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Macêdo SGGF, de Souza Macêdo PR, Barbosa WS, Maciel ÁCC. Use of the Ishii Test for screening sarcopenia in older adults: a systematic review with meta-analysis of diagnostic test accuracy (DTA) studies. BMC Geriatr 2024; 24:609. [PMID: 39014328 DOI: 10.1186/s12877-024-05155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The Ishii Test is recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2), however the use of this technique is still little explored in the clinical context and the scientific literature. OBJECTIVE We aimed to verify the use of the Test of Ishii in screening for sarcopenia in older adults. METHODS We searched three electronic databases and two reviewers independently screened and assessed the studies. Studies with older adults (60 years or more) of both genders, no year or language restriction and which aimed to evaluate sarcopenia using the Ishii Test and another diagnostic criteria were selected. A summary of the ROC curve, sensitivity and specificity were performed using the MedCalc and SPSS software programs, respectively. RESULTS A total of 3,298 references were identified in the database, 278 by manually searching, and finally 11 studies were included for the review. The screening test showed good sensitivity and specificity in both genders. All studies showed values above the considered value for the Area Under the Curve (AUC) results, without discriminating power (0.500). Four studies used the original values, and five studies developed a new cut-off point. A summary of the AUC curve showed the diamond close to one, indicating that the Ishii test has good performance for screening sarcopenia (I2=83,66%; p<0.001; 95%CI: 69.38 to 91.28 for men; and I2=60.04%; p<0.001; 95%CI: 13.06 to 81.63 for women). CONCLUSION The Ishii Test can be considered a useful tool for the early identification of sarcopenia in older adults. However, further studies are still needed to understand the behavior of this screening tool. TRIAL REGISTRATION CRD42023424392.
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Affiliation(s)
- Sabrina Gabrielle Gomes Fernandes Macêdo
- Postgraduate Program in Physiotherapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, Natal, Lagoa Nova, Rio Grande do Norte, 59078-970, Brazil.
| | - Pedro Rafael de Souza Macêdo
- Postgraduate Program in Physiotherapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, Natal, Lagoa Nova, Rio Grande do Norte, 59078-970, Brazil
| | - Weslley Sales Barbosa
- Postgraduate Program in Physiotherapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, Natal, Lagoa Nova, Rio Grande do Norte, 59078-970, Brazil
| | - Álvaro Campos Cavalcanti Maciel
- Postgraduate Program in Physiotherapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, Natal, Lagoa Nova, Rio Grande do Norte, 59078-970, Brazil
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Sato R, Oikawa M, Kakita T, Okada T, Abe T, Akazawa N, Harada Y, Okano H, Ito K, Tsuchiya T. Prognostic significance of Ishii's sarcopenia screening score for patients undergoing curative surgery for obstructive colorectal cancer after intraluminal decompression. Surg Today 2024; 54:683-691. [PMID: 38091062 DOI: 10.1007/s00595-023-02774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/14/2023] [Indexed: 06/21/2024]
Abstract
PURPOSE Sarcopenia influences the short- and long-term outcomes of various medical conditions including malignancy. Ishii's screening test estimates the probability of sarcopenia based on a score calculated by three simple variables: age, grip strength, and calf circumference. We investigated the clinical significance of Ishii's score for patients with non-metastatic obstructive colorectal cancer (OCRC) who underwent curative surgery after intraluminal decompression. METHODS Ishii's score was calculated in 79 patients with OCRC. Muscle volume loss and decreased muscle quality were evaluated by computed tomography (CT) images as skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. RESULTS There were 46 men and 33 women, with a median age of 70 years old. The cutoff value for Ishii's score was 155.1 and 15 patients were in the high-score group. The high-score group was significantly associated with worse time to recurrence (TTR) and overall survival (OS), and a high Ishii's score was an independent negative prognostic factor for TTR (hazard ratio = 2.93, P = 0.015). A high Ishii's score was significantly associated with a low SMI value but not with the IMAC value. CONCLUSION A high Ishii's score was independently associated with poorer TTR in patients with non-metastatic OCRC.
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Affiliation(s)
- Ryuichiro Sato
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan.
- Department of Surgery, Japanese Red Cross Sendai Hospital, 2-43-3Yagiyama Hon-Cho, Taihaku-Ku, Sendai, 982-8501, Japan.
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Tetsuya Kakita
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Tomoya Abe
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Naoya Akazawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-Ku, Sendai, 983-0824, Japan
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Cavalheiro A, Afonso S, Silva M, Ramalhão N, Machado J, Magalhães S. Evaluation of Probable Sarcopenia's Prevalence in Hospitalized Geriatric Patients Using Ishii's Score. Cureus 2023; 15:e49158. [PMID: 38130551 PMCID: PMC10733612 DOI: 10.7759/cureus.49158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sarcopenia is defined as a progressive loss of skeletal muscle mass and strength related to age and comorbidities. Worldwide sarcopenia's prevalence varies between 10-40%, being associated with functional impairment, lower quality of life, and higher mortality. Sarcopenia can be estimated based on age, calf circumference, and handgrip strength (Ishii's formula). Early diagnosis is essential because treatment with nutritional support and rehabilitation programs can prevent complications. The aim of the study was to assess the prevalence of probable sarcopenia in hospitalized patients using Ishii's score and possible associated risk factors. METHODS We developed an observational prospective study in a medicine inpatient ward of a Central Hospital. We applied Ishii's formula to the patients admitted to the medical ward in December 2021 and January 2022. Patients should be aged 60 or above and able to collaborate with the tests. One year later, we analyzed re-hospitalization and mortality rates. Patients with edema of the lower limbs, who were not able to follow instructions, and who were admitted exclusively for symptomatic treatment were excluded. RESULTS Our final sample was 49 patients (55% males, mean age 78 ± 8.88 years). Only one patient had a previous diagnosis of sarcopenia. Estimated sarcopenia´s prevalence was 73.5% N=36), higher in men and people with three or more comorbidities. In the sarcopenic group, 77% had some degree of functional dependency and positive markers for malnutrition. After one year of follow-up, we found a higher mortality rate in the sarcopenic group (44.4% against 7.6%) and a higher number of re-hospitalizations (1.03 hospitalizations per patient, against 0.31). CONCLUSIONS Our data showed that the prevalence of probable sarcopenia is high, but this pathology is still underdiagnosed. Traditional diagnosis is complex in some hospital settings and a simple tool such as Ishii's score can help to improve diagnostic rates. We suggest screening all patients at admission to provide early rehabilitation and nutritional support.
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Affiliation(s)
- Ana Cavalheiro
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sara Afonso
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Marta Silva
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Nuno Ramalhão
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Machado
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sandra Magalhães
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Luo S, Chen X, Hou L, Yue J, Liu X, Xia X, Cao L, Dong B. Cut-off points of the Ishii test to diagnosing severe sarcopenia among multi-ethnic middle-aged to older adults: results from the West China Health and Aging Trend study. Front Med (Lausanne) 2023; 10:1176128. [PMID: 37425295 PMCID: PMC10323675 DOI: 10.3389/fmed.2023.1176128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective This study was designed to establish the cut-off value and diagnostic utility of the Ishii test, which gauges the odds of severe sarcopenia based on the results of an equation based upon age, grip strength, and calf circumference among middle-aged and older adults in Western China. Methods This study incorporated adults ≥ 50 years of age from the West China Health and Aging Trend (WCHAT) study. Severe sarcopenia was defined as per the Asian Working Group for Sarcopenia: 2019 Consensus (AWGS2019) recommendations, with the odds of severe sarcopenia being estimated with the Ishii test score chart. The diagnostic utility of the Ishii test in this patient cohort was assessed by analyzing its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve (AUC). Results In total, 4,177 individuals ≥ 50 years of age were included in this study including 2668 females (63.9%) and 1,509 males (36.1%). These included 568 (13.6%) participants affected by severe sarcopenia, of whom 237 were male (15.7%) and 331 were female (12.4%). Optimal Ishii test cut-off values established based on Youden's index were ≥ 114 for males and ≥ 120 for females when using the AWGS2019 reference standard. The sensitivity/specificity/PPV/NPV of the Ishii test when screening for severe sarcopenia were 89.45%/77.15%/0.42/0.98 in males and 90.03%/77.05%/0.36/0.98 in females. The AUC values for the Ishii test in males and females were 0.899 (95% CI, 0.883-0.916) and 0.905 (95% CI, 0.892-0.917), respectively. Conclusion These data indicate that the Ishii test offers value as a candidate diagnostic test that can be used to screen for severe sarcopenia, with recommended diagnostic cut-off values of ≥ 114 for males and ≥ 120 for females.
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Affiliation(s)
- Shuyue Luo
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyan Chen
- Zigong Psychiatric Research Center, Zigong Affiliated Hospital of Southwest Medical University, Zigong, China
| | - Lisha Hou
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jirong Yue
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolei Liu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Xia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Cao
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Prokopidis K, Giannos P, Reginster JY, Bruyere O, Petrovic M, Cherubini A, Triantafyllidis KK, Kechagias KS, Dionyssiotis Y, Cesari M, Ibrahim K, Scott D, Barbagallo M, Veronese N. Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:671-683. [PMID: 36781175 PMCID: PMC10067503 DOI: 10.1002/jcsm.13190] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 02/15/2023] Open
Abstract
Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta-analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature search of observational studies using PubMed, Web of Science, Scopus and Cochrane Library databases was conducted from inception until June 2022. To determine if sarcopenia is associated with a higher risk of polypharmacy and increased number of medications, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42022337539). Twenty-nine studies were included in the systematic review and meta-analysis. Sarcopenia was associated with a higher prevalence of polypharmacy (odds ratio [OR]: 1.65, 95% confidence interval [CI] [1.23, 2.20], I2 = 84%, P < 0.01) and higher number of medications (mean difference: 1.39, 95% CI [0.59, 2.19], I2 = 95%, P < 0.01) compared with individuals without sarcopenia. Using meta-regression, a high variance was observed due to different populations (i.e., community-dwelling, nursing home residents, inpatients, outpatients) for both outcomes of polypharmacy (r = -0.338, SE = 0.1669, 95% CI [-0.67, -0.01], z = -2.03, P = 0.04) and number of medications (r = 0.589, SE = 0.2615, 95% CI [0.08, 1.10], z = 2.25, P = 0.02). This systematic review and meta-analysis reported a significantly increased risk of polypharmacy and higher number of medications in people with sarcopenia compared with individuals without this condition. Future research should clarify whether the specificity and number of medications is a direct contributor in accelerating the progression of muscle wasting and dysfunction contributing to sarcopenia in older adults.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Biology, Institute of Life Course and Medical SciencesUniversity of LiverpoolLiverpoolUK
- Society of Meta‐research and Biomedical InnovationLondonUK
| | - Panagiotis Giannos
- Society of Meta‐research and Biomedical InnovationLondonUK
- Department of Life Sciences, Faculty of Natural SciencesImperial College LondonLondonUK
| | - Jean Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and AgingLiègeBelgium
- Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Olivier Bruyere
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo‐Skeletal Health and AgeingUniversity of LiègeLiègeBelgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and PaediatricsGhent UniversityGhentBelgium
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCAAnconaItaly
| | - Konstantinos K. Triantafyllidis
- Society of Meta‐research and Biomedical InnovationLondonUK
- Department of Nutrition and DieteticsHomerton University Hospital Foundation TrustLondonUK
| | - Konstantinos S. Kechagias
- Society of Meta‐research and Biomedical InnovationLondonUK
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
| | - Yannis Dionyssiotis
- Medical School, Spinal Cord Injury Rehabilitation Clinic, General University Hospital PatrasUniversity of PatrasPatrasGreece
| | - Matteo Cesari
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Geriatric UnitIRCCS Istituti Clinici Scientifici MaugeriMilanItaly
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University Hospital SouthamptonUniversity of SouthamptonSouthamptonUK
- Applied Research Collaboration Wessex, The National Institute of Health and Care Research (NIHR)University of SouthamptonSouthamptonUK
| | - David Scott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityBurwoodVictoriaAustralia
- Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | - Mario Barbagallo
- Department of Internal Medicine and GeriatricsUniversity of PalermoPalermoItaly
| | - Nicola Veronese
- Department of Internal Medicine and GeriatricsUniversity of PalermoPalermoItaly
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Luo S, Chen X, Hou L, Yue J, Liu X, Xia X, Dong B, Cao L. The accuracy of body mass index and calf circumference values when assessing sarcopenia in a multi-ethnic cohort of middle-aged and older adults: West China health and aging trend study results. Heliyon 2023; 9:e15027. [PMID: 37151646 PMCID: PMC10161364 DOI: 10.1016/j.heliyon.2023.e15027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This analysis was designed to explore the utility of body mass index (BMI) and calf circumference (CC) values in the diagnosis of sarcopenia. Methods A cross-sectional analysis of community-dwelling adults ≥50 years old was conducted. An InBody 770 bioimpedance analysis (BIA) device was used for measuring muscle mass, a grip-strength dynamometer was used to assess muscle strength, and a 4 m gait speed (GS) analysis was used to gauge physical function. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used to define sarcopenia. The cut-off values for BMI and CC were based on the computed Younden's index values and AWGS 2019 criteria, respectively. The area under the ROC curves (AUC), specificity, sensitivity, and positive and negative predictive values (PPV and NPV) were calculated to establish the value of BMI and CC for the diagnosis of sarcopenia. Results In total, the data of 4177 participants ≥50 years of age were analyzed. These included 2668 (63.9%) females and 1509 (36.1%) males. Of these participants, 946 (22.6%) met the criteria for sarcopenia, including 408 (27%) males and 538 (20.2%) females. The sensitivity, specificity, and NPVs obtained when using BMI and CC values to predict sarcopenia were as follows: 84.03%/65.51%/0.90 and 74.76%/83.51%/0.87, respectively, in males; 87.36%/64.12%/0.94 and 78.25%/82.09%/0.93, in females. The respective AUC values for BMI and CC in males were 0.83 (0.80-0.85) and 0.85 (0.83-0.88), while in females they were 0.85 (0.83-0.87) and 0.88 (0.87-0.90). Conclusions These data suggest that BMI and CC can both serve as accurate predictors of sarcopenic incidence in a multi-ethnic population ≥50 years of age. The specificity values for BMI were relatively low in both males and females, however, underscoring the relative advantages of measuring CC when assessing individual sarcopenia risk.
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Frenzel AP, Bielemann RM, Barbosa-Silva TG, Gonzalez MC. Applicability of the SARC-F questionnaire by remote interview. Nutrition 2023; 105:111871. [PMID: 36413820 DOI: 10.1016/j.nut.2022.111871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 10/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess the applicability of the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire by telephone to identify sarcopenia risk (SR; SARC-F ≥6) and low muscle function risk (LMFR; SARC-F ≥ 4) and their associated risk factors in a cohort of community-dwelling older adults in southern Brazil. METHODS A longitudinal study was carried out with community-dwelling older individuals from COMO VAI? STUDY Sociodemographic, behavioral, and health-related information were collected at baseline, and, in the second assessment, the SARC-F questionnaire was applied by phone or in-person interviews. Older adults identified with sarcopenia at the baseline assessment were excluded. Adjusted analysis by Poisson regression according to hierarchical levels was performed. RESULTS Of the 1451 participants interviewed at baseline, only 951 participated in the second assessment. During the second assessment, 732 adults (77%) were interviewed by phone and 219 (23%) in person. There was no statistically significant difference for the SR (9.1 versus 9.7%, P = 0.802) and LMFR (22.4 versus 20.0%, P = 0.435) prevalence when the SARC-F questionnaire was administered in person or by phone, respectively. Age ≥80 y, presence of depressive symptoms, multimorbidity, dependence to perform one or more daily activities, and polypharmacy were factors associated with a higher risk for poor outcomes in older adults interviewed by phone. CONCLUSIONS The similar prevalence between in-person and remote assessments suggests the feasibility of using the SARC-F questionnaire by phone interview as a reliable alternative for sarcopenia and low muscle function risk assessment without the requirement of face-to-face evaluations.
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Affiliation(s)
- Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Renata M Bielemann
- Postgraduate Program in Nutrition and Foods, Federal University of Pelotas (UFPel), Pelotas, Brazil
| | | | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil; Postgraduate Program in Nutrition and Foods, Federal University of Pelotas (UFPel), Pelotas, Brazil.
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Ruthes EMP, Lenardt BCC, Lass AD, Petroski CA, de Mello MF, de Andrade Junior AB, Souza CJF, de Matos O, Castelo-Branco C. Lean mass and strength profile of women submitted to bariatric surgery: comparison of the EWGSOP2 and FNIH classification for sarcopenia - ASBS program phase II. Gynecol Endocrinol 2022; 38:868-873. [PMID: 36067795 DOI: 10.1080/09513590.2022.2119956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aim: To assess the effect of bariatric surgery on the lean mass of women after one year of the procedure, comparing its outcomes upon the classification from both the Foundation of the National Institutes of Health (FNIH) and the European Working Group on Sarcopenia in the Elderly People (EWGSOP). Material and methods: Twenty-eight obese women aged 40.5 ± 9.8 yrs who underwent Roux-en-Y gastric bypass (RYGB) were included. 27 of them were reassessed after 6 months of surgery, and 16 completed the one-year follow-up. Pre-sarcopenia condition was assessed through a handgrip strength test and body composition by dual-energy X-ray absorptiometry (DXA). Total body mass, body mass index, and lean mass (LM) were collected prior to, 6 and 12 months after RYGB surgery. Results: All subjects reassessed after 12 months were diagnosed with pre-sarcopenia according to the FNIH classification criteria, while according to the EWGSOP2 Consensus they presented normal values. LM represented 14% of the influence on handgrip strength (p = .049) after 6 months of surgery; however, its influence on strength after 12 months increased to 30% (p = .028). Conclusion: The FNIH classification is the most effective criteria since it uses LM content as the first test, considering that strength capacity needs more time to be affected by the surgical procedure. On the other hand, the EWGSOP2 classification should not be applied to determine the loss of LM in younger populations regardless of what may have caused such changes.
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Affiliation(s)
- Elena M P Ruthes
- Laboratory for Studies in Biomedical Engineering and Health, Academic Study in Bariatric Surgery Group (ASBS), Federal University of Technology, Curitiba, Brazil
| | - Brenda C C Lenardt
- Laboratory for Studies in Biomedical Engineering and Health, Academic Study in Bariatric Surgery Group (ASBS), Federal University of Technology, Curitiba, Brazil
| | - André Domingos Lass
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Carlos Alberto Petroski
- Laboratory for Studies in Biomedical Engineering and Health, Academic Study in Bariatric Surgery Group (ASBS), Federal University of Technology, Curitiba, Brazil
| | - Maria Fernanda de Mello
- Laboratory for Studies in Biomedical Engineering and Health, Academic Study in Bariatric Surgery Group (ASBS), Federal University of Technology, Curitiba, Brazil
| | | | - Carlos José F Souza
- Bariatric Surgery Department, Angelina Caron Hospital, Campina Grande do Sul, Brazil
| | - Oslei de Matos
- Laboratory for Studies in Biomedical Engineering and Health, Academic Study in Bariatric Surgery Group (ASBS), Federal University of Technology, Curitiba, Brazil
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Faculty of Medicine, University of Barcelona, Institut d' Investigations Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Castillo-Angeles M, Uyeda JW, Seshadri AJ, Ramsis R, Okafor BU, Nitzschke S, Rangel EL, Saillant NN, Salim A, Askari R. Sarcopenia Is Associated With Increased Mortality in Patients With Necrotizing Soft Tissue Infections. J Surg Res 2022; 276:31-36. [PMID: 35334381 DOI: 10.1016/j.jss.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Necrotizing soft tissue infections (NSTIs) are surgical emergencies associated with high morbidity and mortality. Identifying risk factors for poor outcome is a critical part of preoperative decision-making and counseling. Sarcopenia, the loss of lean muscle mass, has been associated with an increased risk of mortality and can be measured using cross-sectional imaging. Our aim was to determine the impact of sarcopenia on mortality in patients with NSTI. We hypothesized that sarcopenia would be associated with an increased risk of mortality in patients with NSTI. METHODS This is a retrospective cohort study of NSTI patients admitted from 1995 to 2015 to two academic institutions. Operative and pathology reports were reviewed to confirm the diagnosis in all cases. Average bilateral psoas muscle cross-sectional area at L4, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography (CT). Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was in-hospital mortality. Multivariate logistic regression was performed to assess the association between sarcopenia and in-hospital mortality. RESULTS There were 115 patients with preoperative imaging, 61% male and a median age of 57 y interquartile range (IQR 46.6-67.0). Overall in-hospital mortality was 12.1%. There was no significant difference in sex, body mass index (BMI), comorbidities and American Society of Anesthesiologists classification (Table 1). After multivariate analysis, sarcopenia was independently associated with increased in-hospital mortality (Odds ratio, 3.5; 95% Confidence Interval [CI], 1.05-11.8). CONCLUSIONS Sarcopenia is associated with increased risk of in-hospital mortality in patients with NSTIs. Sarcopenia identifies patients with higher likelihood of poor outcomes, which can possibly help surgeons in counseling their patients and families.
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Affiliation(s)
- Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anupamaa J Seshadri
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Barbara U Okafor
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Nitzschke
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erika L Rangel
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Reza Askari
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Wang J, Liu C, Zhang L, Liu N, Wang L, Wu J, Wang Y, Hao H, Cao L, Yuan S, Huang L. Prevalence and associated factors of possible sarcopenia and sarcopenia: findings from a Chinese community-dwelling old adults cross-sectional study. BMC Geriatr 2022; 22:592. [PMID: 35850661 PMCID: PMC9290196 DOI: 10.1186/s12877-022-03286-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose To describe the prevalence and analyse the associated factors of possible sarcopenia and sarcopenia among community-dwelling old adults in China, in order to provide effective strategies for early prevention and treatment of sarcopenia. Methods This cross-sectional study evaluated community-dwelling old adults aged over 60 years. The basic information, morphological indices, body composition, physical activities were collected and assessed. Possible sarcopenia and sarcopenia were diagnosed by the criteria of Asian Working Group for Sarcopenia (AWGS) in 2019. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia and sarcopenia. Results In total 729 old adults from Tianjin were included in this study. Eighty-one participants were diagnosed with possible sarcopenia (prevalence of 11.11%). Seventy-five participants were diagnosed with sarcopenia (prevalence of 10.29%). Age (odds ratio (OR):1.047, 95% confidence interval (CI): 1.055–1.090) and lower physical activities (low level OR:4.171, 95% CI:1.790–9.720; medium level OR:2.634, 95% CI:1.352–5.132) were significantly associated with possible sarcopenia. Age (OR:1.187, 95% CI:1.124–1.253), higher body fat percentage (OR:1.225, 95% CI:1.140–1.317), lower BMI (OR:0.424, 95% CI:0.346–0.519), lower mini-mental state examination (MMSE) scores (OR:0.865,95% CI:0.781–0.958) and low physical activities (OR:4.638, 95% CI:1.683–12.782) were significantly associated with sarcopenia. Conclusion Possible sarcopenia and sarcopenia are prevalent among community-dwelling old adults in China. Ageing and lower physical activities were both associated with possible sarcopenia and sarcopenia. Old adults with sarcopenia more likely have higher body fat percentage, lower BMI and lower cognitive function compared with those without this condition.
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Affiliation(s)
- Jiazhi Wang
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Changge Liu
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Lin Zhang
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Ning Liu
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Lei Wang
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Jingqiong Wu
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Yizhao Wang
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Huimin Hao
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Longjun Cao
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China
| | - Shilei Yuan
- Tianjin Yanan Hospital, No. 45 Yashi Road, Nankai District, Tianjin, P.R. China
| | - Liping Huang
- Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, P.R. China.
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Lu JL, Xu XY, Chen L, Ding LY, Hu JM, Li WY, Zhu SQ, Xu Q. The Predictive Values of Five Sarcopenia Screening Tools on Clinical Outcomes Following Surgery in Patients with Gastric Cancer: A Prospective Cohort Study. J Nutr Health Aging 2022; 26:259-265. [PMID: 35297469 DOI: 10.1007/s12603-022-1751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The association between strength, assistance with walking, rise from a chair, climb stairs and falls (SARC-F), strength, assistance with walking, rise from a chair, climb stairs, falls and calf circumference (SARC-CalF), Ishii score chart, the short version of mini sarcopenia risk assessment (MSRA-5), the full version of mini sarcopenia risk assessment (MSRA-7) and clinical outcomes in patients with gastric cancer were unclear. We aimed to investigate the predictive values of the above five sarcopenia screening tools on clinical outcomes following surgery in patients with gastric cancer. METHODS The clinical data of consecutive patients who would undergo gastrectomy from May 2020 to October 2020 at the First Affiliated Hospital of Nanjing Medical University were prospectively collected. On the first admission day, patients' characteristics, Nutrition risk screening 2002 (NRS 2002), the above five sarcopenia screening tools and anthropometric measurements were preoperatively collected. Within 24 hours after discharge, operation information, tumor-node-metastasis (TNM) stage and clinical outcomes in hospital (postoperative complications, hospitalization expenditures and postoperative hospital stay) were collected. Three months after discharge, clinical outcomes out of hospital (hospital readmissions and mortality) were collected. Multivariate analyses were conducted to identify the independent predictors for clinical outcomes. RESULTS A total of 263 patients were finally included in the study, with the average age being 62.44 years. The prevalence of sarcopenia risk ranged from 3.42% to 73.76%. For the above five sarcopenia screening tools, multivariate analyses showed that sarcopenia risk indicated by SARC-CalF was an independent predictor for postoperative complications (OR=3.145 [95%CI: 0.594, 16.665], P=0.037), prolonged postoperative hospital stay (B=2.383 [95%CI: 0.377, 4.388], P=0.020), increased hospitalization expenditures (B=1.305 [95%CI: 0.402, 2.208], P=0.005) and 3-month hospital readmissions (HR=3.626 [95%CI: 1.126, 11.676], P=0.031). Sarcopenia risk indicated by Ishii score chart was an independent predictor for postoperative complications (OR=6.491 [95%CI: 1.514, 27.840], P=0.012) and hospitalization expenditures (B=0.767 [95%CI: 0.065, 1.469], P=0.032). Sarcopenia risk indicated by MSRA-7 was an independent predictor for prolonged postoperative hospital stay (B=1.636 [95%CI: 0.119, 3.153], P=0.035)and increased hospitalization expenditures (B=0.831 [95%CI: 0.146, 1.516], P=0.018). CONCLUSION Among the above five sarcopenia screening tools, SARC-CalF seemed to have better predictive values on clinical outcomes. Preoperative gastric cancer patients with sarcopenia risk indicated by SARC-CalF could have a higher risk of postoperative complications, prolonged postoperative hospital stay, increased hospitalization expenditures and 3-month hospital readmissions.
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Affiliation(s)
- J-L Lu
- Qin Xu, Professor of Nursing, School of Nursing, Nanjing Medical Universirty, 140 Hanzhong Road, Gulou District, Nanjing, 210029, Jiangsu Province, China, E-mail: ; Shu-qin Zhu, Associate Professor of Nursing, School of Nursing, Nanjing Medical University, 140 Hanzhong Road, Gulou District, Nanjing, 210029, Jiangsu Province, China, E-mail:
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12
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Erdogan T, Catikkas NM, Oren MM, Kılıc C, Karan MA, Bahat G. Ishii test for screening sarcopenia: performance in community-dwelling older adults. Aging Clin Exp Res 2022; 34:785-791. [PMID: 34665450 DOI: 10.1007/s40520-021-01998-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/04/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sarcopenia is associated with an increased likelihood of major adverse health outcomes. Therefore, screening and early and timely identification of sarcopenia are essential. EWGSOP2 (European Working Group on Sarcopenia in Older People2) suggests Ishii screening test for formal-case findings. We aimed to define the diagnostic value of the Ishii screening test, which estimates the probability of sarcopenia using an equation-derived score based on three variables (age, grip strength, and calf circumference) in Turkish older adults. METHODS Older adults aged > = 60 who applied to a geriatric outpatient clinic were included in the study. The recommendation of the EWGSOP2 for the definition of sarcopenia was followed. The probability of sarcopenia was estimated by using a score chart of Ishii. Performance of Ishii screening test was analyzed by using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver-operating characteristic (ROC) analysis was performed to determine the area under the curve (AUC). RESULTS We included 1635 patients with the mean age of 74.7 ± 7.0. The prevalence of probable sarcopenia was 11.9%. The prevalence of confirmed sarcopenia according to height2 was 0.7%. The prevalence of severe sarcopenia was 0.3% in total. Against diagnoses of probable sarcopenia, confirmed sarcopenia, and severe sarcopenia, the sensitivity values of the Ishii screening test were 84%, 100%, and 100%; the specificity values were 86.1%, 83.9%, and 84.6%, respectively. PPV values were 44.9%, 4.2%, 2.1%; NPV were 97.6%, 100%, 100%, and the AUC values were 0.933, 0.961, and 0.959, respectively. CONCLUSION Our results suggest that the Ishii screening test is a successful screening and maybe a candidate diagnostic test for sarcopenia.
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Affiliation(s)
- Tugba Erdogan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Meryem Merve Oren
- Department of Public Health, Istanbul Medical School, Istanbul University, İstanbul, Turkey
| | - Cihan Kılıc
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Fatih, 34093, İstanbul, Turkey.
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13
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Yang Q, Huang S, Chen M, Zhu T, Li Q, Chen X. Association of Ishii test scores with pneumonia in stable schizophrenic subjects. Front Psychiatry 2022; 13:1034905. [PMID: 36311511 PMCID: PMC9606461 DOI: 10.3389/fpsyt.2022.1034905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
AIM We investigated the relationship between the sarcopenia-indicating Ishii test scores and pneumonia risk in stable schizophrenia patients. METHODS This prospective investigation involves schizophrenic inpatients from two mental health centers in western China. Patient baseline information was gathered over 1 month from September 1 to 30 in 2020. All pneumonia-related patient information, including diagnosis and treatment, was acquired over 1 year between October 2020 and October 2021. Patients with schizophrenia were screened for sarcopenia utilizing a threshold value established by Ishii et al. Using regression analysis, the link between Ishii test scores and pneumonia risk in schizophrenia patients was investigated. RESULT This study recruited 232 males and 107 females with schizophrenia over the age of 50 and older. During a 1-year follow-up period, four patients (3 males and 1 female) acquired pneumonia within 1 week of relapse in schizophrenia; therefore, these patients were excluded from the study. Finally, data were collected for 335 patients. The pneumonia incidences were 29.3% in males and 14.2% in females. Our analysis confirmed that compared to the male schizophrenia patients with Ishii test scores < 105 (non-sarcopenia), those with Ishii test scores ≥ 105 (sarcopenia) exhibited an elevated pneumonia risk (OR = 2.739, 95%CI: 1.406-5.333). Following confounders adjustment, Ishii test scores ≥ 105 remained a risk factor for pneumonia (OR = 2.064, 95%CI: 1.029-4.143). Among females with schizophrenia, the Ishii test scores were not associated with pneumonia risk. CONCLUSION In conclusion, our results demonstrated that the Ishii test scores ≥ 105 were strongly associated with pneumonia risk in stable schizophrenic male patients.
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Affiliation(s)
- Qin Yang
- Psychiatric Hospital of Ziyang, Ziyang, China
| | - Sha Huang
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
| | - Ming Chen
- Psychiatric Hospital of Ziyang, Ziyang, China
| | - Tian Zhu
- Psychiatric Hospital of Ziyang, Ziyang, China
| | - Qiuxia Li
- Psychiatric Hospital of Ziyang, Ziyang, China
| | - Xiaoyan Chen
- Zigong Affiliated Hospital of Southwest Medical University, Zigong Psychiatric Research Center, Zigong, China
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Dent E, Woo J, Scott D, Hoogendijk EO. Toward the recognition and management of sarcopenia in routine clinical care. NATURE AGING 2021; 1:982-990. [PMID: 37118343 DOI: 10.1038/s43587-021-00136-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/06/2021] [Indexed: 04/30/2023]
Abstract
Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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Dent E, Woo J, Scott D, Hoogendijk EO. Sarcopenia measurement in research and clinical practice. Eur J Intern Med 2021; 90:1-9. [PMID: 34238636 DOI: 10.1016/j.ejim.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/15/2022]
Abstract
Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. This review outlines diagnostic and case finding/screening tools for age-related (primary) sarcopenia used in research and clinical practice. Diagnostic tools critically reviewed include those of the: European Workgroup for Sarcopenia (EWGSOP) versions 1 and 2; Asian Working Group for Sarcopenia (AWGS) versions 1 and 2; Foundation for the National Institutes of Health (FNIH); and the Sarcopenia Definition and Outcomes Consortium (SDOC). Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, 88 Wakefield St, Adelaide SA, 5000 Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC, 3004 Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Central Ave, Hong Kong.
| | - David Scott
- Deakin University, Melbourne VIC, 3004 Australia; Monash University, Wellington Rd, Clayton VIC, 3800 Australia.
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands.
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Ozer FF, Akin S, Tasci İ, Tasar PT, Savas S, Cincin AT, Yavuzer H, Erdincler DS, Balci C, Esme M, Ozturk ZA, Sezgin G, Nalbant S, Varli M, Karan MA, Saka B. Risk of sarcopenia in hospitalized patients and related clinical factors: a multicenter study from Turkey. Eur Geriatr Med 2021; 12:863-870. [PMID: 33866525 DOI: 10.1007/s41999-021-00499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. METHODS This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. RESULTS A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032-1.104, p < 0.001), female gender (OR: 2.414, CI 1.510-3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922-8.632, p < 0.001) were independently associated with sarcopenia risk. CONCLUSIONS Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.
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Affiliation(s)
- Firuzan Fırat Ozer
- Department of Geriatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey.
- Department of Geriatrics, Kayseri City Hospital, Kocasinan, 38080, Kayseri, Turkey.
| | - Sibel Akin
- Department of Geriatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - İlker Tasci
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey
| | - Pinar Tosun Tasar
- Department of Internal Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Sumru Savas
- Department of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Asli Tufan Cincin
- Department of Geriatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Hakan Yavuzer
- Department of Geriatrics, Cerrahpasa University Faculty of Medicine, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Department of Geriatrics, Cerrahpasa University Faculty of Medicine, Istanbul, Turkey
| | - Cafer Balci
- Department of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mert Esme
- Department of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynel Abidin Ozturk
- Department of Geriatrics, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Gulbuz Sezgin
- Department of Internal Medicine, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Selim Nalbant
- Department of Internal Medicine, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Murat Varli
- Department of Geriatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Karan
- Department of Geriatrics, İstanbul University Faculty of Medicine, Istanbul, Turkey
| | - Bülent Saka
- Department of Geriatrics, İstanbul University Faculty of Medicine, Istanbul, Turkey
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Hax V, do Espírito Santo RC, dos Santos LP, Farinon M, de Oliveira MS, Três GL, Gasparin AA, de Andrade NPB, Bredemeier M, Xavier RM, Chakr RMDS. Practical screening tools for sarcopenia in patients with systemic sclerosis. PLoS One 2021; 16:e0245683. [PMID: 33481872 PMCID: PMC7822499 DOI: 10.1371/journal.pone.0245683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction In view of the method of diagnosing sarcopenia being complex and considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends the use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice. Only recently, some studies have turned their attention to the presence of sarcopenia in systemic sclerosis (SSc).There is no data about performance of SARC-F and other screening tests for sarcopenia in this population. Objective To compare the accuracy of SARC-F, SARC-CalF, SARC-F+EBM, and Ishii test as screening tools for sarcopenia in patients with SSc. Methods Cross-sectional study of 94 patients with SSc assessed by clinical and physical evaluation. Sarcopenia was defined according to the revised 2019 EWGSOP diagnostic criteria (EWGSOP2) with assessments of dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB). As case finding tools, SARC-F, SARC-CalF, SARC-F+EBM and Ishii test were applied, including data on calf circumference, body mass index, limitations in strength, walking ability, rising from a chair, stair climbing, and self reported number of falls in the last year. The screening tests were evaluated through receiver operating characteristic (ROC) curves. Standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia. Results Sarcopenia was identified in 15 (15.9%) patients with SSc by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.420–0.756, p = 0.283). The results of sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic Odds Ratio (DOR) with the EWGSOP2 criteria as the gold standard were 40.0% (95% CI, 19.8–64.2), 81.0% (95% CI, 71.0–88.1), 2.11 (95% CI, 0.98–4.55), 0.74 (95% CI, 0.48–1.13) and 2.84 (95% CI, 0.88–9.22), respectively. SARC-CalF and SARC-F+EBM showed better sensitivity (53.3%, 95% CI 30.1–75.2 and 60.0%, 95% CI 35.7–80.2, respectively) and specificity (84.8%, 95% CI 75.3–91.1 and 86.1%, 95% CI 76.8–92.0, respectively) compared with SARC-F. The best sensitivity was obtained with the Ishii test (86.7%, 95% CI 62.1–96.3), at the expense of a small loss of specificity (73.4%, 95% CI 62.7–81.9). Comparing the ROC curves, SARC-F performed worse than SARC-CalF, SARC-F+EBM and Ishii test as a sarcopenia screening tool in this population (AUCs 0.588 vs. 0.718, 0.832, and 0.862, respectively). Direct comparisons between tests revealed differences only between SARC-F and Ishii test for sensitivity (p = 0.013) and AUC (p = 0.031). Conclusion SARC-CalF, SARC-F+EBM, and Ishii test performed better than SARC-F alone as screening tools for sarcopenia in patients with SSc. Considering diagnostic accuracy and feasibility aspects, SARC-F+EBM seems to be the most suitable screening tool to be adopted in routine care of patients with SSc.
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Affiliation(s)
- Vanessa Hax
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | | | | | - Mirian Farinon
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Guilherme Levi Três
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Andrese Aline Gasparin
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Nicole Pamplona Bueno de Andrade
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Markus Bredemeier
- Division of Rheumatology, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Machado Xavier
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Mendonça da Silva Chakr
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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Seo MW, Jung SW, Kim SW, Jung HC, Kim DY, Song JK. Comparisons of Muscle Quality and Muscle Growth Factor Between Sarcopenic and Non-Sarcopenic Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186581. [PMID: 32927586 PMCID: PMC7558172 DOI: 10.3390/ijerph17186581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022]
Abstract
Sarcopenia, an age-related disease, is one of the important health problems in the elderly and the prevalence of sarcopenia is rapidly increased among the Korean population. This study examined the muscle quality and muscle growth factors of elderly women to identify the potential diagnostic tool for sarcopenia. One hundred and thirty-six elderly women, aged over 65 years old, initially enrolled, but only 59 participants who met the criteria (sarcopenic group, n = 27; non-sarcopenic group, n = 32) completed the study. Muscle quality assessment included thigh cross-sectional computed tomography scan and maximal isometric muscle strength. Muscle growth factors such as GDF-15, myostatin, activin A, and follistatin were analyzed, and a battery of Senior Fitness Test was used to examine functional fitness. The statistical significance level was set at 0.05. Elderly women with sarcopenia had a lower thigh muscle volume (-20.1%), and a higher thigh intermuscular adipose tissue (15.8%) than those of the non-sarcopenic group (p < 0.05). However, no significant differences in muscle growth factors were observed between the groups. Muscle quality variables including maximal voluntary isometric contraction (OR: 0.968, p < 0.001), relative maximal voluntary isometric contraction (OR: 0.989, p < 0.05), thigh muscle volume (OR: 0.836, p < 0.001), and thigh intermuscular adipose tissue (OR: 1.138, p < 0.05) were associated with a risk of sarcopenia. Our findings suggest that the sarcopenic group exhibits a poor thigh muscle quality in comparison with the non-sarcopenic group. Muscle quality assessment can be utilized for sarcopenia identification, but our study remains inconclusive for the causality of muscle growth factors in sarcopenia.
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Affiliation(s)
- Myong-Won Seo
- Department of Taekwondo, College of Physical Education, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si, Gyeonggi-do 17014, Korea;
| | - Sung-Woo Jung
- Department of Physical Education, Graduate School, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si, Gyeonggi-do 17014, Korea; (S.-W.J.); (S.-W.K.)
| | - Sung-Woo Kim
- Department of Physical Education, Graduate School, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si, Gyeonggi-do 17014, Korea; (S.-W.J.); (S.-W.K.)
| | - Hyun Chul Jung
- Department of Coaching, College of Physical Education, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si, Gyeonggi-do 17014, Korea;
| | - Deog-Yoon Kim
- Department of Nuclear Medicine, Kyung Hee University School of Medicine, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea;
| | - Jong Kook Song
- Department of Sports & Science, Graduate School of Physical Education, Kyung Hee University, 1732 Deokyoungdaero, Giheung-gu, Yongin-si, Gyeonggi-do 17014, Korea
- Correspondence: ; Tel.: +82-31-201-2708
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19
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Montalcini T, Pujia A, Donini LM, Frittitta L, Galvano F, Natali A, Pironi L, Porrini M, Riso P, Rivellese AA, Russo D, Scapagnini G, Serafini M, Tagliabue A, De Lorenzo A. A Call to Action: Now Is the Time to Screen Elderly and Treat Osteosarcopenia, a Position Paper of the Italian College of Academic Nutritionists MED/49 (ICAN-49). Nutrients 2020; 12:E2662. [PMID: 32878316 PMCID: PMC7550989 DOI: 10.3390/nu12092662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is a risk factor for the development of multiple chronic diseases, including cardiovascular disease, cancer and dementia. Life expectancy has increased in certain countries but this phenomenon is associated with a reduction of years of healthy life. Aging is associated with a number of physical and functional changes, especially sarcopenia. Sarcopenia is a clinical condition associated with a decrease in skeletal muscle and muscle strength, however, sarcopenia is a reversible condition. On the basis of the current scientific literature, sarcopenia could more appropriately capture an individual's vulnerability to negative health-related outcomes since it represents an early form of the chronic diseases. Recognition of this clinical condition can improve the management of older individuals in many different clinical settings. Despite the limitations of the indirect methods used to study body composition, the Italian College of the Academic Nutritionists ME/49 recommends that health authorities and health professionals around the world should make a greater effort to diagnose sarcopenia earlier and to manage it more effectively. In line with the development of cancer screening, the use of two diagnostic tools for sarcopenia (BIA and DXA) should be implemented.
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Affiliation(s)
- Tiziana Montalcini
- Department of Clinical and Experiment Medicine, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Arturo Pujia
- Department of Clinical and Experiment Medicine, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Lorenzo M. Donini
- Department of Experimental Medicine, University of la Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Lucia Frittitta
- Department of Clinical and Experiment Medicine, University of Catania, Via Santa Sofia, 86-95123 Catania, Italy;
| | - Fabio Galvano
- Department of Biomedical and Biotechnology Science, University of Catania, Via Santa Sofia, 86-95123 Catania, Italy;
| | - Andrea Natali
- Department of Clinical and Experiment Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy;
| | - Loris Pironi
- Department of Medical and Surgical Science, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy;
| | - Marisa Porrini
- Department of Food, Nutrition and Environment Science, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; (M.P.); (P.R.)
| | - Patrizia Riso
- Department of Food, Nutrition and Environment Science, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; (M.P.); (P.R.)
| | - Angela Albarosa Rivellese
- Department of Clinical and Experiment Medicine, University of Naples Federico II, Corso Umberto I, 40, 80138 Napoli, Italy;
| | - Diego Russo
- Department of Health Science, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Giovanni Scapagnini
- Department of Medicine and Health Science, University of Molise, Via F. De Sanctis, 86100 Campobasso, Italy;
| | - Mauro Serafini
- Department of Bioscience and food technology, University of Teramo, Via Renato Balzarini, 1, 64100 Teramo, Italy;
| | - Anna Tagliabue
- Department of Public Health, University of Pavia, Corso Str. Nuova, 65, 27100 Pavia, Italy;
| | - Antonino De Lorenzo
- Biomedicine and Prevention, University of Tor Vergata, Via Montpellier, 1, 00133 Roma, Italy;
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20
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Myoprotective Whole Foods, Muscle Health and Sarcopenia: A Systematic Review of Observational and Intervention Studies in Older Adults. Nutrients 2020; 12:nu12082257. [PMID: 32731580 PMCID: PMC7469021 DOI: 10.3390/nu12082257] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 12/17/2022] Open
Abstract
Decline in skeletal muscle strength and mass (sarcopenia) accelerates with age, leading to adverse health outcomes and poor quality of life. Diet plays a crucial role in muscle ageing being an important element of a healthy lifestyle. However, unlike single nutrients, such as dietary protein, or dietary patterns, such as the Mediterranean diet, the relationship between individual whole foods and muscle health has not been systematically evaluated. We aimed to investigate which whole foods (meat, fish, eggs, fruit and vegetables, and non-liquid dairy) may be beneficial (myoprotective) for ageing muscle and sarcopenia in adults aged ≥ 50 years. Nineteen observational and nine intervention studies were identified through systematic searches of the four electronic databases (last search: March 2020). The synthesis of findings showed strong and consistent evidence for a beneficial effect of lean red meat on muscle mass or lean tissue mass in both observational and intervention studies. Higher intake of fruit and vegetables was associated with better muscle function in observational studies, but the evidence from intervention studies was scarce. Non-liquid dairy foods were beneficial for muscle mass in both observational and intervention studies. There was moderate evidence for the role of these foods in muscle strength and sarcopenia, and limited or inconclusive evidence for the benefits of other whole foods (e.g., fish, eggs) for muscle health in older adults. Although current nutritional recommendations are often based on a single nutrient approach, further research about the role of protein-rich and other foods in muscle health will allow for the development of guidelines that are based on whole foods, also highlighting the potential importance of non-protein nutrients within these foods for myoprotection in older adults.
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21
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Marco E, Sanchez-Rodriguez D, López-Escobar J, Meza D, Dávalos-Yerovi V, Duran X, Messaggi-Sartor M, Guillén-Solà A, Muniesa JM, Duarte E. Is peak expiratory flow an accurate sarcopenia screening tool in older patients referred to respiratory rehabilitation? Eur Geriatr Med 2020; 11:297-306. [PMID: 32297196 DOI: 10.1007/s41999-019-00286-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the performance of peak expiratory flow (PEF) for sarcopenia screening in patients with chronic obstructive pulmonary disease (COPD), using the revised European Working Group on Sarcopenia in Older People (EWGSOP-2) criteria as the reference standard in pulmonary rehabilitation patients; and second, to study the factors associated with low PEF in this population. METHODS Diagnostic accuracy study conducted in consecutive community-dwelling COPD rehabilitation patients. Sensitivity, specificity, accuracy, likelihood ratios, predictive values, and area under the Receiver-Operating Characteristic curve were retrospectively calculated for PEF (index test) and compared with EWGSOP-2 criteria (reference standard). RESULTS Of 151 potentially eligible patients, 79 (67.5 ± 7.1 years; 78.8% men) fulfilled inclusion criteria and 10 (12.7%) had a diagnosis of sarcopenia. The PEF cut-off with highest accuracy (65.8%) was PEF ≤ 200 L/min (sensitivity 90%, specificity 62.3%, and positive and negative likelihood ratios 2.39 and 0.16, respectively). Airway obstruction and muscle mass were significantly associated with PEF ≤ 200 L/min. CONCLUSIONS Considering the EWGSOP-2 criteria as the reference standard, a cut-off of PEF ≤ 200 L/min showed only fair validity for detecting sarcopenia, so it cannot be recommended as a stand-alone screening tool in older rehabilitation patients with COPD.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança, Centre Fòrum), Barcelona, Spain. .,Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain. .,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Dolores Sanchez-Rodriguez
- Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Geriatrics Department, Parc de Salut Mar (Centre Fòrum, Hospital del Mar), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Delky Meza
- Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Vanesa Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança, Centre Fòrum), Barcelona, Spain.,School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Duran
- Methodological and Biostatistical Advisory Service, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Monique Messaggi-Sartor
- Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Guillén-Solà
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança, Centre Fòrum), Barcelona, Spain.,Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança, Centre Fòrum), Barcelona, Spain.,Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança, Centre Fòrum), Barcelona, Spain.,Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.,School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Ansari E, Chargi N, van Gemert JTM, van Es RJJ, Dieleman FJ, Rosenberg AJWP, Van Cann EM, de Bree R. Low skeletal muscle mass is a strong predictive factor for surgical complications and a prognostic factor in oral cancer patients undergoing mandibular reconstruction with a free fibula flap. Oral Oncol 2019; 101:104530. [PMID: 31881447 DOI: 10.1016/j.oraloncology.2019.104530] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fibula free flaps (FFF) are effective in accomplishing successful reconstruction for segmental defects of the mandible. Potential risk factors for FFF complications have been described in previous research, e.g. age, comorbidity and smoking. Low skeletal muscle mass (SMM) has shown to be an emerging predictive factor for complications and prognostic factor for survival in head and neck cancer. This study aims to identify the predictive and prognostic value of low SMM for surgical FFF related complications, postoperative complications and survival in patients who underwent mandibular reconstruction with FFF after oral cavity cancer resection. MATERIALS AND METHODS A retrospective study was performed between 2002 and 2018. Pre-treatment SMM was measured at the level of the third cervical vertebra and converted to SMM at the level of the third lumbar vertebra (L3). SMM at the level of L3 was corrected for squared height. Low SMM was defined as a lumbar skeletal muscle index (LSMI) below 43.2 cm2/m2. RESULTS 78 patients were included, of which 48 (61.5%) had low SMM. Low SMM was associated with an increased risk of FFF related complications (HR 4.3; p = 0.02) and severe postoperative complications (Clavien-Dindo grade III-IV) (HR 4.0; p = 0.02). In addition low SMM was a prognosticator for overall survival (HR 2.4; p = 0.02) independent of age at time of operation, ACE-27 score and TNM stage. CONCLUSION Low SMM is a strong predictive factor for FFF reconstruction complications and other postoperative complications in patients undergoing FFF reconstruction of the mandible. Low SMM is also prognostic for decreased overall survival.
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Affiliation(s)
- E Ansari
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - N Chargi
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - J T M van Gemert
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - R J J van Es
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - F J Dieleman
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - A J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - E M Van Cann
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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23
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Januszek R, Ruzsa Z, Nyerges A, Óriás V, Kleczyński P, Wojtasik-Bakalarz J, Pawlik A, Arif S, Dudek D, Bartuś S. Body mass index and long-term outcomes in patients with chronic total occlusions undergoing retrograde endovascular revascularization of the infra-inguinal lower limb arteries. Cardiol J 2019; 28:509-518. [PMID: 31642053 DOI: 10.5603/cj.a2019.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/27/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the present study is to assess the relationship between body mass index (BMI) and long-term clinical outcomes in retrograde endovascular recanalization (ER) regarding chronic total occlusions (CTOs) of the infra-inguinal lower limb arteries. METHODS The study included patients who underwent retrograde ER of CTOs localized in superficial, popliteal or below-the-knee arteries. During follow-up, major adverse cardiac and cerebrovascular and major adverse lower limb events (MALE) were evaluated. MALE was defined as amputation, target lesion re-intervention, target vessel re-intervention and surgical treatment. RESULTS The study included 405 patients at the mean age of 67.2 ± 10.4. The authors divided the overall group of patients according to BMI into < 25 (n = 156, 38.5%) and ≥ 25 kg/m2 (n = 249, 61.5%), and then into < 30 (n = 302, 75.8%) and ≥ 30 kg/m2 (n = 103, 24.2%). During the average follow-up 1,144.9 ± 664.3 days, the mortality rate was higher in the group of patients with BMI < 25 kg/m2 (10.5% vs. 5.3%, p = 0.051), and in the group of patients with BMI < 30 kg/m2 (8.7% vs. 2.9%, p = 0.048). The comparison of Kaplan-Meier curves revealed borderline differences when assessing months to death for the BMI < 25 kg/m2 (p = 0.057) and BMI < 30 kg/m2 (p = 0.056) grouping variables. CONCLUSIONS Obese and overweight patients undergoing CTO ER of the lower limb arteries from retrograde access are related to lower death rates during long-term follow-up.
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Affiliation(s)
- Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland. .,Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
| | - Zoltan Ruzsa
- Semmelweis University, Heart and Vascular Center, Cardiology Department, Budapest, Hungary.,Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Andras Nyerges
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Victor Óriás
- Semmelweis University, Heart and Vascular Center, Cardiology Department, Budapest, Hungary
| | - Paweł Kleczyński
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Joanna Wojtasik-Bakalarz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Pawlik
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Salech Arif
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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