Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients

Safety and Effectiveness of Acceleration Training as Cardiac Rehabilitation Immediately After Open Heart Surgery - A Pilot Study

BACKGROUND

We examined the safety and efficacy of acceleration training (AT) in patients immediately after cardiac surgery.Methods and Results: This randomized controlled study included patients who underwent open-heart surgery using cardiopulmonary bypass. Of these patients, 31 received regular cardiac rehabilitation (CR) and 39 received AT in addition to regular CR (AT group). AT was provided using a vibration platform (Power Plate®Pro7TMand Power plate®personal; Performance Health System, Chicago, IL, USA). The AT group performed 5 static resistance training sessions: squats, wide stance squats, toe stands, banded squats, and front lunges. Each vibration session lasted 30 s. We evaluated the short physical performance battery, anterior mid-thigh thickness, maximum voluntary isometric contraction of the knee extensors, and serum intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) concentrations as indicators of endothelial function. The observation period was during hospitalization and lasted approximately 20 days. No adverse events occurred during AT. Ultrasound revealed a significantly lower reduction in muscle mass at discharge in the AT group. No significant differences were observed in ICAM-1 and VCAM-1 concentrations between the 2 groups preoperatively, postoperatively, or at discharge.

CONCLUSIONS

AT is considered safe and effective for patients immediately after open-heart surgery. AT, along with regular CR, may prevent skeletal muscle mass loss, muscle weakness, and physical function loss immediately after open-heart surgery.

Increased intramuscular adipose tissue of the quadriceps at admission is more strongly related to activities of daily living recovery at discharge compared to muscle mass loss in older patients with aspiration pneumonia

BACKGROUND

Recent studies reported that an increase in intramuscular adipose tissue of the quadriceps in older patients negatively affects the recovery of activities of daily living (ADL) more than the loss of muscle mass. However, whether intramuscular adipose tissue of the quadriceps in older patients with aspiration pneumonia is related to ADL recovery remains unclear. This study aimed to determine the relationship between intramuscular adipose tissue of the quadriceps and ADL recovery in older patients with aspiration pneumonia.

METHODS

Thirty-nine older inpatients who were diagnosed with aspiration pneumonia participated in this prospective study. The main outcome of this study was ADL at discharge. ADL were assessed using the Barthel Index (BI). The intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness observed on ultrasound images. A multiple linear regression analysis was performed to confirm whether the quadriceps echo intensity was related to the BI score at discharge, even after adjusting for confounding factors.

RESULTS

The medians [interquartile range] of the BI score at admission and discharge were 15.0 [0.0-35.0] and 20.0 [5.0-55.0], respectively. The BI score at discharge was significantly higher than that at admission (p = 0.002). The quadriceps echo intensity (β =  - 0.374; p = 0.036) and BI score at admission (β = 0.601; p < 0.001) were independently and significantly related to the BI score at discharge (R2 = 0.718; f2 = 2.546; statistical power = 1.000). In contrast, the quadriceps thickness (β =  - 0.216; p = 0.318) was not independently and significantly related to the BI score at discharge.

CONCLUSIONS

Increased intramuscular adipose tissue of the quadriceps at admission is more strongly and negatively related to ADL recovery at discharge than the loss of muscle mass among older patients with aspiration pneumonia. Interventions targeting the intramuscular adipose tissue of the quadriceps may improve ADL among these patients.

Muscle mass loss measured with portable ultrasound in hospitalized older adults: The ECOSARC study

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.

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.

Muscle ultrasound and its application to point-of-care ultrasonography: a narrative review

Technological advances of hand-held ultrasound devices and educational programmes for their use, such as point-of-care ultrasonography (POCUS) training, have contributed to the increasing application of these devices in clinical practice. With the greater impact of frailty and sarcopenia in aging societies, attention is being focused on the use of ultrasound for skeletal muscle assessment. In this narrative review, we discuss how ultrasound can be applied to skeletal muscle assessment, especially that of the quadriceps muscle, in clinical practice. Muscle thickness by ultrasound has been shown to have good reliability and validity for the evaluation of muscle size, and echo intensity has been used to evaluate muscle quality. Muscle ultrasound has not only been useful to diagnose sarcopenia in various settings, but has also been validated to predict health-related outcomes such as death and functional disability. Recommended methods for muscle ultrasound was published recently, and the results of future studies are expected to be comparable. Although several challenging issues with muscle ultrasound remain, if it could be incorporated into educational programmes such as POCUS training, more clinicians may be able to use ultrasound for skeletal muscle assessment in the future.KEY MESSAGESThe evolution of hand-held ultrasound devices enables physicians to perform ultrasound at the bedside as part of regular medical examinations.Muscle ultrasound is considered an effective tool for evaluating muscle size and quality, and has been studied in various settings.More clinicians may be able to evaluate skeletal muscle assessment with the development of educational programmes on muscle ultrasound in the future.

Greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass

This study aimed to examine the relationships between intramuscular adipose tissue and muscle mass of the quadriceps at post-acute hospital admission and the low rate of home discharge. This prospective study included 389 inpatients aged ≥ 65 years. Patients were divided into two groups according to the destination: home discharge (n = 279) and no-home discharge (n = 110) groups. The primary outcome was hospital discharge destination (home discharge or not). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at post-acute hospital admission using echo intensity and muscle thickness on ultrasound images, respectively. Logistic regression analysis was used for determining whether quadriceps echo intensity is related to home discharge. Quadriceps echo intensity was significantly and independently associated with home discharge (odds ratio [per 1 SD increase] = 1.43, p = 0.045). Quadriceps thickness was not associated with home discharge (odds ratio [per 1 SD increase] = 1.00, p = 0.998). Our study indicates that greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass.

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.

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass

BACKGROUND & AIM

A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia.

METHODS

This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy.

RESULTS

Echo intensity of the quadriceps (β = -0.363, p = 0.012) and FILS at admission (β = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = -0.498, p = 0.012] and FILS at admission [β = -0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS.

CONCLUSION

Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.

Nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to activities of daily living in older inpatients who are judged as severely low body mass index in the Global Leadership Initiative on Malnutrition criteria

BACKGROUND & AIMS

Which factors are related to activities of daily living (ADL) in older inpatients who are judged as the severely low body mass index (BMI) in the Global Leadership Initiative on Malnutrition (GLIM) criteria is unclear. This study aimed to examine the related factors to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria.

METHODS

This cross-sectional study included 377 inpatients aged ≥70 years. We divided the participants into the following three groups: the severely low BMI group (<17.8 kg/m²) (n = 106), moderately low BMI group (≥17.8 to < 20.0 kg/m²) (n = 87), and normal BMI group (≥20.0 kg/m²) (n = 184). ADL were assessed using the motor-Functional Independence Measure (FIM). Multiple regression analyses were used to identify the factors independently associated with the motor-FIM score in each group.

RESULTS

The Food Intake Level Scale (FILS) and Geriatric Nutritional Risk Index (GNRI) were significantly related to the motor-FIM score of the severely low BMI group. The FILS, GNRI, updated Charlson comorbidity index (UCCI), and quadriceps echo intensity were significantly related to the motor-FIM score of the moderately low BMI group. The FILS, GNRI, UCCI, quadriceps thickness, and subcutaneous fat thickness of the thigh were significantly related to the motor-FIM score of the normal BMI group.

CONCLUSIONS

Our findings indicate that nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria. Intervention for nutritional and swallowing statuses may be prioritized over an exercise intervention to improve ADL of older inpatients who are judged as severely low BMI.

Thigh Intramuscular Fat on Prognosis of Patients With Nonischemic Cardiomyopathy

Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also ectopic fat has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with nonischemic cardiomyopathy. We investigated whether ectopic fat in the thigh affects the prognosis of nonischemic cardiomyopathy. This prospective study recruited 145 patients diagnosed with nonischemic cardiomyopathy between September 2017 and January 2020. Finally, 93 patients with a reduced ejection fraction were enrolled. The clinical end points were cardiovascular death or unexpected rehospitalization because of a cardiac event. Using computed tomography, the percentage of intramuscular fat (%IMF) in the thigh was measured in all patients. Patients were divided into 2 groups based on the median %IMF. The results of Spearman's correlation coefficient analysis revealed a correlation among %IMF and peak oxygen uptake (Spearman r = -0.221, p = 0.036). Kaplan-Meier analysis results showed significantly higher risk of adverse events in the high %IMF group (log-rank p = 0.013). Multivariate Cox regression analysis results revealed the %IMF as an independent factor for adverse events (hazard ratio 1.361; 95% confidence interval 1.043 to 1.745; p = 0.018). In conclusion, %IMF may have adverse consequences such as increased cardiac events in patients with nonischemic cardiomyopathy with a reduced ejection fraction.

Altered features of body composition in older adults with type 2 diabetes and prediabetes compared with matched controls

BACKGROUND

Ageing is accompanied by muscle loss and fat gain, which may elevate the risk of type 2 diabetes (T2D). However, there is a paucity of data on the distribution of regional lean and fat tissue in older adults with T2D or prediabetes compared with healthy controls. The objective of this study was to compare regional body composition [by dual-energy x-ray absorptiometry (DXA)], muscle and subcutaneous adipose tissue (SAT) thicknesses (by ultrasound), and ultrasound-based muscle texture features in older adults with T2D or prediabetes compared with normoglycaemic controls.

METHODS

Eighteen adults > 60 years with T2D or prediabetes (T2D group) were individually matched to normoglycaemic participants [healthy matched (HM) group] for age (±5 years), sex, and body fat (±2.5%). In a single study visit, all participants received a whole-body DXA scan and ultrasound assessment of the abdomen and anterior thigh. At these two landmarks, we used ultrasound to measure muscle and SAT thickness, as well as texture features of the rectus femoris and rectus abdominis. We also conducted an exploratory subanalysis on a subset of participants (n = 14/18 in the T2D group and n = 10/18 in the HM group) who underwent additional assessments including strength testing of the knee extensors (using a Biodex dynamometer), and a fasting blood sample for the measurement of circulating markers of glucose metabolism [glucose, insulin, c-peptide, and the homoeostatic model assessment of insulin resistance (HOMA-IR)].

RESULTS

The T2D group was 72 ± 8 years old (mean ± SD), predominantly male (n = 15/18; 83%), and overweight (BMI: 27.8 ± 4.2 kg/m² , 33.2 ± 5.3% body fat). DXA-derived upper arm lean mass was 0.4 kg greater (P = 0.034), and leg fat mass was 1.4 kg lower (P = 0.048), in the T2D vs. HM group. Ultrasound-based texture features were distinct between the groups [rectus abdominis blob size: 0.07 ± 0.06 vs. 0.30 ± 0.43 cm² , P = 0.045; rectus femoris local binary pattern (LBP) entropy: 4.65 ± 0.05 vs. 4.59 ± 0.08 A.U., P = 0.007]. When all participants who underwent additional assessments were pooled (n = 24), we observed that certain ultrasound-based muscle texture features correlated significantly with muscle strength (rectus abdominis histogram skew vs. power during an isokinetic contraction at 60°/s: r = 0.601, P = 0.003) and insulin resistance (rectus femoris LBP entropy vs. HOMA-IR: r = 0.419, P = 0.042).

CONCLUSIONS

Our findings suggest a novel body composition phenotype specific to older adults with T2D or prediabetes. We are also the first to report that ultrasound-based texture features correspond with functional outcomes. Future larger scale studies are needed to uncover the mechanisms underpinning these regional body composition differences.

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.

Muscle Evaluation and Hospital-Associated Disability in Acute Hospitalized Older Adults

OBJECTIVES

We aimed to examine the association of muscle evaluation, including muscle ultrasound, with hospital-associated disability (HAD), focusing on ADL categories.

DESIGN

A prospective observational cohort study.

SETTING AND PARTICIPANTS

We recruited patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital between October 2019 and September 2021.

MEASUREMENTS

Handgrip strength, bioimpedance analyzer-determined skeletal muscle mass, bilateral thigh muscle thickness (BATT), and the echo intensity of the rectus femoris on muscle ultrasound were performed as muscle assessments. HAD was evaluated separately for mobility impairments and self-care impairments.

RESULTS

In total, 256 individuals (mean age, 85.2 years; male sex, 41.8%) were analyzed. HAD in mobility was more common than HAD in self-care (37.5% vs. 30.0%). Only BATT was independently associated with HAD in mobility in multiple logistic regression analysis. There was no significant association between muscle indicators and HAD in self-care.

CONCLUSION

A lower BATT was associated with a higher prevalence of HAD in mobility, suggesting the need to reconsider muscle assessment methods in hospitalized older adults. In addition, approaches other than physical may be required, such as psychosocial and environmental interventions to improve HAD in self-care.

Associations of ADL Disability With Trunk Muscle Mass and Muscle Quality Indicators Measured by Opportunistic Chest Computed Tomography Imaging Among Older Inpatients

Objectives: Sarcopenia is an important predictor of dependence in activities of daily living (ADL disability); however, the association between muscle quality and ADL disability has not been established. We aimed (1) to assess the feasibility of measuring trunk muscle mass and muscle quality by chest CT images; and (2) to explore the possible associations of ADL disability with these muscle mass and muscle quality indicators among older inpatients. Methods: We included older patients in an acute care ward. ADL disability was defined as the Barthel Index (BI) score ≤ 60 points. Unenhanced chest CT images at the 12^th thorax (T12) vertebral level were used to segment skeletal muscle area (SMA) and intermuscular adipose tissue (IMAT) and to measure the mean skeletal muscle radiodensity (SMD). Skeletal muscle index (SMI), the muscle mass indicator, was calculated by SMA (cm²)/body height squared (m²). The percentage of IMAT (IMAT%) was calculated using the equation: IMAT% = IMAT/(SMA+ IMAT) ×100%. Skeletal muscle radiodensity, IMAT, and IMAT% were the muscle quality indicators. Kendall's tau rank correlation coefficients (τ) were calculated to explore the correlations. Univariate and multivariate logistic regression models were performed to calculate odds ratios (OR) and 95% confidence interval (CI). Results: We included 212 participants. Skeletal muscle index and SMD were positively and significantly associated with the BI score (τ = 0.14 and 0.31, respectively, both P < 0.001); whereas IMAT and IMAT% were negatively and significantly associated with the BI score (τ = -0.21, P < 0.001; τ = -0.21, P < 0.012). After adjusting for confounders, SMI (adjusted OR 1.03, 95% CI 0.97-1.09) was not independently associated with ADL disability; however, SMD (adjusted OR 0.94, 95% CI 0.88-0.99), IMAT (adjusted OR 1.11, 95% CI 1.03-1.20), and IMAT% (adjusted OR 1.09, 95% CI 1.02-1.16) were independently associated with ADL disability. Subgroup analysis found similar results in men; however, none of these indicators were independently associated with ADL disability in women. Conclusion: Trunk muscle quality indicators (SMD, IMAT, and IMAT%) measured by chest CT images, but not SMI, are independently associated with ADL disability in a single-center study population of older inpatients, especially in men. Further research is necessary to validate our findings.

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

BACKGROUND

The relationship between intramuscular adipose tissue at admission and recovery of activities of daily living (ADL) remains unclear. This study aimed to examine the relationship between intramuscular adipose tissue in the quadriceps at admission and recovery of ADL in older inpatients.

METHODS

This prospective study included 404 inpatients aged ≥65 years (54.7% female). Recovery of ADL during hospital stay was assessed using the Barthel Index (BI) score at discharge, BI score change, and BI efficiency. Higher BI at discharge, BI score change, and BI efficiency indicate more improvement in ADL. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was performed to identify factors independently associated with BI score at discharge, BI score change, and BI efficiency. The independent variables were BI score at admission, echo intensity and muscle thickness of the quadriceps, age, sex, number of medications, C-reactive protein concentration, updated Charlson Comorbidity Index score, Food Intake Level Scale, Geriatric Nutritional Risk Index score, days from onset disease, length of hospital stay, number of units of rehabilitation therapy, and subcutaneous fat thickness of the thigh.

RESULTS

The medians (inter-quartile range) of the BI score at discharge, BI score change, and BI efficiency were 60.0 (35.0-80.0), 10.0 (0.0-25.0), and 0.11 (0.00-0.37), respectively. The median (inter-quartile range) of the length of hospital stay (days) and days from onset disease were 58.0 (39.0-92.0) and 79.0 (49.0-112.0), respectively. Quadriceps echo intensity was independently and significantly associated with the BI score at discharge (β = -0.13, P < 0.01), BI score change (β = -0.23, P < 0.01), and BI efficiency (β = -0.21, P < 0.01). Quadriceps thickness was not independently and significantly associated with the BI score at discharge (β = -0.02, P = 0.68), BI score change (β = -0.02, P = 0.79), and BI efficiency (β = 0.03, P = 0.67).

CONCLUSIONS

Our study indicates that greater intramuscular adipose tissue in the quadriceps at admission is more strongly related to worse recovery of ADL than less muscle mass in older inpatients. Greater intramuscular adipose tissue in the quadriceps in older inpatients is considered to be a predictor of worse recovery of ADL, and intervening for greater intramuscular adipose tissue may be important for improving ADL in older inpatients.

Intramuscular adipose tissue of the quadriceps is more strongly related to recovery of swallowing ability than is muscle mass in older inpatients: A prospective study

OBJECTIVES

This study aimed to examine whether intramuscular adipose tissue of the quadriceps at admission is related to the recovery of swallowing ability during a hospital stay in older inpatients.

METHODS

This prospective study included 344 inpatients ages ≥ 65 y. Those who had stroke that was the obvious cause of dysphagia were excluded. Recovery of swallowing ability was assessed using Food Intake Level Scale (FILS) score at discharge and FILS change. Ultrasound images were acquired at admission. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Multiple regression analysis was performed to examine whether quadriceps echo intensity is independently associated with FILS score at discharge and FILS change. The independent variables were quadriceps echo intensity and thickness, subcutaneous fat thickness of the thigh, Barthel Index score at admission, age, sex, number of medications, C-reactive protein, updated Charlson Comorbidity Index, FILS score at admission, Geriatric Nutritional Risk Index, days from disease onset, length of hospital stay, and units of rehabilitation therapy.

RESULTS

Quadriceps echo intensity was independently and significantly associated with FILS score at discharge (β = -0.15, P < 0.01) and FILS change (β = -0.19, P < 0.01). Quadriceps thickness was not independently and significantly associated with FILS score at discharge or FILS change.

CONCLUSIONS

The present study revealed that intramuscular adipose tissue of the quadriceps in older inpatients is more strongly related to recovery of swallowing ability than is muscle mass.

Echo intensity is more useful in predicting hospital-associated complications than conventional sarcopenia-related parameters in acute hospitalized older patients

BACKGROUND

Hospital-associated complications are associated with adverse outcomes after discharge, and a method to help predict the occurrence of these complications needs to be established. Sarcopenia is thought to be one of the factors associated with hospital-associated complication, but sarcopenia assessment in hospitalized patients is often difficult. Focus has recently been placed on morphological and qualitative evaluation of muscle by ultrasound as an index of sarcopenia. Therefore, in this study, we sought to clarify the association of hospital-associated complication with muscle thickness or echo intensity measured by ultrasound and with commonly used sarcopenia-related parameters.

METHODS

This is a prospective observational cohort study with 156 hospitalized older patients recruited over a year. Bilateral thigh muscle thickness of rectus femoris and vastus intermedius, echo intensity and corrected echo intensity of rectus femoris were measured by ultrasound. Also measured were the sarcopenia-related parameters of handgrip strength, skeletal muscle index, and maximum calf circumference. Hospital-associated complication was defined as the occurrence of any of the following complications: delirium, functional decline, incontinence, falls, pressure injuries, and nosocomial infections.

RESULTS

Of 156 patients enrolled at admission, hospital-associated complication was observed in 70 (54.3%). With-hospital-associated complication group had a higher prevalence of emergency admission and a higher corrected echo intensity than without-hospital-associated complication group. Multivariate logistic regression analysis showed that only higher corrected echo intensity was associated with hospital-associated complication (odds ratio 1.036; 95% confidence interval, 1.001-1.072), while handgrip strength, bilateral thigh muscle thickness, skeletal muscle index, and maximum calf circumference were not.

CONCLUSIONS

Corrected echo intensity might be a useful parameter to help predict hospital-associated complication in acute hospitalized older patients and might contribute to establishing a strategy to prevent hospital-associated complication.