged ≥ 65 years (186 men and 227 women).

MEASUREMENTS

Muscle mass and intramuscular adipose tissue of the quadriceps were assessed by measuring the muscle thickness and echo intensity on ultrasound images. To examine the relationship between quadriceps thickness and echo intensity and BMI in total participants and each sex, the Kendall rank correlation coefficient was used. Multiple regression analysis was performed to examine whether BMI was independently and significantly related to the quadriceps thickness and echo intensity, even after adjusting for other variables for total participants and each sex. The independent variables in multiple regression analyses were BMI, age, disease, days from onset disease.

RESULTS

The results of the correlation analyses showed that BMI was significantly related to the quadriceps thickness (total participants, τ = 0.431; men, τ = 0.491; women, τ = 0.388) and echo intensity (total participants, τ = -0.239; men, τ = -0.318; women, τ = -0.188). In the multiple regression analysis, BMI was independently and significantly associated with the quadriceps thickness (total participants, β = 0.535; men, β = 0.548; women, β = 0.519) and echo intensity (total participants, β = -0.287; men, β = -0.398; women, β = -0.210).

CONCLUSION

This study indicated that older inpatients with a higher BMI have greater muscle mass and less intramuscular adipose tissue of the quadriceps. These results suggested that a higher BMI in older inpatients is related to higher quadriceps muscle quality.

Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

Mounting evidence has suggested the clinical significance of body composition abnormalities in the context of cirrhosis. Herein, we aimed to investigate the association between visceral adiposity and malnutrition risk in 176 hospitalized patients with cirrhosis. The adiposity parameters were obtained by computed tomography (CT) as follows: total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR). Malnutrition risk was screened using Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Visceral adiposity was determined given a higher VSR based on our previously established cutoffs. Multivariate analysis implicated that male gender (OR = 2.884, 95% CI: 1.360–6.115, p = 0.006), BMI (OR = 0.879, 95% CI: 0.812–0.951, P = 0.001), albumin (OR = 0.934, 95% CI: 0.882–0.989, P = 0.019), and visceral adiposity (OR = 3.413, 95% CI: 1.344–8.670, P = 0.010) were independent risk factors of malnutrition risk. No significant difference was observed regarding TATI, SATI, and VATI among patients with low or moderate and high risk of malnutrition. In contrast, the proportion of male patients embracing visceral adiposity was higher in high malnutrition risk group compared with that in low or moderate group (47.27 vs. 17.86%, p = 0.009). Moreover, this disparity was of borderline statistical significance in women (19.05 vs. 5.88%, p = 0.061). Assessing adipose tissue distribution might potentiate the estimation of malnutrition risk in cirrhotics. It is pivotal to recognize visceral adiposity and develop targeted therapeutic strategies.

Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients

BACKGROUND

The longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living (ADL) in older inpatients remains unclear. This study aimed to examine whether decrease of intramuscular adipose tissue of the quadriceps in older inpatients is related to the recovery of ADL than increase of muscle mass.

METHODS

This longitudinal study included 202 inpatients aged ≥65 years [median age: 83.0 (77.0-88.0), 56.4% female]. Recovery of ADL during hospital stay was assessed using the change in Barthel index (BI) score (i.e. BI score at discharge minus BI score at admission) and BI score at discharge. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Higher echo intensity indicates greater intramuscular adipose tissue. Multiple regression analysis was performed to identify the factors independently associated with the change in BI score and BI score at discharge. Changes in quadriceps echo intensity and thickness and subcutaneous fat thickness of the thigh, quadriceps echo intensity and thickness, and subcutaneous fat thickness of the thigh at admission, age, sex, days from onset disease, BI score at admission, and disease were set as independent variables.

RESULTS

The means of the change in quadriceps echo intensity and thickness were -2.3 ± 15.7 and 0.1 ± 0.4 cm, respectively. The median of the change in BI score was 15.0 (0.0-30.0). The quadriceps echo intensity at discharge was significantly lower than at admission (P = 0.043). The quadriceps thickness (P = 0.004) and BI score at discharge (P < 0.001) were significantly higher than those at admission. Change in quadriceps echo intensity was independently and significantly associated with the change in BI score (β = -0.25, P = 0.006) and BI score at discharge (β = -0.18, P = 0.006). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in BI score (β = 0.09, P = 0.244) and BI score at discharge (β = 0.06, P = 0.244).

CONCLUSIONS

Our study indicates that a decrease of intramuscular adipose tissue of the quadriceps is related to the recovery of ADL than an increase of muscle mass in older inpatients. Intramuscular adipose tissue of the quadriceps in older inpatients is considered to be a predictor for the recovery of ADL, and intervening for intramuscular adipose tissue may be important for improving ADL in older inpatients.

Muscle volume and intramuscular fat of the tongue evaluated with MRI predict malnutrition in people living with dementia: a five-year follow-up study

Malnutrition is highly prevalent in older persons with dementia. Therefore, strong predictors of malnutrition in this population are crucial to initiating early interventions. This study evaluates the association between the probability of having malnutrition with the muscle volume and intramuscular fat (iMAT) of the masseter and the tongue in magnetic resonance images (MRI) of community-dwelling older persons diagnosed with mild dementia followed for five years. This is a longitudinal study conducted in the western part of Norway. Muscle volume and iMAT of the tongue and masseter were computed from structural head MRIs obtained from 65 participants of The Dementia Study of Western Norway (DemVest) using Slice-O-Matic software for segmentation. Malnutrition was assessed using the glim index. Linear mix models were conducted. Having malnutrition at baseline was associated with lower muscle volume (OR 0.60 SE 0.20 p=0.010) and higher iMAT (OR 3.31 SE 0.46 p=0.010) in the tongue. At five years follow-up, those with lower muscle volume (OR 0.55, SE 0.20 p=0.002) and higher iMAT (OR 2.52, SE 0.40 p=0.022) in the tongue had a higher probability of presenting malnutrition. The masseter iMAT and volume were not associated with malnutrition in any of the adjusted models.In people diagnosed with mild dementia, tongue muscle volume and iMAT were associated with baseline malnutrition and the probability of developing malnutrition in a 5-year trajectory. In the masseter, there were no significant associations after adjustments.

Increased intramuscular adipose tissue of the quadriceps is related to decreased activities of daily living in patients who have had a stroke

OBJECTIVE

This study examined the relationships between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and activities of daily living (ADL) at discharge in patients who had a stroke.

METHODS

This prospective cohort study included 44 stroke inpatients. ADL were assessed at discharge using the Barthel index (BI) score. Ultrasound images were acquired at admission using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Relationships between BI score at discharge and quadriceps echo intensity or thickness on the paretic and non-paretic sides were assessed using partial correlation coefficients. Age, sex, days from onset of stroke, Fugl-Meyer assessment lower extremity score, and subcutaneous fat thickness of the thigh were used as the control variables in the partial correlation analysis.

RESULTS

BI score at discharge was significantly related to quadriceps echo intensity on the paretic (partial correlation coefficient = -0.377, P = 0.018) and non-paretic (partial correlation coefficient = -0.364, P = 0.023) sides. By contrast, quadriceps thickness on the paretic (partial correlation coefficient = 0.284, P = 0.075) and non-paretic (partial correlation coefficient = 0.278, P = 0.083) sides were not significantly related to BI score at discharge.

CONCLUSIONS

The present study revealed the negative relationship between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and ADL at discharge. Assessments and interventions of intramuscular adipose tissue in the quadriceps may be essential for predicting and improving ADL of patients who have had a stroke.

A Clinical Epidemiological Analysis of Prognostic Nutritional Index Associated with Diabetic Retinopathy

PURPOSE

Prognostic nutritional index (PNI) is an effective tool to evaluate the nutritional conditions and predict prognosis, but clinical data are limited for the use of PNI in diabetic retinopathy (DR). This study aimed to investigate the relationship of PNI with the prevalence and severity of DR in patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

This cross-sectional analysis enrolled 1023 individuals with T2DM hospitalized between 2017-2020. PNI was calculated as 10 × serum albumin (g/l) + 0.005 × total lymphocyte count (cells/mL). DR severity was categorized as no, nonproliferative, and vision-threatened DR (VTDR) according to the modified Airlie House classification. Multivariate-adjusted odds ratio (OR) with 95% confidence interval (CI) for the prevalent DR in the top (Q4) compared with the bottom quartile (Q1) of PNI levels were estimated by using logistic regression analyses.

RESULTS

PNI levels were significantly lower in individuals with VTDR than those with no and nonproliferative DR (both P < 0.001), and the proportions of individuals with DR were significantly decreased in the top quartile compared with the bottom quartile of PNI levels (P < 0.001). After adjustments for age, gender, DM duration, obesity-related risk factors and clinical biochemical parameters, the higher levels of PNI were significantly associated with a lower prevalence of DR (Q4 vs Q1: OR = 0.402, 95% CI: 0.250-0.649, P < 0.001), with a 5.9% reduction in the prevalence of DR for a per-unit increment in the levels of PNI (OR = 0.941, 95% CI: 0.911-0.972, P < 0.001). The association of PNI and obesity-related indexes (body mass index and waist circumference) with the severity of DR was independent of each other (P<0.001).

CONCLUSION

PNI was inversely and independently associated with the severity and prevalence of DR, which suggested that PNI could likely be used to predict DR prognosis in clinical practice.

Prognostic value of malnutrition using geriatric nutritional risk index in patients with coronary chronic total occlusion after percutaneous coronary intervention

BACKGROUND

Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known.

AIMS

This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI).

METHODS

Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI): moderate to severe, GNRI of <92 (n = 70); low, GNRI of 92-98 (n = 197); and absence of risk, GNRI of ≥98 (n = 402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE).

RESULTS

Average age in this study was 65.32 ± 9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe: 10.5%; low: 29.4%; and absence of risk: 60.1%). Over a median follow-up of 33 months, compared to those with absent risk for malnutrition, moderate to severe risk was associated with significantly increased risk for the all-cause death, cardiovascular death and MACE (hazard ratio [HR]: 2.90, 95% confidence interval [CI]: 1.43 to 5.87, P for trend = 0.002; HR: 3.72, 95% CI: 1.42 to 9.77, P for trend = 0.010; HR: 1.76, 95% CI: 1.02 to 3.03, P for trend = 0.040; respectively) after adjustment for baseline variables. Moreover, addition of the GNRI score significantly raised the predictive value for the all-cause death (0.383, p = 0.004 and 0.022, p = 0.011, NRI and IDI respectively), cardiovascular death (0.488, p < 0.001 and 0.013, p = 0.014, NRI and IDI respectively) and MACE (0.368, p = 0.004 and 0.014, p = 0.008, NRI and IDI respectively) as compared to traditional factors.

CONCLUSIONS

Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.

Relationship Between Aging and Intramuscular Adipose Tissue in Older Inpatients

OBJECTIVE

Although older inpatients are known to develop various conditions, whether aging affects intramuscular adipose tissue in older inpatients remains unclear. In particular, an increase in intramuscular adipose tissue in persons aged ≥85 years has previously not been revealed in either older inpatients or community-dwelling older individuals. This study therefore aimed to examine whether aging affects intramuscular adipose tissue in older inpatients.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

This study was clinical-based and included 404 inpatients aged ≥65 years.

METHODS

We divided the participants into the following age groups: 65-74 years (n = 63), 75-84 years (n = 171), and ≥85 years (n = 170). B-mode ultrasound imaging was performed, and the intramuscular adipose tissue of the quadriceps was assessed based on echo intensity. One-way analysis of variance and analysis of covariance were used to compare the echo intensity of the quadriceps between the 65-74-year, 75-84-year, and ≥85-year groups.

RESULTS

The median (25th-75th percentile) ages of the 65-74-year group, 75-84-year group, and ≥85-year group were 70.0 (68.0-73.0), 80.0 (77.0-82.0), and 89.0 (87.0-91.0), respectively. In the one-way analysis of variance, the quadriceps echo intensity of the ≥85-year group was significantly higher than that of the 65-74-year and 75-84-year groups. In addition, the ≥85-year group had significantly higher quadriceps echo intensity than the 65-74-year group, even after adjusting for other confounding factors.

CONCLUSIONS AND IMPLICATIONS

The current study revealed that intramuscular adipose tissue in older inpatients increases with age, and the levels of intramuscular adipose tissue of older inpatients aged ≥85 years is higher than those of older inpatients aged 65-74 years.