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Zilbershlag Y. From Hospital to Home: Validating a Cognitive-Functional Evaluation of Elders (COFEE-HD). Can J Occup Ther 2024:84174241240226. [PMID: 38783783 DOI: 10.1177/00084174241240226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background. Increase in hospitalizations of older adults emphasizes the need for efficient hospital discharge planning to enable optimal reentry upon returning home. Yet few assessments offer an extensive picture of the older adult's functional-cognitive state. A comprehensive assessment for discharge planning together with a written summary can be beneficial to the older adult and family. Purpose. This quantitative study compared a modified version of a previously validated tool COFEE (cognitive OT functional evaluation of elders), for use in the hospital, HD (hospital discharge) with standard hospitals assessments. Methods. Of the 77 participants recruited in hospital, home assessments were conducted 4 months later on 64 participants. Findings. The COFEE-HD scores (physical functioning, personal and environmental safety and meta cognitive functioning) were significantly correlated with standard hospital measures and with the home assessment. Implications. The COFEE-HD was found to have a high level of validity in a hospital setting, and the resulting evaluation can provide important insights into function, safety and cognitive function for post-discharge behaviors.
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Akazawa N, Funai K, Hino T, Tsuji R, Tamura W, Tamura K, Hioka A, Moriyama H. Increased intramuscular adipose tissue of the quadriceps at admission is more strongly related to activities of daily living recovery at discharge compared to muscle mass loss in older patients with aspiration pneumonia. BMC Geriatr 2024; 24:107. [PMID: 38287269 PMCID: PMC10826265 DOI: 10.1186/s12877-024-04718-7] [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: 07/10/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Recent studies reported that an increase in intramuscular adipose tissue of the quadriceps in older patients negatively affects the recovery of activities of daily living (ADL) more than the loss of muscle mass. However, whether intramuscular adipose tissue of the quadriceps in older patients with aspiration pneumonia is related to ADL recovery remains unclear. This study aimed to determine the relationship between intramuscular adipose tissue of the quadriceps and ADL recovery in older patients with aspiration pneumonia. METHODS Thirty-nine older inpatients who were diagnosed with aspiration pneumonia participated in this prospective study. The main outcome of this study was ADL at discharge. ADL were assessed using the Barthel Index (BI). The intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness observed on ultrasound images. A multiple linear regression analysis was performed to confirm whether the quadriceps echo intensity was related to the BI score at discharge, even after adjusting for confounding factors. RESULTS The medians [interquartile range] of the BI score at admission and discharge were 15.0 [0.0-35.0] and 20.0 [5.0-55.0], respectively. The BI score at discharge was significantly higher than that at admission (p = 0.002). The quadriceps echo intensity (β = - 0.374; p = 0.036) and BI score at admission (β = 0.601; p < 0.001) were independently and significantly related to the BI score at discharge (R2 = 0.718; f2 = 2.546; statistical power = 1.000). In contrast, the quadriceps thickness (β = - 0.216; p = 0.318) was not independently and significantly related to the BI score at discharge. CONCLUSIONS Increased intramuscular adipose tissue of the quadriceps at admission is more strongly and negatively related to ADL recovery at discharge than the loss of muscle mass among older patients with aspiration pneumonia. Interventions targeting the intramuscular adipose tissue of the quadriceps may improve ADL among these patients.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-Cho, Tokushima-City, Tokushima, 770-8514, Japan.
| | - Keita Funai
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Wataru Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-Cho, Tokushima-City, Tokushima, 770-8514, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Funai K, Hino T, Tsuji R, Tamura W, Tamura K, Hioka A, Moriyama H. Increase in protein intake is related to decreasing intramuscular adipose tissue of the quadriceps in older inpatients: A longitudinal study. Clin Nutr ESPEN 2023; 58:136-143. [PMID: 38056997 DOI: 10.1016/j.clnesp.2023.09.922] [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] [Received: 05/02/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIM Several randomized controlled trials indicated that an increase in protein intake decreases intramuscular adipose tissue of the thigh in mobility-limited or pre-frail older persons and stroke patients. However, whether the increase in protein intake in older inpatients is related to decreasing intramuscular adipose tissue remains unclear. The aim of this study was to examine the longitudinal relationship between intramuscular adipose tissue of the quadriceps and protein intake in older inpatients. METHODS This longitudinal study included 193 older inpatients (aged ≥65 years) (median [IQR] age: 83.0 [77.0-88.0]). The primary outcomes were changes in intramuscular adipose tissue of the quadriceps and protein intake. Intramuscular adipose tissue and muscle mass of the quadriceps were examined using ultrasound images (i.e., quadriceps echo intensity and thickness). The changes in quadriceps echo intensity and protein intake were calculated by subtracting the quadriceps echo intensity and protein intake at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in protein intake was independently and significantly related to changes in quadriceps echo intensity and thickness. RESULTS Quadriceps echo intensity at discharge (81.3 ± 20.6 [a.u.]) was significantly lower than at admission (84.0 ± 20.5 [a.u.]). Protein intake at discharge (1.2 [1.0-1.4] g/kg/day) was significantly higher than at admission (1.2 [0.9-1.4] g/kg/day). Change in protein intake was negatively and significantly related to the change in quadriceps echo intensity. In contrast, change in protein intake was not independently and significantly related to change in quadriceps thickness. CONCLUSIONS Our results indicate that an increase in protein intake is related to a decrease in intramuscular adipose tissue of the quadriceps in older inpatients. Nutritional intervention for increasing protein intake in older inpatients may be essential for decreasing intramuscular adipose tissue of the quadriceps.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Keita Funai
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Wataru Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Funai K, Hino T, Tsuji R, Tamura W, Tamura K, Hioka A, Moriyama H. Greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass. Sci Rep 2023; 13:10021. [PMID: 37340034 DOI: 10.1038/s41598-023-37094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023] Open
Abstract
This study aimed to examine the relationships between intramuscular adipose tissue and muscle mass of the quadriceps at post-acute hospital admission and the low rate of home discharge. This prospective study included 389 inpatients aged ≥ 65 years. Patients were divided into two groups according to the destination: home discharge (n = 279) and no-home discharge (n = 110) groups. The primary outcome was hospital discharge destination (home discharge or not). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at post-acute hospital admission using echo intensity and muscle thickness on ultrasound images, respectively. Logistic regression analysis was used for determining whether quadriceps echo intensity is related to home discharge. Quadriceps echo intensity was significantly and independently associated with home discharge (odds ratio [per 1 SD increase] = 1.43, p = 0.045). Quadriceps thickness was not associated with home discharge (odds ratio [per 1 SD increase] = 1.00, p = 0.998). Our study indicates that greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Keita Funai
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Wataru Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different activities of daily living levels. Clin Nutr ESPEN 2023; 53:175-181. [PMID: 36657911 DOI: 10.1016/j.clnesp.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Whether there is a longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps at different activities of daily living (ADL) levels remains unclear. This study aimed to examine the longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different ADL levels. METHODS This prospective cohort study was hospital-based and included 198 inpatients aged ≥65 years. Ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The changes in quadriceps thickness and echo intensity were calculated by subtracting these baseline values from these values at discharge. ADL were assessed at admission using the Barthel Index (BI). The participants were divided into the low BI (BI score <60) and high BI (BI score ≥60) groups in accordance with the BI score. Multiple regression analysis was performed to examine whether the change in quadriceps echo intensity was independently and significantly related to change in quadriceps thickness, even after adjusting for confounding factors in the total participants and high and low BI groups. RESULTS The number of the high and low BI groups were 54 and 144. Change in quadriceps echo intensity was independently and significantly related to changes in quadriceps thickness of the total participants (β = -0.53, p < 0.01) and low BI (β = - 0.51, p < 0.01) and high BI (β = -0.70, p < 0.01) groups. CONCLUSIONS The results of this study indicate that there is a longitudinal negative relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients regardless of ADL level. Intramuscular adipose tissue may be an important contributing factor for muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients. J Nutr Health Aging 2023; 27:103-110. [PMID: 36806865 DOI: 10.1007/s12603-023-1880-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aimed to examine whether the decrease in muscular echo-intensity of the quadriceps by ultrasound in older inpatients is related to the improvement of gait independence than the increase of muscle thickness. DESIGN Longitudinal study. SETTING Hospital-based study. PARTICIPANTS This study included 171 inpatients aged ≥ 65 years (median age: 84.0 [77.0-88.0], 56.1% female). Patients who were able to walk independently at hospital admission were excluded from the study. MEASUREMENTS Improvement of gait independence during hospital stay was assessed using the change in Functional Independence Measure (FIM) gait score (i.e., FIM gait score at hospital discharge minus FIM gait score at hospital admission) and FIM gait score at hospital discharge. Muscular echo-intensity and muscle thickness of the quadriceps were assessed at hospital admission and discharge using ultrasound images, respectively. Muscular echo-intensity has been shown to be mainly related to intramuscular adipose tissue. Multiple linear regression analysis was performed to identify the factors independently associated with the change in FIM gait score and FIM gait score at discharge. RESULTS Change in quadriceps echo-intensity was independently and significantly associated with the change in FIM gait score (β = -0.22, p = 0.017) and FIM gait score at hospital discharge (β = -0.21, p = 0.017). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in FIM gait score (β = 0.16, p = 0.050) and FIM gait score at hospital discharge (β = 0.15, p = 0.050). CONCLUSIONS Our study indicates that a decrease in muscular echo-intensity of the quadriceps by ultrasound is more related to the improvement of gait independence than an increase of muscle thickness in older inpatients. Intervention for intramuscular adipose tissue of the quadriceps may be important for improving gait independence in older inpatients.
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Affiliation(s)
- N Akazawa
- Naoki Akazawa, Assistant Professor, Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima 770-8514, Japan, Tel +81 88 602 8000, Fax +81 88 602 8146,
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass. PLoS One 2022; 17:e0275810. [PMID: 36215269 PMCID: PMC9550090 DOI: 10.1371/journal.pone.0275810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & AIM A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia. METHODS This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy. RESULTS Echo intensity of the quadriceps (β = -0.363, p = 0.012) and FILS at admission (β = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = -0.498, p = 0.012] and FILS at admission [β = -0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS. CONCLUSION Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
- * E-mail:
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Higher malnutrition risk in older inpatients who are referred to the department of rehabilitation is related to increase of intramuscular adipose tissue: A prospective study. Clin Nutr 2022; 41:2087-2093. [PMID: 36067581 DOI: 10.1016/j.clnu.2022.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS A recent cross-sectional study reported that a higher intramuscular adipose tissue of the quadriceps is related to higher malnutrition risk in older inpatients. However, a longitudinal relationship between them in older inpatients remains unclear. This study aimed to examine the relationship between the malnutrition risk at hospital admission and change in quadriceps intramuscular adipose tissue induced during the hospital stay in older inpatients. METHODS The inclusion criteria in this longitudinal study were older patients (aged ≥65 years) who were referred to the department of rehabilitation. Patients who died during a hospital stay, who underwent thigh amputation, and who had a hospital stay of <3 days or a lack of data were excluded from the study. Malnutrition risk at post-acute hospital admission was assessed using Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at hospital admission and discharge using echo intensity and muscle thickness on ultrasound images. The changes in quadriceps echo intensity and thickness were calculated by subtracting these baseline values from these values at discharge. Multiple regression analysis was performed to examine whether GNRI at admission is independently and significantly related to the quadriceps echo intensity and thickness at discharge and changes in quadriceps echo intensity and thickness. The independent variables were GNRI, age, sex, days from onset disease, disease, quadriceps echo intensity or thickness at admission, and change in quadriceps thickness. RESULTS This study included 200 inpatients (median [interquartile range] age: 83.0 [77.0-88.0], 57.0% female). GNRI at admission was significantly and independently related to quadriceps echo intensity at discharge (β = -0.136, p = 0.008) and change in quadriceps echo intensity (β = -0.177, p = 0.008). In contrast, GNRI was not significantly and independently related to quadriceps thickness at discharge (β = 0.087, p = 0.158) and change in quadriceps thickness (β = 0.133, p = 0.158). CONCLUSIONS Our results suggest that a higher malnutrition risk at post-acute hospital admission in older inpatients is related to an increase of intramuscular adipose tissue of the quadriceps during the hospital stay. Malnutrition risk at hospital admission in older inpatients is considered to be a predictor for an increase of intramuscular adipose tissue of the quadriceps during a hospital stay.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Increase in muscle mass of the quadriceps is related to decrease in intramuscular adipose tissue in convalescent stroke patients: A longitudinal study. Clin Nutr ESPEN 2022; 51:199-206. [DOI: 10.1016/j.clnesp.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
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Kodama S, Togami W, Miyamoto T. Psoas Major Skeletal Muscle Mass Is a Predictive Factor for Independent Walking After Living Donor Liver Transplantation. Transplant Proc 2022; 54:2285-2294. [PMID: 36116946 DOI: 10.1016/j.transproceed.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobility affects the ability of patients to live independently post-discharge. This study aimed to identify factors affecting the achievement of independent walking in patients after living donor liver transplantation (LDLT). METHODS This retrospective cohort study involved 40 patients who had undergone LDLT for severe hepatic dysfunction (Child-Pugh class C) in the Department of Transplant Surgery of our hospital between January 2010 and October 2019 and received physiotherapy during hospital admission. To identify factors associated with independent walking, we classified patients based on their ability to walk independently. We performed multiple logistic regression analyses with the patients' attributes, biochemical tests, and physical function, considering the achievement or non-achievement of independent walking as dependent variables, and factors that were significantly different between the 2 groups in the univariate analysis (P < .05) as independent variables, after adjusting for age, sex, and body mass index. Moreover, we calculated cutoff values from the receiver operating characteristic (ROC) curves. RESULTS All patients suffered from severe hepatic dysfunction (Child-Pugh class C). The mobility Functional Independence Measure score following rehabilitation was positively correlated with the psoas major muscle index within 1 month after LDLT and at the beginning of physiotherapy. The only factor associated with achieving independent walking at the end of physiotherapy (on discharge) was the psoas major muscle index within 1 month of LDLT (odds ratio = 35.03, P < .05), and its cutoff value, calculated from the ROC curves curve, was 4.46. CONCLUSION Psoas major skeletal muscle mass is a reliable index for independent walking after LDLT.
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Affiliation(s)
- Satoru Kodama
- Department of Medical Technology, Division of Rehabilitation Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Wakana Togami
- Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan
| | - Takeshi Miyamoto
- Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan; Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
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Engelke K, Ghasemikaram M, Chaudry O, Uder M, Nagel AM, Jakob F, Kemmler W. The effect of ageing on fat infiltration of thigh and paraspinal muscles in men. Aging Clin Exp Res 2022; 34:2089-2098. [PMID: 35633478 PMCID: PMC9464152 DOI: 10.1007/s40520-022-02149-1] [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: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Background Myosteatosis, skeletal muscle fat infiltration, is associated with inflammation and fibrosis. The age-related increase of myosteatosis is an important characteristic of sarcopenia and contributes to fragility. Aims To investigate the impact of healthy aging on intermuscular adipose tissue (IMAT) and muscle fat fraction (FF) in the thigh and the paraspinal muscles in males. Methods In 54 healthy males (age 20–70), all active hobby golfers, magnetic resonance imaging was performed to determine volume of IMAT, volume of muscle tissue (MT) and of percentage of FF. Results Between ages 20–70, at the thigh, IMAT/MT volume and MT FF increased annually by 2.9% and 1.3%, respectively. At the psoas IMAT/Psoas volume did not change with age. MT FF increased by 1.5% annually. At the erector spinae IMAT/Erector volume decreased by 0.3% and MT FF increased by 2.8% annually. Discussion With increasing age, in males, thigh muscle atrophied, muscle tissue was partly replaced by adipose tissue and remaining muscle tissue also contained more fat. Similar effects were observed in the erector spinae. The psoas muscle did not atrophy, although MT FF also increased with age. Overall correlations with age were weak to moderate with higher correlations observed in the paraspinal muscles. Conclusions Age-related increases of muscle fat infiltration were observed in the thigh and in the spine. Muscle atrophy did not occur in the psoas. In cross-sectional studies, an adjustment of volumetric parameters by muscle volume is advisable when comparing age-dependent results. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02149-1.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Mansour Ghasemikaram
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Franz Jakob
- Bernhard-Heine-Center for Locomotion Research, University of Würzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Relationship between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients. PLoS One 2022; 17:e0263973. [PMID: 35176070 PMCID: PMC8853500 DOI: 10.1371/journal.pone.0263973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 02/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2021, the International Society of Physical and Rehabilitation Medicine (ISPRM) special interest group on sarcopenia included the quadriceps thickness assessed with ultrasound image as an indicator of muscle mass in the diagnosis criteria of sarcopenia. If quadriceps echo intensity of older inpatients is to be a strong predictor of quadriceps thickness, muscle quality of the quadriceps may be estimated by the muscle mass when diagnosing sarcopenia using the criteria of ISPRM. OBJECTIVE This study aimed to examine the association between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients. METHODS This cross-sectional study included 399 inpatients aged ≥ 65 years. Primary outcomes were muscle mass and fraction of intramuscular adipose tissue of the quadriceps. Images were acquired using a B-mode ultrasound. Muscle mass and fraction of intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. A multiple regression analysis (forced entry method) was performed to confirm whether quadriceps echo intensity was related to quadriceps thickness even after adjusting for other factors. RESULTS In the multiple regression analyses for both male and female models, quadriceps echo intensity (male: β = - 0.537, p < 0.001; female: β = - 0.438, p < 0.001), Geriatric Nutritional Risk Index (male: β = 0.236, p < 0.001; female: β = 0.213, p < 0.001), and subcutaneous fat thickness of the thigh (male: β = 0.197, p < 0.001; female: β = 0.248, p < 0.001) were independently and significantly associated with quadriceps thickness. CONCLUSIONS Our results show that there is a negative and significant association between muscle mass and fraction of intramuscular adipose tissue in older inpatients. Muscle quality of the quadriceps in older inpatients may be estimated to some extent by the muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
- * E-mail:
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality. J Nutr Health Aging 2022; 26:495-500. [PMID: 35587762 DOI: 10.1007/s12603-022-1785-9] [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: 11/29/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between muscle mass, intramuscular adipose tissue, and body mass index (BMI) in older inpatients. DESIGN Cross-sectional study. SETTING Hospital-based study. PARTICIPANTS This study included 413 inpatients aged ≥ 65 years (186 men and 227 women). MEASUREMENTS Muscle mass and intramuscular adipose tissue of the quadriceps were assessed by measuring the muscle thickness and echo intensity on ultrasound images. To examine the relationship between quadriceps thickness and echo intensity and BMI in total participants and each sex, the Kendall rank correlation coefficient was used. Multiple regression analysis was performed to examine whether BMI was independently and significantly related to the quadriceps thickness and echo intensity, even after adjusting for other variables for total participants and each sex. The independent variables in multiple regression analyses were BMI, age, disease, days from onset disease. RESULTS The results of the correlation analyses showed that BMI was significantly related to the quadriceps thickness (total participants, τ = 0.431; men, τ = 0.491; women, τ = 0.388) and echo intensity (total participants, τ = -0.239; men, τ = -0.318; women, τ = -0.188). In the multiple regression analysis, BMI was independently and significantly associated with the quadriceps thickness (total participants, β = 0.535; men, β = 0.548; women, β = 0.519) and echo intensity (total participants, β = -0.287; men, β = -0.398; women, β = -0.210). CONCLUSION This study indicated that older inpatients with a higher BMI have greater muscle mass and less intramuscular adipose tissue of the quadriceps. These results suggested that a higher BMI in older inpatients is related to higher quadriceps muscle quality.
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Affiliation(s)
- N Akazawa
- Naoki Akazawa, Assistant Professor, Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima 770-8514, Japan, Tel +81 88 602 8000, Fax +81 88 602 8146, Email
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients. J Cachexia Sarcopenia Muscle 2021; 12:2231-2237. [PMID: 34704384 PMCID: PMC8718049 DOI: 10.1002/jcsm.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living (ADL) in older inpatients remains unclear. This study aimed to examine whether decrease of intramuscular adipose tissue of the quadriceps in older inpatients is related to the recovery of ADL than increase of muscle mass. METHODS This longitudinal study included 202 inpatients aged ≥65 years [median age: 83.0 (77.0-88.0), 56.4% female]. Recovery of ADL during hospital stay was assessed using the change in Barthel index (BI) score (i.e. BI score at discharge minus BI score at admission) and BI score at discharge. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Higher echo intensity indicates greater intramuscular adipose tissue. Multiple regression analysis was performed to identify the factors independently associated with the change in BI score and BI score at discharge. Changes in quadriceps echo intensity and thickness and subcutaneous fat thickness of the thigh, quadriceps echo intensity and thickness, and subcutaneous fat thickness of the thigh at admission, age, sex, days from onset disease, BI score at admission, and disease were set as independent variables. RESULTS The means of the change in quadriceps echo intensity and thickness were -2.3 ± 15.7 and 0.1 ± 0.4 cm, respectively. The median of the change in BI score was 15.0 (0.0-30.0). The quadriceps echo intensity at discharge was significantly lower than at admission (P = 0.043). The quadriceps thickness (P = 0.004) and BI score at discharge (P < 0.001) were significantly higher than those at admission. Change in quadriceps echo intensity was independently and significantly associated with the change in BI score (β = -0.25, P = 0.006) and BI score at discharge (β = -0.18, P = 0.006). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in BI score (β = 0.09, P = 0.244) and BI score at discharge (β = 0.06, P = 0.244). CONCLUSIONS Our study indicates that a decrease of intramuscular adipose tissue of the quadriceps is related to the recovery of ADL than an increase of muscle mass in older inpatients. Intramuscular adipose tissue of the quadriceps in older inpatients is considered to be a predictor for the recovery of ADL, and intervening for intramuscular adipose tissue may be important for improving ADL in older inpatients.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients. J Cachexia Sarcopenia Muscle 2021; 12:891-899. [PMID: 33998169 PMCID: PMC8350216 DOI: 10.1002/jcsm.12713] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The relationship between intramuscular adipose tissue at admission and recovery of activities of daily living (ADL) remains unclear. This study aimed to examine the relationship between intramuscular adipose tissue in the quadriceps at admission and recovery of ADL in older inpatients. METHODS This prospective study included 404 inpatients aged ≥65 years (54.7% female). Recovery of ADL during hospital stay was assessed using the Barthel Index (BI) score at discharge, BI score change, and BI efficiency. Higher BI at discharge, BI score change, and BI efficiency indicate more improvement in ADL. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was performed to identify factors independently associated with BI score at discharge, BI score change, and BI efficiency. The independent variables were BI score at admission, echo intensity and muscle thickness of the quadriceps, age, sex, number of medications, C-reactive protein concentration, updated Charlson Comorbidity Index score, Food Intake Level Scale, Geriatric Nutritional Risk Index score, days from onset disease, length of hospital stay, number of units of rehabilitation therapy, and subcutaneous fat thickness of the thigh. RESULTS The medians (inter-quartile range) of the BI score at discharge, BI score change, and BI efficiency were 60.0 (35.0-80.0), 10.0 (0.0-25.0), and 0.11 (0.00-0.37), respectively. The median (inter-quartile range) of the length of hospital stay (days) and days from onset disease were 58.0 (39.0-92.0) and 79.0 (49.0-112.0), respectively. Quadriceps echo intensity was independently and significantly associated with the BI score at discharge (β = -0.13, P < 0.01), BI score change (β = -0.23, P < 0.01), and BI efficiency (β = -0.21, P < 0.01). Quadriceps thickness was not independently and significantly associated with the BI score at discharge (β = -0.02, P = 0.68), BI score change (β = -0.02, P = 0.79), and BI efficiency (β = 0.03, P = 0.67). CONCLUSIONS Our study indicates that greater intramuscular adipose tissue in the quadriceps at admission is more strongly related to worse recovery of ADL than less muscle mass in older inpatients. Greater intramuscular adipose tissue in the quadriceps in older inpatients is considered to be a predictor of worse recovery of ADL, and intervening for greater intramuscular adipose tissue may be important for improving ADL in older inpatients.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Yamashiro-cho, Tokushima, Tokushima, Japan
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Yamashiro-cho, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Intramuscular adipose tissue of the quadriceps is more strongly related to recovery of swallowing ability than is muscle mass in older inpatients: A prospective study. Nutrition 2021; 91-92:111364. [PMID: 34246889 DOI: 10.1016/j.nut.2021.111364] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to examine whether intramuscular adipose tissue of the quadriceps at admission is related to the recovery of swallowing ability during a hospital stay in older inpatients. METHODS This prospective study included 344 inpatients ages ≥ 65 y. Those who had stroke that was the obvious cause of dysphagia were excluded. Recovery of swallowing ability was assessed using Food Intake Level Scale (FILS) score at discharge and FILS change. Ultrasound images were acquired at admission. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Multiple regression analysis was performed to examine whether quadriceps echo intensity is independently associated with FILS score at discharge and FILS change. The independent variables were quadriceps echo intensity and thickness, subcutaneous fat thickness of the thigh, Barthel Index score at admission, age, sex, number of medications, C-reactive protein, updated Charlson Comorbidity Index, FILS score at admission, Geriatric Nutritional Risk Index, days from disease onset, length of hospital stay, and units of rehabilitation therapy. RESULTS Quadriceps echo intensity was independently and significantly associated with FILS score at discharge (β = -0.15, P < 0.01) and FILS change (β = -0.19, P < 0.01). Quadriceps thickness was not independently and significantly associated with FILS score at discharge or FILS change. CONCLUSIONS The present study revealed that intramuscular adipose tissue of the quadriceps in older inpatients is more strongly related to recovery of swallowing ability than is muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Greater Quadriceps Muscle Mass at Post-Acute Care Admission is Associated with Better Swallowing Ability at Discharge among Adults with Stroke. J Am Med Dir Assoc 2021; 22:2486-2490. [PMID: 34023301 DOI: 10.1016/j.jamda.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between muscle mass and intramuscular adipose tissue of the quadriceps at post-acute care admission and recovery of swallowing ability in patients with stroke. DESIGN Prospective study. SETTING AND PARTICIPANTS This study was hospital-based and included 62 inpatients with stroke. METHODS The primary outcome was swallowing ability at discharge. The swallowing ability was assessed using the Food Intake Level Scale (FILS). The FILS change was calculated by subtracting FILS at admission from FILS at discharge. Ultrasound images were acquired at admission using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The mean muscle thickness and echo intensity of the right and left quadriceps were used in the analysis. A multiple regression analysis was performed to identify the factors independently associated with the FILS at discharge and FILS change. The independent variables were the muscle thickness and echo intensity of the quadriceps, FILS at admission, age, sex, body mass index, days from stroke onset, C-reactive protein, updated Charlson comorbidity index, number of medications, unit number of rehabilitation therapy, and Barthel Index score at admission. RESULTS Muscle thickness of the quadriceps was significantly and independently associated with FILS at discharge (β = 0.27) and FILS change (β = 0.40). Echo intensity of the quadriceps was not significantly and independently associated with FILS at discharge (β = 0.22) and FILS change (β = 0.31). CONCLUSIONS AND IMPLICATIONS Our results indicated that greater quadriceps muscle mass at post-acute care admission was associated with better swallowing ability at discharge in patients with stroke. Assessing muscle mass of the quadriceps at admission is important for predicting recovery of swallowing ability and interventions for quadriceps muscle mass may be effective for improving swallowing ability of patients with stroke.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Increased intramuscular adipose tissue of the quadriceps is related to decreased activities of daily living in patients who have had a stroke. Nutrition 2021; 90:111277. [PMID: 34010746 DOI: 10.1016/j.nut.2021.111277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study examined the relationships between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and activities of daily living (ADL) at discharge in patients who had a stroke. METHODS This prospective cohort study included 44 stroke inpatients. ADL were assessed at discharge using the Barthel index (BI) score. Ultrasound images were acquired at admission using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Relationships between BI score at discharge and quadriceps echo intensity or thickness on the paretic and non-paretic sides were assessed using partial correlation coefficients. Age, sex, days from onset of stroke, Fugl-Meyer assessment lower extremity score, and subcutaneous fat thickness of the thigh were used as the control variables in the partial correlation analysis. RESULTS BI score at discharge was significantly related to quadriceps echo intensity on the paretic (partial correlation coefficient = -0.377, P = 0.018) and non-paretic (partial correlation coefficient = -0.364, P = 0.023) sides. By contrast, quadriceps thickness on the paretic (partial correlation coefficient = 0.284, P = 0.075) and non-paretic (partial correlation coefficient = 0.278, P = 0.083) sides were not significantly related to BI score at discharge. CONCLUSIONS The present study revealed the negative relationship between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and ADL at discharge. Assessments and interventions of intramuscular adipose tissue in the quadriceps may be essential for predicting and improving ADL of patients who have had a stroke.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients. Clin Nutr 2021; 40:1381-1387. [DOI: 10.1016/j.clnu.2020.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023]
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Relationship Between Aging and Intramuscular Adipose Tissue in Older Inpatients. J Am Med Dir Assoc 2020; 22:1287-1291.e1. [PMID: 33127329 DOI: 10.1016/j.jamda.2020.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Although older inpatients are known to develop various conditions, whether aging affects intramuscular adipose tissue in older inpatients remains unclear. In particular, an increase in intramuscular adipose tissue in persons aged ≥85 years has previously not been revealed in either older inpatients or community-dwelling older individuals. This study therefore aimed to examine whether aging affects intramuscular adipose tissue in older inpatients. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This study was clinical-based and included 404 inpatients aged ≥65 years. METHODS We divided the participants into the following age groups: 65-74 years (n = 63), 75-84 years (n = 171), and ≥85 years (n = 170). B-mode ultrasound imaging was performed, and the intramuscular adipose tissue of the quadriceps was assessed based on echo intensity. One-way analysis of variance and analysis of covariance were used to compare the echo intensity of the quadriceps between the 65-74-year, 75-84-year, and ≥85-year groups. RESULTS The median (25th-75th percentile) ages of the 65-74-year group, 75-84-year group, and ≥85-year group were 70.0 (68.0-73.0), 80.0 (77.0-82.0), and 89.0 (87.0-91.0), respectively. In the one-way analysis of variance, the quadriceps echo intensity of the ≥85-year group was significantly higher than that of the 65-74-year and 75-84-year groups. In addition, the ≥85-year group had significantly higher quadriceps echo intensity than the 65-74-year group, even after adjusting for other confounding factors. CONCLUSIONS AND IMPLICATIONS The current study revealed that intramuscular adipose tissue in older inpatients increases with age, and the levels of intramuscular adipose tissue of older inpatients aged ≥85 years is higher than those of older inpatients aged 65-74 years.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Moriyama H. Using GLIM criteria, cutoff value for low BMI in Asian populations discriminates high or low muscle mass: A cross-sectional study. Nutrition 2020; 81:110928. [PMID: 32739660 DOI: 10.1016/j.nut.2020.110928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to examine whether differences in muscle mass and intramuscular adipose tissue are present between patients with a moderately and severely low body mass index (BMI) as discriminated by the cutoff value for a low BMI among patients ≥70 y of age in Asian populations according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. METHODS This cross-sectional study included 345 inpatients ≥70 y of age. The participants were placed into one of the following three groups: severely low BMI (<17.8 kg/m2; n = 96), moderately low BMI (≥17.8 to <20 kg/m2; n = 81), and normal BMI (≥20 kg/m2; n = 168). Ultrasound images were obtained with B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. Analysis of covariance was used to examine the differences in the quadriceps thickness and echo intensity among the three groups. RESULTS The quadriceps thickness and echo intensity in the severely low, moderately low, and normal BMI groups were 0.9 ± 0.3, 1.1 ± 0.4, and 1.4 ± 0.5 cm and 93.3 ± 20.8, 91.3 ± 19.3, 80.1 ± 21.6, respectively. The quadriceps thickness in the severely low BMI group was statistically significantly lower than that in the moderately low BMI (P < 0.001) and normal BMI (P < 0.001) groups, and the quadriceps thickness in the moderately low BMI group was also statistically significantly lower than that in the normal BMI group (P < 0.001). The quadriceps echo intensity showed no significant differences among the three groups. CONCLUSIONS The cutoff value for a low BMI discriminates high or low muscle mass. Results of this study supported the validity of 17.8 kg/m2 as the cutoff value for a low BMI with which to grade the severity of malnutrition in Asian populations ≥70 y of age according to the GLIM criteria from the perspective of muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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22
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Maeda H, Imada K, Ishida K, Akima H. Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke. Eur Neurol 2020; 83:167-173. [PMID: 32450559 DOI: 10.1159/000507548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Smaller muscle size and higher adipose tissue ratio of the quadriceps femoris are often observed after stroke. However, it is unclear whether muscle size and the intramuscular fat ratio of the quadriceps measured with ultrasonography (US) reflect gait independence in individuals with mild or severe hemiparetic stroke. OBJECTIVE The present study was performed to examine the relationships of gait independence with muscle thickness (MT) and echo intensity (EI) of the quadriceps femoris in individuals with hemiparesis after stroke. METHODS We examined 43 individuals with hemiparetic stroke. We assessed functional independence measure (FIM) gait scores and measured thickness and EI of the quadriceps using US. The relationships of FIM gait scores with MT and EI were examined using Spearman's correlation coefficients in mild (n = 21) and severe (n = 22) hemiparetic stroke groups. RESULTS In the mild hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.60, p < 0.01) and EI (rho = -0.57, p < 0.01). In the severe hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.67, p < 0.01) and EI (rho = -0.43, p < 0.05), as well as non-paretic limb MT (rho = 0.86, p < 0.01) and EI (rho = -0.56, p < 0.01). CONCLUSIONS Quadriceps thickness and EI were associated with the degree of gait independence. Atrophy and increased intramuscular fat of the quadriceps may be limiting factors for achieving gait independence.
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Affiliation(s)
- Hisashi Maeda
- Graduate School of Medicine, Nagoya University, Nagoya, Japan,
| | - Ken Imada
- Rehabilitation Department, Kinkai Rehabilitation Hospital, Yonago, Japan
| | - Koji Ishida
- Graduate School of Medicine, Nagoya University, Nagoya, Japan.,Research Center of Health, Physical Fitness & Sports, Nagoya University, Nagoya, Japan
| | - Hiroshi Akima
- Research Center of Health, Physical Fitness & Sports, Nagoya University, Nagoya, Japan.,Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
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