Definition of Respiratory Sarcopenia With Peak Expiratory Flow Rate

Analysis of human urinary extracellular vesicles reveals disordered renal metabolism in myotonic dystrophy type 1

Chronic kidney disease (CKD) and the genetic disorder myotonic dystrophy type 1 (DM1) each are associated with progressive muscle wasting, whole-body insulin resistance, and impaired systemic metabolism. However, CKD is undocumented in DM1 and the molecular pathogenesis driving DM1 is unknown to involve the kidney. Here we use urinary extracellular vesicles (EVs), RNA sequencing, droplet digital PCR, and predictive modeling to identify downregulation of metabolism transcripts Phosphoenolpyruvate carboxykinase-1, 4-Hydroxyphenylpyruvate dioxygenase, Dihydropyrimidinase, Glutathione S-transferase alpha-1, Aminoacylase-1, and Electron transfer flavoprotein B in DM1. Expression of these genes localizes to the kidney, especially the proximal tubule, and correlates with muscle strength and function. In DM1 autopsy kidney tissue, characteristic ribonuclear inclusions are evident throughout the nephron. We show that urinary organic acids and acylglycines are elevated in DM1, and correspond to enzyme deficits of downregulated genes. Our study identifies a previously unrecognized site of DM1 molecular pathogenesis and highlights the potential of urinary EVs as biomarkers of renal and metabolic disturbance in these individuals.

Association between bone mineral density T-score and respiratory sarcopenia in older adults

Introduction

Respiratory sarcopenia, characterized by reduced respiratory muscle mass and strength, is underdiagnosed in older adults. This cross-sectional study aimed to investigate the association between bone mineral density (BMD) T-score and respiratory sarcopenia in a Chinese population.

Methods

A total of 530 participants aged ≥60 years were recruited. Respiratory sarcopenia was diagnosed based on peak expiratory flow rate (PEFR) cutoffs. BMD was measured using dual-energy X-ray absorptiometry, and muscle mass was assessed using bioelectrical impedance analysis. Logistic regression models were used to analyze the association between BMD T-score and respiratory sarcopenia risk.

Results

Participants with respiratory sarcopenia exhibited lower BMD T-score, appendicular skeletal muscle index, trunk muscle mass ratio, and lung function parameters compared to those without respiratory sarcopenia. The odds ratio (95% CI) for the lowest BMD T-score tertile with the risk of respiratory sarcopenia was 4.52 (1.71-13.1) compared with the highest tertile. This association remained significant after adjusting for confounding factors.

Conclusion

BMD T-score is significantly associated with an increased risk of respiratory sarcopenia in older adults. This finding highlights the importance of bone mass monitoring and early prevention strategies to reduce the incidence of respiratory sarcopenia.

The systemic inflammation response index as risks factor for all-cause and cardiovascular mortality among individuals with respiratory sarcopenia

BACKGROUND

Respiratory sarcopenia is associated with poor outcomes, yet effective biomarkers for risk stratification remain limited. This study investigates the associations between complete blood count (CBC)-derived inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-monocyte-to-lymphocyte ratio (NMLR), and systemic inflammation response index (SIRI) and both all-cause and cardiovascular mortality in patients with respiratory sarcopenia.

METHODS

We conducted a cohort analysis of 1,673 adults with possible respiratory sarcopenia using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012, with mortality follow-up through December 31, 2019. Possible respiratory sarcopenia was assessed via peak expiratory flow rate (PEFR). Multivariable Cox regression models evaluated associations between NLR, NMLR, SIRI, and mortality outcomes, adjusted for demographic, socioeconomic, and health-related covariates. Additional CBC-derived biomarkers (PLR, dNLR, MLR, SII) were analysed, and mediation analysis assessed albumin's role as a partial mediator of mortality.

RESULTS

Over a median follow-up of 116 months, 263 deaths occurred, including 68 from cardiovascular causes. Elevated NLR, NMLR, and SIRI were significantly associated with increased risks of all-cause and cardiovascular mortality. SIRI emerged as the strongest predictor, with adjusted hazard ratios (HRs) of 1.65 (95% CI, 1.23-2.22) for all-cause mortality and 3.18 (95% CI, 1.83-5.53) for cardiovascular mortality. Albumin partially mediated the relationship between SIRI and all-cause mortality (12.1%).

CONCLUSION

Elevated NLR, NMLR, and SIRI are associated with increased mortality risks in respiratory sarcopenia, with SIRI demonstrating the highest predictive power. Integrating SIRI into clinical assessments may aid in identifying high-risk patients, allowing for targeted interventions.

Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study

OBJECTIVES

Recently, sarcopenia has been linked to unfavorable outcomes in various surgical procedures, including lung cancer surgery. This study aimed to investigate the impact of respiratory sarcopenia (RS) on postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery.

METHODS

This retrospective study included patients aged 70 years and older who underwent lobectomy with curative intent for lung cancer between 2017 and 2019. RS was defined as having values below the median for both the L3 skeletal muscle index, measured from preoperative PET-CT images, and peak expiratory flow (PEF). An inverse probability of treatment weighting (IPTW) approach was applied to balance covariates between the RS and non-RS groups. Baseline characteristics and postoperative outcomes were compared between groups using t-tests and chi-square tests. Kaplan-Meier curves and log-rank tests were used to compare overall and recurrence-free survival. Multivariable logistic regression analysis incorporating IPTW weights was performed to assess the impact of RS on respiratory complications.

RESULTS

A total of 509 patients were included, of whom 123 (24.2%) had RS. After IPTW adjustment, baseline characteristics, including pulmonary function, were similar between the RS and non-RS groups. All patients underwent lobectomy, with 78.8% of the RS group and 80.9% of the non-RS group undergoing minimally invasive surgery. The RS group had a significantly higher rate of respiratory complications compared to the non-RS group (14.5% vs. 7.7%, p = 0.041). Multivariable logistic regression analysis showed that male sex (odds ratio = 15.2, p < 0.01) and lower DLCO (odds ratio = 0.96, p < 0.01) were significantly associated with respiratory complications, whereas RS did not show a significant association (p = 0.05). No significant differences were found in overall survival (p = 0.11) or recurrence-free survival (p = 0.51) between the groups.

CONCLUSIONS

In this study, RS had a limited impact on both postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. These findings suggest that other factors, such as DLCO and male sex, may play a more prominent role in predicting respiratory complications.

Relationship Between Diaphragm Function and Sarcopenia Assessed by Ultrasound: A Cross-Sectional Study

Background/Objectives: The diaphragm is important for respiration, but the effects of age-related muscle loss and sarcopenia on diaphragm function are unclear. We evaluated the associations of sarcopenia and skeletal muscle mass (SMM) with diaphragm function. Methods: This study was conducted at three Japanese hospitals from May 2023 to September 2024. The participants underwent bioelectrical impedance for SMM assessment, as well as pulmonary function tests. Diaphragm ultrasound was used to measure the thickness at functional residual capacity (FRC), thickening fraction (TF), and diaphragm excursion (DE) during deep breathing (DB), and their associations with sarcopenia and low skeletal muscle index (SMI) were analyzed. Results: Overall, 148 patients (mean age 78.1 years; sarcopenia, n = 35; non-sarcopenia, n = 103) were included. No statistically significant differences in thickness(FRC), TF and DE were observed between the sarcopenia group and the non-sarcopenia group. The low SMI group had significantly lower thickness (difference -0.22, 95% CI; -0.41, -0.29) and DE (difference -9.2, 95%CI; -14.0, -4.49) than the normal SMI group. Multivariable linear regression analyses adjusted for age, sex, and stature revealed no association between thickness (FRC) and sarcopenia (p = 0.98), but thickness (FRC) was negatively associated with low SMI (p = 0.034). DE during DB was negatively associated with sarcopenia (p = 0.024) and low SMI (p = 0.001). TF showed no associations. Conclusions: DE during DB was reduced in patients with sarcopenia and low SMI, and thickness (FRC) was reduced in those with low SMI without sarcopenia.

The Role of Diaphragmatic Ultrasound in Identifying Sarcopenia in COPD Patients: A Cross-Sectional Study

Background/Aim

Chronic obstructive pulmonary disease (COPD) is often complicated by sarcopenia, a condition of reduced muscle mass and function that adversely affects quality of life, lung function, and exacerbation rates. Ultrasonography could be an effective tool for detecting sarcopenia, notably by assessing diaphragmatic function, which may indicate muscle health in COPD patients. This study aims to evaluate the effectiveness of diaphragmatic ultrasound in detecting sarcopenia among COPD patients.

Materials and Methods

Thirty-five patients with COPD, with a forced expiratory volume in one second (FEV1) between 30% and 80%, were consecutively enrolled in this cross-sectional and double-blind study. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was assessed with bioelectrical impedance analysis (BIA), muscle strength was assessed using the handgrip test and physical performance was assessed using a 4-meter gait speed test. Pulmonary function tests (PFT) (including maximum inspiratory pressure-MIP and maximum expiratory pressure-MEP) were performed. Diaphragm excursion and thickness at residual volume, functional residual capacity, and total lung capacity were measured using ultrasound. The diaphragm thickening fraction was calculated during normal (TF) and deep breathing (TLC-TF).

Results

Seventeen of 35 patients (48.6%) were found to be sarcopenic. Diaphragm thickness did not show significant variation between the groups. Both TF (27.43%) and TLC-TF (39.7%) were found to be lower in the sarcopenic group (p<0.05). The diaphragmatic excursion in the sarcopenic group was found to be 1.38 cm (p=0.078). There was no difference in median MIP and MEP values between the groups.

Conclusion

Diaphragmatic TF may be a valuable tool for detecting sarcopenia in COPD patients, which may vary independently of PFTs. This study highlights TF as a potential auxiliary measure, but further research with larger sample sizes and additional parameters is needed to confirm its clinical utility.

Breathlessness, Frailty, and Sarcopenia in Older Adults

BACKGROUND

Breathlessness shares aging mechanisms with frailty and sarcopenia.

RESEARCH QUESTION

Are frailty and sarcopenia associated with breathlessness itself?

STUDY DESIGN AND METHODS

We analyzed data from a population-based, prospective cohort study of 780 community-dwelling older adults. Breathlessness was defined using the modified Medical Research Council dyspnea scale (≥ 2 points) and the COPD Assessment Test (≥ 10 points). Frailty was defined by frailty index (FI); frailty phenotype; and fatigue, resistance, ambulation, illness, and weight loss (FRAIL) questionnaire results. Sarcopenia was defined by the Asian Working Group for Sarcopenia in 2019. Sarcopenia phenotype score quantified the number of criteria met. The associations of frailty and sarcopenia with breathlessness were evaluated by logistic regression analyses. Adjusted ORs (aORs) were calculated, accounting for age, sex, chronic airway disease, smoking status, BMI, lung functions, socioeconomic status (living alone, income, education), comorbid conditions (hypertension, diabetes, malignancy, myocardial infarction, heart failure), and other geriatric contributors (cognitive dysfunction, depression, malnutrition, polypharmacy, fall history in the past year). Institutionalization-free survival was compared by log-rank test.

RESULTS

The prevalence of frailty was higher in the breathlessness group compared with the group without breathlessness (42.6% vs 10.5% by FI, 26.1% vs 8.9% by frailty phenotype, and 23.0% vs 4.2% by FRAIL questionnaire) and sarcopenia (38.3% vs 26.9%), with P < .01 for all comparisons. The multivariable logistic regression analyses showed that frailty (FI [aOR, 9.29], FRAIL questionnaire [aOR, 5.21], and frailty phenotype [aOR, 3.09]) and sarcopenia phenotype score (2 [aOR, 2.00] and 3 [aOR, 2.04] compared with 0) were associated with breathlessness. The cumulative incidence of institutionalization-free survival was higher in the breathlessness group than its counterparts (P = .02).

INTERPRETATION

These findings suggest that frailty and sarcopenia strongly contribute to breathlessness in community-dwelling older adults. Measuring sarcopenia and frailty in older adults may offer opportunities to prevent age-related breathlessness.

Incidence and influencing factors for respiratory sarcopenia in older adults: The first longitudinal evidence from the CHARLS

AIM

Respiratory sarcopenia (RS) has been newly defined in a position paper by four professional organizations in Japan, and it is necessary to examine its incidence and influencing factors using this new definition. So far, little work has been undertaken; we therefore conducted a longitudinal study to fill this gap.

METHODS

Our data were extracted from the China Health and Retirement Longitudinal Study. A total of 4301 older adults with complete data and without RS were chosen in 2011, of whom 3065 were followed up until 2015. The presence of low respiratory muscle strength plus low appendicular skeletal muscles mass was defined as RS based on t. A logistic regression model was used to identify the influencing factors for incident RS.

RESULTS

After an average of 4 years of follow-up, the cumulative incidence of RS was 5.2%, and it was particularly high in participants aged >80 (20.9%). Logistic regression analysis showed that being unmarried/divorced/widowed (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.28-2.66, P = 0.001), not having dyslipidemia (OR = 0.35, 95% CI = 0.19-0.65, P = 0.001), having digestive disease (OR = 1.56, 95% CI = 1.11-2.19, P = 0.010), asthma (OR = 2.77, 95% CI = 1.55-4.94, P = 0.001), edentulism (OR = 1.73, 95% CI = 1.24-2.42, P = 0.001), low handgrip strength (OR = 2.82, 95% CI = 1.99-3.99, P < 0.001), or low 5-m gait speed (OR = 1.92, 95% CI = 1.23-3.01, P = 0.004) were associated with a greater likelihood of developing RS. After further adjustment for age and body mass index, asthma, edentulism, and low handgrip strength remained significant.

CONCLUSIONS

The identification and management of older adults with the influencing factors described above could be important in preventing RS. Geriatr Gerontol Int 2024; 24: 1015-1021.

Exploratory study of factors associated with probable respiratory sarcopenia in elderly subjects

BACKGROUND

The diagnostic criteria for respiratory sarcopenia have been recently reported. However, no studies have clarified the characteristics of skeletal muscle impairment of the limbs in subjects with respiratory sarcopenia. This study aimed to explore the factors, including skeletal muscle, associated with probable respiratory sarcopenia in elderly subjects.

METHODS

Subjects were classified into the probable respiratory sarcopenia group and nonrespiratory sarcopenia group. Probable respiratory sarcopenia was defined as the concurrent presence of respiratory muscle weakness (as less than the predicted value calculated from age, sex, and height) and low skeletal muscle mass (<7.0 kg/m2 in males and 5.7 kg/m2 in females). The following factors were measured: respiratory muscle strength, skeletal muscle mass index, muscle thickness and echo intensity of the rectus femoris, extracellular-to-intracellular water ratio, hand grip strength, 5 sit-to-stand, knee extension strength, bone mineral density, age, sex, body mass index, degree of frailty, presence or absence of medical history, presence or absence of habitual exercise, period of time since the start of exercise, and number of hours of exercise at a time. The association subjects with probable respiratory sarcopenia were analyzed using hierarchical logistic regression analysis.

RESULTS

Twenty-six with probable respiratory sarcopenia and 54 with nonrespiratory sarcopenia were included. Hierarchical logistic regression analysis revealed that echo intensity was a significant predictor of probable respiratory sarcopenia. The odds ratio for echo intensity was 2.54 (95% confidence interval: 1.04-6.23).

CONCLUSIONS

Our results suggest that a decrease in muscle quality in the lower extremity is associated with probable respiratory sarcopenia.

Validating respiratory sarcopenia diagnostic criteria by mortality based on a position paper by four professional organizations: Insights from the Otassha study

AIM

The Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height2) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations.

METHODS

Participants of our cohort study in 2015 of 468 community-dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height2, and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut-off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut-off values for each parameter, including ASM/height2, from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut-off values for ASM/height2 and PEFR or %PEFR on a three-dimensional chart to observe the relationship between the different cut-off values and HR.

RESULTS

A total of 31 people died during the 5-year observation period. With ASM/height2 cut-off values of approximately 7.0 kg/m2 for men and 5.7 kg/m2 for women and %PEFR cut-off values of 66-75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36-3.27, point estimation range).

CONCLUSIONS

The definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; 24: 948-953.

Low thoracic skeletal muscle is a risk factor for 6-month mortality of severe community-acquired pneumonia in older men in intensive care unit

BACKGROUND

Patients with severe community-acquired pneumonia (sCAP) admitted to the intensive care unit (ICU) often exhibit muscle catabolism, muscle weakness, and/or atrophy, all related to an increased morbidity and mortality. However, the relationship between thoracic skeletal muscle mass and sCAP-related mortality has not been well-studied. Early recognition of sarcopenia in ICU patients with sCAP would benefit their prognosis.

METHODS

A retrospective study was conducted in Taizhou Hospital of Zhejiang Province, involving 101 patients with sCAP admitted in the ICU between December 2022 and February 2023. We measured the cross-sectional aera of the pectoralis, intercostal, paraspinal, serratus, and latissimus muscles at the T4 vertebral level (T4CSA) using chest computed tomography. Discriminatory thresholds were established by performing receiver operating characteristic curve analysis, with a designated cutoff value of 96.75 cm2 for male patients. This cohort was classified into mortality and survival groups based on a 6-month post-admission outcome. Univariate and multifactorial logistic regression analyses were performed to validate the correlation between low thoracic skeletal muscle area and prognostic outcomes.

RESULTS

The mean age of the patients was 75.39 ± 12.09 years, with an overall 6-month mortality of 73.27%. T4CSA of the 6-month survival group was significantly larger than that in the mortality group for overall cohort. The T4CSA in the survival group was significantly larger than that in the mortality group (104.29 ± 23.98cm2 vs. 87.44 ± 23.0cm2, p = 0.008). T4CSA predicted the 6-month mortality from sCAP in males with an AUC of 0.722 (95% confidence interval (CI), 0.582-0.861). The specificity and sensitivity were 71.4% and 71.1%, respectively, (p < 0.05). No significant difference was observed between the two groups in terms of T4CSA.

CONCLUSIONS

This study revealed that low thoracic skeletal muscle mass increased the risk of all-cause 6-month mortality in ICU patients with sCAP, particularly among male patients.

Establishing an optimal diagnostic criterion for respiratory sarcopenia using peak expiratory flow rate

BACKGROUND

The skeletal muscle changes as aging progresses, causing sarcopenia in the older adult population, which affects the respiratory muscles' mass, strength, and function. The optimal cut-off point of peak expiratory flow rate (PEFR) for respiratory sarcopenia (RS) diagnosis in accordance with sarcopenia identification is needed.

AIM

To establish an optimal cut-off point of PEFR for RS diagnosis in community-dwelling Asian older women.

METHODS

Sarcopenia diagnostic indicators were evaluated according to the Asian Working Group for Sarcopenia 2019 (AWGS) criteria. The respiratory parameters composed of respiratory muscle strength and respiratory function were evaluated by assessing maximal inspiratory pressure (MIP), percent predicted forced vital capacity (Pred FVC), and PEFR.

RESULTS

A total of 325 community-dwelling older women were included in this study. PEFR was negatively associated with RS (OR: 0.440; 95% CI: 0.344-0.564). The area under the curve (AUC) of PEFR was 0.772 (p < 0.001). The optimal cut-off point of PEFR for RS diagnosis was 3.4 l/s (sensitivity, 63.8%; specificity, 77.3%). Significant differences were found between the robust, possible sarcopenia, sarcopenia, and RS groups in terms of both sarcopenia diagnostic indicators and respiratory parameters (p < 0.05).

CONCLUSIONS

The cut-off point of PEFR can be used as a reasonable standard for RS diagnosis. This study finding can serve as a cornerstone for developing concrete criteria of RS in older women, supporting clinical judgment, which is crucial for providing appropriate treatment through accurate diagnosis.

Prevalence and clinical characteristics of Sarcopenia in older adult patients with stable chronic obstructive pulmonary disease: a cross-sectional and follow-up study

BACKGROUND

The relationship between sarcopenia and chronic obstructive pulmonary disease (COPD) has been increasingly reported, and there is some overlap regarding their clinical features and pulmonary rehabilitation (PR) strategies. No Korean study has reported the actual prevalence of sarcopenia in patients with stable COPD who are recommended for pulmonary rehabilitation. This study evaluated the prevalence and clinical features of sarcopenia in older adult outpatients with stable COPD and the changes after 6 months.

METHODS

In this cross-sectional and 6-month follow-up study, we recruited 63 males aged ≥ 65 diagnosed with stable COPD. Sarcopenia was diagnosed using the AWGS 2019 criteria, which included hand grip strength testing, bioelectrical impedance analysis, Short Physical Performance Battery administration, and Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling screening tool administration. A 6-minute walk test (6 MWT) was conducted, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and peak expiratory flow (PEF) were assessed, and patient-reported questionnaires were administered.

RESULTS

At baseline, 14 (22%) patients were diagnosed with possible sarcopenia, and eight (12.6%) were diagnosed with sarcopenia. There were significant differences in the age; body mass index; Body mass index, airflow Obstruction, Dyspnea, and Exercise index; modified Medical Research Council dyspnea scores; and International Physical Activity Questionnaire scores between the normal and sarcopenia groups. Whole-body phase angle, MIP, MEP, PEF, and 6-minute walk distance (6 MWD) also showed significant differences. Over 6 months, the proportion of patients with a reduced FEV1 increased; however, the proportion of patients with sarcopenia did not increase.

CONCLUSION

A relatively low prevalence of sarcopenia was observed in older adult outpatients with stable COPD. No significant change in the prevalence of sarcopenia was found during the 6-month follow-up period.

TRIAL REGISTRATION

The study was registered with the Clinical Research Information Service (KCT0006720). Registration date: 30/07/2021.

Definition, diagnosis, and treatment of respiratory sarcopenia

PURPOSE OF REVIEW

Skeletal muscle weakness and wasting also occurs in the respiratory muscles, called respiratory sarcopenia. Respiratory sarcopenia may lead to worse clinical indicators and outcomes. We present a novel definition and diagnostic criteria for respiratory sarcopenia, summarize recent reports on the association between respiratory sarcopenia, physical and nutritional status, and clinical outcomes, and provide suggestions for the prevention and treatment of respiratory sarcopenia.

RECENT FINDINGS

Recently, a novel definition and diagnostic criteria for respiratory sarcopenia have been prepared. Respiratory sarcopenia is defined as a condition in which there is both low respiratory muscle strength and low respiratory muscle mass. Respiratory muscle strength, respiratory muscle mass, and appendicular skeletal muscle mass are used to diagnose respiratory sarcopenia. Currently, it is challenging to definitively diagnose respiratory sarcopenia due to the difficulty in accurately determining low respiratory muscle mass. Decreased respiratory muscle strength and respiratory muscle mass are associated with lower physical and nutritional status and poorer clinical outcomes. Exercise interventions, especially respiratory muscle training, nutritional interventions, and their combinations may effectively treat respiratory sarcopenia. Preventive interventions for respiratory sarcopenia are unclear.

SUMMARY

The novel definition and diagnostic criteria will contribute to promoting the assessment and intervention of respiratory sarcopenia.

Probable Respiratory Sarcopenia Decreases Activities of Daily Living in Older Patients Hospitalized with Respiratory Diseases: A Cross-sectional Study

Objectives

Respiratory sarcopenia is characterized by low respiratory muscle mass and respiratory muscle strength, but its impact on activities of daily living (ADL) remains unknown. We aimed to investigate the association between respiratory sarcopenia and decreased ADL.

Methods

This retrospective cross-sectional study included older inpatients (≥65 years old) with respiratory diseases who underwent rehabilitation. Because the evaluation of respiratory muscle mass is challenging, probable respiratory sarcopenia was defined according to low appendicular skeletal muscle index (<7 kg/m2 for men, <5.7 kg/m2 for women) and peak expiratory flow rate (<4.4 L/s for men, <3.21 L/s for women). ADL was assessed on the first day of rehabilitation using the baseline Barthel Index (BI).

Results

Of 111 inpatients (median age 75 years; 57 women), 13 (11.7%) had probable respiratory sarcopenia. Forty-five patients (40.5%) had sarcopenia and 12 of these had probable respiratory sarcopenia. Pulmonary functions (Forced Vital Capacity and expiratory volume in 1 s) were significantly lower in patients with probable respiratory sarcopenia than those without. Spearman's rank coefficient analysis showed probable respiratory sarcopenia did not significantly correlate with age, phase angle, Charlson Comorbidity Index (CCI), or hemoglobin (Hb). Multivariate linear regression analysis with baseline BI revealed probable respiratory sarcopenia (β -0.279 and P=0.004) was the significant factor after adjusting for age, sex, body mass index, chronic obstructive pulmonary disease, CCI, and Hb.

Conclusions

Probable respiratory sarcopenia was independently associated with decreased ADL in patients aged 65 years and older who were hospitalized with respiratory diseases.

Relationship between respiratory muscle strength and dynamic balance in older persons requiring care or support: Focusing on the maximal single step length test and maximal double step length test as dynamic balance indices

BACKGROUND

Falls are a major health problem. The relationship between dynamic balance related to falls and respiratory muscle strength related to sarcopenia and frailty is poorly understood.

RESEARCH QUESTION

How do dynamic balance measures, such as maximal single step length test (MSL) and maximal double step length test (MDST), and respiratory muscle strength measures, such as maximal inspiratory (PImax) and maximal expiratory (PEmax), related to the requirement for long-term care or support in older people who live in the community?

METHODS

This was a cross-sectional study of 39 older people (17 men, 22 women) aged ≥ 65 years community-dwelling who were certified as requiring long-term care or support under the Japanese system. The participants' PImax, PEmax, MSL, and MDST results were recorded. The measurement data were evaluated using Pearson's correlation coefficients and multiple regression analysis.

RESULTS

MDST showed a positive correlation with PImax (r = 0.430, p = 0.006) but no correlation with PEmax. MSL showed no correlation with PImax or PEmax. A positive correlation was found between MDST and MSL (r = 0.851, p < 0.001), and multiple regression analysis with MDST as the dependent variable and PImax and MST as independent variables showed significant differences for MSL (p < 0.001) and PImax (p = 0.027).

SIGNIFICANCE

In older people requiring long-term care or support, MDST had a greater association with inspiratory muscle strength compared with MSL. These results suggest the importance of inspiratory muscle strength training and MDST assessment in the prevention of falls in older people requiring long-term care or support.

Association between pulmonary function and rapid kidney function decline: a longitudinal cohort study from CHARLS

BACKGROUND

Pulmonary function has been reported to be associated with chronic kidney disease. However, the relationship between lung function and rapid kidney function decline remains unclear.

METHODS

Participants aged ≥45 years with complete data from the 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. Lung function, assessed by peak expiratory flow (PEF), and kidney function, assessed by estimated glomerular filtration rate (eGFR), were tested at the baseline and endpoint surveys. Rapid kidney function decline was defined as a decrease in eGFR ≥3 mL/min/1.73 m²/year, and ΔeGFR represented the difference between baseline and endpoint eGFR. Multivariate logistic regression models and linear regression models were employed to evaluate the association between PEF and the risk of rapid eGFR decline, as well as the correlation between PEF and ΔeGFR.

RESULTS

A total of 6159 participants were included, with 1157 (18.78%) individuals experiencing a rapid decline in eGFR. After adjusting for potential covariates, higher baseline PEF (Quartile 4 vs Quartile 1, OR=0.95, 95% CI 0.92 to 0.98) and elevated PEF % predicted (OR=0.96, 95% CI 0.94 to 0.99) were found to be associated with a lower risk of rapid eGFR decline. ΔeGFR decreased by 0.217 and 0.124 mL/min/1.73 m² for every 1 L/s increase in baseline PEF (β (95% CI): -0.217 (-0.393 to -0.042)) and 10% increase in PEF % predicted (β (95% CI): -0.124 (-0.237 to -0.011)), respectively. During the follow-up period, ΔeGFR decreased as PEF increased over time among participants in Quartile 1 (β per 1 L/s increase in ΔPEF=-0.581, 95% CI -1.003 to -0.158; β per 10% increase in ΔPEF % predicted=-0.279, 95% CI -0.515 to -0.043).

CONCLUSIONS

Higher PEF was associated with a slower longitudinal eGFR decline in middle-aged and older adults.

Associations of sarcopenia with peak expiratory flow among community-dwelling elderly population: based on the China Health and Retirement Longitudinal Study (CHARLS)

PURPOSE

To cross-sectionally and longitudinally investigate the correlations of sarcopenia and its components with peak expiratory flow (PEF) among Chinese community-dwelling elderly people.

METHODS

The data were extracted from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4053 participants aged ≥ 60 years were enrolled from CHARLS 2011, and 2810 were followed up until 2015. Participants were classified into no-sarcopenia, non-severe sarcopenia, and severe sarcopenia groups based on skeletal muscle mass index (SMI), hand grip strength (HGS), and physical performance [gait speed, five-repetition chair stand test (5CST) and short physical performance battery (SPPB)]. Multivariate linear and logistic regression analyses were used to evaluate the associations of sarcopenia and its components with PEF cross-sectionally and longitudinally.

RESULTS

In the cross-sectional analysis, the prevalence of non-severe sarcopenia was 14.6% and severe sarcopenia was 4.9%. The results of linear regression analysis revealed that sarcopenia and its components were all correlated with PEF and PEF%pred. In the longitudinal analysis, compared with non-sarcopenia, subjects with severe sarcopenia were associated with a higher risk of PEF (OR = 2.05, 95%CI = 1.30-3.26) and PEF%pred (OR = 1.83, 95%CI = 1.17-2.86) decline. The changes in physical performance were correlated with changes in PEF and PEF%pred. No associations were observed between changes in SMI and PEF as well as PEF%pred.

CONCLUSIONS

We demonstrated the associations of baseline sarcopenia status with PEF and longitudinal PEF decline. Also, the changes in physical performance were associated with changes in PEF during a 4-year follow-up. It indicates that improving sarcopenia, especially physical performance may increase PEF.

Improving Respiratory Muscle Strength and Overall Function in Patients With Cardiovascular Disease Through Rehabilitation Hospitals

Background

The prevalence of respiratory sarcopenia and its effect on respiratory muscle strength (RMS) in patients with cardiovascular disease (CVD), who are transferred to a convalescent rehabilitation hospital after acute care and require continuous cardiac rehabilitation (CR), is currently unclear. This study aimed to assess changes in RMS, physical function, and activities of daily living (ADL) before and after CR performed in a rehabilitation hospital.

Methods

Of 50 consecutive patients transferred to a rehabilitation hospital for ongoing CR, 30 fulfilled the inclusion criteria. Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were measured at transfer, and patients with decreased RMS were diagnosed with respiratory sarcopenia. RMS, physical function, exercise tolerance, ADL ability, and health-related quality of life (HR-QoL) were measured and compared at transfer and discharge.

Results

The prevalence of respiratory sarcopenia at the time of transfer to the rehabilitation hospital was 93.3%. RMS assessments at transfer and discharge demonstrated significant improvements in %MIP (from 46.3±26.1% to 63.6±33.7%) and %MEP (from 44.8±17.3% to 56.6±21.8%). Short physical performance battery, gait speed, handgrip strength, and knee extension muscle strength significantly improved, along with significant prolongation of 6-min walking distance as a measure of exercise tolerance. ADL assessment using the functional independence measure revealed significant improvement, as did HR-QoL assessed according to the five-dimension, five-level, EuroQoL instrument, following CR.

Conclusions

Although respiratory sarcopenia was highly prevalent among patients with CVD who required transfer to a rehabilitation hospital after acute care, continuous CR significantly improved RMS, ADL, physical function, and exercise tolerance. These findings support the continued expansion of CR, particularly in dedicated rehabilitation hospitals.

Respiratory sarcopenia screening in dialysis patients: cross-sectional and multicentre study protocol

BACKGROUND

Respiratory sarcopenia is characterized by the weakness of respiratory muscles associated with sarcopenia due to aging or systemic diseases such as chronic kidney disease (CKD). Patients with CKD undergoing dialysis are particularly susceptible to respiratory muscle weakness caused by factors such as fluid overload and electrolyte imbalance. This weakness not only affects ventilation but also impairs oxygen uptake and delivery to muscle tissue, potentially leading to severe sarcopenia. Thus, the objective of this study is to conduct a respiratory sarcopenia screening in patients with CKD undergoing haemodialysis (HD) and peritoneal dialysis (PD).

METHODS

This is an observational, cross-sectional and multicentre study conducted between March 2023 and March 2025. The study was approved by the Research Ethics Committee at two centres. Sarcopenia diagnosis is determined based on low handgrip strength and amount of appendicular skeletal muscle mass, assessed through bioelectrical impedance analysis. Respiratory sarcopenia is diagnosed in patients with sarcopenia who have low inspiratory muscle strength, evaluated through a manovacuometry test. The severity of sarcopenia and respiratory sarcopenia is defined, respectively, by low physical performance (measured using the Short Physical Performance Battery and Timed-Up and Go test) and pulmonary performance (measured through spirometry). Thus, this study will include 81 patients undergoing dialysis (41 on HD and 40 on PD) from three participating centres.

DISCUSSION

The literature has been focused on respiratory function in CKD; however, the relationship with sarcopenia remains understudied. We believe that, similar to appendicular skeleton muscles, the axial skeleton muscles are also likely to weaken with the presence of chronic disease, such as CKD.

Advancing healthcare through thoracic ultrasound research in older patients

This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.

Serum-Creatinine-to-Cystatin C-to-Waist-Circumference Ratios as an Indicator of Severe Airflow Limitation in Older Adults

BACKGROUND

This study aimed to investigate the association between the serum-creatinine-to-cystatin C-to-waist-circumference (CCR/WC) ratio with lung function and severe airflow limitation (SAL).

METHODS

The data were derived from the China Health and Retirement Longitudinal Study. Peak expiratory flow (PEF) was used as a measure of lung function parameter. Logistic and linear regression were utilized separately to evaluate the relationship between the CCR/WC ratio with PEF and SAL in baseline. Restricted cubic spline was used to explore potential non-linear associations between the CCR/WC ratio and SAL. Cox proportional-hazards models were used to assess the association between CCR/WC quartiles and the risk of new-onset SAL.

RESULTS

A total of 6105 participants were included. This study revealed a positive association between the CCR/WC ratio and lung function (PEF: β [partial coefficient]: 25.95, 95%CI: 12.72 to 39.18, p < 0.001; PEF/PEF prediction: β = 0.08, 95%CI: 0.05 to 0.12, p < 0.001) and an inverse association relationship with SAL (OR [odds ratio]: 0.64, 95% confidence interval [CI]: 0.47 to 0.85, p = 0.003). Subgroup analysis showed a significant association between the CCR/WC ratio and SAL in males (OR: 0.58, 95% CI: 0.37 to 0.90, p = 0.017) but not in females (p = 0.059). Cox regression analysis revealed a decreased risk of SAL in the quartiles (Q2-4) compared to the first quartile of the CCR/WC ratio (hazard ratios [HRs]: 0.49 to 0.73, all p < 0.05).

CONCLUSIONS

This study highlights a positive association between the CCR/WC ratio and lung function, with a potential protective effect against SAL.

Association between muscle quality index and pulmonary function in post-COVID-19 subjects

BACKGROUND

The SARS-CoV2 pandemic impacted many critically ill patients, causing sequelae, affecting lung function, and involving the musculoskeletal system. We evaluated the association between lung function and muscle quality index in severely ill post-COVID-19 patients.

METHODS

A cross-sectional study was conducted on a post-COVID-19 cohort at a third-level center. The study included patients who had experienced severe-to-critical COVID-19. Anthropometric measurements, such as body mass index (BMI) and handgrip strength, were obtained to calculate the muscle quality index (MQI). Additionally, spirometry, measurements of expiratory and inspiratory pressure, and an assessment of DLCO in the lungs were performed. The MQI was categorized into two groups: low-MQI (below the 50th percentile) and high-MQI (above the 50th percentile), based on sex. Group differences were analyzed, and a multivariate linear regression analysis was performed to assess the association between respiratory function and MQI.

RESULTS

Among the 748 patients analyzed, 61.96% required mechanical ventilation, and the median hospital stay was 17 days. In patients with a low MQI, it was observed that both mechanical respiratory function and DLCO were lower. The multivariate analysis revealed significantly lower findings in mechanical respiratory function among patients with a low MQI.

CONCLUSION

The Low-MQI is an independent predictor associated with pulmonary function parameters in subjects with Post-COVID-19 syndrome.

Dynapenia and Sarcopenia in Post-COVID-19 Syndrome Hospitalized Patients Are Associated with Severe Reduction in Pulmonary Function

BACKGROUND

After hospital discharge, post-COVID-19 syndrome has been observed to be associated with impaired diffusing capacity, respiratory muscle strength, and lung imaging abnormalities, in addition to loss of muscle mass/strength, sarcopenia, and obesity impact exercise tolerance, pulmonary functions, and overall prognosis. However, the relationship between lung function and the coexistence of obesity with low muscle strength and sarcopenia in post-COVID-19 patients remains poorly investigated. Therefore, our aim was to evaluate the association between lung function and the coexistence of obesity with dynapenia and sarcopenia in post-COVID-19 syndrome patients.

METHODS

This cross-sectional study included subjects who were hospitalized due to moderate to severe COVID-19, as confirmed by PCR testing. Subjects who could not be contacted, declined to participate, or died before the follow-up visit were excluded.

RESULTS

A total of 711 subjects were evaluated; the mean age was 53.64 ± 13.57 years, 12.4% had normal weight, 12.6% were dynapenic without obesity, 8.3% had sarcopenia, 41.6% had obesity, 21.2% had dynapenic obesity, and 3.8% had sarcopenic obesity. In terms of pulmonary function, the dynapenic subjects showed decreases of -3.45% in FEV1, -12.61 cmH2O in MIP, and -12.85 cmH2O in MEP. On the other hand, the sarcopenic subjects showed decreases of -6.14 cmH2O in MIP and -11.64 cmH2O in MEP. The dynapenic obesity group displayed a reduction of -12.13% in PEF.

CONCLUSIONS

In post-COVID-19 syndrome, dynapenia and sarcopenia-both with and without obesity-have been associated with lower lung function.

Development and validation of the modified index of fragility in head and neck cancer surgery

BACKGROUND

This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events.

METHOD

An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG.

RESULTS

A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index.

CONCLUSION

The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.

Thoracic sarcopenia predicts clinical outcomes in patients undergoing coronary artery bypass grafting: A 6-year cohort study

BACKGROUND

The relationship between thoracic sarcopenia and clinical outcomes in patients underwent coronary artery bypass grafting (CABG) is unclear. This study aims to evaluate whether thoracic sarcopenia has a satisfactory prognostic effect on adverse outcomes after CABG.

METHODS

From December 2015 to May 2021, 338 patients who underwent isolated CABG at our institution were recruited in this study. Skeletal muscle area at T12 level acquired by chest computed tomography (CT) was normalized to assess thoracic sarcopenia. Univariate and multivariate analyses were performed to evaluate the risk factors of postoperative complications and overall survival (OS).

RESULTS

The prevalence of thoracic sarcopenia in patients underwent CABG was 13.02%. The incidence of total major complication was significantly higher in thoracic sarcopenia group (81.8% vs 61.9%, p = 0.010). Thoracic sarcopenic patients also had longer postoperative hospital stays (p = 0.047), intensive care unit (ICU) stays (p = 0.001), higher costs (p = 0.001) and readmission rates within 30 days of discharge (18.2% vs 4.4%, p = 0.001). Patients without thoracic sarcopenia showed significantly higher OS at the 2-year follow-up period (93.9% vs 72.7%, p<0.001). Multivariate analyses demonstrated that thoracic sarcopenia was significantly and independently associated with postoperative complications and long-term OS after CABG.

CONCLUSION

Thoracic sarcopenia is an effective clinical predictor of adverse postoperative complications and long-term OS in patients underwent CABG. Thoracic sarcopenia based on chest CT should be included in preoperative risk assessment of CABG.

Patterns of Changes in Respiratory Muscle Strength over 1 Year in Non-Sarcopenia, Sarcopenia, and Severe Sarcopenia

In this prospective longitudinal cohort study, we explored the characteristics of older people with lower respiratory muscle strength, according to sarcopenia severity, over the course of 1 year. The maximum expiratory pressure (MEP), grip strength, walking speed, and skeletal muscle mass index of 58 participants (28 men, 30 women; mean age, 76.9 ± 7.7 years) were measured at baseline and at the 1-year follow-up. Participants were classified into a decreased MEP group (n = 29; MEP decreased by ≥10% after 1 year) and a non-decreased MEP group (n = 29; MEP decreased by <10%). Sarcopenia status in the mild direction at baseline was significantly associated with MEP decline after one year. Repeated two-way analysis of variance showed significant main effects of measurement time (p < 0.001) and severity of sarcopenia (p = 0.026), as well as a significant interaction effect (p = 0.006). Surprisingly, MEP decreased significantly in the non-sarcopenia and sarcopenia groups, but not in the severe sarcopenia group. Thus, individuals without sarcopenia and those with moderate sarcopenia at baseline are predisposed to MEP decline and should be closely monitored for signs of such decline and associated adverse events.

Effects of Diaphragmatic Breathing Exercise on Respiratory Functions and Vocal Sustenance in Apparently Healthy Vocalists

BACKGROUND

Effective vocalization is dependent on breathing efficiency. Previous studies have reported the efficacy of Diaphragmatic Breathing Exercise (DBE) on the respiratory muscles and breath control of vocalists. There is a paucity of data on the effects of DBE on their vocal sustenance (VS), which is determined as Maximum Phonation Time (MPT). No known published study has considered physiotherapy as influencing voice dynamics amongst vocalists; evaluated the relationship between respiratory functions (Forced Vital Capacity - FVC, Forced Expiratory Volume in one second - FEV1, FEV1/FVC, and Peak Expiratory Flow - PEF) and VS in apparently healthy vocalists. Moreover, literature on the benefits of DBE to vocalists has not considered explicitly this aspect of vocalization skill, VS.

METHODS

This is a pre-test - post-test experimental study involving a total of 37 participants (17 males and 20 females) selected by purposive and convenience sampling techniques. The subjects were grouped into DBE and control groups. Spirobank MIR spirometer was used to assess the respiratory function of the singers, while a stopwatch and keyboard were used in assessing the MPT. Statistical analysis was done with SPSS version 21.0. Alpha level set at 0.05.

RESULTS

Significant improvement was found in respiratory functions (FVC, FEV1, FEV1/FVC, PEF) of the DBE group when pre- and post-test results were compared. The DBE and control groups differed significantly. Respiratory values correlated significantly with the MPT values (FVC - r[p] - 0.416[0.011]; FEV1 - r[p] - 0.416[0.010]; PEF - r[p] - 0.566[0.000]), except for FEV1/FVC - r(p) - 0.248(0.138). Voice category did not correlate with respiratory parameters or MPT. While male singers showed more changes in respiratory function the female singers showed more improvement in MPT.

CONCLUSION AND RECOMMENDATION

DBE can improve respiration and VS (increased MPT). Therefore, it can be recommended for vocalists, and Physiotherapy can be relevant in trainings to improve vocal dynamics.

Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders

Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).

Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).

Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).

Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.

Associations of intermuscular adipose tissue and total muscle wasting score in PG-SGA with low muscle radiodensity and mass in nonmetastatic colorectal cancer: A two-center cohort study

Backgrounds

The patient-generated subjective global assessment (PG-SGA) is one of the screening criteria for malnutrition, the skeletal muscle radiodensity (SMD) and skeletal muscle mass index (SMI) are associated with survival in colorectal cancer patients. Body composition parameters can be easily assessed; however, few studies have examined the association between total muscle wasting scores in PG-SGA and body composition parameters and two muscle abnormalities.

Methods

This cohort study included 1,637 stage I-III CRC patients from 2 clinical centers in China, who were enrolled in the training cohort (n = 1,005) and validation cohort (n = 632). Baseline data were collected prospectively from patients including age, BMI, staging, gait speed, hand grip strength (HGS), peak expiratory flow (PEF), neutrophil-lymphocyte ratio (NLR), intermuscular adipose tissue (IMAT), visceral fat area (VFA) and total muscle wasting score in PG-SGA. Relevant risk factors were subjected to logistic regression analysis and Cox regression analysis to identify characteristics associated with muscle abnormalities and survival. Based on the logistic model results, normograms were established to predict muscle abnormalities, and its discrimination and calibration were assessed using the receiver operating characteristic (ROC) curve and calibration curve. The Kaplan-Meier curves were used to assess the survival of colorectal cancer patients with malnutrition or sarcopenia in an inflammatory state (assessed by NLR).

Results

The mean age of all participants was 57.7 ± 10.6 years (56.9% males) and the prevalence of low SMD and low SMI was 32.2 and 39.5%, respectively. Low SMD rate was significantly associated with age, TNM stage, BMI, IMAT, walking speed, total muscle wasting score and NRS2002 score by logistic regression analysis (p < 0.05). Low SMI rate was significantly correlated with age, NLR, BMI, PEF, handgrip strength, calf circumference, walking speed, total muscle wasting score and NRS2002 score (p < 0.05). The AUCs of the diagnostic nomograms were 0.859 (95% CI, 0.831-0.886) for low SMD and 0.843 (95% CI, 0.813-0.871) for low SMI in the validation cohort. We also found that patients with colorectal cancer with malnutrition or sarcopenia had a worse prognosis when NLR ≥3.5.

Conclusion

Muscle abnormalities and malnutrition are strongly associated with mortality in patients with non-metastatic colorectal cancer. Early identification and intervention of the associated risk factors may offer new ways to improve patient prognosis.

Implications of the Metabolic Control of Diabetes in Patients with Frailty Syndrome

Introduction: Frailty syndrome occurs more frequently in patients with diabetes than in the general population. The reasons for this more frequent occurrence and the interdependence of the two conditions are not well understood. To date, there is no fully effective method for the diagnosis, prevention, and monitoring of frailty syndrome. This study aimed to assess the degree of metabolic control of diabetes in patients with frailty syndrome and to determine the impact of frailty on the course of diabetes using a retrospective analysis. Materials and Methods: A total of 103 individuals aged 60+ with diabetes were studied. The study population included 65 women (63.1%) and 38 men (36.9%). The mean age was 72.96 years (SD 7.55). The study was conducted in the practice of a general practitioner in Wielkopolska in 2018−2019. The research instrument was the authors’ original medical history questionnaire. The questions of the questionnaire were related to age, education, and sociodemographic situation of the respondents, as well as their dietary habits, health status, and use of stimulants. Other instruments used were: the Mini-Mental State Examination (MMSE), Lawton Scale (IADL—Instrumental Activities of Daily Living), Katz Scale (ADL—Activities of Daily Living), Geriatric Depression Rating Scale (GDS), and SHARE-FI scale (Survey of Health, Aging, and Retirement in Europe). Anthropometric and biochemical tests were performed. Results: In the study, frailty syndrome was diagnosed using the SHARE-FI scale in 26 individuals (25%): 32 (31.1%) were pre-frailty and 45 (43.7%) represented a non-frailty group. Statistical analysis revealed that elevated HbA1c levels were associated with a statistically significant risk of developing frailty syndrome (p = 0.048). In addition, the co-occurrence of diabetes and frailty syndrome was found to be a risk factor for loss of functional capacity or limitation in older adults (p = 0.00) and was associated with the risk of developing depression (p < 0.001) and cognitive impairment (p < 0.001). Conclusions: Concerning metabolic control of diabetes, higher HbA1c levels in the elderly are a predictive factor for the development of frailty syndrome. No statistical significance was found for the other parameters of metabolic control in diabetes. People with frailty syndrome scored significantly higher on the Geriatric Depression Rating Scale and lower on the MMSE cognitive rating scale than the comparison group. This suggests that frailty is a predictive factor for depression and cognitive impairment. Patients with frailty and diabetes have significantly lower scores on the Basic Activities of Daily Living Rating Scale and the Complex Activities of Daily Living Rating Scale, which are associated with loss or limitation of functioning. Frailty syndrome is a predictive factor for loss of functional capacity in the elderly.

Association of Peak Expiratory Flow with Cognitive Function in the Chinese Middle-Aged and Elderly Population: A 7-Year Longitudinal Study

BACKGROUND

Previous studies have shown that impaired pulmonary function may be associated with cognitive decline, posing the question of whether peak expiratory flow (PEF) % pred could present a modifiable risk factor.

OBJECTIVE

To assess the association between PEF% pred and future cognitive function among Chinese participants aged 45 years and above.

METHODS

Data came from four waves fielded by the China Health and Retirement Longitudinal Study. Cognitive function was assessed by a global cognition score. Multivariate linear regression models and generalized estimating equation (GEE) were used to investigate associations between PEF% pred and later cognitive function.

RESULTS

A total of 2,950 participants were eligible for the final data analysis. After adjustment for baseline cognition and potential confounders, the association remained statistically significant (β = 0.0057, p = 0.027). Domains with increases were focused on episodic memory (β= 0.0028, p = 0.048) and figure drawing (β= 0.0040, p = 0.028). But these associations were not found in women (β= 0.0027, p = 0.379). However, GEE suggested that the rates of decline in global cognition decreased by 0.0096 (p < 0.001) units per year as baseline PEF% pred increased by 1% in middle-aged and elderly individuals, regardless of sex. And higher baseline PEF% pred correlated with declined rates of decrease of in episodic memory, figure drawing, and Telephone Interview of Cognitive Status (TICS).

CONCLUSION

Higher baseline PEF% pred was significantly associated with slower cognitive decline in global cognition, episodic memory, figure drawing, and TICS in middle aged and elderly Chinese adults.

Comparison of Characteristics of Definition Criteria for Respiratory Sarcopenia—The Otassya Study

We compared the definitions of respiratory sarcopenia obtained from a model based on forced vital capacity (FVC) and whole-body sarcopenia, as recommended by the Japanese Association of Rehabilitation Nutrition (JARN), and a model based on the peak expiratory flow rate (PEFR), as recommended in our previous study. A total of 554 community-dwelling older people without airway obstruction who participated in our study in 2017 were included in the current study. Respiratory function, sarcopenia, and frailty were assessed. Pearson’s correlation coefficients of the associations of the FVC and PEFR with physical performance and the receiver operating curves of FVC and PEFR’s association with sarcopenia, long-term care insurance (LTCI) certification, and frailty were calculated. The sensitivity and specificity of the two respiratory sarcopenia models were assessed. The FVC and PEFR were associated significantly with physical performance. The areas under the curve for sarcopenia and the LTCI certification in the FVC and PEFR groups were statistically significant in both sexes. While Kera’s model had a lower specificity in determining sarcopenia, it had a sensitivity higher than the JARN model. Both models provide suitable definitions of respiratory sarcopenia. Future studies are required to determine other appropriate variables to define respiratory sarcopenia.

Effects of cigarette smoking on the association between respiratory muscle strength and skeletal muscle mass in middle-aged and older adults: the Wakayama Study

PURPOSE

This study aimed to examine whether cumulative smoking exposure affects the association between peak expiratory flow rate (PEFR) and skeletal muscle mass in middle-aged and older adults.

METHODS

The study participants comprised 832 community-dwelling individuals aged 50-89 years (mean age: 69 years) without chronic obstructive pulmonary disease. Bioelectrical impedance analysis was performed to estimate the skeletal muscle mass of each participant. PEFR was assessed using an electronic spirometer. Cumulative smoking exposure was expressed in pack years, that is a product of the average number of packs of cigarettes smoked per day and smoking duration in years.

RESULTS

The whole-body skeletal muscle mass progressively reduced with decreasing PEFR levels in both males and females. In the multiple regression analysis, PEFR was found to be significantly associated with skeletal muscle mass, independent of the potential confounding factors. When participants were stratified based on the cumulative smoking exposure, the association between low PEFR and reduced skeletal muscle mass persisted in individuals with non-smoking and light-to-moderate smoking exposure (< 30 pack-years). However, this association was not clearly observed in individuals with heavy smoking exposure (≥ 30 pack-years).

CONCLUSION

The findings of this study support the notion that PEFR declines with a reduction in systemic skeletal muscle mass due to aging. However, chronic cigarette smoking induces respiratory dysfunction exceeding the expected values by age, and thus a low PEFR level may not be used as a marker of reduced muscle mass in older adults exposed to heavy smoking.

Respiratory function correlates with fat mass index and blood triglycerides in institutionalized older individuals

BACKGROUND

We investigated the relationship between respiratory function measured by spirometry analysis and anthropometric variables (skeletal and fat mass) and nutritional status in the institutionalized elderly, particularly at high risk of adverse outcomes after respiratory infections and malnutrition.

DESIGN

A multicenter cross-sectional study with quantitative approach among older people institutionalized living in nursing homes.

METHODS

Respiratory function was assessed by measuring the forced vital capacity, forced expiratory volume in the first second, the ratio between FEV1 and FVC (FEV1/FVC), and peak expiratory flow in percentage by means of spirometric analysis (values of the forced expiratory volume measured during the first second of the forced breath (FEV1) and forced vital capacity (FVC)). Nutritional assessment and anthropometry analysis were done to evaluate under or over nutrition/weight.

RESULTS

There was a significant (p<0.05) and positive correlation between FEV1 and skeletal muscle mass index, whereas fat mass index correlated significantly (p<0.01) with the FEV1/FVC index. FEV1/FVC values were both significantly (p<0.05) associated with high body mass index and triglyceride levels in blood. The prevalence of individuals with ventilator restrictive pattern (FEV1/FVC>70% with FEV1 and FVC<80%) was 27.6% and 12 individuals (21.1%) receive daily bronchodilators as part of the pharmacological treatment for respiratory disorders. A logistic regression was performed to identify predictors of restrictive respiratory pattern. The following variables were entered into the model: age group, female gender, Charlson comorbidity index, body-mass index (BMI), fat mass index, skeletal muscle mass index, total cholesterol and triglycerides concentration. The model was statistically significant (p < 0.05; R2 = 0.39), correctly classifying 70.0% of cases, with a sensitivity of 89.3% and a specificity of 50.0%. Area under curve was 0.71 (IC95% 0.54-0.88; p=0.023). The highest OR for restrictive respiratory pattern were for BMI (OR=5.09) and triglycerides concentration in blood (>150 mg/dl) (OR=5.59).

CONCLUSION

The relationship between a restrictive pattern of respiratory function and fat mass which deserves future investigation to manage these parameters as possible modifiable factor of altered respiratory function in overweight institutionalized older individuals.

Sarcopenia is not associated with inspiratory muscle strength but with expiratory muscle strength among older adults requiring long-term care/support

BACKGROUND

Recently, the concept of respiratory sarcopenia has been advocated, but evidence is lacking regarding which respiratory parameters are appropriate indicators. Therefore, we investigated the association between sarcopenia, respiratory function, and respiratory muscle strength to identify the most appropriate parameters for respiratory sarcopenia.

METHODS

We included 124 older adults (67 men, 57 women; average age 77.2 ± 8.3 years) requiring long-term care/support who underwent Day Care for rehabilitation. Handgrip strength, usual gait speed, and skeletal muscle mass were measured using bioelectrical impedance analysis. Participants were then diagnosed with sarcopenia using the algorithm of the Asian Working Group for Sarcopenia 2019. Parameters of respiratory function (forced vital capacity, forced expiratory volume in one second [FEV1.0], FEV1.0%, and peak expiratory flow rate) and respiratory muscle strength (maximal expiratory pressure [MEP] and maximal inspiratory pressure) were also measured according to American Thoracic Society guidelines. Respiratory parameters significantly related to sarcopenia were identified using binomial logistic regression and receiver operating characteristic analyses.

RESULTS

Seventy-seven participants were classified as having sarcopenia. Binomial logistic regression analysis showed that MEP was the only respiratory parameter significantly associated with sarcopenia. The cut-off MEP value for predicting sarcopenia was 47.0 cmH₂0 for men and 40.9 cmH₂0 for women.

CONCLUSIONS

The most appropriate parameter for assessing respiratory sarcopenia may be MEP, which is an indicator of expiratory muscle strength, rather than FVC, MIP, or PEFR, as suggested in previous studies. Measuring MEP is simpler than measuring respiratory function parameters. Moreover, it is expected to have clinical applications such as respiratory sarcopenia screening.

Are maximum respiratory pressures predictors of sarcopenia in the elderly?

Objective:

To compare maximum respiratory pressures and spirometric parameters among elderly individuals classified as having no sarcopenia, probable sarcopenia, and confirmed sarcopenia, and to test the ability of these variables to discriminate sarcopenia in a community-dwelling elderly population.

Methods:

This was a cross-sectional study involving 221 elderly (≥ 60 years of age) individuals of both sexes. Sarcopenia was diagnosed in accordance with the new consensus of the European Working Group on Sarcopenia in Older People. Maximum respiratory pressures and spirometry parameters were assessed.

Results:

The prevalences of probable sarcopenia and confirmed sarcopenia were 20.4% and 4.1%, respectively. Regardless of the sex, those with confirmed sarcopenia had significantly lower MEP than those with no sarcopenia and probable sarcopenia, whereas only males with confirmed sarcopenia presented with significantly lower MIP than did the other individuals. There was an inverse association of MIP and MEP with sarcopenia, indicating that the decrease by 1 cmH₂O in these parameters increases the chance of sarcopenia by 8% and 7%, respectively. Spirometric parameters were not associated with sarcopenia. Cutoff points for MIP and MEP, respectively, were ≤ 46 cmH₂O and ≤ 50 cmH₂O for elderly women, whereas they were ≤ 63 cmH₂O and ≤ 92 cmH₂O for elderly men, and both were identified as predictors of sarcopenia (area under the ROC curve > 0.70).

Conclusions:

Sarcopenia was associated with lower maximum respiratory pressures, but not with spirometric parameters. Maximum respiratory pressures can be used as markers of sarcopenia in a community-dwelling elderly population regardless of the sex.

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

PURPOSE OF REVIEW

We describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals.

RECENT FINDINGS

Recent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established.

SUMMARY

The International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence-practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.

Decreased peak expiratory flow rate associated with mortality in idiopathic pulmonary fibrosis: A preliminary report

Objectives

The peak expiratory flow rate (PEFR) is known to decrease in patients with sarcopenia. However, little is known about the clinical impact of the PEFR in idiopathic pulmonary fibrosis (IPF). This study aimed to confirm whether a decrease in PEFR over 6 months was associated with survival in IPF patients.

Methods

Consecutive IPF patients who had been assessed at a single center were retrospectively analyzed. The relative decline in PEFR over 6 months was assessed. Survival analyses were performed by univariate and multivariate Cox proportional hazard models.

Results

A total of 61 eligible cases (average age 70 years) were examined, and 21 patients (34.4%) died. The univariate Cox regression analysis showed that the body mass index, baseline % predicted forced vital capacity (FVC), baseline % predicted PEFR, % predicted diffusion capacity for carbon monoxide (DL_CO), relative decline in FVC, and relative decline in PEFR were prognostic factors. On multivariate analyses, relative decline in PEFR (hazard ratio [HR] 1.037, p < .05) and baseline % predicted FVC (HR 0.932, p < .001) were independent prognostic factors, whereas relative decline in FVC was not.

Conclusion

A decrease in PEFR after 6 months may predict worse survival in patients with IPF.

The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults

An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.

The Impact of Glucose-Lowering Drugs on Sarcopenia in Type 2 Diabetes: Current Evidence and Underlying Mechanisms

The age-related decrease in skeletal muscle mass together with the loss of muscle power and function is defined sarcopenia. Mounting evidence suggests that the prevalence of sarcopenia is higher in patients with type 2 diabetes mellitus (T2DM), and different mechanisms may be responsible for this association such as impaired insulin sensitivity, chronic hyperglycemia, advanced glycosylation end products, subclinical inflammation, microvascular and macrovascular complications. Glucose-lowering drugs prescribed for patients with T2DM might impact on these mechanisms leading to harmful or beneficial effect on skeletal muscle. Importantly, beyond their glucose-lowering effects, glucose-lowering drugs may affect per se the equilibrium between protein anabolism and catabolism through several mechanisms involved in skeletal muscle physiology, contributing to sarcopenia. The aim of this narrative review is to provide an update on the effects of glucose-lowering drugs on sarcopenia in individuals with T2DM, focusing on the parameters used to define sarcopenia: muscle strength (evaluated by handgrip strength), muscle quantity/quality (evaluated by appendicular lean mass or skeletal muscle mass and their indexes), and physical performance (evaluated by gait speed or short physical performance battery). Furthermore, we also describe the plausible mechanisms by which glucose-lowering drugs may impact on sarcopenia.

Pulmonary function, muscle strength, and quality of life have differed between chronic kidney disease patients and healthy individuals

Chronic kidney disease (CKD) patients have lower pulmonary function, respiratory and peripheral muscle strength values when compared to the general population, which reflects negatively in the quality of life (QoL). The aim of this study was to compare the pulmonary function, respiratory and peripheral muscle strength, and QoL between CKD patients and healthy individuals. Cross-sectional study with a consecutive sample of 39 individuals separated into three groups: nondialysis-dependent CKD in stage 5 (CKD-5), HD group (CKD-HD), and healthy individuals. The tests performed were spirometry, manovacuometry, handgrip strength (HGS), and Medical Outcomes Short-Form Health Survey (SF-36). A significant difference between groups was observed in forced expiratory volume in 1 second (FEV₁ ) and its predicted value (p = 0.004 and p < 0.001, respectively), forced vital capacity (FVC), and its predicted value (p = 0.008 and p < 0.001, respectively), peak expiratory flow (PEF) and its predicted value (p = 0.004 and p < 0.001, respectively), maximal inspiratory pressure (MIP) and its predicted value (p = 0.022), maximal expiratory pressure (MEP) and its predicted value (p = 0.030 and p = 0.009, respectively) in which CKD-5 presented the worst values, followed by CKD-HD and healthy group. The CKD-5 had worse pulmonary function, respiratory muscle strength, and QoL. Moreover, CKD-HD also showed some impairment in pulmonary function and QoL when compared with healthy individuals. Even with the peripheral muscle strength preserved, its decrease is proportional to the pulmonary impairment in the evaluated CKD patients.

Deterioration of mitochondrial function in the human intercostal muscles differs among individuals with sarcopenia, obesity, and sarcopenic obesity

BACKGROUND & AIMS

Sarcopenic obesity (SO) increases the risk of mortality more than sarcopenia or obesity alone. Sarcopenia weakens the peripheral and respiratory muscles, leading to respiratory complications. It also induces mitochondrial dysfunction in the peripheral muscle; however, whether mitochondrial dysfunction in respiratory muscles differs among individuals with obesity, sarcopenia, and SO remains unknown. We evaluated the deterioration of respiratory muscle strength and mitochondrial function among normal, sarcopenia, obesity, and SO subjects.

METHODS

Twenty-five patients who underwent lung resections were enrolled between April 2017 and January 2021, and their intercostal muscles were harvested. Based on their L3 muscle index and visceral fat area, the patients were divided into four groups (normal, obesity, sarcopenia, and SO). The clinical data, mRNA expression, and protein expressions associated with mitochondrial biogenesis/fusion/fission in the intercostal muscles were compared among the four groups.

RESULTS

The respiratory muscle strength was evaluated using peak expiratory flow rate (PEFR). The PEFR values of the four groups were not significantly different. The levels of pAkt/Akt and mTOR (a marker of protein synthesis) were not significantly different among the four groups; however, those in the SO group were substantially lower than those in the sarcopenia or obesity groups. The levels of Atrogen-1 and MuRF1 (a marker of protein degradation) were not significantly different among the four groups; however, those in the SO group were substantially higher than those in the sarcopenia or obesity groups. Expression of PGC1-α (a marker of mitochondrial biogenesis) in the SO group was significantly lower than that in the normal group. MFN1 and MFN2 (marker of mitochondrial fusion) levels were significantly lower in the SO group than those in the normal group. DRP1 (a marker of mitochondrial fission) level in the SO group was substantially lower than that in the normal group. The expression of TNF-α (a pro-inflammatory cytokine) in the SO group was substantially lower than that in the normal group.

CONCLUSION

Our results suggest that the deterioration of protein synthesis and degradation of mitochondrial function in the respiratory muscles was most prominent in the SO before the weakening of the respiratory muscles. The deterioration mechanism may differentially regulate obesity, sarcopenia, and SO.

Diaphragmatic muscle thickness in older people with and without sarcopenia

BACKGROUND

Studies in mice have suggested that sarcopenic animals may have atrophic diaphragmatic muscles; however, to date, no clinical studies are available.

AIMS

To investigate whether the diaphragmatic thickness is affected in older patients with sarcopenia and if this is associated with impaired respiratory functions.

METHODS

Thirty sarcopenic and 30 non-sarcopenic elderly patients aged over 65 were included. All patients underwent comprehensive geriatric assessment. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in Older People. Ultrasonographic evaluations of the patients were carried out by an experienced radiologist. Diaphragmatic thickness was measured in three positions: end of deep inspiration, quiet breathing, end of forced expiration. Peak expiratory flow (PEF) rate was evaluated by a peak flow meter.

RESULTS

The mean age of the patients was 77 ± 6 years, and 58% were females. Diaphragmatic thickness in three different positions (deep inspiration [2.3 mm (min-max: 1.3-4.1) vs. 2.5 mm (min-max: 1.9-4.9)], quiet breathing [1.8 mm (min-max: 1.0-2.8) vs. 2.00 mm (min-max: 1.3-3.9)] and end of forced expiration [1.1 mm (min-max: 0.7-2.5) vs. 1.5 mm (min-max: 0.5-3.4)]) were found to be thinner in sarcopenic patients compared to non-sarcopenics (p = 0.02, p = 0.02, p < 0.01, respectively). Also, PEF rate results were lower in patients with sarcopenia (245 L/min [min-max: 150-500] vs. 310 L/min [min-max: 220-610], p < 0.01). Diaphragmatic muscle thicknesses in all three positions were independently associated with sarcopenia status of the participants.

CONCLUSIONS

Our results suggest that sarcopenia in older people may be associated with reduced diaphragmatic muscle thickness and respiratory functions. Findings are needed to be confirmed in further multicenter studies with big sample sizes.

Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview

The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.

Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.