Grip Strength and Demographic Variables Estimate Appendicular Muscle Mass Better Than Bioelectrical Impedance in Taiwanese Older Persons

The Optimal Cut-off Value of Upper Arm Circumference and Calf Circumference for Assessing Sarcopenia Among Chinese Community-Dwelling Older Adults

Objective

To explore the cut-off values and health evaluations of upper arm circumference (AC) and calf circumference (CC) on sarcopenia in Chinese community-dwelling older people.

Methods

In this cross-sectional study, AC, CC, handgrip strength, muscle mass and gait speed were measured in 1537 Chinese community-dwelling older people in Sub-study 1. Correlation analysis, receiver operator characteristic curve (ROC curve) analysis, and consistency analysis were used for determination of AC and CC cut-off values for sarcopenia diagnosis (sarcopenia-AC and CC). Thereafter, 269 participants accepted additional assessments on physical function, body composition and muscle strength in Sub-study 2. T-test or Mann-Whitney U-test was used to explore the differential effects of sarcopenia-AC and CC on health indicators between sarcopenic and non-sarcopenic participants.

Results

In Sub-study 1, the Area Under ROC (AUC) of AC and CC for sarcopenia screening were greater than 0.700 (P<0.05). The cut-off values, sensitivity and specificity of AC and CC on sarcopenia in males were 25.9 cm (86.0%, 83.6%) and 33.7 cm (90.7%, 81.4%) whereas in females were 26.5 cm (70.8%, 69.7%) and 33.0 cm (86.5%, 69.4%), respectively. In Sub-study 2, the participants with sarcopenia-AC or sarcopenia-CC showed lower muscle strength and lower fat and muscle mass than the ones without (P<0.05). Additionally, males instead of females with sarcopenia-AC or sarcopenia-CC showed worse performance in time-up and go test and 6-Minute Walk Test (P<0.05). However, the 30-second chair stand test was not different between participants with and without sarcopenia-AC or sarcopenia-CC in both sexes.

Conclusion

We found accurate and Chinese population targeted cut-off values of AC and CC on sarcopenia diagnosis (25.9 cm and 33.7 cm in males; 26.5 cm and 33.0 cm in females) and a good evaluation effect of AC and CC on fat and muscle mass, muscle strength and physical functions in males, not females.

Development and validation of reference equations for dual-energy X-ray absorptiometry-derived measures of fat-free mass in adults aged 45-85 years: results from the Canadian Longitudinal Study on Aging

Reference equations for fat-free mass (FFM) and lean soft tissue mass (LM) measures obtained from dual-energy X-ray absorptiometry (DEXA) are important for the interpretation of body composition. This study developed and validated reference equations for FFM and LM using DEXA from the Canadian Longitudinal Study on Aging. Reference equations were developed using data from a random population-based sample of ostensibly healthy and functionally independent adults aged 45-85 years. Reference equations for absolute (accounting for age, sex, height, and body mass) and height-adjusted aka index (accounting for age, sex, and body mass index) measures of FFM and LM were developed using quantile regression. Reference equations were respectively developed and validated in derivation (80%) and validation cohorts (20%). Reference equations were applied to symptomatic adults with self-reported chronic obstructive pulmonary disease (COPD) or heart disease to assess discriminant validity; and compared with other published equations to assess performance. Bland-Altman analyses and Lin's concordance correlation coefficients were utilised to assess agreement. Reference equations for 5th, 10th, 50th, 90th, and 95th percentiles were developed for DEXA-derived estimates of FFM and LM based on 1881 healthy participants (57% male) aged 55 [IQR: 50-61] years. Reference equations performed comparably in the validation cohort and discriminated reference values between ostensibly healthy adults and people with symptomatic COPD or heart disease. Previously published reference equations tended to over- or under-predict estimates of LM compared with the current reference equations. This study provides a comprehensive and validated set of reference equations for estimating and interpreting FFM and LM from DEXA in Canadian adults aged 45-85 years, although additional validation may be required for those >75 years.

Development and Validation of Estimation Equations for Appendicular Skeletal Muscle Mass in Chinese Community-Dwelling Older Adults

Purpose

This study aimed to establish equations for estimating muscle mass through anthropometric parameters or together with physical function parameters in the community-dwelling older adults, providing a simple way of muscle mass assessment.

Methods

In this cross-sectional descriptive study, a total of 1537 older adults were recruited from the community and accepted the measurements of height, weight, upper arm and calf circumferences, grip strength, and walking speed. Body composition including appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis (BIA). Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop equations in the development group. Thereafter, Pearson correlation coefficients, Bland-Altman plots, paired t-test, intraclass correlation coefficient (ICC) and paired-samples t-tests were used to assess the validity of the equations.

Results

All parameters were significantly correlated with ASM (r = 0.195~0.795, P < 0.001) except for the age in the validation group (P = 0.746). The most optimal anthropometric equation was: [adjusted R2 = 0.911, standard error of the estimate (SEE) = 1.311, P < 0.001]. Comparatively speaking, this equation showed high correlation coefficient (r = 0.951, P < 0.001) and ICC (ICC = 0.950, P < 0.001). No significant differences were found between BIA-measured ASM and the estimated ASM. The Bland-Altman plot showed that the mean difference between the estimated ASM and BIA-measured ASM was 0 kg and the limits of agreement of ASM was -2.70~2.60 kg. Furthermore, inclusion of physical function did not significantly improve the adjusted R2 and SEE.

Conclusion

The anthropometric equation offers a practical alternative simple and dependable method for estimating ASM in community-dwelling older adults.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study

BACKGROUND

Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke.

AIM

This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke.

METHODS

In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes.

RESULTS

A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome.

CONCLUSION

Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.

Prediction equations to estimate muscle mass using anthropometric data: a systematic review

CONTEXT

Reduced muscle mass is linked to poor outcomes in both inpatients and outpatients, highlighting the importance of muscle mass assessment in clinical practice. However, laboratory methods to assess muscle mass are not yet feasible for routine use in clinical practice because of limited availability and high costs.

OBJECTIVE

This work aims to review the literature on muscle mass prediction by anthropometric equations in adults or older people.

DATA SOURCES

The following databases were searched for observational studies published until June 2022: MEDLINE, Embase, Scopus, SPORTDiscus, and Web of Science.

DATA EXTRACTION

Of 6437 articles initially identified, 63 met the inclusion criteria for this review. Four independent reviewers, working in pairs, selected and extracted data from those articles.

DATA ANALYSIS

Two studies reported new equations for prediction of skeletal muscle mass: 10 equations for free-fat mass and lean soft tissue, 22 for appendicular lean mass, 7 for upper-body muscle mass, and 7 for lower-body muscle mass. Twenty-one studies validated previously proposed equations. This systematic review shows there are numerous equations in the literature for muscle mass prediction, and most are validated for healthy adults. However, many equations were not always accurate and validated in all groups, especially people with obesity, undernourished people, and older people. Moreover, in some studies, it was unclear if fat-free mass or lean soft tissue had been assessed because of an imprecise description of muscle mass terminology.

CONCLUSION

This systematic review identified several feasible, practical, and low-cost equations for muscle mass prediction, some of which have excellent accuracy in healthy adults, older people, women, and athletes. Malnourished individuals and people with obesity were understudied in the literature, as were older people, for whom there are only equations for appendicular lean mass.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42021257200.

Anthropometric equations to estimate appendicular muscle mass from dual-energy X-ray absorptiometry (DXA): A scoping review

BACKGROUND

Appendicular skeletal muscle mass (ASM) obtained from dual-energy x-ray absorptiometry (DXA) is recommended to quantify sarcopenia, but has limited availability in disadvantaged-income countries, moreover in an epidemiological context. Predictive equations are easier and less costly to apply, but a review of all available models is still lacking in the scientific literature. The objective of this work is to map, with a scoping review, the different proposed anthropometric equations to predict ASM measured by DXA.

METHODS

Six databases were searched without restriction on publication date, idiom, and study type. A total of 2,958 studies were found, of which 39 were included. Eligibility criteria involved ASM measured by DXA, and equations proposed to predict ASM.

RESULTS

predictive equations (n = 122) were gathered for 18 countries. The development phase involves sample size, coefficient of determination (r²), and a standard error of estimative (SEE) varying between 15 and 15,239 persons, 0.39 and 0.98, 0.07 and 3.38 kg, respectively. The validation phase involves a sample size, accuracy, and a SEE between 15 and 3,003 persons, 0.61 and 0.98, 0.09 and 3.65 kg, respectively.

CONCLUSIONS

The different proposed predictive anthropometric equations of ASM DXA were mapped, including validated pre-existing equations, offering an easy-to-use referential article for clinical and research applications. It is necessary to propose more equations for other continents (Africa and Antarctica) and specific health-related conditions (e.g., diseases), once the equations can only have sufficient validity and accuracy to predict ASM generally when applied to the same population.

Changes in Body Weight, Body Composition, Phase Angle, and Resting Metabolic Rate in Male Patients with Stage IV Non-Small-Cell Lung Cancer Undergoing Therapy

Background and Objectives: Cancer treatments can adversely influence body weight status, body composition, phase angle (PhA), and resting metabolic rate (RMR), which could possibly affect disease course. Τhe aim was to assess differences in body composition, PhA, RMR, and related parameters in non-small-cell lung cancer (NSCLC) patients after treatment. Methods: The sample consisted of 82 NSCLC (stage IV) male patients (chemotherapy (C) 15.7%; immunotherapy (I) 13.3%; C + I 25.3%; (C) + radiotherapy (R) 22.9 %; and other 15.5%). Body weight and body composition, PhA, RMR, oxygen consumption (VO2), ventilation rate, and diet were assessed at baseline and at 3 months after initiation of therapy. Results: Reductions in PhA, RMR, VO2, ventilation rate, and intracellular water were observed at follow up. Weight loss was evident for 45% of patients who also had a reduction in lean body mass. In the group under C, lean mass was reduced at follow up (55.3 ± 11.53 vs. 52.4 ± 12.6, p = 0.04) without significant weight changes. In subjects with a low adherence to the Mediterranean diet (MedDietScore < 30), RMR (1940 ± 485 vs. 1730 ± 338 Kcal, p = 0.001), VO2 (277.1 ± 70.2 vs. 247 ± 49.1 mL/min, p = 0.001), and ventilation rate (10.1 ± 2.28 vs. 9. ± 2 2.2 L/min, p = 0.03) were significantly reduced. The changes in body weight were positively related to % of change in fat mass (rho = 0.322, p = 0.003) and absolute lean mass change (rho = 0.534, p < 0.001) and negatively associated with % of change in total body water (rho = −0.314, p = 0.004) (Spearman correlation coefficients). Conclusions: In conclusion, cancer therapy related to reductions in PhA and RMR, while lean mass reduction may be related to the type of treatment. Our results emphasize the importance of a more holistic nutritional and body composition assessment beyond body weight, to better address patients’ needs in clinical practice.

Estimation of Appendicular Skeletal Muscle Mass for Women Aged 60-70 Years Using a Machine Learning Approach

OBJECTIVES

This article aimed to develop and validate an anthropometric equation based on the least absolute shrinkage and selection operator (LASSO) regression, a machine learning approach, to predict appendicular skeletal muscle mass (ASM) in 60-70-year-old women.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Community-dwelling women aged 60-70 years.

METHODS

A total of 1296 community-dwelling women aged 60-70 years were randomly divided into the development or the validation group (1:1 ratio). ASM was evaluated by bioelectrical impedance analysis (BIA) as the reference. Variables including weight, height, body mass index (BMI), sitting height, waist-to-hip ratio (WHR), calf circumference (CC), and 5 summary measures of limb length were incorporated as candidate predictors. LASSO regression was used to select predictors with 10-fold cross-validation, and multiple linear regression was applied to develop the BIA-measured ASM prediction equation. Paired t test and Bland-Altman analysis were used to validate agreement.

RESULTS

Weight, WHR, CC, and sitting height were selected by LASSO regression as independent variables and the equation is ASM = 0.2308 × weight (kg) - 27.5652 × WHR + 8.0179 × CC (m) + 2.3772 × Sitting height (m) + 22.2405 (adjusted R² = 0.848, standard error of the estimate = 0.661 kg, P < .001). Bland-Altman analysis showed a high agreement between BIA-measured ASM and predicted ASM that the mean difference between the 2 methods was -0.041 kg, with the 95% limits of agreement of -1.441 to 1.359 kg.

CONCLUSIONS AND IMPLICATIONS

The equation for 60-70-year-old women could provide an available measurement of ASM for communities that cannot equip with BIA, which promotes the early screening of sarcopenia at the community level. Additionally, sitting height could predict ASM effectively, suggesting that maybe it can be used in further studies of muscle mass.

Dietary Habits Are Related to Phase Angle in Male Patients with Non-Small-Cell Lung Cancer

Introduction: Lung cancer constitutes the most common cause of cancer death. Phase angle (PhA) has been related to lung cancer prognosis, which implies that the identification of dietary or other factors that could predict or modify PhA may have beneficial effects. Νutritional interventions have been linked with positive changes in PhA in certain types of cancer. Aim: The present study aimed to investigate the relationships between dietary habits/nutrition and PhA in NSCLC patients. Methods: The sample consisted of 82 male patients with non-small-cell lung cancer (NSCLC; stage IV) from the 'Theageneio' Cancer Hospital (Thessaloniki, Greece). Several parameters were assessed, such as body mass index (BMI), lean mass, PhA, Mediterranean diet score (MedDietScore), dietary patterns, smoking, resting metabolic rate, resting oxygen consumption (VO2), ventilation rate, and physical activity. Results: According to our results, a dietary pattern rich in potatoes and animal proteins (meat and poultry) was a significant determinant of PhA (B ± SE, p: 0.165 ± 0.08, p = 0.05) in multiple linear regression models after adjusting for age, smoking, lean tissue, and MedDietScore. Conclusion: In conclusion, dietary patterns may affect PhA, suggesting the crucial role of protein in cancer management and the prevention of sarcopenia.

Obesity, waist circumference, and appendicular muscle mass ratio in relation to blood pressure among the community-dwelling elderly population in Taiwan

Hypertension is known to be related to obesity and both are the major factors for cardiovascular diseases. The relationship between body composition and blood pressure (BP) are discussed recently. Our study aims to evaluate the association between waist circumference (WC) and appendicular muscle mass (AMM) in relation to BP among the community‐dwelling elderly population.

Total 3739 patients (1600 males and 2139 females) were recruited in a series of community‐based surveys that were conducted among the elderly population in Taiwan from 2017 to 2019. We collected data on anthropometric characteristics, handgrip strength, and BP using standard methods. AMM was calculated with an equation. History of chronic disease and lifestyle profiles were collected using questionnaires.

The group with high AMM to body weight ratio (AMMW) showed lower systolic BP (SBP) (136.8 ± 19.1 to 140.6 ± 17.0 for males; 137.8 ± 18.3 to 142.7 ± 17.5 for females, both P < .001). Among central obese persons those with higher AMMW ratio had lower SBP. In the final model, AMMW in percentage is negatively associated to SBP (β = −0.641 in male, −0.780 in female, both P < .01). In other words, every 10% increase in AMMW is associated with decrease of SBP 6.41 mmHg in male and 7.80 mmHg in female.

Obesity and central obesity were positively associated with BP. The AMMW ratio was negatively associated with HTN and with a protective effect on BP even among the central obese. Health promotion programs to increase physical training may prevent hypertension among the elderly in Taiwan.

Nutritional Status and Renal Function in Relation to Frailty among the Community-Dwelling Elderly Taiwanese Population

OBJECTIVES

Frailty is a significant public health and clinical issue among the elder population. This study aimed to evaluate the nutritional status and renal function in relation to frailty among elderly Taiwanese.

DESIGN

We administered community-based health surveys to the elder population in Chiayi County, Taiwan, from 2017 to 2019.

MEASUREMENTS

We measured nutritional status (including serum albumin and total protein levels), renal function (including serum blood urea nitrogen, creatinine, urine protein, and urine creatinine levels), hand grip strength (GS) and calculated appendicular muscle mass (AMM).

RESULTS

The study recruited 3739 participants (2139 women). Participants of both sexes with normal GS had higher serum albumin levels and lower urine protein/creatinine ratios (UPCRs). For the men with normal and weak GS, serum albumin levels were 4.15 ± 0.2 and 4.10 ± 0.2 g/dL (p < 0.01), and UPCRs were 123.1 ± 219.6 and 188.7 ± 366.2 (p < 0.001), respectively. GS was positively correlated with serum albumin and urine creatinine levels (r = 0.136 and 0.177, both p < 0.001). AMM was also positively correlated with serum albumin and urine creatinine levels (r = 0.078 and 0.091, both p < 0.001). In the multivariate regression model, for every 1 g/dL increase in serum albumin level, there was a 1.9 and 1.7-kg increase in GS for men and women (p < 0.05 and p < 0.01), respectively. The final model for predicting GS included age, albumin, BUN, and UPCR (urine creatinine for women) which presented a variance of 22.1% and 13.8%, respectively.

CONCLUSION

Proper dietary nutritional intake and maintaining renal function are key elements for preventing frailty among elder population in Taiwan.

Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan

Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0—29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8—21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m²); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.

Diagnostic accuracy of sarcopenia by "possible sarcopenia" premiered by the Asian Working Group for Sarcopenia 2019 definition

PURPOSE

The Asian Working Group for Sarcopenia 2019 (AWGS 2019) proposed a simple assessment of sarcopenia called "possible sarcopenia" for the purpose of early detection and intervention of sarcopenia. The purpose of this study was to report the accuracy of possible sarcopenia against definitive sarcopenia and the characteristics of false-negative cases.

MATERIALS AND METHODS

This was a cross-sectional study using a research registry with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. The diagnosis of possible sarcopenia and sarcopenia was performed according to the AWGS 2019 criteria, using calf circumference (CC) for case-finding. The accuracy of the diagnosis of sarcopenia in participants with possible sarcopenia was evaluated by calculating sensitivity, specificity, and F-value.

RESULTS

Of the 349 patients (mean age, 78.0±6.0 years; 63% women) analyzed, 86 (24.6%) revealed possible sarcopenia. Possible sarcopenia predicted sarcopenia with a sensitivity of 0.893 and 0.921, specificity of 0.990 and 0.870, and F-values of 0.926 and 0.714 for men and women, respectively. When either the grip strength test or 5-time chair stand test result was examined, the sensitivity of possible sarcopenia to predict sarcopenia decreased, whereas the specificity remained at 0.990-1.000 in men and 0.890-0.940 in women. An extremely decreased CC was identified as a significant characteristic of patients with sarcopenia not detected in the simplified assessment.

CONCLUSIONS

The diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. Sarcopenia should be actively examined in patients with extremely decreased CC.

Assessing Additional Characteristics of Muscle Function With Digital Handgrip Dynamometry and Accelerometry: Framework for a Novel Handgrip Strength Protocol

Maximal handgrip strength (HGS) is a convenient and reliable, but incomplete, assessment of muscle function. Although low HGS is a powerful predictor of poor health, several limitations to maximal HGS exist. The predictive value of HGS is restricted because low HGS is associated with a wide range of unspecified health conditions, and other characteristics of muscle function aside from strength capacity are not evaluated. Current HGS protocol guidelines emphasize the ascertainment of maximal force, which is only a single muscle function characteristic. Muscle function is intrinsically multivariable, and assessing other attributes in addition to strength capacity will improve screenings for age-related disabilities and diseases. Digital handgrip dynamometers and accelerometers provide unique opportunities to examine several aspects of muscle function beyond strength capacity, while also maintaining procedural ease. Specifically, digital handgrip dynamometry and accelerometry can assess the rate of force development, submaximal force steadiness, fatigability, and task-specific tremoring. Moreover, HGS protocols can be easily refined to include an examination of strength asymmetry and bilateral strength. Therefore, evaluating muscle function with new HGS technologies and protocols may provide a more comprehensive assessment of muscle function beyond maximal strength, without sacrificing feasibility. This Special Article introduces a novel framework for assessing multiple attributes of muscle function with digital handgrip dynamometry, accelerometry, and refinements to current HGS protocols. Such framework may aid in the discovery of measures that better predict and explain age-related disability, biological aging, and the effects of comorbid diseases that are amenable to interventions. These additional HGS measures may also contribute to our understanding of concepts such as resilience. Using sophisticated HGS technologies that are currently available and modernizing protocols for developing a new muscle function assessment may help transform clinical practice by enhancing screenings that will better identify the onset and progression of the disabling process.