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de Luis Roman D, García Almeida JM, Bellido Guerrero D, Guzmán Rolo G, Martín A, Primo Martín D, García-Delgado Y, Guirado-Peláez P, Palmas F, Tejera Pérez C, García Olivares M, Maíz Jiménez M, Bretón Lesmes I, Alzás Teomiro CM, Guardia Baena JM, Calles Romero LA, Prior-Sánchez I, García-Luna PP, González Pacheco M, Martínez-Olmos MÁ, Alabadí B, Alcántara-Aragón V, Palma Milla S, Martín Folgueras T, Micó García A, Molina-Baena B, Rendón Barragán H, Rodríguez de Vera Gómez P, Riestra Fernández M, Jiménez Portilla A, López-Gómez JJ, Pérez Martín N, Montero Madrid N, Zabalegui Eguinoa A, Porca Fernández C, Tapia Guerrero MJ, Ruiz Aguado M, Velasco Gimeno C, Herrera Martínez AD, Novo Rodríguez M, Iglesias Hernández NC, de Damas Medina M, González Navarro I, Vílchez López FJ, Fernández-Pombo A, Olveira G. Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk. Nutrients 2024; 16:1552. [PMID: 38892486 PMCID: PMC11174631 DOI: 10.3390/nu16111552] [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: 04/10/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.
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Affiliation(s)
- Daniel de Luis Roman
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - José Manuel García Almeida
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
| | - Diego Bellido Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
| | - Germán Guzmán Rolo
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - Andrea Martín
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - David Primo Martín
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Yaiza García-Delgado
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
| | - Fiorella Palmas
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Tejera Pérez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
| | - María García Olivares
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Surgery, Malaga University, 29010 Malaga, Spain
| | - María Maíz Jiménez
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
| | - Irene Bretón Lesmes
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | | | - Juan Manuel Guardia Baena
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | - Laura A. Calles Romero
- Endocrinology and Nutrition Service, Basurto University Hospital, 48903 Bilbao, Spain; (L.A.C.R.); (N.C.I.H.)
| | | | - Pedro Pablo García-Luna
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - María González Pacheco
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Miguel Ángel Martínez-Olmos
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
- Molecular Endocrinology Research Group, Health Research Institute of Santiago de Compostela-IDIS, 15706 Santiago de Compostela, Spain
- CIBERObn, National Health Institute Carlos III, 28031 Madrid, Spain
| | - Blanca Alabadí
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain;
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Valeria Alcántara-Aragón
- Endocrinology and Nutrition Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Samara Palma Milla
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Service, University Hospital of La Paz, 28046 Madrid, Spain;
| | - Tomás Martín Folgueras
- Endocrinology and Nutrition Service, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Andrea Micó García
- Endocrinology and Nutrition Service, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Begoña Molina-Baena
- Deparment of Endocrinology and Nutrition, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain;
| | - Henry Rendón Barragán
- Endocrinology and Nutrition, FEA Endocrinology and Nutrition, Navarra University Hospital, 31008 Pamplona, Spain;
| | | | - María Riestra Fernández
- Endocrinology Service, Cabueñes University Hospital, 33394 Gijón, Spain;
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Ana Jiménez Portilla
- Endocrinology and Nutrition Service, Consorci Hospital General Universitari de València, 46014 Valencia, Spain;
| | - Juan J. López-Gómez
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Nuria Pérez Martín
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Natalia Montero Madrid
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
| | - Alba Zabalegui Eguinoa
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Porca Fernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
- Professor Novoa Santos Foundation, 15405 A Coruña, Spain
| | - María José Tapia Guerrero
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Marta Ruiz Aguado
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
- i+12 Research Institute, 28041 Madrid, Spain
| | - Cristina Velasco Gimeno
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | - Aura D Herrera Martínez
- Reina Sofía University Hospital, 14004 Córdoba, Spain; (C.M.A.T.); (A.D.H.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - María Novo Rodríguez
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | | | - María de Damas Medina
- Endocrinology Service, Complejo Hospitalario de Jaén, 23007 Jaén, Spain; (I.P.-S.); (M.d.D.M.)
| | - Irene González Navarro
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - Francisco Javier Vílchez López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
| | - Gabriel Olveira
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
- CIBER of Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, 28029 Madrid, Spain
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Tu X, Lin T, Ju Y, Shu X, Jiang T, Ge N, Yue J. Sarcopenia in systemic sclerosis: prevalence and impact-a systematic review and meta-analysis. BMJ Open 2024; 14:e078034. [PMID: 38448063 PMCID: PMC10916105 DOI: 10.1136/bmjopen-2023-078034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE This review aims to provide an estimate of sarcopenia prevalence and its impact on clinical characteristics in patients with systemic sclerosis (SSc). DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, Web of Science and the Cochrane Central Register of Controlled Trials were systemically searched from inception to 24 May 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included observational studies that reported the prevalence of sarcopenia in patients with SSc. DATA EXTRACTION AND SYNTHESIS Two reviewers independently performed study selection and data extraction using standardised methods. Risk of bias was assessed using the Agency for Healthcare Research and Quality Scale and the Newcastle-Ottawa Scale. Meta-analysis was conducted using random effects models. RESULTS A total of 4583 articles were screened and 9 studies with data from 815 patients were included in the analysis (8 cross-sectional studies and 1 retrospective cohort study). The overall prevalence of sarcopenia in patients with SSc was 22% (95% CI 17% to 28%). Patients with SSc with sarcopenia had a poorer quality of life (mean difference -12.02; 95% CI -19.11 to -4.93) and higher C reactive protein (CRP) levels (standardised mean difference 0.67; 95% CI 0.35 to 1.00). CONCLUSIONS Sarcopenia is common in patients with SSc. Patients with SSc with sarcopenia had a worse quality of life and higher CRP levels, based on our findings. Given the detrimental impact of sarcopenia on quality of life, future efforts aimed at early identification of sarcopenia in the clinical assessment of patients with SSc may have significance. PROSPERO REGISTRATION NUMBER CRD42022368326.
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Affiliation(s)
- Xiangping Tu
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Taiping Lin
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yuan Ju
- Sichuan University Library, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyu Shu
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Tingting Jiang
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ning Ge
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jirong Yue
- Department of Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
- National Clinical Research Center for Geriatrics, Sichuan University West China Hospital, Chengdu, Sichuan, China
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de Carvalho ESV, da Silva Santos G, de Siqueira GR, Duarte ALBP, Dantas AT. Ultrasound assessment of diaphragm and quadriceps muscles and its relationship with handgrip and respiratory muscle strength in patients with systemic sclerosis: a cross-sectional study. Clin Rheumatol 2024; 43:289-295. [PMID: 38015305 DOI: 10.1007/s10067-023-06812-4] [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: 09/13/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Muscle dysfunction may cause disability and reduce the quality of life of patients with systemic sclerosis (SSc) when compared to healthy individuals. However, the literature on the topic is scarce and uses several criteria for assessing muscle dysfunction in this population. OBJECTIVES To compare diaphragm and quadriceps muscle thickness, diaphragm mobility, and handgrip strength between patients with SSc and healthy individuals. METHOD This cross-sectional study included 16 patients with SSc and 16 self-reported healthy individuals matched for age. We assessed quadriceps and diaphragm thickness and diaphragmatic mobility (ultrasound), handgrip strength (hand-held dynamometer), and respiratory muscle strength (manovacuometer). Patients also responded to the Health Assessment Questionnaire Disability Index and the International Physical Activity Questionnaire. RESULTS Patients with SSc presented lower quadriceps thickness (p < 0.0001), diaphragmatic mobility (p = 0.01), handgrip (p < 0.0001), and respiratory muscle strength (p < 0.0001) than healthy individuals. A moderate positive correlation was observed between handgrip strength and quadriceps thickness in patients with SSc (rho = 0.576; p = 0.02). CONCLUSIONS Patients with SSc presented reduced quadriceps thickness, diaphragmatic mobility, handgrip, and respiratory muscle strength when compared to healthy individuals Also, handgrip strength was correlated with quadriceps thickness in patients with SSc, suggesting that loss of muscle mass accompanies loss of peripheral muscle strength group of patients. Key Points • SSc patients presented reduced quadriceps thickness and diaphragmatic mobility • SSc patients have reduced handgrip and respiratory muscle strength • Lower handgrip muscle strength correlated with lower quadriceps thickness.
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Affiliation(s)
| | | | | | | | - Andréa Tavares Dantas
- Department of Clinical Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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Fu H, Wang L, Zhang W, Lu J, Yang M. Diagnostic test accuracy of ultrasound for sarcopenia diagnosis: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:57-70. [PMID: 36513380 PMCID: PMC9891970 DOI: 10.1002/jcsm.13149] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Muscle ultrasound is an emerging tool for diagnosing sarcopenia. This review aims to summarize the current knowledge on the diagnostic test accuracy of ultrasound for the diagnosis of sarcopenia. We collected data from Ovid Medline, Embase and the Cochrane Central Register of Controlled Trials. Diagnostic test accuracy studies using muscle ultrasound to detect sarcopenia were included. Bivariate random-effects models based on sensitivity and specificity pairs were used to calculate the pooled estimates of sensitivity, specificity and the area under the curves (AUCs) of summary receiver operating characteristic (SROC), if possible. We screened 7332 publications and included 17 studies with 2143 participants (mean age range: 52.6-82.8 years). All included studies had a high risk of bias. The study populations, reference standards and ultrasound measurement methods varied across the studies. Lower extremity muscles were commonly studied, whereas muscle thickness (MT) was the most widely measured parameter, followed by the cross-sectional area (CSA). The MTs of the gastrocnemius, rectus femoris, tibialis anterior, soleus, rectus abdominis and geniohyoid muscles showed a moderate diagnostic accuracy for sarcopenia (SROC-AUC 0.83, 8 studies; SROC-AUC 0.78, 5 studies; AUC 0.82, 1 study; AUC 0.76-0.78, 2 studies; AUC 0.76, 1 study; and AUC 0.79, 1 study, respectively), whereas the MTs of vastus intermedius, quadriceps femoris and transversus abdominis muscles showed a low diagnostic accuracy (AUC 0.67-0.71, 3 studies; SROC-AUC 0.64, 4 studies; and AUC 0.68, 1 study, respectively). The CSA of rectus femoris, biceps brachii muscles and gastrocnemius fascicle length also showed a moderate diagnostic accuracy (AUC 0.70-0.90, 3 studies; 0.81, 1 study; and 0.78-0.80, 1 study, respectively), whereas the echo intensity (EI) of rectus femoris, vastus intermedius, quadriceps femoris and biceps brachii muscles showed a low diagnostic accuracy (AUC 0.52-0.67, 2 studies; 0.48-0.50, 1 study; 0.43-0.49, 1 study; and 0.69, 1 study, respectively). The combination of CSA and EI of biceps brachii or rectus femoris muscles was better than either CSA or EI alone for diagnosing sarcopenia. Muscle ultrasound shows a low-to-moderate diagnostic test accuracy for sarcopenia diagnosis depending on different ultrasound parameters, measured muscles, reference standards and study populations. The combination of muscle quality indicators (e.g., EI) and muscle quantity indicators (e.g., MT) might provide better diagnostic test accuracy.
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Affiliation(s)
- Hongbo Fu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Wang
- Department of Medical Ultrasound, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Wenyi Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Lu
- Medical Insurance Office, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Di Matteo A, Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti MA, de Agustin JJ, Destro Castaniti GM, Di Carlo M, Di Donato E, Di Geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire MV, Mashadi Mirza R, Massarotti M, Musca AA, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè CA, Tamas MM, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari PV, Vreju FA, Vukatana G, Hereter JZ, Zanetti A, Grassi W, Filippucci E. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study. Front Med (Lausanne) 2023; 9:1090468. [PMID: 36733934 PMCID: PMC9886677 DOI: 10.3389/fmed.2022.1090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom,*Correspondence: Andrea Di Matteo,
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Maria Giovanna Lommano
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Carla Airoldi
- Hospital Provincial, Rheumatology, Rosario, Argentina
| | - Sibel Zehra Aydin
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Davide Corradini
- Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA, Italy
| | - Micaela Ana Cosatti
- CEMIC, Centro de Educación Médica e Investigaciones Médicas “Norberto Quirno”, Buenos Aires, Argentina
| | - Juan Josè de Agustin
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Daniela Fodor
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Gabba
- Local Health Unit (ASL), Samugheo, OR, Italy,Local Health Unit (ASL), Orosei, NU, Italy
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Diogo Jesus
- Department of Rheumatology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Josefina Marin
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, United Kingdom
| | | | - Jagdish Nair
- Department of Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
| | - Javier Rosa
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Crescenzio Scioscia
- Rheumatology Unit, Department of Emergency and Organ Transplants (DETO), University of Bari, Bari, Italy
| | | | - Maria-Magdalena Tamas
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Catalina Villota-Eraso
- IPS Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, Pasto, Colombia
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
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The Diagnostic Value of Ultrasound of the Rectus Femoris for the diagnosis of Sarcopenia in adults: A systematic review. Injury 2022; 53 Suppl 3:S23-S29. [PMID: 35732560 DOI: 10.1016/j.injury.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND & AIM Sarcopenia is defined as a loss of muscle mass and function, which can be caused by normal ageing or factors such as physical inactivity. Severe health consequences caused by sarcopenia highlight the need for early identification. Computed Tomography (CT) imaging, often mentioned as the gold standard due to its accuracy, is costly and not routinely performed in daily clinical care. Ultrasound of the rectus femoris, however, is low in costs and easily accessible. The aim is to present the current and most recent literature regarding the diagnostic value of ultrasound measurements of the rectus femoris for the diagnosis of sarcopenia in adults. METHODS The databases PubMed and Web of Science were used to search for studies comparing ultrasound of the rectus femoris with a reference test to diagnose sarcopenia in adults. The quality of the final eligible studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies, version 2, tool (QUADAS-2). RESULTS Six studies were included in this systematic review. The muscle thickness and cross-sectional area of the rectus femoris were assessed and compared with the reference tests CT, Dual-Energy X-ray Absorptiometry (DXA), and Bioelectrical Impedance Analysis (BIA). Half of the studies had a low risk of bias on all QUADAS-2 domains. Three studies reported statistical significant outcomes and diagnostic values ranging from 60 to 81% sensitivity and 51 to 94% specificity. CONCLUSIONS Ultrasound of the rectus femoris muscle to diagnose sarcopenia has been shown to be a promising method in multiple clinical populations. However, there were some limitations such as a high methodological heterogeneity. Future research should develop standardized protocols and determine clear cut-off values to allow for a better implementation of ultrasound in clinical practice.
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7
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Thepwiwatjit S, Charoensri S, Sirithanaphol W, Mahakkanukrauh A, Suwannaroj S, Foocharoen C. Prevalence and clinical associations with primary hypogonadism in male systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:234-242. [PMID: 36211203 PMCID: PMC9537708 DOI: 10.1177/23971983221112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/18/2022] [Indexed: 10/03/2023]
Abstract
Background Systemic sclerosis may affect male and female fertility. Premature ovarian failure has been reported in female systemic sclerosis patients, but the effects on male fertility in systemic sclerosis have not been studied. Objectives We aimed to determine the prevalence and clinical associations with primary hypogonadism among male systemic sclerosis patients. Methods This was a cross-sectional pilot study, including 30 adult male systemic sclerosis patients attending the Scleroderma Clinic, Khon Kaen University. Testosterone deficiency symptoms were assessed using the Aging Males' Symptoms Rating Scale, urological examination, and blood testing (for total testosterone, free testosterone, follicle-stimulating hormone, and luteinizing hormone). We excluded patients with congenital hypogonadism and any acquired disorders of the testes and genitalia. The definition of primary hypogonadism was based on the International Society for the Study of the Aging Male 2015 diagnostic criteria for hypogonadism. Results Seven patients met the definition of primary hypogonadism-a prevalence of 23.3% (95% confidence interval: 9.9-42.3). The respective mean age and mean systemic sclerosis duration was 59.4 ± 11.9 and 5.5 ± 4.7 years. Older age at onset, high triglyceride level, and older age starting corticosteroid treatment were significantly associated with primary hypogonadism (p = 0.02, 0.02, and 0.03, respectively). Systemic sclerosis subset, disease severity, and immunosuppressant use were not associated with primary hypogonadism among Thai male systemic sclerosis patients. Conclusion Around one-quarter of male systemic sclerosis patients had primary hypogonadism. Elderly onset of systemic sclerosis, hypertriglyceridemia, and late corticosteroid treatment were risk factors for developing primary hypogonadism.
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Affiliation(s)
- Sapol Thepwiwatjit
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suranut Charoensri
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wichien Sirithanaphol
- Department of Surgery, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chingching Foocharoen
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
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8
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Salaffi F, Carotti M, Di Matteo A, Ceccarelli L, Farah S, Villota-Eraso C, Di Carlo M, Giovagnoni A. Ultrasound and magnetic resonance imaging as diagnostic tools for sarcopenia in immune-mediated rheumatic diseases (IMRDs). Radiol Med 2022; 127:1277-1291. [DOI: 10.1007/s11547-022-01560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023]
Abstract
AbstractSarcopenia is characterized by loss of muscle mass, altered muscle composition, fat and fibrous tissue infiltration, and abnormal innervation, especially in older individuals with immune-mediated rheumatic diseases (IMRDs). Several techniques for measuring muscle mass, strength, and performance have emerged in recent decades. The portable dynamometer and gait speed represent the most frequently used tools for the evaluation of muscle strength and physical efficiency, respectively. Aside from dual-energy, X-ray, absorptiometry, and bioelectrical impedance analysis, ultrasound (US) and magnetic resonance imaging (MRI) techniques appear to have a potential role in evaluating muscle mass and composition. US and MRI have been shown to accurately identify sarcopenic biomarkers such as inflammation (edema), fatty infiltration (myosteatosis), alterations in muscle fibers, and muscular atrophy in patients with IMRDs. US is a low-cost, easy-to-use, and safe imaging method for assessing muscle mass, quality, architecture, and biomechanical function. This review summarizes the evidence for using US and MRI to assess sarcopenia.
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Prediction Model including Gastrocnemius Thickness for the Skeletal Muscle Mass Index in Japanese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074042. [PMID: 35409723 PMCID: PMC8998399 DOI: 10.3390/ijerph19074042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Non-invasive and easy alternative methods to indicate skeletal muscle mass index (SMI) have not been established when dual energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) cannot be performed. This study aims to construct a prediction model including gastrocnemius thickness using ultrasonography for skeletal muscle mass index (SMI). Total of 193 Japanese aged ≥65 years participated. SMI was measured by BIA, and subcutaneous fat thickness and gastrocnemius thickness in the medial gastrocnemius were measured by using ultrasonography, and age, gender and body mass index (BMI), grip strength, and gait speed were collected. The stepwise multiple regression analysis was conducted, which incorporated SMI as a dependent variable and age, gender, BMI, gastrocnemius thickness, and other factors as independent variables. Gender, BMI, and gastrocnemius thickness were included as significant factors, and the formula: SMI = 1.27 × gender (men: 1, women: 0) + 0.18 × BMI + 0.09 × gastrocnemius thickness (mm) + 1.3 was shown as the prediction model for SMI (R = 0.89, R2 = 0.8, adjusted R2 = 0.8, p < 0.001). The prediction model for SMI had high accuracy and could be a non-invasive and easy alternative method to predict SMI in Japanese older adults.
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10
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Manzano W, Lenchik L, Chaudhari AS, Yao L, Gupta S, Boutin RD. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol 2022; 51:513-524. [PMID: 34268590 DOI: 10.1007/s00256-021-03863-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
Sarcopenia is defined as the loss of muscle mass, strength, and function. Increasing evidence shows that sarcopenia is common in patients with rheumatic disorders. Although sarcopenia can be diagnosed using bioelectrical impedance analysis or DXA, increasingly it is diagnosed using CT, MRI, and ultrasound. In rheumatic patients, CT and MRI allow "opportunistic" measurement of body composition, including surrogate markers of sarcopenia, from studies obtained during routine patient care. Recognition of sarcopenia is important in rheumatic patients because sarcopenia can be associated with disease progression and poor outcomes. This article reviews how opportunistic evaluation of sarcopenia in rheumatic patients can be accomplished and potentially contribute to improved patient care.
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Affiliation(s)
- Wilfred Manzano
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA.
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
| | - Lawrence Yao
- Department of Radiology, National Institute of Health, Bethesda, MD, 20892, USA
| | - Sarthak Gupta
- Department of Medicine, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 20892, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
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Beretta MV, Feldman JV, da Silva CN, da Costa Rodrigues T. Association of Subjective Global Assessment and Adductor pollicis muscle thickness with the Sarcopenia in older patients with type 2 diabetes. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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