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Simó-Servat A, Ibarra M, Libran M, Escobar L, Perea V, Quirós C, Puig-Jové C, Barahona MJ. Prospective Study to Evaluate Rectus Femoris Muscle Ultrasound for Body Composition Analysis in Patients Undergoing Bariatric Surgery. J Clin Med 2024; 13:3763. [PMID: 38999329 PMCID: PMC11242698 DOI: 10.3390/jcm13133763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Bariatric surgery (BS) has a significant impact on body composition (BC) and consequently may affect established sarcopenic obesity (SO) in candidate patients. The aim of this study was to assess the utility of muscle ultrasound (MUS) of rectus femoris thickness (RFT) for the evaluation of BC and skeletal muscle function in patients undergoing BS compared to bioimpedance analysis (BIA), dual-energy X-ray absorptiometry (DEXA) and dynamometry. On the other hand, we aimed to demonstrate how MUS of RFT correlates with quality of life (QoL) in this population, likely due to its ability to detect regional quadriceps muscle sarcopenia compared to the other mentioned methods. Methods: This was a prospective pilot study that included 77 participants (64.9% female, mean age: 53.2 ± 8.67 years) who underwent BS. Handgrip strength was measured using a dynamometer, fat-free mass index (iFFM) was assessed by BIA, appendicular muscle index (AMI) was calculated using DEXA, and RFT was measured by MUS. Moreover, homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. All these measurements were conducted 1 month prior to BS and at the 12-month follow-up. QoL was assessed using the Moorehead-Ardelt questionnaire. Results: The mean BMI decreased by 12.95 ± 3.56 kg/m2 (p = 0.001). Firstly, we observed a positive correlation pre-surgery between HOMA and RFT (r = 0.27, p = 0.02), iFFM (r = 0.36, p = 0.001), AMI (r = 0.31, p = 0.01) and dynamometer readings (r = 0.26, p = 0.02). In addition, we found a correlation between RFT and iFFM (pre-surgery: r = 0.31, p = 0.01; post-surgery: r = 0.25, p = 0.05) and between RFT and lower-extremity AMI post-surgery (r = 0.27, p = 0.04). Secondly, we observed significant reductions in iFFM, AMI and RFT (p = 0.001), but not in dynamometer readings (p = 0.94). Finally, a tendency to a positive correlation between QoL questionnaire and RFT post-surgery results (r = 0.23, p = 0.079) was observed. Conclusions: Our results suggest that RFT measured by MUS is useful for evaluating SO and for the follow-up of these patients after BS. Moreover, RFT can provide relevant information about regional sarcopenia and probably has an accurate correlation with QoL in comparison with the other methods.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Montse Ibarra
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Mireia Libran
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Lilian Escobar
- Department of General Surgery, Hospital Universitari MútuaTerrassa, 08221 Terrassa, Spain;
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Carlos Puig-Jové
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
| | - Maria-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari MútuaTerrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (V.P.); (C.Q.); (C.P.-J.)
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Welch C, Bravo L, Gkoutos G, Greig C, Lewis D, Lord J, Majid Z, Masud T, McGee K, Moorey H, Pinkney T, Stanley B, Jackson T. Establishing Predictors of Acute Sarcopenia: A Proof-Of-Concept Study Utilising Network Analysis. Aging Dis 2024:AD.2024.0167. [PMID: 39012665 DOI: 10.14336/ad.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/11/2024] [Indexed: 07/17/2024] Open
Abstract
Dynamic changes in sarcopenia status following stressor events are defined as acute sarcopenia; it is currently unknown how to stratify risk. Prospective observational study involving elective colorectal surgery, emergency abdominal surgery, and medical patients with infections aged ≥70 years-old. Handgrip strength, muscle quantity (ultrasound Bilateral Anterior Thigh Thickness, BATT, and Bioelectrical Impedance Analysis), and muscle quality (rectus femoris echogenicity) were measured preoperatively in the elective group, and within 48hours, 7days after, and 13weeks after admission/surgery. Serum/plasma samples were collected preoperatively (elective group) and within 48hours of admission/surgery (all groups). LASSO models adjusting for baseline sarcopenia status were performed. Seventy-nine participants were included (mean age 79.1, 39.2% female). Chronic Obstructive Pulmonary Disease (COPD) (48hours β 0.67, CI 0.59-0.75), and prescription of steroids during admission (48hours β 1.11, CI 0.98-1.24) were positively associated with sarcopenia at 7days. Delirium was negatively associated with change in BATT to 7days (7days β -0.47, CI -0.5- -0.44). COPD (Preoperative β 0.35, CI 0.12-0.58) and delirium (48hours β 0.13, CI 0.06-0.2) were positively associated with change in echogenicity to 7days in analysis including systemic biomarkers. Participants with sarcopenia at baseline had higher IL-7 concentrations during acute phase of illness (median 8.78pg/mL vs 6.52pg/mL; p=0.014). IL-1b within 48hours of admission/surgery was positively associated with sarcopenia status at 7days (β 0.24, CI 0.06-0.42). Patients most at risk of acute sarcopenia or reductions in muscle quantity and quality included those prescribed steroids, with COPD or delirium, or with heightened systemic inflammation.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- Department of Twin Research &;amp Genetic Epidemiology, King's College London, St Thomas' Campus, London, SE1 7EH, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, SE1 7EH, UK
| | - Laura Bravo
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Georgios Gkoutos
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Carolyn Greig
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Danielle Lewis
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Janet Lord
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Tahir Masud
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kirsty McGee
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Hannah Moorey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Thomas Pinkney
- Institute of Applied Health Research, College of Medical and Dental Sciences, Birmingham Clinical Trials Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Benjamin Stanley
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Jackson
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
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Staempfli JS, Kistler-Fischbacher M, Gewiess J, Bastian JD, Eggimann AK. The Validity of Muscle Ultrasound in the Diagnostic Workup of Sarcopenia Among Older Adults: A Scoping Review. Clin Interv Aging 2024; 19:993-1003. [PMID: 38831963 PMCID: PMC11146336 DOI: 10.2147/cia.s463917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Muscle ultrasound has emerged as a promising method in the diagnostic work-up of sarcopenia. The objective of this scoping review was to explore the validity of muscle ultrasound against the latest sarcopenia definitions among older adults. Methods We adhered to the PRISMA guidelines for scoping reviews. A systematic search of databases was performed by two independent reviewers. All articles comparing the performance of ultrasound to an internationally acknowledged sarcopenia definition among older adults (≥60 years) and published between 2019/01/01 (the year updated sarcopenia definitions were introduced) and 2023/11/15 were included. Data were extracted and collated by muscle and muscle parameters. Results Out of 2290 articles screened, six studies comprising 24 validity tests among a total of 1619 older adults (mean age 74.1 years, 52.2% female) were included. The validity tests investigated the rectus femoris (n = 7), biceps brachii (n = 5), gastrocnemius medialis (n = 4), tibialis anterior (n = 4), soleus (n = 3), and rectus abdominis (n = 1). The parameter muscle thickness (MT) (n = 14) was most commonly measured. The latest European and Asian sarcopenia definitions (EWGSOP2, AWGS2) were applied as reference standards in four validity tests each. None of the studies used the Sarcopenia Definition and Outcome Consortium (SDOC) criteria. The highest area under the curve AUC (0.92, 95% confidence interval [CI] 0.89-0.94) was found for the muscle thickness of the rectus femoris muscle. Due to substantial heterogeneity among the studies, pooling of data using a meta-analytic approach was not feasible. Conclusion Limited number of studies have examined the validity of muscle ultrasound for diagnosing sarcopenia based on recent definitions among older adults. Thereby, muscle thickness of the rectus femoris showed promising results regarding validity. Further studies are needed to investigate the validity of key muscles and to validate muscle ultrasound among older hospitalized patients.
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Affiliation(s)
| | - Melanie Kistler-Fischbacher
- Centre on Aging and Mobility, Department of Geriatrics and Aging Research, University of Zurich, Zurich, Switzerland
| | - Jan Gewiess
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Johannes Dominik Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Anna K Eggimann
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, 3010, Switzerland
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Oranchuk DJ, Bodkin SG, Boncella KL, Harris-Love MO. Exploring the associations between skeletal muscle echogenicity and physical function in aging adults: A systematic review with meta-analyses. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:S2095-2546(24)00076-0. [PMID: 38754733 DOI: 10.1016/j.jshs.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/18/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Assessment and quantification of skeletal muscle within the aging population is vital for diagnosis, treatment, and injury/disease prevention. The clinical availability of assessing muscle quality through diagnostic ultrasound presents an opportunity to be utilized as a screening tool for function-limiting diseases. However, relationships between muscle echogenicity and clinical functional assessments require authoritative analysis. Thus, we aimed to (a) synthesize the literature to assess the relationships between skeletal muscle echogenicity and physical function in older adults (≥60 years), (b) perform pooled analyses of relationships between skeletal muscle echogenicity and physical function, and (c) perform sub-analyses to determine between-muscle relationships. METHODS CINAHL, Embase, MEDLINE, PubMed, and Web of Science databases were systematically searched to identify articles relating skeletal muscle echogenicity to physical function in older adults. Risk-of-bias assessments were conducted along with funnel plot examination. Meta-analyses with and without sub-analyses for individual muscles were performed utilizing Fisher's Z transformation for the most common measures of physical function. Fisher's Z was back-transformed to Pearson's r for interpretation. RESULTS Fifty-one articles (n = 5095, female = ∼2759, male = ∼2301, 72.5 ± 5.8 years, mean ± SD (1 study did not provide sex descriptors)) were extracted for review, with previously unpublished data obtained from the authors of 13 studies. The rectus femoris (n = 34) and isometric knee extension strength (n = 22) were the most accessed muscle and physical qualities, respectively. The relationship between quadriceps echogenicity and knee extensor strength was moderate (n = 2924, r = -0.36 (95% confidence interval: -0.38 to -0.32), p < 0.001), with all other meta-analyses (grip strength, walking speed, sit-to-stand, timed up-and-go) resulting in slightly weaker correlations (r: -0.34 to -0.23, all p < 0.001). Sub-analyses determined minimal differences in predictive ability between muscle groups, although combining muscles (e.g., rectus femoris + vastus lateralis) often resulted in stronger correlations with maximal strength. CONCLUSION While correlations were modest, the affordable, portable, and noninvasive ultrasonic assessment of muscle quality was a consistent predictor of physical function in older adults. Minimal between-muscle differences suggest that echogenicity estimates of muscle quality are systemic. Therefore, practitioners may be able to scan a single muscle to estimate full-body skeletal muscle quality/composition, while researchers should consider combining multiple muscles to strengthen the model.
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Affiliation(s)
- Dustin J Oranchuk
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Stephan G Bodkin
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Katie L Boncella
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael O Harris-Love
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Abdulsalam AJ, Kara M, Özçakar L. The ISarcoPRM Algorithm: A Thoroughfare for the 'Geriatric Pandemic'. Calcif Tissue Int 2024; 114:450. [PMID: 38141135 DOI: 10.1007/s00223-023-01174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Ahmad J Abdulsalam
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
- Department of Physical Medicine and Rehabilitation, Mubarak Alkabeer Hospital, Jabriya, Kuwait.
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Minata S, Kudou G, Imaoka S. The Impact of Diabetes Complications on the Physical Function of Maintenance Hemodialysis Patients. Cureus 2024; 16:e57867. [PMID: 38725793 PMCID: PMC11078590 DOI: 10.7759/cureus.57867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
This study investigated the impact of diabetes on the physical function of patients undergoing dialysis. This study included 22 patients undergoing outpatient dialysis with continued exercise therapy during dialysis at our hospital between January 2021 and August 2021. The participants were divided into two groups based on the presence or absence of diabetes, and various parameters were compared between the groups. To compare each physical function assessment and measurement of anterior thigh muscle thickness, repeated-measures analysis of variance was conducted to test for the presence of interactions and main effects. Significant differences were observed in the absence of dyslipidemia (p < 0.01), high-density lipoprotein cholesterol level (p < 0.01), and foot sole skin perfusion pressure (p < 0.02). In terms of physical function, a main effect between the groups was observed in the five-time sit-to-stand test, and anterior thigh muscle thickness showed a main effect over time. Significant differences in the anterior thigh muscle thickness were observed between three and six months after the intervention (p < 0.05). In patients undergoing dialysis with diabetes complications, a decrease in physical activity and lack of exercise can lead to a reduction in overall physical activity levels. Additionally, impairments such as peripheral neuropathy may contribute to an accelerated decrease in skeletal muscle mass.
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Affiliation(s)
- Shohei Minata
- Department of Rehabilitation, Oita Oka Hospital, Oita, JPN
| | - Genki Kudou
- Department of Rehabilitation, Oita Oka Hospital, Oita, JPN
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Kamwa V, Jackson T, Hassan-Smith Z, Sapey E. Exploring fraity and sarcopenia in older adults admitted to acute medical unit, looking at prevalence, trajectory, and outcomes: A protocol testing the feasibility and acceptability of the TYSON study. PLoS One 2023; 18:e0293650. [PMID: 37922241 PMCID: PMC10624263 DOI: 10.1371/journal.pone.0293650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Frailty and sarcopenia are common in older people and are associated with adverse outcomes including increased mortality and morbidity. It is unclear whether screening for frailty and sarcopenia would identify specific populations most at risk of poor outcomes during unplanned hospital admissions, which screening tools should be used and what the trajectory of both conditions are over the course of an admission. The TYSON study is an observational cohort study aiming to determine the prevalence, trajectory and outcomes associated with frailty and sarcopenia in different patient cohorts. This protocol tests the feasibility and acceptability of TYSON processes. OBJECTIVES To determine in acutely admitted medical patients who are older adults: Primary: The feasibility and acceptability of frailty and sarcopenia assessments; Secondary: (1) Differences in community and hospital frailty assessments, as assessed by the medical team, the patient and elderly care physicians, (2) The dynamic changes in frailty and sarcopenia during a hospital admission, and patient outcomes; Exploratory: Inflammatory and metabolic mediators associated with frailty and sarcopenia. METHODS A single centre, prospective observational study including patients aged ≥ 65 years admitted to an acute medical unit. Frailty assessments include the Rockwood clinical frailty and e-frailty index. Sarcopenia assessments include the Bilateral Anterior Thigh Thickness (BATT) measurement. Each participant will be asked to complete 5 visits, at day 0, day 3, day 7, month 3 and month 6. Blood samples will be collected to explore inflammatory and metabolic markers associated with frailty and sarcopenia. The study and protocol have been ethically approved by the Health Research Authority (REC 20/WA/0263). DISCUSSION The study will determine the feasibility and acceptability of frailty and sarcopenia assessments in an acute hospital setting, and inform on the prevalence, trajectory and associated outcomes of frailty and sarcopenia in this group of patients. An inflammatory and metabolic profile will be explored in frailty and sarcopenia.
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Affiliation(s)
- Vicky Kamwa
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Thomas Jackson
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Department of Geriatrics, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
| | - Zaki Hassan-Smith
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Institute of Metabolism and Systems Research, The University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Elizabeth Sapey
- Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, The University of Birmingham, Birmingham, West Midlands, United Kingdom
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Kitagawa T, Nakamura M, Fukumoto Y. Usefulness of muscle echo intensity for evaluating functional performance in the older population: A scoping review. Exp Gerontol 2023; 182:112301. [PMID: 37776985 DOI: 10.1016/j.exger.2023.112301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/16/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
Muscle echo intensity, as measured by ultrasonography, could be used as a new marker of functional performance in older populations. This scoping review aimed to present evidence on the utility of muscle echo intensity as determined by ultrasonography for assessing functional performance in older adults. The eligibility criterion included observational studies that investigated the associations between muscle echo intensity and functional performance in older adults. Terms, such as "echo intensity" and "older adults", were searched for in databases, such as PubMed, Web of Science, the Cochrane database of systematic reviews, and the Cumulative Index of Nursing and Allied Health Literature, in April 2021. Two independent reviewers screened and extracted the data; 46 papers, of which almost one-third were Japanese, were subsequently identified for inclusion. The representative functional performances included in this review were muscle strength, gait speed, sit-to-stand test results, and timed up-and-go test results. Poor to moderate associations were found between muscle echo intensity and functional performance; however, heterogeneities were observed in the characteristics of study participants. Moreover, the accurate effect size and causal inferences between muscle echo intensity and functional performance remained unclear. Further longitudinal studies are needed to determine these causal inferences.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki 842-8585, Japan.
| | - Yoshihiro Fukumoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Japan.
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Chen M, Liu X, Liu Q, Ding C, Zhao P, Zhang Y, Mao C, Liu C. The value of ultrasound measurement of muscle thickness at different sites and shear wave elastography in Parkinson's disease with sarcopenia: a pilot study. Front Neurosci 2023; 17:1254859. [PMID: 37904815 PMCID: PMC10613525 DOI: 10.3389/fnins.2023.1254859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Background Patients with Parkinson's disease (PD) and sarcopenia often exhibit resilience, frailty, disability, and depression, highlighting the complex and interrelated nature of these conditions. Objective Despite the presence of clinical manifestations of muscle atrophy in both PD and sarcopenia, accurately discerning the coexistence of sarcopenia in PD patients remains a challenging task with significant implications for treatment strategies and prognostic assessments. This study aims to elucidate the specific ultrasonic diagnostic parameters associated with PD accompanied by sarcopenia through a comparative analysis of muscle ultrasound parameters in patients with PD, thereby presenting a novel approach for rapid identification of this condition. Methods A total of 110 participants were enrolled in this study, including patients with PD and control subjects. Demographic data, clinical characteristics, physical performance tests, appendicular skeletal muscle mass index (ASMI), bioelectrical impedance analysis and muscle ultrasound measurements were collected from all participants. The muscle ultrasound measurements encompassed assessments of muscle thickness, pennation angle and shear wave elastography at various anatomical sites. Results Parkinson's disease patients exhibited decreased muscle strength and physical performance, and increased shear wave elastography value. In PD patients with sarcopenia, body circumference, including calf circumference, mid-arm circumference, Waist-to-Hip Ratio and body mass index (BMI) were all significantly decreased. Biceps brachii muscle thickness (MT) and gastrocnemius MT decreased in PD patients with sarcopenia and low ASMI. Binary logistic regression analysis revealed that male PD patients, BMI and gastrocnemius MT were predictive factors for ASMI in PD patients. Conclusion Biceps brachii MT and gastrocnemius MT are important indicators for distinguishing whether PD patients have sarcopenia. Male patients, low BMI and gastrocnemius MT were identified as valid predictors of low ASMI in PD patients. The findings of this study provide important insights into the use of muscle ultrasound in the diagnosis of PD with sarcopenia.
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Affiliation(s)
- Minglei Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofang Liu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiuwan Liu
- Department of Neurology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Changwei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ping Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chengjie Mao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunfeng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
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Fukumoto Y, Taniguchi M, Hirono T, Yagi M, Yamagata M, Nakai R, Yamada Y, Kimura M, Ichihashi N. Association of Regional Muscle Thickness and Echo Intensity with Muscle Volume, Intramuscular Adipose Tissue, and Strength of the Quadriceps Femoris. Clin Interv Aging 2023; 18:1513-1521. [PMID: 37724172 PMCID: PMC10505373 DOI: 10.2147/cia.s424504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
Purpose This study aimed to investigate the association of muscle thickness (MT) and echo intensity (EI) obtained at different regions along the muscle length with muscle volume (MV), intramuscular adipose tissue (IntraMAT), and muscle strength of the quadriceps femoris (QF). Patients and Methods A total of 135 community-dwelling adults (64 men and 71 women) participated in the study. Ultrasound scanning of the rectus femoris (RF) and vastus intermedius (VI) was performed at three locations (from mid- to distal thigh). The MT of the RF and VI and EI of the RF were measured. MRI-derived MV, IntraMAT, and muscle strength of the QF were measured. Results The correlation between RF-MT and RF-MV weakened as scanning approached the distal thigh, and the difference between the coefficients for the scanning locations was significant for women. However, the correlation of VI-MT with VI-MV and that of the combined MT of RF and VI with the MV of the whole QF and muscle strength were comparable among the scanning locations for both sexes. The correlation of RF-EI with the IntraMAT of the RF and the whole QF and muscle strength was also comparable among the scanning locations for both sexes. Conclusion The results of this study suggest that ultrasound measurements at the distal thigh can predict MV, IntraMAT, and muscle strength of the QF to the same degree as those at the mid-thigh.
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Affiliation(s)
- Yoshihiro Fukumoto
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Yamagata
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryusuke Nakai
- Kyoto University Institute for the Future of Human Society, Kyoto, Japan
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health, and Nutrition, Tokyo, Japan
| | - Misaka Kimura
- Institute for Active Health, Kyoto University of Advanced Science, Kameoka, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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11
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Stanley B, Greig C, Jackson T, Lewis D, Moorey H, Majid Z, Masud T, Pinkney T, Welch C. Investigating the impact of fluid status on the ultrasound assessment of muscle quantity and quality in the diagnosis of sarcopenia - a multidimensional cross-sectional study. BMC Geriatr 2023; 23:493. [PMID: 37582710 PMCID: PMC10428636 DOI: 10.1186/s12877-023-04177-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/16/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Sarcopenia is a clinical manifestation of adverse ageing, characterised by progressive loss of muscle mass and function. Diagnosis requires assessment of muscle quantity and quality; ultrasound represents an emerging tool for this. However, ultrasound muscle assessment may be impacted by fluid balance. This is particularly important when assessing for acute sarcopenia in hospitalised patients, where fluid disturbance often occurs. The primary aim of this study was to characterise the impact of fluid status on ultrasound muscle assessment, such that this may be accounted for in sarcopenia diagnostics. METHODS This Multidimensional Cross-sectional study involved 80 participants, who were inpatients at QEHB, a large UK tertiary centre. Fluid status was evaluated clinically and quantified using Bioelectrical Impedance Analysis (BIA). Muscle quantity was measured using Bilateral Anterior Thigh Thickness (BATT) with Rectus Femoris (RF) echogenicity used to assesses muscle adiposity and hence provide an inverse measure of muscle quality. RESULTS A significant positive correlation was found between fluid status, measured using BIA, and BATT as a measure of muscle quantity, in males (rs = 0.662, p < 0.001) and females (rs = 0.638, p < 0.001). A significant negative correlation was found between fluid status and RF echogenicity (rs=-0.448, p < 0.001). CONCLUSIONS These findings demonstrate associations between fluid balance and ultrasound assessment of muscle quantity and quality. Given the emerging use of ultrasound muscle assessment in sarcopenia diagnosis, there is a need to account for this in clinical practice. Future research should focus on the development of a corrective equation allowing assessment of muscle quantity and quality which account for changes in fluid status, hence aiding accurate diagnosis of sarcopenia.
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Affiliation(s)
- Benjamin Stanley
- Northern Care Alliance NHS Foundation Trust, Salford Royal, Stott Lane, Salford, M6 8HD, UK.
| | - Carolyn Greig
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Thomas Jackson
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Healthcare for Older People, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Danielle Lewis
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Hannah Moorey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Zainab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Tahir Masud
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
- School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Thomas Pinkney
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Carly Welch
- Medical Research Council - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Healthcare for Older People, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Shpoliansky M, Chavhan GB, Zhou A, Ng VL, Kamath BM. A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease. Hepatol Commun 2023; 7:e0211. [PMID: 37506186 PMCID: PMC10389755 DOI: 10.1097/hc9.0000000000000211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia. METHODS A prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data. RESULTS Thirty children were studied between September 2021 and December 2022, 15 listed patients aged 4-30 months, and 15 controls aged 4-32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9-32.8 mm) versus 32.7 mm (interquartile range: 31.8-36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics. CONCLUSIONS This study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children.
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Affiliation(s)
- Michael Shpoliansky
- Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Govind B Chavhan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alex Zhou
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Binita M Kamath
- Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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13
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Welch C, Greig C, Lewis D, Majid Z, Masud T, Moorey H, Pinkney T, Stanley B, Jackson T. Baseline Nutritional Status and In-Hospital Step Count are Associated with Muscle Quantity, Quality, and Function: Results of an Exploratory Study. J Nutr Gerontol Geriatr 2023; 42:110-126. [PMID: 37787986 DOI: 10.1080/21551197.2023.2259335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
This exploratory study aimed to assess associations of baseline nutritional status and in-hospital step count with muscle quantity, quality, and function. Seventy-nine participants aged ≥70 years (mean age 79.1 years, 44.3% female) were recruited (elective colorectal surgery, emergency abdominal surgery, and general medical patients with infections). Baseline nutrition (Mini Nutritional Assessment) and in-hospital step count (Fitbit Inspire devices) were assessed. Ultrasound quadriceps, bioelectrical impedance analysis, and physical function were assessed at baseline and 7 (±2) days and 13 (±1) weeks post-admission/post-operatively. Baseline nutritional status was associated with baseline rectus femoris ultrasound echogenicity (normal: 58.5, at risk: 68.5, malnourished: 81.2; p = 0.025), bilateral anterior thigh thickness (normal: 5.07 cm, at risk: 4.03 cm, malnourished: 3.05 cm; p = 0.021), and skeletal muscle mass (Sergi equation) (normal: 21.6 kg, at risk: 18.2 kg, malnourished: 12.0 kg; p = 0.007). Step count was associated with baseline patient-reported physical function (<900 37.1, ≥900 44.5; p = 0.010). There was a significant interaction between nutrition, step count, and time for skeletal muscle mass (Janssen equation) (p = 0.022).
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Twins Research, King's College London, London, UK
| | - Carolyn Greig
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Danielle Lewis
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tahir Masud
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Hannah Moorey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Surgery, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Stanley
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Jackson
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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14
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Simó-Servat A, Guevara E, Perea V, Alonso N, Quirós C, Puig-Jové C, Barahona MJ. Role of Muscle Ultrasound for the Study of Frailty in Elderly Patients with Diabetes: A Pilot Study. BIOLOGY 2023; 12:884. [PMID: 37372168 DOI: 10.3390/biology12060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Sarcopenia and diabetes contribute to the development of frailty. Therefore, accessible methods, such as muscle ultrasounds (MUSs), to screen for sarcopenia should be implemented in clinical practice. METHODS We conducted a cross-sectional pilot study including 47 patients with diabetes (mean age: 77.72 ± 5.08 years, mean weight: 75.8 kg ± 15.89 kg, and body mass index: 31.19 ± 6.65 kg/m2) categorized as frail by the FRAIL Scale or Clinical Frailty Scale and confirmed by Fried's Frailty Phenotype or Rockwood's 36-item Frailty Index. We used the SARC-F questionnaire to identify sarcopenia. The Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) tests were used to assess physical performance and the risk of falls, respectively. In addition, other variables were measured: fat-free mass (FFM) and Sarcopenia Risk Index (SRI) with the bioimpedance analysis (BIA); thigh muscle thickness (TMT) of the quadriceps with MUS; and hand-grip strength with dynamometry. RESULTS We observed correlations between the SARC-F and FFM (R = -0.4; p < 0.002) and hand-grip strength (R = -0.5; p < 0.0002), as well as between the TMT and FFM of the right leg (R = 0.4; p < 0.02) and the SRI (R = 0.6; p < 0.0001). We could predict sarcopenia using a logistic regression model with a ROC curve (AUC = 0.78) including FFM, handgrip strength, and TMT. The optimal cut-off point for maximum efficiency was 1.58 cm for TMT (sensitivity = 71.4% and specificity = 51.5%). However, we did not observe differences in the TMT among groups of greater/less frailty based on the SARC-F, SPPB, and TUG (p > 0.05). CONCLUSIONS MUSs, which correlated with the BIA (R = 0.4; p < 0.02), complemented the diagnosis, identifying regional sarcopenia of the quadriceps in frail patients with diabetes and improving the ROC curve to AUC = 0.78. In addition, a TMT cut-off point for the diagnosis of sarcopenia of 1.58 cm was obtained. Larger studies to validate the MUS technique as a screening strategy are warranted.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ernesto Guevara
- Department of Geriatrics, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - María-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
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15
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Gender Disparity in Expression of Sarcopenia in Haemodialysis Recipients: Analysis from the FITNESS Cohort. Int J Nephrol 2023; 2023:5885059. [PMID: 37363696 PMCID: PMC10290558 DOI: 10.1155/2023/5885059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background There has been little exploration of the interplay between sarcopenia and frailty in haemodialysis, particularly regarding gender difference. We aimed to (1) assess whether ultrasound-derived low muscle mass (LMM) and sarcopenia are more common in male or female haemodialysis recipients; (2) assess whether age influences any observed gender difference, and (3) explore the interplay between sarcopenia, frailty, and gender in haemodialysis recipients. Methods This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis with frailty phenotype (FP) scores. Bilateral anterior thigh thickness (BATT) was obtained according to an established ultrasound protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, LMM, and sarcopenia with a priori covariables, stratified by gender. Results In total of 223 studies, participants had ultrasound measurements. Males showed greater prevalence of LMM. On adjusted analyses, LMM was associated with lower hand grip strength in males (β = -4.17; 95% C.I. -7.57 to -0.77; P=0.02), but not females (β = -1.88; 95% C.I. -5.41 to 1.64; P=0.29). LMM was also associated with slower walking speed in both males (β = -0.115; 95% C.I. -0.258 to -0.013; P=0.03) and females (β = -0.152; 95% C.I. -0.300 to -0.005; P=0.04). Sarcopenia was associated with greater odds of frailty on adjusted models in males (OR = 9.86; 95% C.I. 1.8 to 54.0; P=0.01), but not females (OR = 5.16; 95% C.I. 0.22 to 124; P=0.31). Conclusions The clinical expression and significance of sarcopenia differ substantially between males and females on haemodialysis. Further work is required to elucidate underlying mechanisms and guide tailored treatment.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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López Jiménez E, Neira Álvarez M, Ramírez Martín R, Alonso Bouzón C, Amor Andrés MS, Bermejo Boixareu C, Brañas F, Menéndez Colino R, Arias Muñana E, Checa López M, Grau Jiménez C, Pérez Rodríguez P, Alcantud Ibáñez M, Vasquez Brolen B, Oliva J, Peña Longobardo LM, Alcantud Córcoles R, Cortés Zamora EB, Gómez Jiménez E, Romero Rizos L, Avendaño Céspedes A, Hernández Socorro CR, Abizanda P. "SARCOPENIA MEASURED BY ULTRASOUND IN HOSPITALIZED OLDER ADULTS" (ECOSARC): multi-centre, prospective observational study protocol. BMC Geriatr 2023; 23:163. [PMID: 36949412 PMCID: PMC10035149 DOI: 10.1186/s12877-023-03891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Measurement of muscle mass and function, and thereafter, screening and diagnosis of sarcopenia, is a challenge and a need in hospitalized older adults. However, it is difficult in complex real-world old patients, because usually they are unable to collaborate with clinical, functional, and imaging testing. Ultrasound measurement of quadriceps rectus femoris (QRF) provides a non-invasive, real-time assessment of muscle quantity and quality, and is highly acceptable to participants with excellent inter-rater and intra-rater variability. However, normative data, protocol standardization, and association with longitudinal outcomes, needs further research and consensus. METHODS Prospective exploratory multicenter study in older adults admitted to Acute Geriatric Units (AGUs) for medical reasons. 157 subjects from 7 AGUs of Spain were recruited between May 2019 and January 2022. Muscle ultrasound measurements of the anterior vastus of the QRF were acquired on admission and on discharge, using a previously validated protocol, using a Chieson model ECO2 ultrasound system (Chieson Medical Technologies, Co. Ltd, Wimxu District Wuxi, Jiangsu, China). Measurements included the cross-sectional area, muscle thickness in longitudinal view, intramuscular central tendon thickness, echogenicity, and the presence or absence of edema and fasciculations. Functional, nutritional, and DXA measurements were provided. Clinical follow-up was completed at discharge, and 30 and 90 days after discharge. Variations between hospital admission and discharge ultrasound values, and the relationship with clinical variables, will be analyzed using paired t-tests, Wilcoxon tests, or Mc Nemar chi-square tests when necessary. Prevalence of sarcopenia will be calculated, as well as sensitivity and specificity of ultrasound measurements to determine sarcopenia. Kappa analysis will be used to analyze the concordance between measurements, and sensitivity analysis will be conducted for each participating center. DISCUSSION The results obtained will be of great interest to the scientific geriatric community to assess the utility and validity of ultrasound measurements for the detection and follow-up of sarcopenia in hospitalized older adults, and its association with adverse outcomes. TRIAL REGISTRATION NCT05113758. Registration date: November 9th 2021. Retrospectively registered.
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Affiliation(s)
- Esther López Jiménez
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain
| | - Marta Neira Álvarez
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | | | | | | | - Fátima Brañas
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | | | | | | | | | - Juan Oliva
- Department of Economic Analysis and Finance, Universidad de Castilla-La Mancha, Toledo, Spain
| | | | | | - Elisa Belén Cortés Zamora
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Gómez Jiménez
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain
- Fundación Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Luis Romero Rizos
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Almudena Avendaño Céspedes
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | - Pedro Abizanda
- Complejo Hospitalario Universitario de Albacete, C/ Seminario 4, 02006, Albacete, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain.
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17
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Usefulness of Ultrasound in Assessing the Impact of Bariatric Surgery on Body Composition: a Pilot Study. Obes Surg 2023; 33:1211-1217. [PMID: 36849786 PMCID: PMC10079718 DOI: 10.1007/s11695-023-06510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Bariatric surgery (BS) has a significant impact on body composition. The purpose of the study is to evaluate the usefulness of musculoskeletal ultrasound (MUS) to bioelectrical impedance (BIA) in the follow-up of patients undergoing BS in terms of body composition and quality of life (QoL). METHODS This is a prospective pilot study including 32 subjects (75% female, mean age: 49.15 ± 1.9 years) who underwent BS. Fat mass (FM), lean mass (LM), and skeletal muscle index (SMI) were calculated by BIA. MUS measured subcutaneous fat (SF) and thigh muscle thickness (TMT) of the quadriceps. QoL was assessed by the Moorehead-Ardelt questionnaire. All these measurements were performed 1 month prior to BS and at 12-month follow-up. RESULTS The mean BMI decreased by 6.63 ± 1.25 kg/m2 (p=0.001). We observed significant reductions in FM (p=0.001) and SF (p=0.007) and in LM (p=0.001) but not in SMI and TMT. We found a correlation between the FM and SF (pre-surgical, r=0.42, p=0.01; post-surgical, r=0.52, p=0.003) and between SMI and TMT (pre-surgical, r=0.35, p=0.04; post-surgical, r=0.38, p=0.03). QoL test showed significant improvement (p=0.001). In addition, a correlation between the QoL questionnaire and TMT post-surgery (r=0.91, p=0.019) was observed. However, we did not find any statistically significant correlation between QoL assessment and SMI or LM. CONCLUSIONS Our results suggest that MUS can be complementary to BIA for the evaluation and the follow-up of body composition after BS. TMT of quadriceps can provide relevant information about regional sarcopenia and has a significant correlation with QoL.
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Ultrasound quadriceps muscle thickness is variably associated with frailty in haemodialysis recipients. BMC Nephrol 2023; 24:16. [PMID: 36653750 PMCID: PMC9847024 DOI: 10.1186/s12882-022-03043-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Ultrasonographic quantitation of quadriceps muscle mass is increasingly used for assessment of sarcopenia, but its relationship with frailty in haemodialysis recipients is not known. This study explores the relationship between ultrasound-derived bilateral anterior thigh thickness (BATT), sarcopenia, and frailty by common frailty tools (Frailty Phenotype [FP], Frailty Index [FI], Edmonton Frailty [EFS], and Clinical Frailty Scale [CFS]). METHODS This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis recipients deeply phenotyped for frailty. Ultrasound assessment of BATT was obtained with participants at an angle of ≤45°, with legs outstretched and knees resting at 10°-20°, according to an established protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, Low Muscle Mass (LMM), and sarcopenia with stepwise adjustment for a priori covariables. RESULTS In total 223 study participants had ultrasound measurements. Frailty ranged from 34% for FP to 58% for FI. BATT was associated with increasing frailty on simple linear regression by all frailty tools, but lost significance on addition of covariables. Upon dichotomising frailty tools into Frail/Not Frail, BATT was associated with frailty by all tools on univariable analyses, but only retained association for EFS on the fully adjusted model (OR 0.97, 95% C.I. 0.94-1.00, P = 0.05). CONCLUSIONS Ultrasound measures of quadriceps thickness is variably associated with frailty in prevalent haemodialysis recipients, dependent upon the frailty tool used, but not independent of other variables. Further work is required to establish the added value of sarcopenia measurement in frail haemodialysis patients. TRIAL REGISTRATION Clinicaltrials.gov : NCT03071107 registered 06/03/2017.
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Affiliation(s)
- Benjamin M. Anderson
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- grid.414618.e0000 0004 6005 2224Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK ,PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Fuentes-Abolafio IJ, Ricci M, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI, Pérez-Belmonte LM. Biomarkers and the quadriceps femoris muscle architecture assessed by ultrasound in older adults with heart failure with preserved ejection fraction: a cross-sectional study. Aging Clin Exp Res 2022; 34:2493-2504. [PMID: 35939260 PMCID: PMC9637604 DOI: 10.1007/s40520-022-02189-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sarcopenia is an important comorbidity in patients with heart failure with preserved ejection fraction (HFpEF). The ultrasound (US) assessment has all the advantages of being used in primary care to assess muscle quantity and quality. Some biomarkers could be indicative of muscle mass loss. AIMS To describe the quantitative and qualitative characteristics of the quadriceps femoris assessed by US in older adults with HFpEF and to assess the relationship of the blood and urinary biomarkers, the polypharmacy and comorbidities with US outcomes in older adults with HFpEF. METHODS A cross-sectional study was conducted. 76 older adults with HFpEF were included. The quadriceps femoris muscle thickness (MT, cm), the subcutaneous fat tissue thickness (FT, cm), the muscle echo intensity (MEI) and the subcutaneous fat tissue echo intensity (FEI) were assessed by US in a non-contraction (non-con) and contraction (con) situations. Polypharmacy, comorbidities, blood and urine biomarkers were also collected. RESULTS The carbohydrate antigen 125 (CA-125), the folic acid and the urine creatinine shared the 86.6% variance in the non-con MT, adjusted by age, sex and body mass index (BMI). The folic acid shared the 38.5% of the variance in the con MT, adjusted by age, sex and BMI. The glycosylated haemoglobin explained the 39.6% variance in the non-con MEI, adjusted by age, sex and BMI. The chlorine (Cl-) explained the 40.2% of the variance in the non-con FT, adjusted by age, sex and BMI. The polypharmacy and the folic acid explained the 37.9% of variance in the non-con FEI, while the polypharmacy and the thyrotropin (TSH) shared the 44.4% of variance in the con FEI, both adjusted by age, sex and BMI. No comorbidities, polypharmacy, or blood and urinary biomarkers could explain the con MEI and the con FT variance. CONCLUSIONS Blood and urinary biomarkers obtained in routine analyses could help clinicians detect US outcome changes in older adults with HFpEF and identify a worsening of sarcopenia. TRIAL REGISTRATION NCT03909919. April 10, 2019. Retrospectively registered.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Universidad de Málaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA, Plataforma Bionand, Málaga, Spain
| | - Michele Ricci
- Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María Rosa Bernal-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA, Plataforma Bionand, Málaga, Spain
- Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER Fisio-Patología de La Obesidad Y La Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA, Plataforma Bionand, Málaga, Spain
- Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
- CIBER Fisio-Patología de La Obesidad Y La Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Universidad de Málaga, C/Arquitecto Peñalosa, 3, 29071, Málaga, Spain.
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA, Plataforma Bionand, Málaga, Spain.
- School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, QLD, Australia.
| | - Luis Miguel Pérez-Belmonte
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA, Plataforma Bionand, Málaga, Spain
- Departamento de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
- Unidad de Neurofisiología Cognitiva, Centro de Investigaciones Médico Sanitarias (CIMES), Universidad de Málaga (UMA), Campus de Excelencia Internacional (CEI) Andalucía Tech, Málaga, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Simó-Servat A, Ibarra M, Libran M, Rodríguez S, Perea V, Quirós C, Orois A, Pérez N, Simó R, Barahona MJ. Usefulness of Muscle Ultrasound to Study Sarcopenic Obesity: A Pilot Case-Control Study. J Clin Med 2022; 11:jcm11102886. [PMID: 35629009 PMCID: PMC9143348 DOI: 10.3390/jcm11102886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background and objectives: Sarcopenic obesity (SO) is an emerging problem, especially in candidates for bariatric surgery (BS). We hypothesized that musculoskeletal ultrasound (MUS), a simple and accessible method, could be a reliable index of SO. Materials and Methods: A cross-sectional pilot study including 122 subjects (90 cases and 32 controls, 73% female, mean age: 51.2 years) who underwent BS was conducted at University Hospital Mútua Terrassa. The lean mass (LM) was calculated by bioelectrical impedance analysis (BIA) and the thigh muscle thickness (TMT) by MUS. To identify the subjects with SO by BIA, we used skeletal muscle index (SMI). The validity of MUS was determined using the ROC curve. Results: The mean BMI in the obesity group was 44.22 kg/m2. We observed a correlation between the LM and SMI assessed by BIA and the TMT assessed by MUS (R = 0.46, p < 0.001). This correlation was maintained at significant levels in the SO group (n = 40): R = 0.79; p = 0.003). The TMT assessed by MUS was able to predict SMI using BIA (AUC 0.77; 95% CI: 0.68242 to 0.84281). The optimal cut-off point for maximum efficiency was 1.57 cm in TMT (sensitivity = 75.6% and specificity = 71.1%). Conclusions: The TMT of the quadriceps assessed by US is a useful tool for identifying subjects with SO. Larger studies to validate this simple low-cost screening strategy are warranted.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
- Department of Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Spain
- Correspondence: (A.S.-S.); (M.-J.B.)
| | - Montse Ibarra
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Mireia Libran
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Silvia Rodríguez
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Noelia Pérez
- Department of General Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain;
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute and CIBERDEM (ISCIII), Autonomous University of Barcelona, 08193 Bellaterra, Spain;
| | - Maria-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
- Correspondence: (A.S.-S.); (M.-J.B.)
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21
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Welch C, Greig C, Majid Z, Masud T, Moorey H, Pinkney T, Jackson T. The feasibility of conducting acute sarcopenia research in hospitalised older patients: a prospective cohort study. Eur Geriatr Med 2022; 13:463-473. [PMID: 34608617 PMCID: PMC8490139 DOI: 10.1007/s41999-021-00565-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess feasibility of conducting acute sarcopenia research in complex populations of hospitalised older adults. METHODS Patients ≥ 70 years old were recruited to three cohorts: elective colorectal surgery, emergency (abdominal) surgery, medical patients with infections. Participants were recruited to the elective cohort in preoperative assessment clinic, and acutely admitted participants from surgical and medical wards at the Queen Elizabeth Hospital Birmingham. Serial measures of muscle quantity (ultrasound quadriceps, bioelectrical impedance analysis), muscle function (hand grip strength, physical performance), and questionnaires (mini-nutritional assessment, physical function) were performed at baseline, within 7 (± 2) days of admission/surgery, and 13 (± 1) weeks post-admission/surgery. Feasibility outcomes were assessed across timepoints including recruitment and drop-out rates, and procedure completion rates. RESULTS Eighty-one participants were recruited (mean age 79, 38.3% females). Recruitment rates were higher in elective (75%, 24/32) compared to emergency surgery (37.2%, 16/43), and medical participants (45.1%, 41/91; p = 0.003). Drop-out rates varied from 8.3 to 19.5% at 7 days, and 12.5-43.9% at 13 weeks. Age and gender did not differ between patients assessed for eligibility, approached, or recruited. Completion rates were highest for ultrasound quadriceps (98.8%, 80/81 across all groups at baseline). Gait speed completion rates were lower in medical (70.7%, 29/41) compared to elective participants (100%, 24/24) at baseline. CONCLUSION Higher participation refusal and drop-out rates should be expected for research involving recruitment of participants from the acute setting. Assessment of muscle quantity/quality through ultrasound is recommended in early-stage trials in the acute setting, where completion rates of physical performance testing are expected to be lower.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK.
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK.
| | - Carolyn Greig
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
| | - Tahir Masud
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hannah Moorey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
- Academic Department of Surgery, University of Birmingham, Birmingham, B152TT, UK
| | - Thomas Jackson
- Medical Research Council (MRC)-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Nottingham, B152TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152GW, UK
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Welch C, Greig C, Lewis D, Majid Z, Masud T, Moorey H, Pinkney T, Stanley B, Jackson T. Trajectories of muscle quantity, quality and function measurements in hospitalized older adults. Geriatr Gerontol Int 2022; 22:311-318. [PMID: 35246911 PMCID: PMC9313889 DOI: 10.1111/ggi.14366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
AIM Acute sarcopenia is defined by the development of incident sarcopenia (low muscle quantity/quality and function) within 6 months of a stressor event. However, outcome measures for clinical trials have not been validated. This study aimed to characterize changes in muscle quantity, quality, strength, and physical function during and after hospitalization. METHODS Patients aged ≥70 years admitted for elective colorectal surgery, emergency abdominal surgery or acute infections were recruited from a single university hospital. Assessments were carried out at baseline, and within 7 ± 2 days and 13 ± 1 weeks postoperatively or post-admission. RESULTS A total of 79 participants (mean age 79 years, 39% female) were included. Physical function defined by the Patient-Reported Outcome Measures Information System T-score declined from baseline (42.3, 95% CI 40.2-44.3) to 7 days (36.6, 95% CI 34.5-38.8; P = 0.001), with improvement after 13 weeks (40.5, 95% CI 37.9-43.0). Changes in muscle quantity, quality and function measurements were overall heterogeneous, with few significant changes at the study population level. Change in rectus femoris echogenicity over 13 weeks correlated with changes in handgrip strength (r = 0.53; P < 0.001) and gait speed (r = 0.59; P = 0.003) over the same period. CONCLUSIONS Patient-Reported Outcome Measures Information System T-score provides a sensitive measure of change in physical function in hospitalized older patients. However, changes in muscle quantity, quality and function measurements were heterogeneous, and not significant at the study population level. Further research should assess for factors that might be predictive of changes within individuals to enable stratified interventions. Geriatr Gerontol Int 2022; 22: 311-318.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Carolyn Greig
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- School of Sport, Exercise, and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- Birmingham Biomedical Research CenterUniversity of Birmingham and University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Danielle Lewis
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Zeinab Majid
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Tahir Masud
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
- University of NottinghamNottinghamUK
| | - Hannah Moorey
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - Benjamin Stanley
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Thomas Jackson
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Nagae M, Umegaki H, Yoshiko A, Fujita K, Komiya H, Watanabe K, Yamada Y, Sakai T, Kuzuya M. Muscle changes on muscle ultrasound and adverse outcomes in acute hospitalized older adults. Nutrition 2022; 102:111698. [DOI: 10.1016/j.nut.2022.111698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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Paris MT, Bell KE, Avrutin E, Mourtzakis M. Body size normalization of ultrasound measured anterior upper leg muscle thickness in younger and older males and females. Eur J Clin Nutr 2022; 76:958-963. [DOI: 10.1038/s41430-022-01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022]
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Nagae M, Umegaki H, Yoshiko A, Fujita K, Komiya H, Watanabe K, Yamada Y, Sakai T. Muscle Evaluation and Hospital-Associated Disability in Acute Hospitalized Older Adults. J Nutr Health Aging 2022; 26:681-687. [PMID: 35842758 PMCID: PMC9194346 DOI: 10.1007/s12603-022-1814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- M Nagae
- Hiroyuki Umegaki. Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. E-mail:
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Bahat G, Catikkas NM, Karan MA. Skeletal muscle mass assessment to detect low muscle mass: Regional or total? Clin Nutr 2021; 40:4642-4643. [PMID: 34229270 DOI: 10.1016/j.clnu.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/09/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Gulistan Bahat
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey.
| | - Nezahat Muge Catikkas
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey
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Nagae M, Umegaki H, Yoshiko A, Fujita K, Komiya H, Watanabe K, Yamada Y, Kuzuya M. Echo intensity is more useful in predicting hospital-associated complications than conventional sarcopenia-related parameters in acute hospitalized older patients. Exp Gerontol 2021; 150:111397. [PMID: 33965558 DOI: 10.1016/j.exger.2021.111397] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Akito Yoshiko
- School of International Liberal Studies, Chukyo University, Aichi, Japan
| | - Kosuke Fujita
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
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Kara M, Frontera WR, Özçakar L. Measure What Matters Most in Sarcopenia: Regional vs. Appendicular Muscle Mass? J Am Med Dir Assoc 2021; 22:883-884. [PMID: 33705744 DOI: 10.1016/j.jamda.2021.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, Department of Physiology, University of Puerto Rico, School of Medicine, San Juan, PR, USA
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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29
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Welch C, Majid Z, Greig C, Gladman J, Masud T, Jackson T. Interventions to ameliorate reductions in muscle quantity and function in hospitalised older adults: a systematic review towards acute sarcopenia treatment. Age Ageing 2021; 50:394-404. [PMID: 33098419 PMCID: PMC7936029 DOI: 10.1093/ageing/afaa209] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Assimilate evidence for interventions to ameliorate negative changes in physical performance, muscle strength and muscle quantity in hospitalised older adults. METHODS We searched for articles using MEDLINE, Embase, CINAHL and Cochrane library using terms for randomised controlled trials, older adults, hospitalisation and change in muscle quantity, strength or physical performance. Two independent reviewers extracted data and assessed risk of bias. We calculated standardised mean differences for changes in muscle function/quantity pre- and post-intervention. RESULTS We identified 9,805 articles; 9,614 were excluded on title/abstract; 147 full texts were excluded. We included 44 studies including 4,522 participants; mean age 79.1. Twenty-seven studies (n = 3,417) involved physical activity interventions; a variety were trialled. Eleven studies involved nutritional interventions (n = 676). One trial involved testosterone (n = 39), two involved Growth Hormone (n = 53), one involved nandrolone (n = 29), and another involved erythropoietin (n = 141). Three studies (n = 206) tested Neuromuscular Electrical Stimulation. Evidence for effectiveness/efficacy was limited. Strongest evidence was for multi-component physical activity interventions. However, all studies exhibited at least some concerns for overall risk of bias, and considering inconsistencies of effect sizes across studies, certainty around true effect sizes is limited. CONCLUSION There is currently insufficient evidence for effective interventions to ameliorate changes in muscle function/quantity in hospitalised older adults. Multiple interventions have been safely trialled in heterogeneous populations across different settings. Treatment may need to be stratified to individual need. Larger scale studies testing combinations of interventions are warranted. Research aimed at understanding pathophysiology of acute sarcopenia will enable careful risk stratification and targeted interventions.
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Affiliation(s)
- Carly Welch
- Address correspondence to: Carly Welch, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, B15 2GW, UK. Tel: +01213713243.
| | - Zeinab Majid
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Carolyn Greig
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- University Hospitals Birmingham NHS Trust, Birmingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - John Gladman
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Tahir Masud
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Biomedical Research Centre: Musculoskeletal Disease theme, Nottingham, UK
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thomas Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- University Hospitals Birmingham NHS Trust, Birmingham, UK
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Welch C, Greig C, Masud T, Jackson TA. Muscle quantity and function measurements are acceptable to older adults during and post- hospitalisation: results of a questionnaire-based study. BMC Geriatr 2021; 21:141. [PMID: 33632138 PMCID: PMC7905966 DOI: 10.1186/s12877-021-02091-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND To evaluate the acceptability of handgrip strength, gait speed, quadriceps ultrasound, and Bioelectrical Impedance Analysis (BIA) to older adults conducted during and following hospitalisation. METHODS Questionnaire-based study conducted upon completion of prospective cohort study, with follow-up in either Queen Elizabeth Hospital Birmingham (QEHB), UK, or participant's own home following recent admission to QEHB. Outcome measures were acceptability as defined by total multi-domain score for each test (maximum score 35), and by frailty status. RESULTS Forty adults aged 70 years and older admitted for emergency abdominal surgery, elective colorectal surgery, or acute bacterial infections (general medicine) participated. Handgrip strength (median 33, IQR 30-35; p = 0.001), gait speed (median 32, IQR 30-35; p = 0.002), ultrasound quadriceps (median 33, IQR 31-35; p = 0.001), and BIA (median 33.5, IQR 31-35; p = 0.001) were considered highly acceptable. Participants responded positively that they enjoyed participating in these tests, and considered these tests of importance. There was no difference in scores between tests (p = 0.166). Individual total test scores did not differ between patients with and without frailty. Qualitative data are also presented on drivers for research participation. CONCLUSIONS Handgrip strength, gait speed, ultrasound quadriceps, and BIA are acceptable tests to older adults during and following hospitalisation. Our results may serve as standards when evaluating acceptability of other tests. TRIAL REGISTRATION Prospectively registered February 2019: https://clinicaltrials.gov/ct2/show/NCT03858192.
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Affiliation(s)
- Carly Welch
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK.
| | - Carolyn Greig
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tahir Masud
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK
- University of Nottingham, Nottingham, NG7 2RD, UK
- Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
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Welch C, Majid Z, Andrews I, Hassan-Smith Z, Kamwa V, Picton H, Wilson D, Jackson TA. Effect of position and exercise on measurement of muscle quantity and quality: towards a standardised pragmatic protocol for clinical practice. BMC Sports Sci Med Rehabil 2021; 13:3. [PMID: 33413560 PMCID: PMC7792326 DOI: 10.1186/s13102-020-00227-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/16/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Ultrasonography is an emerging non-invasive bedside tool for muscle quantity/quality assessment; Bioelectrical Impedance Analysis (BIA) is an alternative non-invasive bedside measure of body composition, recommended for evaluation of sarcopenia in clinical practice. We set out to assess impact of position and exercise upon measures towards protocol standardisation. METHODS Healthy volunteers aged 18-35 were recruited. Bilateral Anterior Thigh Thickness (BATT; rectus femoris and vastus intermedius), BATT: Subcutaneous Ratio (BATT:SCR), and rectus femoris echogenicity were measured using ultrasound and BIA was performed; 1) lying with upper body at 45° (Reclined), 2) lying fully supine at 180o (Supine), 3) sat in a chair with upper body at 90o (Sitting), and 4) after exercise Reclined. Variability of Skeletal Muscle Mass (SMM) by two different equations from BIA (SMM-Janssen, SMM-Sergi), phase angle, fat percentage, and total body (TBW), extracellular (ECW), and intracellular water (ICW) were assessed. RESULTS Forty-four participants (52% female; mean 25.7 years-old (SD 5.0)) were recruited. BATT increased from Reclined to Sitting (+ 1.45 cm, 1.27-1.63), and after exercise (+ 0.51, 0.29-0.73). Echogenicity reduced from Reclined to Sitting (- 2.1, - 3.9 - -0.26). SMM-Sergi declined from Reclined to Supine (- 0.65 kg, - 1.08 - - 0.23) and after exercise (- 0.70 kg, - 1.27 - -0.14). ECW increased from Reclined to Sitting (+ 1.19 L, 0.04-2.35). There were no other statistically significant changes. CONCLUSION Standardisation of protocols is especially important for assessment of muscle quantity by ultrasonography; BIA measurements may also vary dependent on the equations used. Where possible, participants should be rested prior to muscle ultrasonography and BIA, and flexion of the knees should be avoided.
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Affiliation(s)
- Carly Welch
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
| | - Zeinab Majid
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
| | - Isabelle Andrews
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
| | - Zaki Hassan-Smith
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
- Musculoskeletal Endocrinology Research Group, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Vicky Kamwa
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
- Musculoskeletal Endocrinology Research Group, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Hannah Picton
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
| | - Daisy Wilson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
| | - Thomas A. Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
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Welch C, Greig CA, Masud T, Pinkney T, Jackson TA. Protocol for understanding acute sarcopenia: a cohort study to characterise changes in muscle quantity and physical function in older adults following hospitalisation. BMC Geriatr 2020; 20:239. [PMID: 32650734 PMCID: PMC7350619 DOI: 10.1186/s12877-020-01626-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Older adults are vulnerable to the effects of acute sarcopenia (acute muscle insufficiency) following hospitalisation. However, this condition remains poorly characterised to date. It is hypothesised that acute sarcopenia arises due to a combination of bed rest and inflammatory surge. This study aims to characterise changes in muscle quantity and function, determining which factors (clinical and biological) are most predictive, and how these relate to change in physical function at 13 weeks. METHODS This study will include three groups of patients aged 70 years and older; patients undergoing elective colorectal surgery, patients admitted for emergency abdominal surgery, and patients admitted under general medicine with acute bacterial infections. Changes in muscle quantity (Bilateral Anterior Thigh Thickness with ultrasound and bioelectrical impedance analysis) and muscle function (muscle strength, physical performance) within 1 week of hospitalisation or surgery will be characterised, with follow-up of patients at 13 weeks. Physical function will be measured using the Patient Reported Outcome Measures Information System, and the Short Physical Performance Battery (or gait speed alone within 1 week of surgery). DISCUSSION This study will fully characterise changes in muscle quantity and function in hospitalised older adults and enable risk stratification towards targeted interventions in clinical practice. The results of this study will inform further research involving interventions to ameliorate changes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03858192 ; Prospectively registered 28th February 2019.
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Affiliation(s)
- Carly Welch
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW UK
| | - Carolyn A. Greig
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tahir Masud
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Clinical Gerontology Research Unit (CGRU), First Floor, South Corridor, City Hospital, Nottingham, NG5 1PB UK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Surgery, University of Birmingham, Room 29, 4th Floor, Heritage Building, Edgbaston, Birmingham, B15 2TH UK
| | - Thomas A. Jackson
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW UK
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Kara M, Ata AM, Çakır B, Kaymak B, Özçakar L. The Impact of Cut-Off Values and Adjustments for Muscle Mass and Strength on Diagnosis of Sarcopenia. J Am Med Dir Assoc 2019; 20:1653. [PMID: 31515068 DOI: 10.1016/j.jamda.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ayşe Merve Ata
- Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey
| | - Banu Çakır
- Department of Public Health, Hacettepe University Medical School, Ankara, Turkey
| | - Bayram Kaymak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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