Hormones and the aging process

Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy

The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)-assessed by computed tomography (CT) and ultrasound (US)-and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (<18.0 mm) had a significantly higher incidence of grade ≥3 neutropenia (50.0% vs. 10.8%, p = 0.005), and males with low RF values (<20.0 mm) had a higher incidence (80.0% vs. 22.2%, p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3-4 neutropenia by 9.210 times (95% CI = 2.401-35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice.

Steroid hormones: risk and resilience in women's Alzheimer disease

More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying women's risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2's crucial role in women's brain reserve, (3) women's verbal memory advantage as a cognitive reserve factor, and (4) E2's potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.

Genome-Wide Integrative Transcriptional Profiling Identifies Age-Associated Signatures in Dogs

Mammals experience similar stages of embryonic development, birth, infancy, youth, adolescence, maturity, and senescence. While embryonic developmental processes have been extensively researched, many molecular mechanisms regulating the different life stages after birth, such as aging, remain unresolved. We investigated the conserved and global molecular transitions in transcriptional remodeling with age in dogs of 15 breeds, which revealed that genes underlying hormone level regulation and developmental programs were differentially regulated during aging. Subsequently, we show that the candidate genes associated with tumorigenesis also exhibit age-dependent DNA methylation patterns, which might have contributed to the tumor state through inhibiting the plasticity of cell differentiation processes during aging, and ultimately suggesting the molecular events that link the processes of aging and cancer. These results highlight that the rate of age-related transcriptional remodeling is influenced not only by the lifespan, but also by the timing of critical physiological milestones.

Shared and Divergent Epigenetic Mechanisms in Cachexia and Sarcopenia

Significant loss of muscle mass may occur in cachexia and sarcopenia, which are major causes of mortality and disability. Cachexia represents a complex multi-organ syndrome associated with cancer and chronic diseases. It is often characterized by body weight loss, inflammation, and muscle and adipose wasting. Progressive muscle loss is also a hallmark of healthy aging, which is emerging worldwide as a main demographic trend. A great challenge for the health care systems is the age-related decline in functionality which threatens the independence and quality of life of elderly people. This biological decline can also be associated with functional muscle loss, known as sarcopenia. Previous studies have shown that microRNAs (miRNAs) play pivotal roles in the development and progression of muscle wasting in both cachexia and sarcopenia. These small non-coding RNAs, often carried in extracellular vesicles, inhibit translation by targeting messenger RNAs, therefore representing potent epigenetic modulators. The molecular mechanisms behind cachexia and sarcopenia, including the expression of specific miRNAs, share common and distinctive trends. The aim of the present review is to compile recent evidence about shared and divergent epigenetic mechanisms, particularly focusing on miRNAs, between cachexia and sarcopenia to understand a facet in the underlying muscle wasting associated with these morbidities and disclose potential therapeutic interventions.

Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

Background

The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD.

Methods

PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated.

Results

Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I² = 60.0%, P_{heterogeneity} = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I² = 0%, P_{heterogeneity} = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I² = 91.0%, P_{heterogeneity} < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I² = 90.5%, P_{heterogeneity} = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I² = 62.0%, P_{heterogeneity} = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention.

Conclusion

Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02438-w.

Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis

OBJECTIVES

The present study investigated the association between adherence to Mediterranean diet (MeDi) and physical performance and cognitive function in older adults.

METHODS

We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated older adults aged 60+ years and assessed adherence to MeDi diet using validated composite scores. Observational studies, including cross-sectional, case-control, and longitudinal cohort studies, if crude baseline data was available, which investigated as a primary or secondary outcome the association of MeDi diet adherence with physical performance and/or cognitive function in non-demented older adults were included in the cross-sectional analysis. For the longitudinal analysis, case-control and longitudinal cohort studies that investigated the longitudinal associations between adherence to MeDi diet with the incidence of mild cognitive impairment (MCI), dementia, and/or Alzheimer's disease (AD), and/or changes in physical performance and cognition in non-demented older adults were included. Studies published in other languages than English were excluded. Studies were retrieved from MEDLINE, SCOPUS, CINAHL, and AgeLine databases until May 19, 2021. The risk of bias was evaluated using the Newcastle - Ottawa Quality Assessment Scale (NOS). A pooled effect size was calculated based on standard mean differences (SMD), log odds ratio (OR) and log risk ratio (RR). This study is registered on PROSPERO (CRD42021250254).

RESULTS

Nineteen cross-sectional studies that investigated 19.734 community-dwelling and institutionalized older adults free of disability and dementia were included. A high adherence to MeDi was cross-sectionally associated with better walking speed (SMD = 0.42; 95 % Confidence Interval (CI) = 0.12-0.72, P = 0.006; I² = 65 %, P = 0.06), knee muscle strength speed (SMD = 0.26; 95 % CI = 0.17-0.36, P < 0.00001; I² = 0 %, P = 0.69), global cognition (SMD = 0.24; 95 % CI = 0.15-0.33, P < 0.00001; I² = 85 %, P < 0.00001), and memory (SMD = 0.18; 95 % CI = 0.13-0.25, P < 0.00001; I² = 100 %, P < 0.00001). The association between MeDi adherence and global cognition remained significant after stratifying the analysis by the region where the study was conducted, MeDi diet adherence composite score, and Mini Mental State Examination (MMSE). Studies had a moderate to low risk of bias. In relation to longitudinal analysis, thirty-four prospective studies with an average follow-up period that varied from 3.0 to 12.6 years and investigated 98.315 community-dwellers were included. Results indicated that older adults with high MeDi scores had a lower decline in global cognition RR = 0.26; 95 % CI = 0.23-0.29, P < 0.00001; I² = 100 %, P < 0.00001). In contrast, no significant associations between MeDi and mobility, MCI, dementia were found. A low risk of bias was found in the longitudinal studies.

DISCUSSION

Findings of the present study indicated that high adherence to MeDi was cross-sectionally associated with physical performance and cognitive function. Results of the pooled analysis of longitudinal studies revealed that high adherence to MeDi reduced the risk of global cognitive decline in non-demented older adults. However, no significant associations between MeDi adherence and the incidence of mobility problems, MCI, and dementia were found. Although important, our findings should be carefully interpreted due to the presence of heterogeneity and publication bias.

A Narrative Review of Sex Differences in Eating Disorders: Is There a Biological Basis?

PURPOSE

Eating disorders and their core symptoms (eg, binge eating, body weight/shape concerns) disproportionately affect females, and these sex-differentiated effects become prominent during and after puberty. Although psychosocial influences such as heightened sociocultural pressures for thinness in girls and women contribute to this sex imbalance, biological factors could also play an important role.

METHODS

This narrative review summarizes evidence of biological factors underlying the sex-differentiated prevalence of eating pathology as well as within-sex variability in risk.

FINDINGS

There are sex differences in the pubertal emergence of genetic effects on eating pathology (adrenarche in males; gonadarche in females), and at least some genetic contributions to eating pathology seem to vary between the sexes. Furthermore, sex steroid hormones (eg, testosterone, estradiol, progesterone) are leading contributors to differential risk for eating pathology in males and females across the life span. Emerging data suggest that between-sex and within-sex variability in risk might occur via hormone-driven modulation (activation/deactivation) of genetic influences and neural responsiveness to food-related cues.

IMPLICATIONS

There is a biological basis to heightened risk for eating pathology in females, relative to males, as well as unique biological influences within each sex. Findings from this review highlight the importance of studying both sexes and considering sex-specific biological mechanisms that may underlie differential risk for eating pathology.

Thyroid hormones in diabetes, cancer, and aging

Thyroid function is central in the control of physiological and pathophysiological processes. Studies in animal models and human research have determined that thyroid hormones modulate cellular processes relevant for aging and for the majority of age‐related diseases. While several studies have associated mild reductions on thyroid hormone function with exceptional longevity in animals and humans, alterations in thyroid hormones are serious medical conditions associated with unhealthy aging and premature death. Moreover, both hyperthyroidism and hypothyroidism have been associated with the development of certain types of diabetes and cancers, indicating a great complexity of the molecular mechanisms controlled by thyroid hormones. In this review, we describe the latest findings in thyroid hormone research in the field of aging, diabetes, and cancer, with a special focus on hepatocellular carcinomas. While aging studies indicate that the direct modulation of thyroid hormones is not a viable strategy to promote healthy aging or longevity and the development of thyromimetics is challenging due to inefficacy and potential toxicity, we argue that interventions based on the use of modulators of thyroid hormone function might provide therapeutic benefit in certain types of diabetes and cancers.

Sleep duration and sarcopenia risk: a systematic review and dose-response meta-analysis

PURPOSE

Present systematic literature review and dose-response meta-analysis were carried out to evaluate the association between sleep duration and sarcopenia risk.

METHODS

Related studies were found by searching ISI Web of science databases, Scopus, and PubMed, up to May, 2019. Data were available from four studies. A total odds ratio of 17551 participants in these studies was pooled for the current study.

RESULTS

Pooled outcomes from random effects model demonstrated that lowest category of sleep duration (under 6 h) versus reference category (6-8 h) was significantly related with increased risk of sarcopenia (OR: 1.71 95% CI, 1.11, 2.64). Pooled OR also indicated that highest category (more than 8 h) of sleep duration versus reference category (6-8 h) was significantly associated with increased risk of sarcopenia (OR: 1.52 95% CI, 1.23, 1.88). Moreover, subgroup analysis by sex showed that women were affected by both short and long sleep while men were only affected by long sleep duration. The nonlinear dose-response meta-analysis revealed a U-shaped association between sleep duration and the risk of sarcopenia, with a nadir at 8 h per day. The linear dose-response meta-analysis illustrated that the risk of sarcopenia did not change significantly nor for a 0.5-h increment neither for 1-h increment in sleep duration per day.

CONCLUSION

The outcomes from this meta-analysis indicate that the public should be made aware of the negative consequences of long and short sleep for sarcopenia especially among women. Further studies should now be undertaken to establish possible links between risk of sarcopenia and sleep duration.

Ultrasound measurements of gastrocnemius muscle thickness in older people with sarcopenia

Background

Sarcopenia, defined as low muscle mass and low muscle strength and/or low physical performance, is affecting more and more people. The European Working Group on Sarcopenia in Older People has suggested the routine community screening. However, selecting the most suitable method to evaluate muscle mass to detect sarcopenia in community screening is a challenge. This study sought to analyze the correlation between ultrasound (US) measurements of the gastrocnemius muscle and low muscle mass, as defined by sarcopenia.

Methods

One hundred thirty-five elderly participants were enrolled. US measurements included muscle thickness (MT), fat thickness (FT), MT/body mass index (BMI), and MT/FT. The definition of low muscle mass was based on the proposal from the Asian Working Group for Sarcopenia, in which the cutoff values for low muscle mass were 7.0 kg/m² for men and 5.4 kg/m² for women using dual energy X-ray absorptiometry (DXA). The participants were divided into low and normal muscle mass groups. Participants with low muscle mass were divided into presarcopenia, sarcopenia, and severe sarcopenia groups.

Results

Those in the low muscle mass group were older and had lower weights and BMIs (P<0.05). In addition, MT and MT/BMI were lower in the low muscle mass group (P<0.05). Binary logistic regression analysis revealed that MT was the factor associated with low skeletal muscle mass (OR =0.001, P<0.001). ANOVA revealed that MT was not significantly different between subjects with presarcopenia, sarcopenia, and severe sarcopenia (F=1.69, P=0.192). Receiver operating characteristic curve analyses indicated that the cutoff value of the gastrocnemius MT for low muscle mass was 1.50 cm.

Conclusion

MT measured by US was identified as the factor associated with low skeletal muscle mass. Those with gastrocnemius MT less than 1.5 cm can be considered as low muscle mass.

An aPPARent Functional Consequence in Skeletal Muscle Physiology via Peroxisome Proliferator-Activated Receptors

Skeletal muscle comprises 30–40% of the total body mass and plays a central role in energy homeostasis in the body. The deregulation of energy homeostasis is a common underlying characteristic of metabolic syndrome. Over the past decades, peroxisome proliferator-activated receptors (PPARs) have been shown to play critical regulatory roles in skeletal muscle. The three family members of PPAR have overlapping roles that contribute to the myriad of processes in skeletal muscle. This review aims to provide an overview of the functions of different PPAR members in energy homeostasis as well as during skeletal muscle metabolic disorders, with a particular focus on human and relevant mouse model studies.

The cortisol-activating enzyme 11β-hydroxysteroid dehydrogenase type 1 in skeletal muscle in the pathogenesis of the metabolic syndrome

The enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) contributes to intracellular glucocorticoid action by converting inactive cortisone to its receptor-active form cortisol (11-dehydrocorticosterone and corticosterone in mice and rats). The potential role of 11β-HSD1 in the pathogenesis of the metabolic syndrome has emerged over the past three decades. However, the precise impact of 11β-HSD1 in obesity-related diseases remains uncertain. Many studies from animal experiments to clinical studies have investigated liver and adipose tissue 11β-HSD1 in relation to obesity and its metabolic disorders including insulin resistance. But the relevance of 11β-HSD1 in skeletal muscle has been less extensively studied. On the other hand, skeletal muscle is assumed to be the main site of peripheral insulin resistance, but the biological relevance of 11β-HSD1 in skeletal muscle is unclear. This mini-review will focus on 11β-HSD1 in skeletal muscle and its postulated link to obesity and insulin-resistance.

Skeletal muscle aging: influence of oxidative stress and physical exercise

Skeletal muscle abnormalities are responsible for significant disability in the elderly. Sarcopenia is the main alteration occurring during senescence and a key public health issue as it predicts frailty, poor quality of life, and mortality. Several factors such as reduced physical activity, hormonal changes, insulin resistance, genetic susceptibility, appetite loss, and nutritional deficiencies are involved in the physiopathology of muscle changes. Sarcopenia is characterized by structural, biochemical, molecular and functional muscle changes. An imbalance between anabolic and catabolic intracellular signaling pathways and an increase in oxidative stress both play important roles in muscle abnormalities. Currently, despite the discovery of new targets and development of new drugs, nonpharmacological therapies such as physical exercise and nutritional support are considered the basis for prevention and treatment of age-associated muscle abnormalities. There has been an increase in information on signaling pathways beneficially modulated by exercise; nonetheless, studies are needed to establish the best type, intensity, and frequency of exercise to prevent or treat age-induced skeletal muscle alterations.

Low FT3: a possible marker of frailty in the elderly

Introduction

Frailty is associated with a functional decline of multiple physiological systems, of which they may be a cause or consequence. The objective of the study was to evaluate the prevalence of thyroid hormone modifications in elderly frail subjects and its relationship with frailty.

Study population and methods

An observational study was carried out at the University Hospital “Tor Vergata” in Rome among ambulatory and hospitalized patients. The study population consisted of 112 elderly subjects: 62 were hospitalized following hip fracture and 50 control subjects were outpatients. Participating patients received a multidimensional geriatric evaluation. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was used to assess the degree of frailty. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured to evaluate thyroid status.

Results

FT3, but not FT4, was significantly correlated with Frailty score, both in patients with hip fracture and in patients from the control group. In the entire study population, FT3 under normal limits is effective in discriminating frail/prefrail subjects from nonfrail subjects.

Discussion

The reduction in serum concentrations of FT3 is a clear manifestation of stress associated with fractures. Numerous preexisting factors, such as the fracture patients’ nutritional status, sarcopenia, disability and comorbidities, which characterize the condition of frailty and influence its pathogenesis, are strongly correlated with FT3 values, suggesting the existence of latent nonthyroidal illness syndrome (NTIS).

Conclusion

We conclude that measuring FT3 can be a useful laboratory parameter in clinical assessment, which can play an important role in identifying vulnerable elderly subjects and in quantifying the condition of frailty.

Aging and Oxidative Stress Decrease Pineal Elongation Factor 2: In Vivo Protective Effect of Melatonin in Young Rats Treated With Cumene Hydroperoxide

We studied the alterations of Elongation Factor 2 (eEF2) in the pineal gland of aged rats as well as the possible protective role of exogenous melatonin on these changes in young rats treated with cumene hydroperoxide (CH), a compound that promotes lipid peroxidation and inhibits protein synthesis. The study was performed using male Wistar rats of 3 (control), 12, and 24 months and 3-month-old rats treated with CH, melatonin, and CH plus melatonin. We found that pineal eEF-2 is affected by aging and CH, these changes being prevented by exogenous melatonin in the case of CH-treated rats. The proteomic studies show that many other proteins are affected by aging and oxidative stress in the pineal gland. The results suggest that one of the possible mechanisms underlying pineal gland dysfunction during aging is the effect of lipid peroxidation on eEF-2, which is a key component of protein synthesis machinery. J. Cell. Biochem. 118: 182-190, 2017. © 2016 Wiley Periodicals, Inc.

Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism

Sarcopenic obesity is the coexistance of sarcopenia and obesity. Modern sarcopenia definition includes low muscle mass, weak muscle strength (handgrip strength) and poor physical function (slow walking), although the clinical definition of each varies worldwide. The cut-points for low muscle mass for men and women using appendicular lean mass divided by height (kg/m2) are ≤7.0 and ≤5.4 in Asians, and ≤7.23 and ≤5.67 in Caucasians, respectively. The cut-points for weak handgrip strength (kg) for men and women are <26 and <18 in Asians, and <30 and <20 in Caucasians, respectively. The cut-point for slow walking is ≤0.8 m/s in men and women. Current data suggest the potential benefits of physical activity and fitness on sarcopenic obesity in older adults.

[Intestinal microbiota and ageing: A new intervention route?]

Intestinal microbiota (IM) has continued to be the subject in all types of studies and publications. More is known on its different components and functions, as well as the changes that take place in IM through the life cycle, and the role of the factors involved in these changes. The aim of this review is to update the relationship between IM and aging. The presentation in 4 sections: (i)main factors of the human ageing process, underlining those related with gut changes; (ii)conceptual meaning of words like microbiota and other related terms; (iii)to comment on the most current findings as regards the changes in IM that occur in the ageing process, whether arising from the physiology or from disease situations, or other factors (environment, diet, drugs, etc.), and the health-consequences of these changes, and (iv)possibilities of different active positive interventions, with emphasis on diet measures.

Patient Psoas Muscle Mass as a Predictor of Complications and Survival After Radical Cystectomy

As a treatment for high-risk bladder cancer, radical cystectomy (RC) remains a highly morbid operation with complication rates of 40-60% and mortality rates as high as 9% in the first 90 days after surgery (Aziz et al., Eur Urol 66(1):156-163, 2014; Shabsigh et al., Eur Urol 55(1):164-174, 2009). Many patients suffer from a failure-to-thrive syndrome associated with anorexia, weight loss, dehydration, and immobility. In elderly patients, failure-to-thrive may result in loss of independence and a cascade of events that increases the risk of perioperative morbidity and mortality, ultimately resulting in impaired survival. Psoas muscle mass has been used to predict morbidity and mortality after major surgical procedures in vulnerable populations with substantial comorbidities. Increasingly, psoas muscle mass is also being used to predict outcomes after RC. If patients with a high risk of impaired survival are identified preoperatively, prehabilitative interventions can be integrated into their preparation for surgical treatment (Porserud et al., Clin Rehab 28(5):451-459, 2014; Friedman et al., Nutr Clin Pract: Off Publ Am Soc Parenter Enter Nutr 30(2):175-179, 2015). This chapter discusses the role of psoas muscle mass as a predictor of negative surgical outcomes after cystectomy.

Prevalence of site-specific thigh sarcopenia in Japanese men and women

The purpose of this study was to compare the prevalence of severe sarcopenia detected by total skeletal muscle mass (SM) index and of site-specific thigh sarcopenia for differing age groups in men and women. Japanese nonobese men and women aged 20 to 85 (n = 1,994, 55 % women) had muscle thickness (MTH) measured by ultrasound at six sites on the anterior and posterior aspects of the body. SM was estimated from ultrasound-derived prediction equations. Site-specific thigh sarcopenia was calculated using ultrasound-measured MTH at the anterior and posterior aspects of the thigh (MTH ratio, anterior 50 %/posterior 50 % thigh MTH (A50/P50 MTH)). Sarcopenia was defined as a SM index (SM divided by height(2)) of >2 standard deviations (SD) below the mean for young adults. Site-specific thigh sarcopenia was defined as a ratio of A50/P50 MTH of >2 SD below the mean for young adults. Age was inversely correlated to SM index and A50/P50 MTH in men (r = -0.480 and r = -0.522) and women (r = -0.243 and r = -0.516). The prevalence rate of sarcopenia was less than 3 % for women under the age of 60, 7 % for ages 60-69, and 24 % for ages 70-80. In men, the prevalence rate of sarcopenia was less than 7 % under the age of 50, 18 % for ages 50-59, 33 % for ages 60-69, and 47 % for ages 70-85. Compared to the sarcopenia estimated by SM index, there was a higher prevalence of site-specific thigh sarcopenia observed in both sexes. These results suggest that site-specific thigh sarcopenia appears before it is able to be detected at the whole body level.

Thymus and aging: morphological, radiological, and functional overview

Aging is a continuous process that induces many alterations in the cytoarchitecture of different organs and systems both in humans and animals. Moreover, it is associated with increased susceptibility to infectious, autoimmune, and neoplastic processes. The thymus is a primary lymphoid organ responsible for the production of immunocompetent T cells and, with aging, it atrophies and declines in functions. Universality of thymic involution in all species possessing thymus, including human, indicates it as a long-standing evolutionary event. Although it is accepted that many factors contribute to age-associated thymic involution, little is known about the mechanisms involved in the process. The exact time point of the initiation is not well defined. To address the issue, we report the exact age of thymus throughout the review so that readers can have a nicely pictured synoptic view of the process. Focusing our attention on the different stages of the development of the thymus gland (natal, postnatal, adult, and old), we describe chronologically the morphological changes of the gland. We report that the thymic morphology and cell types are evolutionarily preserved in several vertebrate species. This finding is important in understanding the similar problems caused by senescence and other diseases. Another point that we considered very important is to indicate the assessment of the thymus through radiological images to highlight its variability in shape, size, and anatomical conformation.

Sarcopenia and nutrition

Preserving or restoring adequate nutritional status is a key factor to delay the onset of chronic diseases and to accelerate recovery from acute illnesses. In particular, consistent and robust data show the loss of muscle mass, that is, sarcopenia, is clinically relevant since it is closely related to increased morbidity and mortality in healthy individuals and patients. Sarcopenia is defined as the age-related loss of muscle mass and function. International study groups have recently proposed separate definitions and diagnostic criteria for sarcopenia. Unfortunately, the rate of agreement in assessing the prevalence of sarcopenia is just fair, which highlights the need for a common effort to harmonize definitions and diagnostic criteria. Sarcopenia should be distinct from myopenia, which is the disease-associated loss of muscle mass, although in clinical practice it may be impossible to separate them (i.e., in old cancer patients). The pathogenesis of sarcopenia is complex and multifactorial. Consequently, its treatment should target the different factors involved, including quantitatively and qualitatively inappropriate food intake and reduced physical activity.

Pharmacologic Approaches to the Aging Athlete

As America’s baby boomer population matures, there is an increasing interest in supplements that can delay or oppose the aging process. This antiaging movement has exploded over the past decade. While most supplements are not supported by scientific literature or government controls, a number of products have been the subject of significant scientific inquiry. Hormone replacement therapy, including testosterone and growth hormone, has mixed results, and antioxidative strategies are supported by basic science but lack clinical evidence-based outcomes. While the process of aging has become better understood leading to more rational approaches to combat its effects on health, the clinician is reminded to carefully discern between the science and marketing that is available in this area.

Transition to sarcopenia and determinants of transitions in older adults: a population-based study

BACKGROUND

Diagnostic criteria for sarcopenia from appendicular lean mass (ALM), strength, and performance have been proposed, but little is known regarding the progression of sarcopenia. We examined the time course of sarcopenia and determinants of transitioning toward and away from sarcopenia.

METHODS

ALM, gait speed, and grip strength were assessed seven times over 9 years in 2,928 initially well-functioning adults aged 70-79. Low ALM was defined as less than 7.95 kg/m(2) (men) or less than 6.24 kg/m(2) (women), low performance as gait speed less than 1.0 m/s, low strength as grip strength less than 30 kg (men) or less than 20 kg (women). Presarcopenia was defined as low ALM and sarcopenia as low ALM with low performance or low strength. Hidden Markov modeling was used to characterize states of ALM, strength, and performance and model transitions leading to sarcopenia and death. Determinants of transitioning toward and away from sarcopenia were examined with logistic regression.

RESULTS

Initially, 54% of participants had normal ALM, strength, and performance; 21% had presarcopenia; 5% had sarcopenia; and 20% had intermediate characteristics. Of participants with normal ALM, strength, and performance, 1% transitioned to presarcopenia and none transitioned to sarcopenia. The greatest transition to sarcopenia (7%) was in presarcopenic individuals. Low-functioning and sarcopenia states were more likely to lead to death (12% and 13%). Higher body mass index (p < .001) and pain (p = .05) predicted transition toward sarcopenia, whereas moderate activity predicted transition from presarcopenia to more normal states (p = .02).

CONCLUSIONS

Pain, physical activity, and body mass index, potentially modifiable factors, are determinants of transitions. Promotion of health approaching old age is important as few individuals transition away from their initial state.

The prevalence of presarcopenia in Asian Indian individuals with and without type 2 diabetes

OBJECTIVE

This study compared the skeletal muscle mass and prevalence of presarcopenia between Asian Indian individuals with and without type 2 diabetes.

SUBJECTS AND METHODS

Participants with type 2 diabetes (n=76) and age- and sex-matched controls without diabetes (n=76) were drawn from the Chennai Urban Rural Epidemiological Study (CURES), which was carried out on a representative sample of Chennai City in South India. Skeletal muscle mass was estimated by dual-energy X-ray absorptiometry, and skeletal muscle mass index (SMI) was calculated by dividing the appendicular skeletal muscle mass by the square of the individual's height in meters and expressed as kg/m(2). Presarcopenia was defined as an SMI of ≤7.26 kg/m(2) for males and ≤5.5 kg/m(2) for females. Biochemical and anthropometric measurements were done using standardized procedures.

RESULTS

The 152 participants included 68 women (44.7%). Mean age was 44±9 years (range, 28-67 years), and the mean body mass index (BMI) was 25.7±3.8 kg/m(2). The prevalence rates of presarcopenia among individuals with and without diabetes were 39.5% and 15.8%, respectively (P=0.001). The mean SMI values were significantly lower in those with diabetes (6.84±1.02 kg/m(2)) compared with participants without diabetes (7.28±1.01 kg/m(2)) (P=0.009). SMI showed a positive correlation with BMI and waist circumference but a negative correlation with age, fasting plasma glucose, glycated hemoglobin, and low-density lipoprotien cholesterol in the total study population. Logistic regression analysis showed that diabetes was independently associated with presarcopenia (P=0.001).

CONCLUSIONS

Prevalence of presarcopenia is higher among Asian Indian subjects with type 2 diabetes compared with age- and sex-matched participants without diabetes.

A Telfairia Occidentalis Seed-incorporated Diet May Be Useful in Inhibiting the Induction of Experimental Andropause

Background:

Andropause, a prevalent pathology of men, results from an imbalance in steroid hormone concentrations that often is associated with aging, and reduces the quality of life of the sufferer. This study investigates the usefulness of a diet containing 15% Telfairia occidentalis seeds in the inhibition of the induction of experimental andropause.

Materials and Methods:

Twenty male rats were divided into four equal groups. Rats in the test group received dihydrotestosterone and estradiol valerate (ratio 10:1) subcutaneously every other day for 28 days and were placed on the test diet. Those in control I received the hormones, but not the test diet. Rats in controls II and III received olive oil (vehicle) and were placed on the test diet and normal diet, respectively. Testes weights and relative weights, serum testosterone concentrations, and testosterone concentration per gram of testicular tissue were measured or determined in all rats using standard protocols. Data were analyzed and differences between means separated using one-way analysis of variance.

Results:

Rats in the test group had slightly larger mean relative testes weights compared to those in control I, though both were significantly (P<0.001) smaller than the values obtained in controls II and III, respectively. Rats in the test group had significantly higher (P=0.034) serum testosterone concentrations relative to the control I group 6.9(0.3) ng/ml vs. 4.7(0.1) ng/ml, while the testosterone relative to testes weight values (ng/ml/g) of the test group was 16.8(3.4), and for controls I, II, and III the values were 12.3(1.4), 5.5(0.4), and 4.6(0.7), respectively. The differences between the test and control groups were all significant (P=0.04 in control I, and <0.001 in controls II and III).

Conclusion:

The test diet resulted in a modest reduction of biochemical castration and an improvement in secretory capacity of the testes of the test rats, relative to the control group that received the hormones but was placed on a normal diet. T. occidentalis seeds-incorporated diet may be useful in inhibiting the induction of experimental andropause.

Relationship between site-specific loss of thigh muscle and gait performance in women: the HIREGASAKI study

Sarcopenia is observed as a site-specific loss of skeletal muscle mass, however, it is unknown whether the site-specific sarcopenia is associated with development of physical disability. The purpose of this study was to examine the relationship between age-related thigh muscle loss and gait performance. Fifty-three women aged 52-83 years had their thigh muscle thickness (MTH) measured by ultrasound at five sites on the anterior (30%, 50%, and 70% of thigh length) and posterior (50% and 70% of thigh length) aspects of their thigh. Maximum and normal walking speeds, zig-zag walking time, and maximal voluntary isometric knee extension and flexion strength were measured. Age was inversely correlated to the anterior and posterior MTH ratio (e.g., anterior 50%:posterior 70% MTH ratio [r=-0.426, p=0.002]), thus the site-specific muscle loss of the thigh was observed in the present sample. There were no significant correlations between the anterior/posterior MTH ratio and maximum and normal walking speeds. However, the ratios of anterior 50%:posterior 70% MTH (r=-0.430) and anterior 30%:posterior 70% MTH (r=-0.444) were correlated (p=0.001) to zig-zag walking test. After adjusting for age, height and weight, the anterior 30%:posterior 70% MTH (r=-0.292, p=0.040) was inversely correlated to zig-zag walking performance. Isometric knee extension strength was also inversely correlated to zig-zag walking. Our results suggest that an age-related loss of adductor/quadriceps muscles may be associated with a decrease in a relatively difficult task performance such as zig-zag walking.

Molecular control over thymic involution: from cytokines and microRNA to aging and adipose tissue

The thymus is the primary organ for T-cell differentiation and maturation. Unlike other major organs, the thymus is highly dynamic, capable of undergoing multiple rounds of almost complete atrophy followed by rapid restoration. The process of thymic atrophy, or involution, results in decreased thymopoiesis and emigration of naïve T cells to the periphery. Multiple processes can trigger transient thymic involution, including bacterial and viral infection(s), aging, pregnancy and stress. Intense investigations into the mechanisms that underlie thymic involution have revealed diverse cellular and molecular mediators, with elaborate control mechanisms. This review outlines the disparate pathways through which involution can be mediated, from the transient infection-mediated pathway, tightly controlled by microRNA, to the chronic changes that occur through aging.

Component characteristics of thigh muscle volume in young and older healthy men

The purpose of this study was to compare the component characteristics of thigh muscle volume in Japanese young and older men. The subjects in both young (YM, n = 15) and older (OM, n = 13) men were physically active (performed aerobic-type exercise 1-3 times per week), but none of the subjects had regularly participated in resistance training for a minimum of 3 years prior to the study. Contiguous transverse magnetic resonance imaging (1.5-T scanner) images were obtained from the thigh, and total and individual (quadriceps, hamstrings and adductors) muscle volumes were calculated by multiplying the muscle cross-sectional area (CSA) by slice thickness and the total number of slices. Muscle length and average muscle CSA (muscle volume divided by muscle length) were determined for each muscle. Maximum voluntary isometric (MVC) knee extension and flexion strength were measured, and muscle quality was defined as MVC per unit average muscle CSA (MVC/CSA). Quadriceps muscle volume and average CSA were, respectively, 20% and 16% lower (P < 0.05) in the OM than in the YM, while hamstrings and adductors muscle volumes and average CSA were similar in both groups. Knee extension and flexion MVC were lower (P < 0.05) in the OM than in the YM. Knee extensor MVC/CSA was similar in the two groups, while knee flexor MVC/CSA was lower (P < 0.05) in the OM than in the YM. Our results suggest that age-related thigh muscle volume loss is muscle specific, in that greater quadriceps muscle loss was found in the older group.

Sarcopenia: designing phase IIB trials

Sarcopenia is the age-related involuntary loss of skeletal muscle mass and functionality that can lead to the development of disability, frailty and increased health care costs. The development of interventions aimed at preventing and/or treating sarcopenia is complex, requiring the adoption of assumptions and standards that are not well established scientifically or clinically. A number of investigators and clinicians (both from academia and industry) met in Rome (Italy) in 2009 to develop a consensus definition of sarcopenia. Subsequently, in Albuquerque (New Mexico, USA) in 2010, the same group met again to consider the complex issues necessary for designing Phase II clinical trials for sarcopenia. Current clinical trial data indicate that fat-free mass (FFM) parameters are responsive to physical activity/nutritional treatment modalities over short time periods, but pharmacological trials of sarcopenia have yet to show significant efficacy. In order to conduct a clinical trial within a reasonable time frame, groups that model or display accelerated aging and loss of FFM are necessary. Few studies have used acceptable designs for testing treatment effects, sample sizes or primary outcomes that could provide interpretable findings or effects across studies. Dual energy x-ray absorptiometry (DXA) is the measure of choice for assessing FFM, but sufficient time is needed for changes to be detected accurately and reliably. A tool set that would allow clinical, basic and epidemiological research on sarcopenia to advance rapidly toward diagnosis and treatment phases should be those reflecting function and strength.

Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia

Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is ≤ 7.23 kg/m(2) in men and ≤ 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.

Skeletal muscle loss: cachexia, sarcopenia, and inactivity

Loss of skeletal muscle mass occurs during aging (sarcopenia), disease (cachexia), or inactivity (atrophy). This article contrasts and compares the metabolic causes of loss of muscle resulting from these conditions. An understanding of the underlying causes of muscle loss is critical for the development of strategies and therapies to preserve muscle mass and function. Loss of skeletal muscle protein results from an imbalance between the rate of muscle protein synthesis and degradation. Cachexia, sarcopenia, and atrophy due to inactivity are characterized by a loss of muscle mass. Each of these conditions results in a metabolic adaptation of increased protein degradation (cachexia), decreased rate of muscle protein synthesis (inactivity), or an alteration in both (sarcopenia). The clinical consequences of bedrest may mimic those of cachexia, including rapid loss of muscle, insulin resistance, and weakness. Prophylaxis against bedrest-induced atrophy includes nutrition support with an emphasis on high-quality protein. Nutritional supplementation alone may not prevent muscle loss secondary to cachexia, but, in combination with the use of an anabolic agent, it may slow or prevent muscle loss.

A review of the effects of growth hormone changes on symptoms of frailty in the elderly with chronic kidney disease

The incidence and prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in the elderly. Recently, functional impairment and frailty have been recognized as factors affecting the quality of life, and outcomes in elderly patients with CKD and therapeutic interventions to improve function and reduce frailty are therefore being considered. Growth hormone (GH) levels decrease with age and GH actions are impaired in CKD patients. GH stimulates protein synthesis, bone, and glucose metabolism, and affects body composition by reducing body fat and increasing lean body mass. An increase in lean body mass may reduce frailty and thus avoid functional impairment. Thus, providing GH to elderly CKD patients could potentially improve outcomes and quality of life by lowering the risk of frailty and associated functional impairment. There are few studies assessing the long-term effects of GH administration on symptoms of frailty in elderly patients with CKD. In this review we will try to shed some light on the trials assessing the administration of GH to elderly subjects and to patients with CKD and focus on the possible role GH administration may play to improve frailty and quality of life in those patients.

Down-regulation of serum gonadotropins is as effective as estrogen replacement at improving menopause-associated cognitive deficits

Declining levels of estrogen in women result in increases in gonadotropins such as luteinizing hormone (LH) through loss of feedback inhibition. LH, like estrogen, is modulated by hormone replacement therapy. However, the role of post-menopausal gonadotropin increases on cognition has not been evaluated. Here, we demonstrate that the down-regulation of ovariectomy-driven LH elevations using the gonadotropin releasing hormone super-analogue, leuprolide acetate, improves cognitive function in the Morris water maze and Y-maze tests in the absence of E2. Furthermore, our data suggest that these effects are independent of the modulation of estrogen receptors alpha and beta, or activation of CYP19 and StAR, associated with the production of endogenous E2. Importantly, pathways associated with improved cognition such as CaMKII and GluR1-Ser831 are up-regulated by leuprolide treatment but not by chronic long-term E2 replacement suggesting independent cognition-modulating properties. Our findings suggest that down-regulation of gonadotropins is as effective as E2 in modulating cognition but likely acts through different molecular mechanisms. These findings provide a potential novel protective strategy to treat menopause/age-related cognitive decline and/or prevent the development of AD.

State of the Art Reviews: Male Menopause: Fact or Fiction?

The possible existence of a menopause-like process in aging men has been speculated, given certain age-related hormonal and other biological changes noted to occur. Specifically, a slow decline in serum testosterone levels has been reported to occur with normal male aging. Androgen deficiency, which may result from this process, could have an effect on various systems and physiologic parameters, including bone density, body composition, sexual function, and the cardiovascular system, thus significantly affecting health and quality-of-life issues in older men. There has been an increasing interest in evaluating the possible use of testosterone replacement in preventing some detrimental aspects of aging and age-related hypogonadism, as well as in the investigation of the potential adverse effects of this therapy on different target organs. It is the purpose of this review to summarize currently available information with regard to the changes in testosterone and other hormones in older men, discuss their possible clinical manifestations and relationship with other age-related changes, and provide an updated description of testosterone replacement therapy for older men, including its indications, formulations, and safety considerations.

Frailty

Frailty is a common condition in older people. It now can be objectively defined by the Fried criteria. When recognized, early intervention should begin with the institution of endurance, resistance, and balance exercises. In men with testosterone deficiency a trial of testosterone replacement should be considered. Vitamin D deficiency needs to be recognized and treated. Appropriate treatment of underlying diseases, such as anemia, diabetes mellitus, and congestive heart failure, are a key management principle. In people who have frailty aggressive health promotion and disease prevention techniques can lead to an inhibition of the downward spiral to disability.

Responses to mild cold stress are predicted by different individual characteristics in young and older subjects

Older individuals' ability to maintain core temperature during cold stress is impaired; however, the relative importance of individual characteristics that influence this response are unknown. The purpose of this study was to determine the relative influence of individual characteristics on core temperature and tissue insulation (I(t)) during mild cold stress. Forty-two young (23 +/- 1 yr, range 18-30 yr) and 46 older (71 +/- 1 yr, range 65-89 yr) subjects, varying widely in muscularity, adiposity, and body size, underwent a transient cooling protocol during which esophageal temperature (T(es)) was measured continuously and I(t) was calculated using standard equations. Multiple-regression analyses were performed to determine predictors of T(es) and I(t), and standardized regression coefficients were analyzed to determine the relative influence of each predictor. Candidate predictors included age, sex, weight, body surface area, body surface area-to-mass ratio, sum of skinfolds, percent fat, appendicular skeletal muscle mass, and thyroid hormone concentrations (triiodothyronine, thyronine). The sum of skinfolds explained 67% (P < 0.01) of the T(es) variance in young subjects vs. 2% (P = 0.30) in older subjects. Conversely, appendicular skeletal muscle mass explained a greater portion of the variance in older subjects for both T(es) (older: 28%, P < 0.01; young: 8%, not significant) and I(t) (older: 46%, P < 0.01; young: 17%, P < 0.01). The T(es) residual variance was considerably larger in older subjects (59-72% vs. 14-42% in young subjects), possibly due to varying rates of physiological aging. These results suggest that the relative influence of individual characteristics changes with aging.

Why and how antipsychotic drugs are used in 40 Sydney nursing homes

BACKGROUND

For decades there has been a high use of antipsychotic medication in nursing homes, though recently the use of typical antipsychotics has reduced while use of atypical antipsychotic medication has increased. The Australian government subsidises use of the latter in management of schizophrenia, and since April 2005 has subsidised use of risperidone (but still not the other atypicals) in cases of dementia with behavioural disturbance. This study was designed to examine the pattern of, and reasons for, antipsychotic use in a range of Sydney nursing homes.

METHODS

Clinical files and medication cards in 40 Sydney nursing homes were examined in late 2003 by a research nurse, who recorded documented diagnoses, blood glucose levels and use of medication in the previous 4 weeks.

RESULTS

Antipsychotics were prescribed for 577 (25.1%) of the 2302 residents. Of these, 114 had schizophrenia. Of the 2302, 6.1% and 15.6%, respectively, had documented diagnoses of schizophrenia and/or diabetes. Of those with schizophrenia, 13.6% had diabetes. Two-thirds of those given antipsychotics had dementia or cerebral disease and not schizophrenia. Two-thirds of the antipsychotic prescriptions for residents with schizophrenia, and also for those without, were for atypicals (n = 200 olanzapine, 174 risperidone, 19 quetiapine). Blood glucose measurements had been recorded in less than 45%.

CONCLUSIONS

In Sydney in 2003, most (80%) of the nursing home residents for whom antipsychotics were prescribed did not have a diagnosis of schizophrenia. The records suggested that insufficient attention had been given to the possibility that use of certain antipsychotics can be associated with impaired glucose metabolism.

Sexual desire in later life

The has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. The existing literature consists of studies of small samples, much of it from a biomedical perspective. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. The study reports results from a survey of a large sample (N=1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. We report bivariate and multivariate analysis conducted separately for women and men. We find that the principal influences on strength of sexual desire among women are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors.