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Chaunzwa TL, Qian JM, Li Q, Ricciuti B, Nuernberg L, Johnson JW, Weiss J, Zhang Z, MacKay J, Kagiampakis I, Bikiel D, Di Federico A, Alessi JV, Mak RH, Jacob E, Awad MM, Aerts HJWL. Body Composition in Advanced Non-Small Cell Lung Cancer Treated With Immunotherapy. JAMA Oncol 2024; 10:773-783. [PMID: 38780929 PMCID: PMC11117154 DOI: 10.1001/jamaoncol.2024.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 05/25/2024]
Abstract
Importance The association between body composition (BC) and cancer outcomes is complex and incompletely understood. Previous research in non-small-cell lung cancer (NSCLC) has been limited to small, single-institution studies and yielded promising, albeit heterogeneous, results. Objectives To evaluate the association of BC with oncologic outcomes in patients receiving immunotherapy for advanced or metastatic NSCLC. Design, Setting, and Participants This comprehensive multicohort analysis included clinical data from cohorts receiving treatment at the Dana-Farber Brigham Cancer Center (DFBCC) who received immunotherapy given alone or in combination with chemotherapy and prospectively collected data from the phase 1/2 Study 1108 and the chemotherapy arm of the phase 3 MYSTIC trial. Baseline and follow-up computed tomography (CT) scans were collected and analyzed using deep neural networks for automatic L3 slice selection and body compartment segmentation (skeletal muscle [SM], subcutaneous adipose tissue [SAT], and visceral adipose tissue). Outcomes were compared based on baseline BC measures or their change at the first follow-up scan. The data were analyzed between July 2022 and April 2023. Main Outcomes and Measures Hazard ratios (HRs) for the association of BC measurements with overall survival (OS) and progression-free survival (PFS). Results A total of 1791 patients (878 women [49%]) with NSCLC were analyzed, of whom 487 (27.2%) received chemoimmunotherapy at DFBCC (DFBCC-CIO), 825 (46.1%) received ICI monotherapy at DFBCC (DFBCC-IO), 222 (12.4%) were treated with durvalumab monotherapy on Study 1108, and 257 (14.3%) were treated with chemotherapy on MYSTIC; median (IQR) ages were 65 (58-74), 66 (57-71), 65 (26-87), and 63 (30-84) years, respectively. A loss in SM mass, as indicated by a change in the L3 SM area, was associated with worse oncologic outcome across patient groups (HR, 0.59 [95% CI, 0.43-0.81] and 0.61 [95% CI, 0.47-0.79] for OS and PFS, respectively, in DFBCC-CIO; HR, 0.74 [95% CI, 0.60-0.91] for OS in DFBCC-IO; HR, 0.46 [95% CI, 0.33-0.64] and 0.47 [95% CI, 0.34-0.64] for OS and PFS, respectively, in Study 1108; HR, 0.76 [95% CI, 0.61-0.96] for PFS in the MYSTIC trial). This association was most prominent among male patients, with a nonsignificant association among female patients in the MYSTIC trial and DFBCC-CIO cohorts on Kaplan-Meier analysis. An increase of more than 5% in SAT density, as quantified by the average CT attenuation in Hounsfield units of the SAT compartment, was associated with poorer OS in 3 patient cohorts (HR, 0.61 [95% CI, 0.43-0.86] for DFBCC-CIO; HR, 0.62 [95% CI, 0.49-0.79] for DFBCC-IO; and HR, 0.56 [95% CI, 0.40-0.77] for Study 1108). The change in SAT density was also associated with PFS for DFBCC-CIO (HR, 0.73; 95% CI, 0.54-0.97). This was primarily observed in female patients on Kaplan-Meier analysis. Conclusions and Relevance The results of this multicohort study suggest that loss in SM mass during systemic therapy for NSCLC is a marker of poor outcomes, especially in male patients. SAT density changes are also associated with prognosis, particularly in female patients. Automated CT-derived BC measurements should be considered in determining NSCLC prognosis.
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Affiliation(s)
- Tafadzwa L. Chaunzwa
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jack M. Qian
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Qin Li
- AstraZeneca, Cambridge, England and Waltham, Massachusetts
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leonard Nuernberg
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands
| | - Justin W. Johnson
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | - Jakob Weiss
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Diagnostic and Interventional Radiology, University Freiburg, Freiburg im Breisgau, Germany
| | - Zhongyi Zhang
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | - Jamie MacKay
- AstraZeneca, Cambridge, England and Waltham, Massachusetts
| | | | - Damian Bikiel
- AstraZeneca, Cambridge, England and Waltham, Massachusetts
| | | | - Joao V. Alessi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Raymond H. Mak
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Etai Jacob
- AstraZeneca, Cambridge, England and Waltham, Massachusetts
| | - Mark M. Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hugo J. W. L. Aerts
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, the Netherlands
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Mooshage CM, Tsilingiris D, Schimpfle L, Kender Z, Aziz-Safaie T, Hohmann A, Szendroedi J, Nawroth P, Sturm V, Heiland S, Bendszus M, Kopf S, Kurz FT, Jende JME. Insulin Resistance Is Associated With Reduced Capillary Permeability of Thigh Muscles in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 109:e137-e144. [PMID: 37579325 DOI: 10.1210/clinem/dgad481] [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: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
CONTEXT Insulin-mediated microvascular permeability and blood flow of skeletal muscle appears to be altered in the condition of insulin resistance. Previous studies on this effect used invasive procedures in humans or animals. OBJECTIVE The aim of this study was to demonstrate the feasibility of a noninvasive assessment of human muscle microcirculation via dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of skeletal muscle in patients with type 2 diabetes (T2D). METHODS A total of 56 participants (46 with T2D, 10 healthy controls [HC]) underwent DCE-MRI of the right thigh at 3 Tesla. The constant of the musculature's microvascular permeability (Ktrans), extravascular extracellular volume fraction (ve), and plasma volume fraction (vp) were calculated. RESULTS In T2D patients, skeletal muscle Ktrans was lower (HC 0.0677 ± 0.002 min-1, T2D 0.0664 ± 0.002 min-1; P = 0.042) while the homeostasis model assessment (HOMA) index was higher in patients with T2D compared to HC (HC 2.72 ± 2.2, T2D 6.11 ± 6.2; P = .011). In T2D, Ktrans correlated negatively with insulin (r = -0.39, P = .018) and HOMA index (r = -0.38, P = .020). CONCLUSION The results signify that skeletal muscle DCE-MRI can be employed as a noninvasive technique for the assessment of muscle microcirculation in T2D. Our findings suggest that microvascular permeability of skeletal muscle is lowered in patients with T2D and that a decrease in microvascular permeability is associated with insulin resistance. These results are of interest with regard to the impact of muscle perfusion on diabetic complications such as diabetic sarcopenia.
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Affiliation(s)
- Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Taraneh Aziz-Safaie
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Volker Sturm
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Center for Diabetes Research, DZD, 85764 München-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, 85764 Neuherberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Hu Y, Xia Y, Gu B. An image-based shape analysis approach and its application to young women's waist-hip-leg position. ERGONOMICS 2023; 66:2074-2090. [PMID: 36825638 DOI: 10.1080/00140139.2023.2184366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Digital image processing has been widely used for researches in the fashion industry. This study presented a method to classify women's waist-hip-leg position based on body images. 135 healthy female students were selected as the experimental subjects, and then photo and 3D body measuring methods were used to obtain 40 shape parameters. Through factor analysis, five factors were extracted for the waist-hip position and eight factors for the leg position. The waist-hip and leg were separately classified into four categories after clustering analysis with optimised factors. The distribution of waist-hip-leg shape was analysed by combining the waist-hip and leg classification results. The results showed that 12.31% of the subjects had prominent abdomens, flat buttocks, and round and thin legs. The landmarks and parameters were automatically extracted for waist-hip-leg shape identification. The image-based shape analysis approach (ISA) was finally verified with an accuracy rate of over 90% with 30 new subjects.Practitioner summary: This study will propose an image-based shape analysis approach (ISA) to realise the quick automatic shape identification of the waist-hip-leg position based on body images. In addition, the method can be applied to pants' pattern alteration for different body types by analysing the relationship between the waist-hip-leg shape and pants.
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Affiliation(s)
- Yupeng Hu
- Fashion College, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yuanping Xia
- Fashion College, Zhejiang Sci-Tech University, Hangzhou, China
| | - Bingfei Gu
- Fashion College, Zhejiang Sci-Tech University, Hangzhou, China
- Clothing Engineering Research Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Silk Culture Heritage and Products Design Digital Technology, Ministry of Culture and Tourism, Hangzhou, China
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Yoshimura Y, Hashimoto Y, Okada H, Takegami M, Nakajima H, Miyoshi T, Yoshimura T, Yamazaki M, Hamaguchi M, Fukui M. Changes in glycemic control and skeletal muscle mass indices after dapagliflozin treatment in individuals with type 1 diabetes mellitus. J Diabetes Investig 2023; 14:1175-1182. [PMID: 37424302 PMCID: PMC10512910 DOI: 10.1111/jdi.14054] [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: 02/27/2023] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023] Open
Abstract
AIMS/INTRODUCTION Dapagliflozin is used for individuals with type 1 diabetes, although the effect of this medication on skeletal muscle mass is not well established. In addition, there are few studies examining the effects of good glycemic control on skeletal muscle mass in type 1 diabetes patients. We investigated changes in glycemic control and skeletal muscle mass with dapagliflozin in individuals with type 1 diabetes, and the association between these changes. MATERIALS AND METHODS This was a post-hoc analysis of a multicenter, open-label, non-randomized, prospective, interventional study in individuals with type 1 diabetes. The participants received dapagliflozin at 5 mg/day for 4 weeks, and were reviewed before and after treatment. Weight- and height-corrected appendicular skeletal muscle mass (ASM) were calculated as indices of skeletal muscle mass using bioelectrical impedance analysis. RESULTS A total of 36 individuals were included in the analysis. After the 4 weeks of dapagliflozin treatment, ASM/height2 decreased in the body mass index <23 group (P = 0.004). ASM / weight decreased in all men aged >60 years. The change in ASM / weight (%) was negatively correlated with the change in glycated hemoglobin (%;P = 0.023). The change in ASM / height2 (kg/m2 ) was also positively correlated with the change in time within the glucose range of 70-180 mg/dL (P = 0.036). CONCLUSION Dapagliflozin treatment of individuals with type 1 diabetes, particularly non-obese individuals and older men, might result in loss of skeletal muscle mass. However, good glycemic control during treatment might prevent the onset and progression of sarcopenia.
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Affiliation(s)
- Yuta Yoshimura
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
- Department of Metabolism and ImmunologySaiseikai Suita HospitalSuitaJapan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
- Department of Diabetes and EndocrinologyMatsushita Memorial HospitalMoriguchiJapan
| | - Hiroshi Okada
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Maya Takegami
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Hanako Nakajima
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Tomoki Miyoshi
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Takashi Yoshimura
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Masahiro Yamazaki
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
- Department of Metabolism and ImmunologyJapanese Red Cross Kyoto Daini HospitalKyotoJapan
| | - Masahide Hamaguchi
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
| | - Michiaki Fukui
- Department of Endocrinology and MetabolismKyoto Prefectural University of Medicine, Graduate School of Medical ScienceKyotoJapan
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Deng P, Ozaki H, Natsume T, Ishihara Y, Ke D, Suzuki K, Naito H. Relationship between Skeletal Muscle Thickness and Physical Activity in 4- to 6-Year-Olds in Japan. CHILDREN 2023; 10:children10030455. [PMID: 36980012 PMCID: PMC10047195 DOI: 10.3390/children10030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
Purpose: Physical activity (PA) is widely recognized as a key factor in promoting skeletal muscle growth, though little is known about the specific impact of PA on the skeletal muscle development of preschool children. The purpose of this study is to investigate whether there is a relationship between PA levels and skeletal muscle thickness in preschoolers. By exploring this relationship, we hope to gain a better understanding of how PA can be used to promote healthy skeletal muscle development in preschoolers. Methods: In this study, a total of 275 healthy Japanese preschoolers, aged 4–6 years, from seven nursery schools in the town of Togo were recruited. Participants were asked to wear an accelerometer for four consecutive days to record their daily steps and the amount of time spent in moderate-to-vigorous PA and t total physical activity. Muscle thickness (MTs) was measured using B-mode ultrasonography at four sites: the anterior and posterior thigh (AT and PT, respectively) and the anterior and posterior lower leg (AL and PL, respectively). Results: On weekdays, boys were found to be more physically active and engaged in significantly higher levels of total physical activity and moderate-to-vigorous PA than girls. Both boys and girls recorded more physical activity, daily steps, and higher levels of total physical activity and MVPA on weekdays compared to weekends. After adjusting for daylight duration, multivariable regression analyses revealed that increased total physical activity and moderate-to-vigorous PA were positively associated with greater muscle thickness size in the anterior tibialis (AT) and posterior lower leg (PL) muscles (β = 1.11 and β = 1.37 for AT, β = 1.18 and β = 0.94 for PL, p < 0.05) in Japanese preschoolers. Conclusions: The time spent involved in most of the different categories of moderate-to-vigorous PA was significantly higher for boys than for girls on the weekdays and weekends. Additionally, there was a positive correlation between time spent in moderate-to-vigorous PA and greater development of skeletal muscle in the lower body.
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Affiliation(s)
- Pengyu Deng
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, Inzai 270-1695, Chiba, Japan
- Correspondence: ; Tel.: +81-476-98-1001 (ext. 312); Fax: +81-476-98-1010
| | - Hayao Ozaki
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- School of Sport and Health Science, Tokai Gakuen University, Miyoshi 470-0207, Aichi, Japan
| | - Toshiharu Natsume
- School of Medicine, Tokai University, Isehara 259-1193, Kanagawa, Japan
| | - Yoshihiko Ishihara
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- School of Science and Technology for Future Life, Tokyo Denki University, Adachi, Tokyo 120-8551, Japan
| | - Dandan Ke
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- School of Public Health, Fudan University, Shanghai 200433, China
| | - Koya Suzuki
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, Inzai 270-1695, Chiba, Japan
| | - Hisashi Naito
- Faculty of Health and Sports Science, Juntendo University, Inzai 270-1695, Chiba, Japan
- Institute of Health and Sports Science & Medicine, Juntendo University, Inzai 270-1695, Chiba, Japan
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Nuzzo JL. Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations. J Strength Cond Res 2023; 37:494-536. [PMID: 36696264 DOI: 10.1519/jsc.0000000000004329] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ABSTRACT Nuzzo, JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 37(2): 494-536, 2023-Biological sex and its relation with exercise participation and sports performance continue to be discussed. Here, the purpose was to inform such discussions by summarizing the literature on sex differences in numerous strength training-related variables and outcomes-muscle strength and endurance, muscle mass and size, muscle fiber type, muscle twitch forces, and voluntary activation; strength training participation rates, motivations, preferences, and practices; and injuries and changes in muscle size and strength with strength training. Male subjects become notably stronger than female subjects around age 15 years. In adults, sex differences in strength are more pronounced in upper-body than lower-body muscles and in concentric than eccentric contractions. Greater male than female strength is not because of higher voluntary activation but to greater muscle mass and type II fiber areas. Men participate in strength training more frequently than women. Men are motivated more by challenge, competition, social recognition, and a desire to increase muscle size and strength. Men also have greater preference for competitive, high-intensity, and upper-body exercise. Women are motivated more by improved attractiveness, muscle "toning," and body mass management. Women have greater preference for supervised and lower-body exercise. Intrasexual competition, mate selection, and the drive for muscularity are likely fundamental causes of exercise behaviors in men and women. Men and women increase muscle size and strength after weeks of strength training, but women experience greater relative strength improvements depending on age and muscle group. Men exhibit higher strength training injury rates. No sex difference exists in strength loss and muscle soreness after muscle-damaging exercise.
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Affiliation(s)
- James L Nuzzo
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Pang S, Qi H, Chen S, Liu J, Sheng Y. Muscle Strength, but Not Muscle Mass, Is Associated with Left Ventricular Diastolic Function during Aging in Chinese. Int Heart J 2022; 63:1115-1120. [DOI: 10.1536/ihj.22-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Sisi Pang
- Division of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University
| | - Hanmei Qi
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
| | - Shu Chen
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
| | - Jin Liu
- Clinical Medicine Research Institution, The First Affiliated Hospital of Nanjing Medical University
| | - Yunlu Sheng
- Division of Geriatric Endocrinology, The First Affiliated Hospital of Nanjing Medical University
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Training-Induced Muscle Fatigue with a Powered Lower-Limb Exoskeleton: A Preliminary Study on Healthy Subjects. Med Sci (Basel) 2022; 10:medsci10040055. [PMID: 36278525 PMCID: PMC9590077 DOI: 10.3390/medsci10040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Powered lower-limb exoskeletons represent a promising technology for helping the upright stance and gait of people with lower-body paralysis or severe paresis from spinal cord injury. The powered lower-limb exoskeleton assistance can reduce the development of lower-limb muscular fatigue as a risk factor for spasticity. Therefore, measuring powered lower-limb exoskeleton training-induced fatigue is relevant to guiding and improving such technology’s development. In this preliminary study, thirty healthy subjects (age 23.2 ± 2.7 years) performed three motor tasks: (i) walking overground (WO), (ii) treadmill walking (WT), (iii) standing and sitting (STS) in three separate exoskeleton-based training sessions of 60 min each. The changes in the production of lower-limb maximal voluntary isometric contraction (MVIC) were assessed for knee and ankle dorsiflexion and extension before and after the three exoskeleton-based trained motor tasks. The MVIC forces decreased significantly after the three trained motor tasks except for the ankle dorsiflexion. However, no significant interaction was found between time (before-, and after-training) and the training sessions except for the knee flexion, where significant fatigue was induced by WO and WT trained motor tasks. The results of this study pose the basis to generate data useful for a better approach to the exoskeleton-based training. The STS task leads to a lower level of muscular fatigue, especially for the knee flexor muscles.
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Poon PKM, Tam KW, Zhang D, Yip BHK, Woo J, Wong SYS. Handgrip strength but not SARC-F score predicts cognitive impairment in older adults with multimorbidity in primary care: a cohort study. BMC Geriatr 2022; 22:342. [PMID: 35440016 PMCID: PMC9020051 DOI: 10.1186/s12877-022-03034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Assessing motor function is a simple way to track cognitive impairment. We analysed the associations between cognitive and motor function and assessed the predictive value of two motor function measuring tools for cognitive impairment in older adults with multimorbidity in primary care settings. Methods We conducted a prospective cohort study with a 1 year follow-up. Patients aged ≥60 years with ≥2 morbidities were recruited from four primary care clinics. Motor function was assessed using handgrip strength and a sarcopenia screening scale (SARC-F). Cognitive function was measured using the Hong Kong Montreal Cognitive Assessment (HK-MoCA). We defined cognitive impairment as an HK-MoCA score < 22. The associations between cognitive and motor functions were examined from a bidirectional perspective. Results We included 477 participants (mean age 69.4, 68.6% female) with a mean (SD) HK-MoCA score of 25.5 (3.38), SARC-F score of 1.1 (1.36), and handgrip strength of 21.2 (6.99) kg at baseline. Multivariable linear regression models showed bidirectional cross-sectional associations of the HK-MoCA score and cognitive impairment with SARC-F score and handgrip strength at baseline and 1 year. Cox regression revealed a longitudinal association between baseline handgrip strength and cognitive impairment at 1 year (hazard ratio: 0.48, 95% CI 0.33–0.69) but no longitudinal association between SARC-F and cognitive impairment. Variation in the SARC-F score increased with decreasing HK-MoCA score (Brown–Forsythe test F statistic = 17.9, p < 0.001), while variability in the handgrip strength remained small (modified signed-likelihood ratio test, p < 0.001). Conclusions Primary healthcare providers may use handgrip strength to track cognitive function decline in older adults with multimorbidity. However, the SARC-F scale may not have the same predictive value. Further research is needed to evaluate the performance and variability of the SARC-F score in individuals with poor cognitive function. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03034-2.
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Affiliation(s)
- Paul Kwok Ming Poon
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - King Wa Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Dexing Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Benjamin Hon Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Samuel Yeung Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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10
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Su H, Sun X, Li F, Guo Q. Association between handgrip strength and cognition in a Chinese population with Alzheimer's disease and mild cognitive impairment. BMC Geriatr 2021; 21:459. [PMID: 34380435 PMCID: PMC8356394 DOI: 10.1186/s12877-021-02383-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to explore the level and changes in handgrip strength among preclinical Alzheimer’s disease (AD) and AD patients and to evaluate the association between handgrip strength and cognitive function. Methods A total of 1431 participants from the memory clinic of Shanghai JiaoTong University Affiliated Sixth People’s Hospital and community were enrolled in the final analysis, including 596 AD, 288 mild cognitive impairment (MCI), and 547 normal individuals (NC). All participants received a comprehensive neuropsychological assessment. Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Basic (MoCA-BC), and the Chinese version of Addenbrooke’s Cognitive Examination III (ACE-III-CV) were used as cognitive tests. The receiver operating characteristic curve (ROC) was plotted to assess the power of handgrip strength as a screening measure to discriminate AD and MCI. Results The results showed that handgrip strength in the MCI group was significantly lower than that of NC group, and the AD group had a further decline (both P < 0.01). Multivariate logistic regression was performed with the handgrip strength quartiles, and the results showed that the ORs of AD for increasing levels of handgrip strength were 1.00, 0.58 (0.46–0.78), 0.51 (0.36–0.73), and 0.50 (0.35–0.68), showing a decreasing trend (Pfor trend < 0.01). The ROC curve demonstrated that the handgrip strength cutoff points for the identification of AD were 16.8 and 20.7 kg among the female participants above and under 70 yrs and 24.4 and 33.3 kg for the male participants above and under 70 yrs, respectively. Similarly, for the identification of MCI, cutoff points were 17.5 and 21.9 kg for females above 70 yrs and under 70 yrs, and 25.8 and 36.2 kg for males above 70 yrs and under 70 yrs, respectively. Conclusions Our study provided the further knowledge on the relationship between noncognitive features and cognition in populations with differing cognitive status, revealed that the stronger handgrip strength was associated with better performances on cognitive function. It can be speculated that handgrip strength can help early recognition of Chinese AD patients.
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Affiliation(s)
- Hang Su
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, 200233, Shanghai, China
| | - Xiaokang Sun
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, 200233, Shanghai, China
| | - Fang Li
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing, China.
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, 200233, Shanghai, China.
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11
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Mizuno T, Matsui Y, Tomida M, Suzuki Y, Nishita Y, Tange C, Shimokata H, Imagama S, Otsuka R, Arai H. Differences in the mass and quality of the quadriceps with age and sex and their relationships with knee extension strength. J Cachexia Sarcopenia Muscle 2021; 12:900-912. [PMID: 34009738 PMCID: PMC8350198 DOI: 10.1002/jcsm.12715] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although muscle quality evaluations are currently considered important for diagnosing sarcopenia, data from the general population are lacking. This study used mid-thigh computed tomography measurements to evaluate age-related and sex-related differences in quadriceps femoris muscle quality and mass and their relationships with knee extension strength (KES). METHODS Cross-sectional data from 520 Japanese individuals (273 men and 247 women, mean age: 63.1 ± 10.6 years) were analysed. Mass and quality were assessed using quadriceps cross-sectional areas (CSAs) and computed tomography values (CTVs), respectively. The four constituent muscles, intermuscular adipose tissue, and entire quadriceps area (total quadriceps muscles + intermuscular adipose tissue) were assessed, and the data were stratified by five age groups and sex. To evaluate age-related decline, linear and quadratic equations were tested for fit according to the constituent muscles and sex. KES could be measured in 472 of the 520 participants (254 men and 218 women, mean age: 62.3 ± 10.3). Multiple linear regression analyses with age-adjusted models were then used for evaluating the relationships between KES and quadriceps measurements. RESULTS All muscle CSAs and CTVs showed downward trends with age (men: P < 0.001 for all; women: vastus medialis CTV, P = 0.004; others, P < 0.001); the intermuscular adipose tissue CSA did not show any trend (men: P = 0.938; women: P = 0.139), although its percentage of the entire quadriceps area showed an upward trend in both sexes (P < 0.001). Men exhibited a quadratic decline in the CSAs for the entire quadriceps area (P = 0.016), total quadriceps muscles (P = 0.021), the vastus medialis (P = 0.010) and vastus lateralis (P = 0.038), and all CTVs (rectus femoris, P = 0.044; others, P < 0.001). Women exhibited a quadratic equation in the CTV for rectus femoris (P = 0.031), but a linear decline in the other variables (P < 0.001 for all). Both the total quadriceps muscles CSA and CTV were significantly associated with KES in both sexes (P < 0.001). For each muscle, the CSAs of the vastus medialis (P < 0.001) and vastus intermedius (P = 0.001) were significantly associated with KES in men, whereas the vastus medialis CSA (P < 0.001), vastus lateralis CSA (P = 0.006), rectus femoris CSA (P = 0.020), and vastus intermedius CTV (P = 0.025) were significantly associated with KES in women CONCLUSIONS: Age-related quadriceps femoris changes in mass and quality differed by sex and the constituent muscles. The constituent muscles contributing to KES differed between men and women. Quadriceps CSA and CTV measurements are useful for objectively assessing age-related and sex-related muscle deterioration and KES.
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Affiliation(s)
- Takafumi Mizuno
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasumoto Matsui
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Makiko Tomida
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yasuo Suzuki
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, Obu, Japan.,Faculty of Health Sciences, Department of Human Care Engineering, Nihon Fukushi University, Mihama, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Chikako Tange
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroshi Shimokata
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan.,Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Otsuka
- Section of NILS-LSA, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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12
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Huschtscha Z, Parr A, Porter J, Costa RJS. Sarcopenic Characteristics of Active Older Adults: a Cross-Sectional Exploration. SPORTS MEDICINE-OPEN 2021; 7:32. [PMID: 33999277 PMCID: PMC8128944 DOI: 10.1186/s40798-021-00323-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ageing is associated with a decline in skeletal muscle mass and function (strength and power), known as sarcopenia. Inadequate dietary protein and inactivity have been shown to accelerate sarcopenia outcomes, occurring at different rates in males and females. Regardless, active older adults who often exceed the exercise guidelines still show signs of sarcopenia. This study aimed to explore the link between age, physical activity, protein intake, and biological sex with skeletal muscle mass, strength, power, and physical capacity/performance in active older adults. Fifty-four active older adults were recruited from this trial and grouped according to age (middle aged: 50-59 years, and older age: ≥ 60 years), exercise volume (low: ≥ 90-149 min/week, moderate: ≥ 150-299 min/week, and high: ≥ 300 min/week), protein intake (low: < 0.8 g/kg body mass (BM), moderate: ≥ 0.8-1.19g /kg BM, and high: ≥ 1.2 g/kg BM), and biological sex (males and females). Skeletal muscle and fat mass (dual X-ray absorptiometry), strength (1-repetition maximum using leg press, chest press, lateral pull down, and hand grip), power (counter movement jump), and general fitness (cardiorespiratory capacity and gait speed) were assessed. Data were grouped based on variables, and a general linear model (ANCOVA) or an independent t test was used to determine between group differences. RESULTS Fifty three of the total participants' data were analysed. The middle-aged group had 18%, 11%, and 10% higher leg press, chest press, and lateral pull down, respectively, compared to the older-aged group (p < .05). There were no significant differences between different levels of training volume and any of the outcomes. Higher protein intakes were associated with significantly less body fat mass (p = .005) and a trend towards a higher leg press (p = .053) and higher relative power (W/kg) (p = .056) compared with the moderate and low protein intake groups. Significant differences based on biological sex were observed for all outcomes except for gait speed (p = .611) and cardiorespiratory fitness (p = .147). CONCLUSIONS Contributions of age, physical activity, daily protein intake, and biological sex can explain the individual variation in outcomes related to changes in body composition, strength, power, and/or cardiorespiratory fitness in a cohort of active older adults. The preprint version of this work is available on Research Square: https://www.researchsquare.com/article/rs-51873/v1 . TRIAL REGISTRATION This trial is registered in the ANZCTR.org.au, no. ACTRN12618001088235 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375286 ).
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Affiliation(s)
- Zoya Huschtscha
- Department of Nutrition Dietetics & Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Alexandra Parr
- Department of Nutrition Dietetics & Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Judi Porter
- Department of Nutrition Dietetics & Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia.,School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Ricardo J S Costa
- Department of Nutrition Dietetics & Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia.
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13
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Physiological responses and cycle characteristics during double-poling versus diagonal-stride roller-skiing in junior cross-country skiers. Eur J Appl Physiol 2021; 121:2229-2241. [PMID: 33893836 PMCID: PMC8260529 DOI: 10.1007/s00421-021-04689-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022]
Abstract
Purpose This study aimed to compare physiological factors and cycle characteristics during cross-country (XC) roller-skiing at matched inclines and speeds using the double-poling (DP) and diagonal-stride (DS) sub-techniques in junior female and male XC skiers. Methods Twenty-three well-trained junior XC skiers (11 women, 12 men; age 18.2 ± 1.2 yr.) completed two treadmill roller-skiing tests in a randomized order using either DP or DS. The exercise protocols were identical and included a 5 min warm-up, 4 × 5 min submaximal stages, and an incremental test to exhaustion, all performed at a 5° incline. Results No significant three-way interactions were observed between sex, submaximal exercise intensity, and sub-technique. For the pooled sample, higher values were observed for DP versus DS during submaximal exercise for the mean oxygen uptake kinetics response time (33%), energy cost (18%), heart rate (HR) (9%), blood lactate concentration (5.1 versus 2.1 mmol·L−1), rating of perceived exertion (12%), and cycle rate (25%), while cycle length was lower (19%) (all P < 0.001). During the time-to-exhaustion (TTE) test, peak oxygen uptake (\documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak), peak HR, and peak oxygen pulse were 8%, 2%, and 6% lower, respectively, for DP than DS, with a 29% shorter TTE during DP (pooled data, all P < 0.001). Conclusion In well-trained junior XC skiers, DP was found to exert a greater physiological load than DS during uphill XC roller-skiing at submaximal intensities. During the TTE test, both female and male athletes were able to ski for longer and reached markedly higher \documentclass[12pt]{minimal}
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\begin{document}$$\dot{V}$$\end{document}V˙O2peak values when using DS compared to DP.
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14
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Elam C, Aagaard P, Slinde F, Svantesson U, Hulthén L, Magnusson PS, Bunketorp-Käll L. The effects of ageing on functional capacity and stretch-shortening cycle muscle power. J Phys Ther Sci 2021; 33:250-260. [PMID: 33814713 PMCID: PMC8012187 DOI: 10.1589/jpts.33.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To examine the effects of age and gender in an ageing population with respect
to functional decline and the relationship between muscle power and functional capacity.
[Participants and Methods] The cohort (N=154) was subdivided into youngest-old
(65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.;
n=46). Measures of mechanical muscle function included countermovement jump height, muscle
power, leg strength and grip strength. Functional performance-based measures included
heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old
performed significantly worse than the middle-old, whereas the youngest-old did not
outperform the middle-old to the same extent. Increased contribution of muscle power was
observed with increasing age. Males had consistently higher scores in measures of
mechanical muscle function, whereas no gender differences were observed for functional
capacity. [Conclusion] The age-related decline in functional capacity appears to
accelerate when approaching 80 years of age and lower limb muscle power seems to
contribute to a greater extent to the preservation of functional balance and gait capacity
at that stage. Males outperform females in measures of mechanical muscle function
independent of age, while the findings give no support for the existence of gender
differences in functional capacity.
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Affiliation(s)
- Cecilia Elam
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg: Gothenburg, Sweden
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Frode Slinde
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Sweden
| | - Ulla Svantesson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg: Gothenburg, Sweden
| | - Lena Hulthén
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Peter S Magnusson
- Department of Physical Therapy, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Denmark.,Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Lina Bunketorp-Käll
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg: Gothenburg, Sweden
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15
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Large-scale analysis of iliopsoas muscle volumes in the UK Biobank. Sci Rep 2020; 10:20215. [PMID: 33214629 PMCID: PMC7677387 DOI: 10.1038/s41598-020-77351-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022] Open
Abstract
Psoas muscle measurements are frequently used as markers of sarcopenia and predictors of health. Manually measured cross-sectional areas are most commonly used, but there is a lack of consistency regarding the position of the measurement and manual annotations are not practical for large population studies. We have developed a fully automated method to measure iliopsoas muscle volume (comprised of the psoas and iliacus muscles) using a convolutional neural network. Magnetic resonance images were obtained from the UK Biobank for 5000 participants, balanced for age, gender and BMI. Ninety manual annotations were available for model training and validation. The model showed excellent performance against out-of-sample data (average dice score coefficient of 0.9046 ± 0.0058 for six-fold cross-validation). Iliopsoas muscle volumes were successfully measured in all 5000 participants. Iliopsoas volume was greater in male compared with female subjects. There was a small but significant asymmetry between left and right iliopsoas muscle volumes. We also found that iliopsoas volume was significantly related to height, BMI and age, and that there was an acceleration in muscle volume decrease in men with age. Our method provides a robust technique for measuring iliopsoas muscle volume that can be applied to large cohorts.
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16
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Liu Y, Cao X, Gu N, Yang B, Wang J, Li C. A Prospective Study on the Association Between Grip Strength and Cognitive Function Among Middle-Aged and Elderly Chinese Participants. Front Aging Neurosci 2019; 11:250. [PMID: 31551762 PMCID: PMC6747049 DOI: 10.3389/fnagi.2019.00250] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To study the efficacy of grip strength (GS) as a predictor of cognitive function in a large, nationwide sample of Chinese participants aged 45 years and above. Methods We used data from three waves (W1, W2, and W3) fielded by the China Health and Retirement Longitudinal Study (CHARLS). Cognitive function was tested biennially and calculated using two categories: episodic memory and mental intactness. Demographics, health behaviors, and medical conditions were considered potential confounders. Using multivariate linear regression models (MLRMs), we examined the association between baseline GS (measure in W1) and cognitive function in W3. Using a generalized estimating equation (GEE), we examined baseline GS as a predictor of cognitive function change. Results Total 9,333 individuals (53.2% women), with a mean baseline episodic memory score of 6.5, mean baseline mental intactness score of 7.2, and aged over 45 years (mean age = 58.6), were selected. The mean follow-up time was 4.0 years (range: 3.3–5.0 years). Using MLRMs and comparing the lowest GS score with the highest baseline GS score, we observed a significant correlation with a higher global cognitive function in both women (β = 1.061, p < 0.001) and men (β = 1.233, p < 0.001). After adjusting baseline global cognition, the highest GS level was still statistically significant in both women (β = 0.543, p < 0.05) and men (β = 0.742, p < 0.001). GEE suggested that the participants in the highest GS quartile had better cognitive performance over time in both women (β = 0.116, p = 0.030) and men (β = 0.143, p = 0.008) than those in the lowest quartile. Conclusion Higher baseline level of GS was significantly related to better cognitive function and slowed the rate of its decline. Thus, it is an independent predictor of better cognitive status in middle-aged and elderly Chinese.
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Affiliation(s)
- Yong Liu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Cao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Neurocognitive Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nannan Gu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bixi Yang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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17
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Haid TH, Zago M, Promsri A, Doix ACM, Federolf PA. PManalyzer: A Software Facilitating the Study of Sensorimotor Control of Whole-Body Movements. Front Neuroinform 2019; 13:24. [PMID: 31024286 PMCID: PMC6461015 DOI: 10.3389/fninf.2019.00024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Motion analysis is used to study the functionality or dysfunctionality of the neuromuscular system, as human movements are the direct outcome of neuromuscular control. However, motion analysis often relies on measures that quantify simplified aspects of a motion, such as specific joint angles, despite the well-known complexity of segment interactions. In contrast, analyzing whole-body movement patterns may offer a new understanding of movement coordination and movement performance. Clinical research and sports technique evaluations suggest that principal component analysis (PCA) provides novel and valuable insights into control aspects of the neuromuscular system and how they relate to coordinative patterns. However, the implementation of PCA computations are time consuming, and require mathematical knowledge and programming skills, drastically limiting its application in current research. Therefore, the aim of this study is to present the Matlab software tool "PManalyzer" to facilitate and encourage the application of state-of-the-art PCA concepts in human movement science. The generalized PCA concepts implemented in the PManalyzer allow users to apply a variety of marker set independent PCA-variables on any kinematic data and to visualize the results with customizable plots. In addition, the extracted movement patterns can be explored with video options that may help testing hypotheses related to the interplay of segments. Furthermore, the software can be easily modified and adapted to any specific application.
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Affiliation(s)
- Thomas H. Haid
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Matteo Zago
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Arunee Promsri
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Physical Therapy, University of Phayao, Mae Ka, Thailand
| | | | - Peter A. Federolf
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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18
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Peng LN, Lee WJ, Liu LK, Lin MH, Chen LK. Healthy community-living older men differ from women in associations between myostatin levels and skeletal muscle mass. J Cachexia Sarcopenia Muscle 2018; 9:635-642. [PMID: 29654636 PMCID: PMC6104118 DOI: 10.1002/jcsm.12302] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 02/13/2018] [Accepted: 02/28/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Myostatin is a negative regulator of muscle growth but the relationship between serum myostatin levels and muscle mass is unclear. This study investigated the association between serum myostatin levels and skeletal muscle mass among healthy older community residents in Taiwan, to evaluate the potential of serum myostatin as a biomarker for diagnosing sarcopenia and/or evaluating the effect of its treatment. METHODS Study data were excerpted from a random subsample of the I-Lan Longitudinal Aging Study population. Serum myostatin levels were determined and categorized into tertiles (low, medium, high). Relative appendicular skeletal muscle mass (RASM) was calculated as appendicular lean body mass by dual-energy X-ray absorptiometry divided by height squared (kg/m2 ). Low muscle mass was defined as recommended by the Asian Working Group for Sarcopenia. RESULTS The analytic study sample comprised 463 adults (mean age: 69.1 years; 49.5% men). Compared with subjects with normal RASM, those with lower RASM were older and frailer, with significantly higher prevalence of malnutrition, lower serum dehydroepiandrosterone (DHEA) levels, and were more likely to have low serum myostatin status. Multivariable logistic regression analysis showed that male sex (OR 3.60, 95% CI 1.30-9.92), malnutrition (OR 4.39, 95% CI 1.56-12.36), DHEA (OR 0.99, 95% CI 0.99-1.00), and low myostatin (OR 3.23, 95% CI 1.49-7.01) were all independent risk factors for low RASM (all P < 0.05). In men, DHEA (OR 0.99, 95% CI 0.98-1.00) and low myostatin (OR 4.89, 95% CI 1.79-13.37) were significantly associated with low RASM (both P < 0.05); however, only malnutrition was associated with low RASM in women (OR 13.59, 95% CI 2.22-83.25, P < 0.05). CONCLUSIONS Among healthy community-living older adults, low serum myostatin levels were associated with low skeletal muscle mass in men, but not in women. Our results do not support using serum myostatin levels to diagnose sarcopenia, or to monitor how it responds to treatments. Further research is needed to understand why men apparently differ from women in the interrelationship between their myostatin levels and muscle mass.
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Affiliation(s)
- Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan
| | - Wei-Ju Lee
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, No. 386 Rongguang Rd., Yuanshan Township, Yilan County, 264, Taiwan.,Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, No. 155, Sec. 2, Linong St, Taipei, 11221, Taiwan
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Jang BY, Bu SY. Total energy intake according to the level of skeletal muscle mass in Korean adults aged 30 years and older: an analysis of the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011. Nutr Res Pract 2018; 12:222-232. [PMID: 29854328 PMCID: PMC5974068 DOI: 10.4162/nrp.2018.12.3.222] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/26/2018] [Accepted: 04/12/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES Since gain or loss of skeletal muscle mass is a gradual event and occurs due to a combination of lifestyle factors, assessment of dietary factors related to skeletal muscle is complicated. The aim of this study was to investigate the changes in total energy intake according to the level of skeletal muscle mass. SUBJECTS/METHODS A total of 8,165 subjects ≥ 30 years of age from the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011 were included in the analysis, and multivariate-adjusted regression analyses were performed to analyze the association of the quartiles of sarcopenia index (SI) with energy intake of the study population after adjusting for age and metabolic parameters. RESULTS The increase in SI quartile was in proportion to the gradual decrease in systemic lipids and the anthropometric measurement of fat accumulation (P < 0.001). Subjects in higher SI quartiles tended to consume more total energy and energy-producing nutrients than those in lower quartiles (P < 0.001). After age, body weight, alcohol consumption, and metabolic parameters were adjusted in the analysis, total energy intake gradually increased according to the increase in SI quartile, and the association between total energy intake and SI was more pronounced in men. However, the risk (odd ratio) of having a low SI was not affected by any single macronutrient intake. CONCLUSIONS In this study, total energy intake was positively associated with SI and relative skeletal mass in both men and women. However, no significant association or a weak association was observed between any single macronutrient intake and skeletal muscle mass. The data indicated that acquiring more energy intake within the normal range of energy consumption may help to maintain skeletal muscle mass.
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Affiliation(s)
- Bo Young Jang
- Department of Food and Nutrition, Daegu University, 201 Daegudae-ro, Gyeongsan-si, Gyeongbuk 38453, Korea
| | - So Young Bu
- Department of Food and Nutrition, Daegu University, 201 Daegudae-ro, Gyeongsan-si, Gyeongbuk 38453, Korea
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Johnson Stoklossa CA, Ghosh SS, Forhan M, Sharma AM, Terada T, Siervo M, Baracos VE, Padwal RS, Hung PA, Sawyer MB, Maia YLM, Prado CM. Poor Physical Function as a Marker of Sarcopenia in Adults with Class II/III Obesity. Curr Dev Nutr 2018; 2:nzx008. [PMID: 30377678 PMCID: PMC6201683 DOI: 10.3945/cdn.117.001743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/12/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adults with class II/III obesity [body mass index (in kg/m2) ≥35] may present with a phenotype characterized by low lean mass and excess fat mass, a condition known as sarcopenic obesity (SO). Little is known about the prevalence and relevance of SO in these individuals, primarily due to a lack of relevant diagnostic criteria. OBJECTIVE Here, we explored the definition of SO based on physical function as an outcome of interest in adults with class II/III obesity and applied this definition to compare clinical characteristics between SO and non-SO patients. METHODS In this cross-sectional analysis, patients' demographic, anthropometric, and biochemical characteristics, as well as comorbidities and physical activity levels, were collected at an obesity specialty clinic prior to any treatment. Body composition was assessed by dual-energy X-ray absorptiometry. Physical function was assessed by self-reported difficulties with activities of daily living (ADLs) from an 11-item questionnaire. Five SO definitions were tested against reported difficulty with ADLs with the use of receiver operating characteristic (ROC) analysis. RESULTS A total of 120 subjects (86% women) aged 46 ± 11 y were included. Based on ROC analysis, SO was best defined by an appendicular skeletal mass (ASM)/weight x 100 (%) <19.35% for women and <24.33% for men, resulting in a prevalence of 25% (n = 30, women 22.3%, men 41.2%). SO was significantly associated with older age, higher waist circumference, higher triglycerides, greater use of antihypertensive medications, and lower physical activity. CONCLUSIONS In this sample of adults with class II/III obesity, difficulties with ADLs were best associated with measures of ASM in relation to total body weight. Patients identified with SO using this criterion presented with poorer clinical outcomes such as factors of elevated cardiometabolic risk.
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Affiliation(s)
| | - Sunita S Ghosh
- Departments of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mary Forhan
- Departments of Oncology Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Arya M Sharma
- Departments of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tasuku Terada
- Departments of Oncology Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | - Mario Siervo
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vickie E Baracos
- Departments of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Raj S Padwal
- Departments of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Pam A Hung
- Primary Health Care, Alberta Health Services, Edmonton General Hospital, Edmonton, AB, Canada
| | - Michael B Sawyer
- Departments of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Yara LM Maia
- Curso de Farmácia, Universidade Paulista Campus Flamboyant and Faculdade Estácio de Sá, Goiânia, Goiás, Brazil
| | - Carla M Prado
- Departments of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
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Ten Haaf DSM, De Regt MF, Visser M, Witteman BJM, de Vries JHM, Eijsvogels TMH, Hopman MTE. Insufficient Protein Intakes is Highly Prevalent among Physically Active Elderly. J Nutr Health Aging 2018; 22:1112-1114. [PMID: 30379311 DOI: 10.1007/s12603-018-1075-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Sufficient protein intake and habitual physical activity are key factors in the prevention and treatment of sarcopenia. In the present study, we assessed habitual dietary protein intake and the contribution of animal proteins in male versus female physically active elderly and identified determinants of protein intake. DESIGN a cross-sectional study. SETTING the study was performed within the Nijmegen Exercise Study. PARTICIPANTS physically active elderly ≥ 65 yrs. MEASUREMENTS Physical activity was assessed using the SQUASH questionnaire and expressed in Metabolic Equivalent of Task hours per week (METhr/wk). Dietary protein intake was determined using a validated food frequency questionnaire (FFQ). Multivariate linear regression analysis was used to determine whether age, sex, educational level, smoking, alcohol intake and physical activity were associated with protein intake (g/kg/d). RESULTS A total of 910 participants (70±4 yrs, 70% male) were included and reported a habitual physical activity level of 85.0±53.5 METhr/wk. Protein intake was 1.1±0.3 g/kg/d with 57% animal-based proteins for males, and 1.2±0.3 g/kg/d with 59% animalbased proteins for females (both P<0.05). In total, 16%, 42% and 67% of the male elderly and 10%, 34% and 56% of the female elderly did not meet the recommended protein intake of 0.8, 1.0 and 1.2 g/kg/d, respectively. Female sex (β=0.055, P=0.036) and more physical activity (β=0.001, P=0.001) were associated with a higher daily protein intake (g/kg/d). CONCLUSION The majority of physically active elderly and in particular males (i.e. 67%) does not reach a protein intake of 1.2 g/kg/d, which may offset the health benefits of an active lifestyle on muscle synthesis and prevention of sarcopenia. Intervention studies are warranted to assess whether protein supplementation may enhance muscle mass and strength in physically active elderly.
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Affiliation(s)
- D S M Ten Haaf
- Prof. Maria T.E. Hopman. Department of Physiology (392), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands, , Tel. (+31) (0)243614200, Fax. (+31) (0)243668340
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Fritz NE, McCarthy CJ, Adamo DE. Handgrip strength as a means of monitoring progression of cognitive decline - A scoping review. Ageing Res Rev 2017; 35:112-123. [PMID: 28189666 DOI: 10.1016/j.arr.2017.01.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/13/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
Cognitive decline in older adults contributes to reduced ability to perform daily tasks and continued disuse leads to muscle weakness and potentiates functional loss. Despite explicit links between the motor and cognitive systems, few health care providers assess motor function when addressing the needs of individuals with cognitive loss. Early and easy measurable biomarkers of cognitive decline have the potential to improve care for individuals with dementia and mild cognitive impairment. The aim of this study was to conduct a systematic search to determine the relationship among handgrip strength, as a measure of global muscle strength, and cognitive decline over time. Fifteen prospective, cohort, longitudinal studies of adults >60years old who were healthy or at risk of cognitive decline at study onset were included in the review. Studies that investigated changes in cognition relative to baseline grip strength and, those that investigated changes in grip strength relative to cognitive function were revealed. Findings here support the use of handgrip strength as a way to monitor cognitive changes and show that reduced handgrip strength over time may serve as a predictor of cognitive loss with advancing age.
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Won H, Abdul Manaf Z, Mat Ludin AF, Shahar S. Wide range of body composition measures are associated with cognitive function in community-dwelling older adults. Geriatr Gerontol Int 2016; 17:554-560. [PMID: 27231255 DOI: 10.1111/ggi.12753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/23/2015] [Accepted: 01/04/2016] [Indexed: 12/29/2022]
Abstract
AIM Studies of the association between body composition, both body fat and body muscle, and cognitive function are rarely reported. The aim of the present study was to determine the association between a wide range of body composition measures with cognitive function in older adults. METHODS A total of 2322 Malaysian older adults aged 60 years and older were recruited using multistage random sampling in a population-based cross-sectional study. Out of 2322 older adults recruited, 2309 (48% men) completed assessments on cognitive function and body composition. Cognitive functions were assessed using the Malay version of the Mini-Mental State Examination, the Bahasa Malaysia version of Montreal Cognitive Assessment, Digit Span Test, Digit Symbol Test and Rey Auditory Verbal Learning Test. Body composition included body mass index, mid-upper arm circumference, waist circumference, calf circumference, waist-to-hip ratio, percentage body fat and skeletal muscle mass. RESULTS The association between body composition and cognitive functions was analyzed using multiple linear regression. After adjustment for age, education years, hypertension, hypercholesterolemia, diabetes mellitus, depression, smoking status and alcohol consumption, we found that calf circumference appeared as a significant predictor for all cognitive tests among both men and women (P < 0.05), except for the Rey Auditory Verbal Learning Test. Waist-to-hip ratio was detected as a significant predictor for all cognitive tests among women (P < 0.05), but was only a significant predictor for the Bahasa Malaysia version of Montreal Cognitive Assessment among men (P < 0.05). CONCLUSIONS These results suggest that there is a need to maintain muscle mass and lower adipose tissue among older adults for optimal cognitive function. Geriatr Gerontol Int 2017; 17: 554-560.
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Affiliation(s)
- Huiloo Won
- Nutrition Program, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Biomedical Science Program, School of Diagnostic and Applied Health Sciences, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Drain J, Billing D, Neesham-Smith D, Aisbett B. Predicting physiological capacity of human load carriage - a review. APPLIED ERGONOMICS 2016; 52:85-94. [PMID: 26360198 DOI: 10.1016/j.apergo.2015.07.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 06/07/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
This review article aims to evaluate a proposed maximum acceptable work duration model for load carriage tasks. It is contended that this concept has particular relevance to physically demanding occupations such as military and firefighting. Personnel in these occupations are often required to perform very physically demanding tasks, over varying time periods, often involving load carriage. Previous research has investigated concepts related to physiological workload limits in occupational settings (e.g. industrial). Evidence suggests however, that existing (unloaded) workload guidelines are not appropriate for load carriage tasks. The utility of this model warrants further work to enable prediction of load carriage durations across a range of functional workloads for physically demanding occupations. If the maximum duration for which personnel can physiologically sustain a load carriage task could be accurately predicted, commanders and supervisors could better plan for and manage tasks to ensure operational imperatives were met whilst minimising health risks for their workers.
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Affiliation(s)
- Jace Drain
- Land Division, Defence Science and Technology Organisation, 506 Lorimer Street, Fishermans Bend, 3207, Australia.
| | - Daniel Billing
- Land Division, Defence Science and Technology Organisation, 506 Lorimer Street, Fishermans Bend, 3207, Australia
| | - Daniel Neesham-Smith
- Centre for Exercise and Sports Science, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia
| | - Brad Aisbett
- Centre for Exercise and Sports Science, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia
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Glenn JM, Gray M, Wethington LN, Stone MS, Stewart RW, Moyen NE. Acute citrulline malate supplementation improves upper- and lower-body submaximal weightlifting exercise performance in resistance-trained females. Eur J Nutr 2015; 56:775-784. [DOI: 10.1007/s00394-015-1124-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/29/2015] [Indexed: 02/07/2023]
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Stölting MNL, Hefermehl LJ, Tremp M, Azzabi F, Sulser T, Eberli D. The role of donor age and gender in the success of human muscle precursor cell transplantation. J Tissue Eng Regen Med 2014; 11:447-458. [PMID: 25052735 DOI: 10.1002/term.1935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 02/14/2014] [Accepted: 05/21/2014] [Indexed: 11/09/2022]
Abstract
Autologous cell transplantation for the treatment of muscle damage is envisioned to involve the application of muscle precursor cells (MPCs) isolated from adult skeletal muscle. At the onset of trauma, these cells are recruited to proliferate and rebuild injured muscle fibres. However, a variety of donor-specific cues may directly influence the yield and quality of cells isolated from a muscle biopsy. In this study, we isolated human MPCs and assessed the role of donor gender and age on the ability of these MPCs to form functional bioengineered muscle. We analysed the cell yield, growth and molecular expression in vitro, and the muscle tissue formation and contractility of the bioengineered muscle, from cells isolated from men and women in three different age groups: young (20-39 years), adult (40-59 years) and elderly (60-80 years). Our results suggest that human MPCs can be successfully isolated and grown from patients of all ages and both genders. However, young female donors provide fast-growing cells in vitro with an optimum contractile output in vivo and are therefore an ideal cell source for muscle reconstruction. Taken together, these findings describe the donor-related limitations of MPC transplantation and provide insights for a straightforward and unbiased clinical application of these cells for muscle reconstruction. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Meline N L Stölting
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
| | - Lukas J Hefermehl
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
| | - Mathias Tremp
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
| | - Fahd Azzabi
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
| | - Tullio Sulser
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
| | - Daniel Eberli
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Division of Urology, University of Zurich, Switzerland
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Coban YK. Rhabdomyolysis, compartment syndrome and thermal injury. World J Crit Care Med 2014; 3:1-7. [PMID: 24834396 PMCID: PMC4021149 DOI: 10.5492/wjccm.v3.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/24/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
Rhabdomyolysis (RML) after electrical burns and crush injuries is a well-known clinical entity, but its occurrence following thermal injury has not gained so much attention. Capillary leak syndrome and following polycompartmental syndrome are devastating end results of major thermal injuries. In the current review, polycompartment syndrome within the clinical picture of systemic oedema and its relationship to RML is discussed along with its management and prevention.
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Genetic variations in the androgen receptor are associated with steroid concentrations and anthropometrics but not with muscle mass in healthy young men. PLoS One 2014; 9:e86235. [PMID: 24465978 PMCID: PMC3900506 DOI: 10.1371/journal.pone.0086235] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/10/2013] [Indexed: 12/20/2022] Open
Abstract
Objective The relationship between serum testosterone (T) levels, muscle mass and muscle force in eugonadal men is incompletely understood. As polymorphisms in the androgen receptor (AR) gene cause differences in androgen sensitivity, no straightforward correlation can be observed between the interindividual variation in T levels and different phenotypes. Therefore, we aim to investigate the relationship between genetic variations in the AR, circulating androgens and muscle mass and function in young healthy male siblings. Design 677 men (25–45 years) were recruited in a cross-sectional, population-based sibling pair study. Methods Relations between genetic variation in the AR gene (CAGn, GGNn, SNPs), sex steroid levels (by LC-MS/MS), body composition (by DXA), muscle cross-sectional area (CSA) (by pQCT), muscle force (isokinetic peak torque, grip strength) and anthropometrics were studied using linear mixed-effect modelling. Results Muscle mass and force were highly heritable and related to age, physical activity, body composition and anthropometrics. Total T (TT) and free T (FT) levels were positively related to muscle CSA, whereas estradiol (E2) and free E2 (FE2) concentrations were negatively associated with muscle force. Subjects with longer CAG repeat length had higher circulating TT, FT, and higher E2 and FE2 concentrations. Weak associations with TT and FT were found for the rs5965433 and rs5919392 SNP in the AR, whereas no association between GGN repeat polymorphism and T concentrations were found. Arm span and 2D:4D finger length ratio were inversely associated, whereas muscle mass and force were not associated with the number of CAG repeats. Conclusions Age, physical activity, body composition, sex steroid levels and anthropometrics are determinants of muscle mass and function in young men. Although the number of CAG repeats of the AR are related to sex steroid levels and anthropometrics, we have no evidence that these variations in the AR gene also affect muscle mass or function.
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Muscle strength and its relationship with skeletal muscle mass indices as determined by segmental bio-impedance analysis. Eur J Appl Physiol 2013; 114:177-85. [PMID: 24178819 DOI: 10.1007/s00421-013-2764-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/24/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Despite increasing interest in bio-impedance analysis (BIA) for estimation of segmental skeletal muscle mass (SMM), published results have not been entirely convincing. Furthermore, a better understanding of the relationship between muscle strength and SMM will be useful in interpreting outcomes of physical/training interventions particularly in groups with diverse body sizes (e.g. men vs women). This study aimed to measure SMM in the upper body (upper extremity and torso), to determine its correlation with muscle strength and to examine the effects of gender on muscle strength-muscle mass relationship. METHODS Segmental (upper extremity and torso) SMM and muscle strength in five distinct shoulder planes (forward flexion, abduction in scapular plane, abduction in coronal plane, internal and external rotation) were measured in 45 healthy participants (22 males, 23 females) with mean age 30.3 years. Statistical analysis included independent t tests, Pearson correlation, and multiple regression analysis. RESULTS Men and women differed significantly in body mass (BMI: 25.9 ± 4.3 vs 23 ± 3.6) and SMM (p < 0.01). A strong relationship correlation was found between the five shoulder strength measurements and upper extremity SMM (r = 0.66-0.80, p < 0.01), which was not affected by gender. There was a significant gender difference (p < 0.01) in absolute shoulder strength, but not after normalisation to the SMM. CONCLUSION BIA-estimated SMM of upper extremity and torso was highly correlated with upper extremity (shoulder) strength independent of gender. SMM may, therefore, be useful for the normalisation of muscle strength allowing size-independent comparisons of muscle strength in individuals with diverse physical characteristics.
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Kilgour AH, Firth C, Harrison R, Moss P, Bastin ME, Wardlaw JM, Deary IJ, Starr JM. Seropositivity for CMV and IL-6 levels are associated with grip strength and muscle size in the elderly. IMMUNITY & AGEING 2013; 10:33. [PMID: 23938060 PMCID: PMC3765201 DOI: 10.1186/1742-4933-10-33] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 08/12/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sarcopenia is an important cause of morbidity and mortality in older adults, with immunosenescence and inflammation being possible underlying mechanisms. We investigated the relationship between latent cytomegalovirus (CMV) infection, Interleukin 6 (IL-6) levels, muscle size and strength in a group of healthy older community-dwelling people. METHODS Participants were healthy volunteers from the Lothian Birth Cohort 1936 study. Participants had IL-6 level and CMV antibody titre measured at age 70 years and grip strength and a volumetric T1-weighted MRI brain scan (allowing measurement of neck muscle cross-sectional area (CSA)) at age 73. Markers of childhood deprivation were adjusted for in the analysis due to correlations between childhood deprivation and latent CMV infection. RESULTS 866 participants were studied; 448 men (mean age 72.48 years, sd 0.70) and 418 women (mean age 72.51 years, sd 0.72). In men, CMV seropositivity was associated with smaller neck muscle CSA (p = 0.03, partial eta squared = 0.01), even after adjustment for IL-6 levels. Neck muscle CSA was not associated with CMV seropositivity in women, or CMV antibody titre or IL-6 level in either sex. Grip strength associated negatively with IL-6 level (right grip strength p<0.00001, partial eta squared 0.032 and left grip strength p<0.00001, partial eta squared 0.027) with or without adjustment for CMV serostatus or antibody titre. CMV status and antibody titre were not significantly associated with grip strength in either hand. CONCLUSION These findings support the hypothesis that there is a relationship between markers of immunosenescence (i.e. CMV serostatus and IL6 level) and low muscle mass and strength and longitudinal studies in older cohorts are now required to investigate these relationships further.
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Affiliation(s)
- Alixe Hm Kilgour
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK.
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Kilgour AHM, Subedi D, Gray CD, Deary IJ, Lawrie SM, Wardlaw JM, Starr JM. Design and validation of a novel method to measure cross-sectional area of neck muscles included during routine MR brain volume imaging. PLoS One 2012; 7:e34444. [PMID: 22509305 PMCID: PMC3317946 DOI: 10.1371/journal.pone.0034444] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 03/05/2012] [Indexed: 12/25/2022] Open
Abstract
Introduction Low muscle mass secondary to disease and ageing is an important cause of excess mortality and morbidity. Many studies include a MR brain scan but no peripheral measure of muscle mass. We developed a technique to measure posterior neck muscle cross-sectional area (CSA) on volumetric MR brain scans enabling brain and muscle size to be measured simultaneously. Methods We performed four studies to develop and test: feasibility, inter-rater reliability, repeatability and external validity. We used T1-weighted MR brain imaging from young and older subjects, obtained on different scanners, and collected mid-thigh MR data. Results After developing the technique and demonstrating feasibility, we tested it for inter-rater reliability in 40 subjects. Intraclass correlation coefficients (ICC) between raters were 0.99 (95% confidence intervals (CI) 0.98–1.00) for the combined group (trapezius, splenius and semispinalis), 0.92 (CI 0.85–0.96) for obliquus and 0.92 (CI 0.85–0.96) for sternocleidomastoid. The first unrotated principal component explained 72.2% of total neck muscle CSA variance and correlated positively with both right (r = 0.52, p = .001) and left (r = 0.50, p = .002) grip strength. The 14 subjects in the repeatability study had had two MR brain scans on three different scanners. The ICC for between scanner variation for total neck muscle CSA was high at 0.94 (CI 0.86–0.98). The ICCs for within scanner variations were also high, with values of 0.95 (CI 0.86–0.98), 0.97 (CI 0.92–0.99) and 0.96 (CI 0.86–0.99) for the three scanners. The external validity study found a correlation coefficient for total thigh CSA and total neck CSA of 0.88. Discussion We present a feasible, valid and reliable method for measuring neck muscle CSA on T1-weighted MR brain scans. Larger studies are needed to validate and apply our technique with subjects differing in age, ethnicity and geographical location.
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Affiliation(s)
- Alixe H M Kilgour
- Geriatric Medicine Unit, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.
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Scafoglieri A, Tresignie J, Provyn S, Marfell-Jones M, Reilly T, Bautmans I, Clarys JP. Prediction of segmental lean mass using anthropometric variables in young adults. J Sports Sci 2012; 30:777-85. [DOI: 10.1080/02640414.2012.670716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Zhong K, Lei SF, Yang F, Chen XD, Tan LJ, Zhu XZ, Tian Q, Deng HW. The differences of sarcopenia-related phenotypes: effects of gender and population. Eur Rev Aging Phys Act 2011. [DOI: 10.1007/s11556-011-0082-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Sarcopenia is a serious condition especially in the elderly population mainly characterized by the loss of skeletal muscle mass and strength with aging. Extremity skeletal muscle mass index (EMMI) (sum of skeletal muscle mass in arms and legs/height2) is gaining popularity in sarcopenia definition (less than two standard deviations below the mean of a young adult reference group), but little is known about the gender- and population-specific differences of EMMI. This study aimed at investigating the differences of EMMI, arm muscle mass index (AMMI), and leg muscle mass index (LMMI) between gender groups and populations (Chinese vs. Caucasians). The participants included 1,809 Chinese and 362 Caucasians with normal weight aged from 19 to 45 years old. Extremity muscle mass, arm muscle mass, and leg muscle mass were measured by using dual energy x-ray absorptiometry. Independent sample t tests were used to analyze the differences in muscle mass indexes between the studied groups. All the study parameters including EMMIs, AMMIs, and LMMIs were significantly higher (P ≤ 0.0003) in the Caucasian group than in the Chinese group and also higher in the male group than in the female group, and these significant differences (P ≤ 0.0005) remained after adjusting for age by simple regressions. The detected differences of muscle mass indexes between different gender and ethnic groups may provide important implications in their different risk of future sarcopenia.
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Ridgway CL, Sharp SJ, Derom C, Beunen G, Fagard R, Vlietinck R, Ekelund U, Loos RJF. The contribution of prenatal environment and genetic factors to the association between birth weight and adult grip strength. PLoS One 2011; 6:e17955. [PMID: 21423582 PMCID: PMC3058058 DOI: 10.1371/journal.pone.0017955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/18/2011] [Indexed: 11/29/2022] Open
Abstract
Low birth weight has been associated with reduced hand grip strength, which is a marker of future physical function and disease risk. The aim of this study was to apply a twin pair approach, using both ‘individual’ data and ‘within-pair’ differences, to investigate the influence of birth weight on hand grip strength and whether this association may be mediated through fat free mass (FFM). Participants from the East Flanders Prospective Twin Survey were included if born without congenital abnormalities, birth weight >500 g and ≥22 weeks of gestation. Follow up in adulthood (age: 18–34 year), included anthropometric measures and hand grip (n = 783 individuals, n = 326 same-sex twin pairs). Birth weight was positively associated with hand grip strength (β = 2.60 kg, 95% CI 1.52, 3.67, p<0.001) and FFM (β = 4.2, 95% CI 3.16, 5.24, p<0.001), adjusted for gestational age, sex and adult age. Using ‘within-pair’ analyses, the birth weight hand grip association was significant in DZ men only (β = 5.82, 95% CI 0.67, 10.97, p = 0.028), which was attenuated following adjustment for FFM. Within-pair birth weight FFM associations were most pronounced in DZ men (β = 11.20, 95% CI 7.18, 15.22, p<0.001). Our ‘individual’ analyses show that higher birth weight is associated with greater adult hand grip strength, which is mediated through greater adult FFM. The ‘within-pair’ analyses confirm this observation and furthermore show that, particularly in men, genetic factors may in part explain this association, as birth weight differences in DZ men result in greater differences in adult strength and FFM.
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Affiliation(s)
- Charlotte L Ridgway
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, United Kingdom.
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Silva AM, Shen W, Heo M, Gallagher D, Wang Z, Sardinha LB, Heymsfield SB. Ethnicity-related skeletal muscle differences across the lifespan. Am J Hum Biol 2010; 22:76-82. [PMID: 19533617 DOI: 10.1002/ajhb.20956] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Despite research and clinical significance, limited information is available on the relations between skeletal muscle (SM) and age in adults, specifically among Hispanics, African Americans (AA), and Asians. The aim was to investigate possible sex and ethnic SM differences in adults over an age range of 60 years. Subjects were 468 male and 1280 female adults (> or =18 years). SM was estimated based on DXA-measured appendicular lean-soft tissue using a previously reported prediction equation. Locally weighted regression smoothing lines were fit to examine SM trends and to localize age cutoffs; piecewise multiple linear regression models were then applied, controlling for weight and height, to identify age cutoffs for sex-specific changes in SM among the ethnic groups. The age of 27 years was identified for women and men as the cut-off after which SM starts to show a negative association with age. Both sexes had a similar ethnic pattern for expected mean SM at the age cutoff, with AA presenting the highest SM values, followed by Whites, Hispanics, and Asians. After the age cutoffs, the lowering of SM differed by ethnicity and sex: AA women showed the greatest SM lowering whereas Hispanic women had the least. Hispanic men tended to show a higher negative association of SM with age followed by AA and Whites. To conclude, significant sex and ethnic differences exist in the magnitude of negative associations of SM with age >27 years. Further studies using a longitudinal design are needed to explore the associations of ethnicity-related decline of SM with health risks.
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Aleman Mateo H, Lee SY, Javed F, Thornton J, Heymsfield SB, Pierson RN, Pi Sunyer FX, Wang ZM, Wang J, Gallagher D. Elderly Mexicans have less muscle and greater total and truncal fat compared to African-Americans and Caucasians with the same BMI. J Nutr Health Aging 2009; 13:919-23. [PMID: 19924354 PMCID: PMC2819676 DOI: 10.1007/s12603-009-0252-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND How body composition, specifically skeletal muscle mass, compares in Mexican elderly to other ethnic groups has not previously been reported. We tested the hypothesis that older adults from Northwest Mexico (Mex) would have similar total appendicular skeletal muscle (TASM) compared with New York dwelling Caucasians (Cauc) and African-Americans (AA). METHODS Two hundred and eighty nine Mex (135 males and 154 females), 166 AA (36 males and 130 females) and 229 Cauc (64 males and 165 females), aged 60-98 years were assessed. Total and regional fat and lean tissues were measured by whole-body dual energy X-ray absorptiometry where TASM is the sum of arm and leg bone-free and fat-free lean tissue. Differences in TASM were tested by ANCOVA, with age, height, and body mass index (BMI) as covariates. RESULTS TASM adjusted for ethnicity, age, height and BMI, were 22.6 +/- 0.2 kg and 17.8 +/- 0.1 kg for males and females, respectively (p < 0.001). Among males with similar age, height, and BMI, Mex had less TASM compared with AA and Cauc (p < 0.001). Total body fat and truncal fat were higher (p < 0.001) and FFM lower (p < 0.001) in Mex compared to both AA and Cauc males after adjusting for age and BMI. Among females, Mex had higher total and truncal fat (p < 0.001) after adjusting for age and BMI, and significantly lower TASM (p < 0.001) after adjusting for age, height, and BMI compared to AA and Cauc females. CONCLUSIONS Elderly Mex have a different body composition compared with AA and Cauc of a similar BMI and age. Mex have significantly less TASM with greater total and truncal fat. In the long-term, Mex elderly may be at greater risk for sarcopenic obesity compared to other ethnic groups.
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Affiliation(s)
- H Aleman Mateo
- Departamento de Nutrición y Metabolismo, Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Sonora, México
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Aleman-Mateo H, Lee SY, Javed F, Thornton J, Heymsfield SB, Pierson RN, Pi-Sunyer FX, Wang ZM, Wang J, Gallagher D. Elderly Mexicans have less muscle and greater total and truncal fat compared to African-Americans and Caucasians with the same BMI. J Nutr Health Aging 2009. [DOI: 10.1007/s12603-009-0114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Halet KA, Mayhew JL, Murphy C, Fanthorpe J. Relationship of 1 repetition maximum lat-pull to pull-up and lat-pull repetitions in elite collegiate women swimmers. J Strength Cond Res 2009; 23:1496-502. [PMID: 19620915 DOI: 10.1519/jsc.0b013e3181b338ec] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purposes of this study were to determine the relationships among pull-ups, lat-pull repetitions, and 1 repetition maximum (1RM) lat-pull in elite women swimmers and to assess the effect of various anthropometric dimensions on each exercise. Women members (n = 28) of an elite National Collegiate Athletic Association (NCAA) Division II swim team were measured for their ability to perform a maximum number of free-hanging pull-ups, 1RM lat-pull, and lat-pull repetitions at 80% of 1RM. Anthropometric dimensions included selected arm lengths, percent body fat (%fat), and lean body mass (LBM) estimated from skinfold measurements. The correlations of 1RM lat-pull with body mass (r = 0.38, p = 0.04) and LBM (r = 0.41, p = 0.03) were significant, whereas that with %fat (r = 0.13, p = 0.49) was not. The same variables had a significant negative pattern with pull-ups (r = -0.48, -0.43, -0.32, respectively). Pull-ups were moderately correlated with 1RM lat-pull (r = 0.34, p = 0.08) but not with lat-pull repetitions (r = 0.07, p = 0.73). The product of pull-ups times body mass (PU x BM) was a better predictor of 1RM lat-pull (r = 0.86, standard errors of estimate [SEEs] = 4.4 kg) than either measurement alone. The addition of %fat to PU x BM in a stepwise regression analysis raised the correlation (R = 0.90) and reduced the SEE (3.9 kg) only slightly. Addition of arm or forearm lengths failed to increase the multiple R significantly. These results confirmed that the seemingly analogous exercises of pull-ups and lat-pulls were not highly related and should not be substituted for one another in a training regimen.
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Affiliation(s)
- Kristin A Halet
- Human Performance Laboratory, Truman State University, Kirksville, Missouri 63501, USA
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Tanimoto Y, Watanabe M, Higuchi Y, Hirota C, Kono K. [Evaluation of the best indicator of muscle mass in community-dwelling elderly persons]. Nihon Ronen Igakkai Zasshi 2008; 45:213-9. [PMID: 18441496 DOI: 10.3143/geriatrics.45.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The purpose of this study was to determine the best way to indicate muscle mass of community-dwelling elderly men and women. METHODS We recruited 398 elderly men and women (age range, 61-96, years) who use a community center and live in a metropolitan suburb. We measured appendicular and whole body muscle mass by using bioelectrical impedance analysis and analyzed our results in relation to indicators of physical function. We assessed muscle mass with no adjustment, adjustment by body mass, and adjustment by body height. RESULTS In men, appendicular muscle mass adjusted by body mass correlated significantly with 10-m obstacle walking time, and whole body muscle mass adjusted by body mass correlated significantly with all indicators physical function except five chair stands and maximum walking speed. In women, appendicular and whole body muscle mass adjusted by body mass correlated significantly with all indicators of physical function. However, appendicular and whole body muscle mass adjusted by body height were unrelated to indicators of physical function. CONCLUSIONS Only whole body muscle mass adjusted by body mass was related to physical function in both men and women. This finding suggests that whole body muscle mass adjusted by body mass is the best indicator of muscle mass in community-dwelling elderly persons.
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Assessment of calf muscle contraction by diffusion tensor imaging. Eur Radiol 2008; 18:2303-10. [DOI: 10.1007/s00330-008-1012-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 03/26/2008] [Accepted: 03/30/2008] [Indexed: 12/25/2022]
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Anders C, Brose G, Hofmann GO, Scholle HC. Gender specific activation patterns of trunk muscles during whole body tilt. Eur J Appl Physiol 2007; 101:195-205. [PMID: 17522886 DOI: 10.1007/s00421-007-0490-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2007] [Indexed: 12/25/2022]
Abstract
Gender specific differences as evidenced in both anthropometric data and physical performance of healthy persons have been broadly demonstrated. Recently advancements in surface electromyography (SEMG) have shown possible differences in men's and women's muscle coordination patterns. However, quantitative information about gender related muscle co-ordination patterns are rare. This investigation was carried out to both verify if trunk muscle SEMG amplitude-force relationship differs between men and women and refine techniques of measurement and data analysis using SEMG. Thirty-one healthy volunteers (16 women, 15 men) were investigated during whole body tilt at angles from 5 degrees to 90 degrees (from quasi vertical to horizontal position). Subjects had to maintain body in body axis while their lower body was fixed and the upper body remained unsupported. SEMG was taken from five different trunk muscles of both sides simultaneously. At corresponding tilt angles women exhibited higher amplitude levels of their abdominal muscles in comparison to men, who were characterized by higher back muscle amplitudes. Abdominal muscles showed a non-linear SEMG amplitude-force relationship but differed between genders with more linearity in women. Back muscles showed a linear amplitude-force relationship with no differences between genders. Women were characterized by higher levels of co-contraction of all investigated muscles. The data are in accordance with histological investigations, which already proved specific fiber distribution patterns in both abdominal and back muscles and gender related differences in relative area of Type 1 fibers of back muscles. The observed differences in SEMG-force relationship for the abdominal muscles remain hypothetical because of lack of histological information.
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Affiliation(s)
- Christoph Anders
- Clinic for Trauma-, Hand- and Reconstructive Surgery, Division for Motor Research, Pathophysiology and Biomechanics, Friedrich Schiller University Jena, 07740, Jena, Germany.
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Alfaro-Acha A, Al Snih S, Raji MA, Kuo YF, Markides KS, Ottenbacher KJ. Handgrip strength and cognitive decline in older Mexican Americans. J Gerontol A Biol Sci Med Sci 2006; 61:859-65. [PMID: 16912105 PMCID: PMC1635471 DOI: 10.1093/gerona/61.8.859] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive decline and dementia are associated with disability and premature death in old age. We examined whether low handgrip strength predicts subsequent cognitive decline in older Mexican Americans. METHODS We worked with a 7-year prospective cohort of 2160 noninstitutionalized Mexican Americans aged 65 years or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) who had a Mini-Mental State Examination (MMSE) score > or = 21 at baseline. Measures included: (i) sociodemographic factors (age, gender, and education), handgrip strength, and near and distant visual impairment from baseline interview; and (ii) MMSE, body mass index (BMI), and medical conditions (stroke, heart attack, diabetes, depression, and hypertension) from four waves of data collection. RESULTS Using general linear mixed models, we found a significant trend with scores in the lowest quartile of handgrip strength at baseline to be associated with lower MMSE scores over time (estimate = -1.28, standard error = 0.16; p <.0001). There was a significant handgrip Strength-by-Time interaction with MMSE scores. Participants in the lowest handgrip strength quartile had a greater cognitive decline over time (estimate = -0.26, standard error = 0.07; p <.001) than did those participants in the highest quartile. This association remained statistically significant after controlling for potential confounding factors. CONCLUSION Older Mexican Americans with reduced handgrip strength at baseline demonstrated a statistically significant decline in cognitive function over a 7-year period. By contrast, participants in the highest handgrip strength quartile maintained a higher level of cognitive function.
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Affiliation(s)
- Ana Alfaro-Acha
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX 77555-0460, USA
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Wielopolski L, Ramirez LM, Gallagher D, Sarkar SR, Zhu F, Kaysen GA, Levin NW, Heymsfield SB, Wang ZM. Measuring partial body potassium in the arm versus total body potassium. J Appl Physiol (1985) 2006; 101:945-9. [PMID: 16741259 PMCID: PMC1850529 DOI: 10.1152/japplphysiol.00999.2005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Skeletal muscle (SM), the body's main structural support, has been implicated in metabolic, physiological, and disease processes in humans. Despite being the largest tissue in the human body, its assessment remains difficult and indirect. However, being metabolically active it contains over 50% of the total body potassium (TBK) pool. We present our preliminary results from a new system for measuring partial body K (PBK) that presently are limited to the arm yet provide a direct and specific measure of the SM. This uniquely specific quantification of the SM mass in the arm, which is shielded from the body during measurement, allows us to simplify the assumptions used in deriving the total SM, thereby possibly improving the modeling of the human body compartments. Preliminary results show that PBK measurements are consistent with those from the TBK previously obtained from the same subjects, thus offering a simpler alternative to computed tomography and magnetic resonance imaging used for the same purposes. The PBK system, which can be set up in a physician's office or bedside in a hospital, is completely passive, safe, and inexpensive; it can be used on immobilized patients, children, pregnant women, or other at-risk populations.
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Affiliation(s)
- L Wielopolski
- Brookhaven National Laboratory, Medical Department, Upton, NY 11973, USA.
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Al Snih S, Raji MA, Peek MK, Ottenbacher KJ. Pain, lower-extremity muscle strength, and physical function among older Mexican Americans. Arch Phys Med Rehabil 2005; 86:1394-400. [PMID: 16003670 DOI: 10.1016/j.apmr.2004.12.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the relation between pain on weight bearing, lower-extremity muscle strength, and physical function among older Mexican Americans. DESIGN Cross-sectional study. SETTING Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS A population-based sample of 544 noninstitutionalized Mexican-American men and women age 71 years and older. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain on weight bearing, lower-extremity muscle strength, and physical function. RESULTS Of the 544 subjects, 244 (44.9%) reported pain on weight bearing. Mean muscle strength in men ranged from 9.3 kg for knee extension, 12.8 kg for hip flexion, to 13.0 kg for hip abduction. In women, mean strength ranged from 6.6 kg for knee extension, 9.5 kg for hip flexion, to 8.6 kg for hip abduction. Mean of physical function score was 70.7 for men and 60.6 for women. Pain on weight bearing was negatively associated with summary lower-extremity muscle strength only in women (-.05, P < .001) after controlling for all covariates. Pain on weight bearing was negatively associated with physical function in both men (-15.33, P < .001) and women (-11.03, P < .001), and lower-extremity muscle strength was positively associated with physical function in both men (37.77, P < .001) and women (73.50, P < .001), after controlling for all covariates. CONCLUSIONS Among older Mexican Americans, the presence of pain was associated with decreased muscle strength in women and decreased physical function in both men and women. High muscle strength was associated with high physical function in both men and women.
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Affiliation(s)
- Soham Al Snih
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.
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Obisesan TO, Aliyu MH, Bond V, Adams RG, Akomolafe A, Rotimi CN. Ethnic and age-related fat free mass loss in older Americans: the Third National Health and Nutrition Examination Survey (NHANES III). BMC Public Health 2005; 5:41. [PMID: 15840167 PMCID: PMC1097739 DOI: 10.1186/1471-2458-5-41] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2004] [Accepted: 04/19/2005] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although age-related loss of fat free mass (FFM) is well known, there is paucity of data on national estimates, and on the differential influence of ethnicity on the decline in FFM with increasing age. We determined whether age-related loss in FFM and fat free mass index (FFMI) vary by gender and or ethnicity, using representative data from the Third National Health and Nutrition Examination Survey (NHANES III). METHODS Analyses were limited to 5,803 non-institutionalized, non-Hispanic Whites and African Americans (Blacks) over the age of 40 years. Body density was calculated from the sum of 3-skinfolds, and percent body fat estimated from body density. FFM was estimated by subtracting body fat from body weight, while FFMI was defined as FFM (kilograms) divided by the square of body height (meter2). RESULTS Overall FFM and FFMI were significantly higher in black women than white women (P = 0.001; P = 0.001 respectively), but similar in black men compared to white men. Age-related decline in FFM reached significance level earlier in black men (at age 65-69) than white men (at age 70-74), and in black women (at age 70-74) than white women (at age 75-79). Similar decline in FFMI was noted in men and in women. In multivariate analyses, FFM significantly associated with ethnicity (p = 0.012) and with age (p < 0.001) in women, but only with age (p < 0.001) in men. In men and in women, FFMI significantly associated with ethnicity (p < 0.001; p = 0.003 respectively) and with age (p < 0.001; p = 0.004 respectively). CONCLUSION Age-related loss and decline in FFM and FFMI in older Americans is higher for black men and women, than for white men and women. The development of focused population-based preventive strategies is likely to improve functional independence in the aged.
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Affiliation(s)
- Thomas O Obisesan
- Section of Geriatrics, Department of Medicine, Howard University Hospital, Washington DC, USA
| | - Muktar H Aliyu
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vernon Bond
- Department of Physical Education, Howard University Washington DC, USA
| | - Richard G Adams
- Pulmonary and Critical Care, Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | | | - Charles N Rotimi
- National Human Genome Center, Genetic Epidemiology Unit, Department of Microbiology, Howard University, Washington DC, USA
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Al Snih S, Markides KS, Ottenbacher KJ, Raji MA. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res 2004; 16:481-6. [PMID: 15739601 DOI: 10.1007/bf03327406] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Little is known about muscle strength as a predictor of disability among older Mexican Americans. The aim of this study was to examine the association between hand grip strength and 7-year incidence of ADL disability in older Mexican American men and women. METHODS A 7-year prospective cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states. Maximal hand grip strength test, body mass index, cognitive function, activities of daily living, self-reports of medical conditions (arthritis, diabetes, heart attack, stroke, cancer, hip fracture), and depressive symptoms were obtained. RESULTS In a Cox proportional regression analysis, there was a linear relationship between hand grip strength at baseline and risk of incident ADL disability over a 7-year follow-up. Among non-disabled men at baseline, the hazard ratio of any new ADL limitation was 1.90 (95% CI 1.14-3.17) for those in the lowest quartile, when compared with men in the highest hand grip strength quartile, after controlling for age, marital status, medical conditions, high depressive symptoms, MMSE score, and BMI at baseline. Among non-disabled women at baseline, the hazard ratio of any new ADL limitation was 2.28 (95% CI 1.59-3.27) for those in the lowest quartile, when compared with women in the highest hand grip strength quartile. CONCLUSIONS Hand grip strength is an independent predictor of ADL disability among older Mexican American men and women. The hand grip strength test is an easy, reliable, valid, inexpensive method of screening to identify older adults at risk of disability.
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Affiliation(s)
- Soham Al Snih
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.
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Al Snih S, Markides KS, Ray L, Ostir GV, Goodwin JS. Handgrip strength and mortality in older Mexican Americans. J Am Geriatr Soc 2002; 50:1250-6. [PMID: 12133020 DOI: 10.1046/j.1532-5415.2002.50312.x] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the association between handgrip strength and mortality in older Mexican American men and women. DESIGN A 5-year prospective cohort study. SETTING Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS A population-based sample of 2,488 noninstitutionalized Mexican-American men and women aged 65 and older. MEASUREMENTS Maximal handgrip strength, timed walk, and body mass index were assessed at baseline during 1993/94. Self-reports of functional disability, various medical conditions, and status at follow-up were obtained. RESULTS Of the baseline sample with complete data, 507 persons were confirmed deceased 5 years later. Average handgrip strength +/- standard deviation was significantly higher in men (28.4 kg +/- 9.5) than in women (18.2g +/- 6.5). Of men who had a handgrip strength less than 22.01 kg and women who had a handgrip strength less than 14 kg, 38.2% and 41.5%, respectively, were dead 5 years later. In men in the lowest handgrip strength quartile, the hazard ratio of death was 2.10 (95% confidence interval (CI) = 1.31-3.38) compared with those in the highest handgrip strength quartile, after controlling for sociodemographic variables, functional disability, timed walk, medical conditions, body mass index, and smoking status at baseline. In women in the lowest handgrip strength quartile, the hazard ratio of death was 1.76 (95%I = 1.05-2.93) compared with those in the highest handgrip strength quartile. Poorer performance in the timed walk and the presence of diabetes mellitus, hypertension, and cancer were also significant predictors of mortality 5 years later. CONCLUSION Handgrip strength is a strong predictor of mortality in older Mexican Americans, after controlling for relevant risk factors.
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Affiliation(s)
- Soham Al Snih
- Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Nindl BC, Scoville CR, Sheehan KM, Leone CD, Mello RP. Gender differences in regional body composition and somatotrophic influences of IGF-I and leptin. J Appl Physiol (1985) 2002; 92:1611-8. [PMID: 11896028 DOI: 10.1152/japplphysiol.00892.2001] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study evaluated the arm, trunk, and leg for fat mass, lean soft tissue mass, and bone mineral content (BMC) assessed via dual-energy X-ray absorptiometry in a group of age-matched (approximately 29 yr) men (n = 57) and women (n = 63) and determined their relationship to insulin-like growth factor I (IGF-I) and leptin. After analysis of covariance adjustment to control for differences in body mass between genders, the differences that persisted (P < or = 0.05) were for lean soft tissue mass of the arm (men: 7.1 kg vs. women: 6.4 kg) and fat mass of the leg (men: 5.3 kg vs. women: 6.8 kg). Men and women had similar (P > or = 0.05) values for fat mass of the arms and trunk and lean soft tissue mass of the legs and trunk. Serum IGF-I and insulin-like growth factor binding protein-3 correlated (P < or = 0.05) with all measures of BMC (r values ranged from 0.31 to 0.39) and some measures of lean soft tissue mass for women (r = 0.30) but not men. Leptin correlated (P < or = 0.05) similarly for measures of fat mass for both genders (r values ranging from 0.74 to 0.85) and for lean soft tissue mass of the trunk (r = 0.40) and total body (r = 0.32) for men and for the arms in women (r = 0.56). These data demonstrate that 1) the main phenotypic gender differences in body composition are that men have more of their muscle mass in their arms and women have more of their fat mass in their legs and 2) gender differences exist in the relationship between somatotrophic hormones and lean soft tissue mass.
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Affiliation(s)
- Bradley C Nindl
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts 01760, USA.
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Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985) 2000; 89:81-8. [PMID: 10904038 DOI: 10.1152/jappl.2000.89.1.81] [Citation(s) in RCA: 1742] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We employed a whole body magnetic resonance imaging protocol to examine the influence of age, gender, body weight, and height on skeletal muscle (SM) mass and distribution in a large and heterogeneous sample of 468 men and women. Men had significantly (P < 0.001) more SM in comparison to women in both absolute terms (33.0 vs. 21.0 kg) and relative to body mass (38.4 vs. 30.6%). The gender differences were greater in the upper (40%) than lower (33%) body (P < 0.01). We observed a reduction in relative SM mass starting in the third decade; however, a noticeable decrease in absolute SM mass was not observed until the end of the fifth decade. This decrease was primarily attributed to a decrease in lower body SM. Weight and height explained approximately 50% of the variance in SM mass in men and women. Although a linear relationship existed between SM and height, the relationship between SM and body weight was curvilinear because the contribution of SM to weight gain decreased with increasing body weight. These findings indicate that men have more SM than women and that these gender differences are greater in the upper body. Independent of gender, aging is associated with a decrease in SM mass that is explained, in large measure, by a decrease in lower body SM occurring after the fifth decade.
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Affiliation(s)
- I Janssen
- School of Physical and Health Education, Queen's University, Kingston, Ontario, Canada K7L 3N6
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