Current review of the SarQoL®: a health-related quality of life questionnaire specific to sarcopenia

Muscle strength, not muscle mass, determines the health-related quality of life in Indonesian women with systemic lupus erythematosus

OBJECTIVE

No study evaluated the impact of low muscle strength and mass on the Sarcopenia-related Quality of Life (SarQoL) in women with SLE.

METHODS

This cross-sectional study recruited 145 women with SLE consecutively; muscle strength was measured with a calibrated Jamar handheld dynamometer, muscle mass was measured with appendicular muscle mass index (Tanita MC-780 MAP body impedance analyser) and health-related quality of life with SarQoL Questionnaire. The cut-off points for low muscle strength, low muscle mass and sarcopenia were derived from the Asian Working Group on Sarcopenia 2019. Statistical analysis was conducted with a t-test for mean difference, and logistic regression was used to evaluate for low muscle strength contributing factors.

RESULTS

There was a significant difference in the mean total score of SarQoL in individuals with normal compared with low muscle strength (74.36 vs 64.85; mean difference 9.50; 95% CI 2.10 to 5.33; p<0.001). On the other hand, there was no difference in individuals with normal compared with low muscle mass (71.07 vs 70.79; mean difference 0.28; -5.18 to 5.74; p=0.91). After minimally adjusted with age, we found moderate-severe joint pain (B -9.280; p<0.001) and low muscle strength (B -6.979; p=0.001) to be independently associated with low mean SarQoL total score.

CONCLUSION

There was a lower total SarQoL score in individuals with low muscle strength but not with low muscle mass.

Muscle mass, strength, power and physical performance and their association with quality of life in older adults, the Study of Muscle, Mobility and Aging (SOMMA)

Background

Sarcopenia negatively impacts quality of life. It is unclear whether different measures of muscle size, strength, physical performance, and fitness have similar associations with quality of life.

Objective

To describe associations of sarcopenia metrics with quality of life outcomes.

Participants

Community-dwelling adults aged 70+ years participating in the SOMMA (Study of Muscle, Mobility and Aging) study.

Design and settings

Two academic medical centers.

Measurements

Measures included muscle size (MRI- muscle volume. D3Cr muscle mass); strength and power (grip strength, leg extension power and strength); walking and physical performance (4m and 400m walk, SPPB (Short Physical Performance Battery), stair climb, chair stand); fitness (VO2 peak); health related quality of life (EQ-5D); and anthropometrics (weight, height, and body mass index).Results were stratified by sex. Correlations, scatterplots and linear regression models described the association between various measures of sarcopenia and fitness with overall quality of life score (EQ5D VAS) as a continuous variable. We also quantified differences between sarcopenia and fitness measures by overall QOL (Quality of Life) as a categorical variable (low, medium, high) and by QOL subcomponents (pain and discomfort, problems with usual activities, mobility, anxiety and depression, and problems with self-care) using distributionally appropriate methods.

Results

Walking tests and physical performance were most consistently (but modestly) associated with overall quality of life (r~0.2, p<.001) and its subcomponents. Both men and women several sarcopenia and fitness measures were more strongly associated with pain and usual activity than other QOL components.

Conclusions

Poor performance, lower fitness and lower strength are related to worse quality of life, particularly pain, in older adults. Future studies should quantify these relationships longitudinally.

Sarcopenia and health-related quality of life: A systematic review and meta-analysis

The decrease of physical abilities and functional decline that can be caused by musculoskeletal conditions such as sarcopenia, can lead to higher levels of dependency and disability. Therefore, it may influence patient reported outcome measures (PROM), such as the health-related quality of life (HRQoL). The purpose of this systematic review and meta-analysis is to provide a comprehensive overview of the relationship between sarcopenia and HRQoL. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed throughout the whole process of this work. A protocol was previously published on PROSPERO. The electronic databases MEDLINE, Scopus, Allied and Complementary Medicine (AMED), EMB Review - ACP Journal Club, EBM Review - Cochrane Central of Register of Controlled Trials and APA PsychInfo were searched until October 2022 for observational studies reporting a HRQoL assessment in both sarcopenic and non-sarcopenic individuals. Study selection and data extraction were carried out by two independent researchers. Meta-analysis was performed using a random effect model, reporting an overall standardized mean difference (SMD) and its 95% confidence interval (CI) between sarcopenic and non-sarcopenic individuals. Study quality was measured using the Newcastle-Ottawa Scale and the strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The search strategy identified 3725 references from which 43 observational studies were eligible and included in this meta-synthesis study. A significantly lower HRQoL was observed for sarcopenic individuals compared with non-sarcopenic ones (SMD -0.76; 95% CI -0.95; -0.57). Significant heterogeneity was associated with the model (I²  = 93%, Q test P-value <0.01). Subgroup analysis showed a higher effect size when using the specific questionnaire SarQoL compared with generic questionnaires (SMD -1.09; 95% CI -1.44; -0.74 with the SarQoL versus -0.49; 95% CI -0.63; -0.36 with generic tools; P-value for interaction <0.01). A greater difference of HRQoL between sarcopenic and non-sarcopenic was found for individuals residing in care homes compared with community-dwelling individuals (P-value for interaction <0.001). No differences were found between age groups, diagnostic techniques, and continents/regions. The level of evidence was rated as moderate using the GRADE assessment. This systematic review and meta-analysis combining 43 observational studies shows that HRQoL is significantly reduced in sarcopenic patients. The use of disease-specific HRQoL instruments may better discriminate sarcopenic patients with respect to their quality of life.

Spondyloarthritis and Sarcopenia: Prevalence of Probable Sarcopenia and its Impact on Disease Burden: The Saspar Study

To evaluate the prevalence of probable, confirmed, and severe sarcopenia in spondyloarthritis (SpA), according to the European Working Group on Sarcopenia in Older People 2019 (EWGSOP2) definition. A total of 103 patients (51% women) with SpA, mean age 47.1 ± 13.7 years, were included and compared to 103 age- and sex-matched controls. Grip strength was measured by dynamometry. Body composition was assessed by whole-body densitometry. In SpA patients gait speed was measured by the 4-m-distance walk test and quality of life was evaluated with a specific health-related questionnaire for sarcopenia (SaRQoL®). Twenty-two SpA patients (21%) versus 7 controls (7%) had a low grip strength, i.e., probable sarcopenia (p < 0.01), 15 SpA (15%) patients and 7 controls (7%) had low Skeletal Muscle mass Index (SMI) (ns), respectively, and 5 and 2% of SpA patients and controls had low grip strength and low SMI, i.e., confirmed sarcopenia (ns). All the sarcopenic SpA patients had a low gait speed, i.e., severe sarcopenia. Finally, probable sarcopenic SpA patients had significantly higher C-Reactive Protein (CRP, p < 0.001) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI score, p < 0.01), lower gait speed (p < 0.001), and SarQoL® score (p < 0.001) than SpA patients with normal grip strength. According to EWGSOP2 definition, the prevalence of probable sarcopenia was significantly higher in SpA patients compared to controls. Probable sarcopenia was associated with higher inflammation and disease activity, impaired muscle performance, and quality of life. These results suggest that muscle strength may be a salient hallmark in SpA.

Translation and validation of the Taiwanese SarQoL, a quality of life questionnaire specific to sarcopenia

BACKGROUND

The Sarcopenia Quality of Life (SarQoL) questionnaire has been translated into various languages. This study validated the Taiwanese version of the SarQoL (SarQoL-TW) questionnaire.

METHODS

Forward-backward translation was conducted, along with a test of the prefinal version of the translated questionnaire. To validate the psychometric properties of the questionnaire, 50 older adults with sarcopenia and 50 older adults without sarcopenia completed the SarQoL-TW, the Short Form12 Health Survey (SF-12), and the EQ-5D-3L questionnaire. Participants with sarcopenia were asked to complete the SarQoL-TW questionnaire once more after 2 weeks. Validating the psychometric properties of the SarQoL-TW questionnaire involved assessing its discriminative power, internal consistency, construct validity, test-retest reliability, and potential floor and ceiling effects.

RESULTS

The SarQoL-TW questionnaire was translated without major difficulties. The psychometric analysis revealed that older adults with sarcopenia scored significantly lower on the SarQoL-TW, both overall and in some of the domains. The Cronbach's alpha of 0.846 indicated high internal consistency. The SarQoL-TW questionnaire correlated well with similar constructs on the SF-12 and EQ-5D-3L for convergent validity and correlated weakly with distinct domains for divergent validity, confirming its favorable construct validity. The test-retest reliability was excellent (intraclass correlation coefficient: 0.970). Neither floor nor ceiling effects were observed.

CONCLUSION

The SarQoL-TW questionnaire is a reliable and valid questionnaire, useful for assessing quality of life in older adults with sarcopenia in clinical practice and research.

Cross-cultural adaptation and validation of Sarcopenia and Quality of Life (SarQoL) in Brazil

BACKGROUND

Sarcopenia is defined as a slow, progressive, and apparently inevitable process of involuntary loss of muscle mass, strength, and quality, which occurs with advancing age. It is widely accepted that sarcopenia can directly affect quality of life.

OBJECTIVE

Translate, adapt and validate the "Sarcopenia and Quality of Life" instrument (SarQoL) to the Brazilian context.

DESIGN AND SETTINGS

Translation, cross-cultural adaptation, and validation study carried out at the Federal University of São Carlos, São Carlos, São Paulo, Brazil.

METHODS

The population consisted of 221 older adult participants. The steps recommended by the guidelines from the authors of the original instrument were followed sequentially: initial translation, synthesis of translations, backward translation, evaluation by a panel of judges, pre-test, and analysis of psychometric properties. The translation and adaptation process was conducted as recommended.

RESULTS

Two hundred and twenty-one participants took part in the step analysis of the psychometric properties of SarQoL, in which 55 presented sarcopenia. Cronbach's alpha coefficient of the total SarQoL questionnaire was 0.976, indicating excellent internal consistency. Excellent agreements between the test and retest with an Interclass Correlation Coefficient (ICC) of 0.983 (95% confidence interval: 0.901-0.996) were observed in the SarQoL domains. The domains of Short-Form 36 and EuroQoL 5-dimension showed significant correlation, from moderate to strong magnitude, with SarQoL total score, indicating convergent validity.

CONCLUSION

The Brazilian version of SarQoL presented evidence of reliability and validity.

Correlation of reduced temporal muscle thickness and systemic muscle loss in newly diagnosed glioblastoma patients

PURPOSE

Reduced temporal muscle thickness (TMT) has recently been postulated as a prognostic imaging marker and an objective tool to assess patients frailty in glioblastoma. Our aim is to investigate the correlation of TMT and systemic muscle loss to confirm that TMT is an adequate surrogate marker of sarcopenia in newly diagnosed glioblastoma patients.

METHODS

TMT was assessed on preoperative MR-images and skeletal muscle area (SMA) was assessed at the third lumbar vertebra on preoperative abdominal CT-scans. Previous published TMT sex-specific cut-off values were used to classify patients as 'patient at risk of sarcopenia' or 'patient with normal muscle status'. Correlation between TMT and SMA was assessed using Spearman's rank correlation coefficient.

RESULTS

Sixteen percent of the 245 included patients were identified as at risk of sarcopenia. The mean SMA of glioblastoma patients at risk of sarcopenia (124.3 cm2, SD 30.8 cm2) was significantly lower than the mean SMA of patients with normal muscle status (146.3 cm2, SD 31.1 cm2, P < .001). We found a moderate association between TMT and SMA in the patients with normal muscle status (Spearman's rho 0.521, P < .001), and a strong association in the patients at risk of sarcopenia (Spearman's rho 0.678, P < .001).

CONCLUSION

Our results confirm the use of TMT as a surrogate marker of total body skeletal muscle mass in glioblastoma, especially in frail patients at risk of sarcopenia. TMT can be used to identify patients with muscle loss early in the disease process, which enables the implementation of adequate intervention strategies.

Association between sarcopenia and quality of life among adults aged ≥ 65 years from low- and middle-income countries

BACKGROUND

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce.

AIMS

To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs.

METHODS

Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted.

RESULTS

Data on 14,585 people aged ≥ 65 years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant - 3.37 points [95% CI - 5.56, - 1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL.

DISCUSSION

The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia.

CONCLUSIONS

In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

Analysis of Structural Characteristics and Psychometric Properties of the SarQoL® Questionnaire in Different Languages: A Systematic Review

BACKGROUND

Sarcopenia is the gradual and global loss of muscle and its functions. Primary sarcopenia is associated with the typical changes of advanced aging and affects approximately 5-10% of the population. The Sarcopenia and Quality of Life (SarQoL®) questionnaire is composed of 55 items, 22 questions, and is organized into seven domains of quality of life. The main objective of this systematic review was to analyze the structural characteristics and psychometric properties of it, as well as to classify its measurement properties, its methodological quality, and the criteria as good measurement properties of the adaptations and validations made on the SarQoL® questionnaire in different languages.

METHODS

A systematic review was carried out in the PUBMED, Web of Science, Cinahl, LatinIndex, and SCOPUS databases. The keywords used were: "SarQoL", "assessment", "sarcopenia", "geriatric", "PROM", "quality of life", and "questionnaire", using the Boolean operator "AND". All articles published up to 15 January 2022 were considered. Methodological quality and psychometric properties were assessed based on the COSMIN guidelines and the guidelines and general recommendations of PRISMA. Documents published in languages other than English were excluded, as well as versions of the SarQoL® published in the form abstracts for conferences when the full text was not available.

RESULTS

A total of 133 articles were identified, 14 of which were included. The evaluated questionnaires and the structural characteristics and psychometric properties of each of them were collected.

CONCLUSION

The different cross-cultural versions of the questionnaire showed good basic structural and psychometric characteristics for the evaluation of patients with sarcopenia.

Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls?

Background

Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium.

Aim

Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial^® magnesium associated with therapeutic exercise on the outcome of these patients.

Methods

We divided the study into two parts. In the first part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise.

Results

Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a significant improvement in blood levels of magnesium (2.11 ± 0.15 vs. 1.94 ± 0.11; p < 0.05), on the NRS scale (5.7 ± 0.81 vs. 6.6 ± 1.18; p < 0.05), the Tinetti scale (17.3 ± 1.15 vs. 15.2 ± 2.98; p < 0.05) and the SarQoL questionnaire (47.3 ± 5.21 vs. 44.9 ± 5.54; p < 0.05).

Conclusions

More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifiable risk factors for osteoporosis.

Sarcopenia reduces quality of life in the long-term: longitudinal analyses from the English longitudinal study of ageing

Aim

To examine the association between sarcopenia at baseline and changes in quality of life at 10 years follow-up in a large representative sample of older English adults.

Findings

After considering numerous confounders, sarcopenia at baseline was associated with a higher incidence of poor quality of life. People having sarcopenia at baseline reported significantly lower values in CASP-19 after ten years of follow-up.

Message

Sarcopenia is an important and independent risk factor for poor quality of life in older people.

Purpose

Mixed findings exist for sarcopenia/quality of life (QoL) relationship. Moreover, the majority of studies in this area have utilized a cross-sectional design or specific clinical populations. Therefore, the aim of the present study was to examine the association between sarcopenia at baseline and QoL at 10 years follow-up in a large representative sample of older English adults.

Methods

Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index. QoL was measured using the CASP (control, autonomy, self-realisation and pleasure)-19, with higher values reflecting higher QoL. Multivariable logistic regression analysis was conducted to assess prospective associations between sarcopenia at baseline and poor QoL at follow-up; generalized linear model with repeated measures was used for reporting mean changes during follow-up between sarcopenia and not.

Results

Among 4044 older participants initially included at baseline (mean age: 70.7 years; 55.1% females), 376 had sarcopenia. In the multivariable analysis, after adjusting for several potential confounders, sarcopenia at baseline was associated with a higher incidence of poor QoL (odds ratio, OR = 5.82; 95% confidence interval, CI 3.45–9.82). After matching for QoL values at baseline and adjusting for potential confounders, people with sarcopenia reported significantly lower values in CASP-19 (mean difference = − 3.94; 95% CI − 4.77 to − 3.10).

Conclusions

In this large representative sample of older English adults, it was observed that sarcopenia at baseline was associated with worse scores of QoL at follow-up compared to those without sarcopenia at baseline. It may be prudent to target those with sarcopenia to improve QoL.

Assessment of Sarcopenia Related Quality of Life Using SarQoL® Questionnaire in Patients With Liver Cirrhosis

Introduction

Sarcopenia, malnutrition, physical deconditioning, and frailty contribute to a significantly altered quality of life (QoL) in patients with cirrhosis and sarcopenia.

Aim

To investigate the sarcopenia-linked alterations of QoL by SarQoL® questionnaire in patients with end-stage liver disease.

Methods

Consecutive patients with liver cirrhosis, admitted to our department between May and August 2021, completed the SarQoL® questionnaire by themselves. They were evaluated for sarcopenia according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) definition [hand grip cut-offs and skeletal muscle index (SMI) calculation at CT scan].

Results

A total of 71 patients with liver cirrhosis were included in the study, with a median age of 54 years. Sarcopenia was present in 31.2% of patients with Child-Pugh class A, in 58.3% with class B, and in 93.5% with class C. The SarQoL® score was statistically significant and lower in Child-Pugh class C vs. class B and class A (70.2 vs. 66.5 vs. 52.5 points, p = 0.0002). The SarQoL® score was evaluated according to different complications of cirrhosis, with statistically significant lower scores in patients with sarcopenia (p < 0.0001), in patients with ascites requiring paracentesis (p = 0.0006), and in patients with hepatic encephalopathy (p < 0.0001). A cut-off level of 75.9 points for SarQoL® score can accurately detect sarcopenia in patients with end-stage liver disease [area under the receiver operating characteristic (AUROC) curve of.823, SE of 92.1%, SP of 45.5%, positive predictive value (PPV) and negative predictive value (NPV) of 66 and 83.3%, respectively, correctly classified 73.2% of cirrhotic patients with sarcopenia].

Conclusions

The use of SarQoL® questionnaire in cirrhotic patients can, at the same time, evaluate the quality of life and identify subjects with sarcopenia and altered QoL.

Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

The purpose of this study was to evaluate the prevalence of sarcopenia and/or myosteatosis in elderly patients with pelvic ring injuries and their influence on mortality, patient-perceived physical functioning and quality of life (QoL). A multicenter retrospective cohort study was conducted including elderly patients aged ≥ 65 treated for a pelvic ring injury. Cross-sectional computed tomography (CT) muscle measurements were obtained to determine the presence of sarcopenia and/or myosteatosis. Kaplan–Meier analysis was used for survival analysis, and Cox proportional hazards regression analysis was used to determine risk factors for mortality. Patient-reported outcome measures for physical functioning (SMFA) and QoL (EQ-5D) were used. Multivariable linear regression analyses were used to determine the effect of sarcopenia and myosteatosis on patient-perceived physical functioning and QoL. Data to determine sarcopenia and myosteatosis were available for 199 patients, with a mean follow-up of 2.4 ± 2.2 years: 66 patients (33%) were diagnosed with sarcopenia and 65 (32%) with myosteatosis, while 30 of them (15%) had both. Mortality rates in patients at 1 and 3 years without sarcopenia and myosteatosis were 13% and 21%, compared to 11% and 36% in patients with sarcopenia, 17% and 31% in patients with myosteatosis and 27% and 43% in patients with both. Higher age at the time of injury and a higher Charlson Comorbidity Index (CCI) were independent risk factors for mortality. Patient-reported mental and emotional problems were significantly increased in patients with sarcopenia.

Associations between the quality of life in sarcopenia measured with the SarQoL® and nutritional status

BACKGROUND

The purpose of this study was to evaluate the relationship between nutritional status and health-related quality of life after adjusting for essential factors of muscle mass, calf circumference, grip strength, and the timed up and go (TUG) test for diagnosis of sarcopenia.

METHODS

The subjects of this study were those who visited a health care center or a senior welfare center among the aged 65 years or older living in a community in two counties (Jinju, Sacheon), and the survey was conducted from April to August 2019. Among them, those with cardiovascular disease, cognitive disorder, or malignancy were excluded. To determine the nutritional status of the elderly subjects, a questionnaire-based screening tool called DETERMINE was used. Developed as a health-related quality of life tool for sarcopenia, the Sarcopenia-specific Quality of Life (SarQoL) questionnaire was used. For screening of sarcopenia, a rapid questionnaire based on self-reported information about falls, mobility, and strength known as the SARC-F questionnaire was used. Assessment of sarcopenia included skeletal muscle mass, calf circumference, grip strength, and the TUG test.

RESULTS

A total of 324 elderly people living in rural villages who were able to move to senior and welfare centers was surveyed. As a result of evaluating the association between SarQoL and nutritional risk in elderly subjects, the association was statistically significant in the moderate-risk group (B = - 5.542, p = 0.001) and in the high-risk group (B = - 8.136, p < 0.001) in comparison to the low-risk group. Significant correlations were found in all seven domains of SarQoL, except the fear domain.

CONCLUSIONS

This study confirms an association between quality of life dimensions surveyed by the SarQoL questionnaire and nutritional status in elderly subjects. Therefore, appropriate interventions are needed following brief evaluation of sarcopenia and nutritional deficiency among elderly people in communities.

The Relationships Between Skeletal Muscle Index and Bone Variables in a Group of Young Adults

The purpose of this study was to investigate the relationships between skeletal muscle index (SMI) and bone variables in a group of young adults. Three hundred and thirty-five young adults (129 men and 206 women) whose ages ranged from 18 to 35 yr voluntarily participated in this study. Weight and height were measured, and body mass index (BMI) was calculated. Body composition, bone mineral content (BMC), bone mineral density (BMD), geometric indices of hip bone strength and trabecular bone score (TBS) were determined for each individual by Dual-energy X-ray absorptiometry (DXA). Appendicular skeletal mass (ASM, in kg) was calculated by summing the muscle masses of the 4 limbs, assuming that all nonfat and nonebone mass is skeletal muscle. Skeletal muscle index (SMI) was defined as ASM/height². In young men, SMI was positively correlated to WB BMC (r = 0.63; p < 0.001), WB BMD (r = 0.53; p < 0.001), L1-L4 BMC (r = 0.33; p < 0.001), L1-L4 BMD (r = 0.30; p < 0.001), L1-L4 TBS (r = 0.26; p < 0.01), TH BMC (r = 0.61; p < 0.001), TH BMD (r = 0.46; p < 0.001), FN BMC (r = 0.51; p < 0.001), FN BMD (r = 0.46; p < 0.001), FN cross-sectional area (CSA) (r = 0.56; p < 0.001), FN cross-sectional moment of inertia (CSMI) (r = 0.52; p < 0.001) and FN section modulus (Z) (r = 0.54; p < 0.001) but negatively correlated to FN strength index (SI) (r = -0.24; p < 0.01). In young women, SMI was positively correlated to WB BMC (r = 0.61; p < 0.001), WB BMD (r = 0.60; p < 0.001), L1-L4 BMC (r = 0.35; p < 0.001), L1-L4 BMD (r = 0.33; p < 0.001), L1-L4 TBS (r = 0.29; p < 0.001), TH BMC (r = 0.61; p < 0.001), TH BMD (r = 0.53; p < 0.001), FN BMC (r = 0.45; p < 0.001), FN BMD (r = 0.49; p < 0.001), FN CSA (r = 0.60; p < 0.001), FN CSMI (r = 0.52; p < 0.001), and FN Z (r = 0.40; p < 0.001) but negatively correlated to FN SI (r = -0.20; p < 0.01). The current study suggests that SMI is a positive determinant of bone mineral density and geometric indices of hip bone strength in young adults.

Novel approaches to sarcopenic obesity and weight management before and after kidney transplantation

PURPOSE OF REVIEW

Although a widely recognized and complex pathophysiological condition, sarcopenic obesity remains less appreciated and may elude diagnosis and workup in both kidney transplant waitlisted candidates and kidney transplant recipients. The lack of consensus definition, and practical diagnostic tools for evaluating waitlisted candidates and transplant recipients are barriers to early detect and initiate therapeutic management for sarcopenic obesity. Although sarcopenia leads to poor clinical outcomes, posttransplant obesity yields conflicting results. Exercise and nutritional managements are common therapies for sarcopenic obese patients; however, surgery weight loss or bariatric surgery in both transplant candidates and potential living kidney donors shows promising benefits for kidney transplant access in waitlist obese candidates but may require to be selected for appropriate patients.

RECENT FINDINGS

Pathogenesis and management for sarcopenia and obesity are interconnected. The benefits of exercise to improve muscle mass and function is clear in waitlist kidney transplant candidates and transplant recipients. However, there are several barriers for those to increase exercise and improve physical activity including patient, provider, and healthcare or environmental factors. The advantages of fat mass reduction to lose weight can promote muscle mass and strength. However, epidemiological data regarding the obesity paradox in dialysis-dependent patients when overnutrition provides survival benefits for this population should be taken into account when performing weight loss especially bariatric surgery.

SUMMARY

Barriers in providing optimal care to kidney transplant waitlisted candidates and transplant recipients may partly result from underdiagnosis of sarcopenic obesity; notwithstanding that this entity has increasingly been more recognized. Mechanistic studies to better understand pathogenesis of sarcopenic obesity will help determine pathogenesis and clinical tools for diagnosis of this entity, which can facilitate further studies related to the outcomes and weight management to ultimately improve kidney transplant outcomes.

Correlations between the Quality of Life Domains and Clinical Variables in Sarcopenic Osteoporotic Postmenopausal Women

(1) Background: both sarcopenia and osteoporosis are major health problems in postmenopausal women. The aim of the study was to evaluate the quality of life (QoL) and the associated factors for sarcopenia in osteoporotic postmenopausal women, diagnosed according to EWGSOP2 criteria. (2) Methods: the study sample comprised 122 osteoporotic postmenopausal women with low hand grip strength and was divided into two groups: group 1 (probable sarcopenia) and group 2 (sarcopenia). QoL was assessed using the validated Romanian version of SarQol questionnaire. (3) Results: the D1, D4, D5, D7 and total SarQoL scores were significantly lower in women from group 2 compared to group 1. In group 2, women older than 70 years had significant lower values for D1, D3, D4, D6 and total SarQoL scores. Age, history of falls and the presence of confirmed and severe sarcopenia were predictors for overall QoL. (4) Conclusions: the frequency of sarcopenia was relatively high in our sample, with body mass index and history of falls as predictors for sarcopenia. Older osteoporotic postmenopausal women, with previous falls and an established sarcopenia diagnosis (low muscle strength and low muscle mass), were more likely to have a decreased quality of life.

Osteosarcopenic obesity, the coexistence of osteoporosis, sarcopenia and obesity and consequences in the quality of life in older adults ≥65 years-old in Greece

OBJECTIVE

We investigated the coexistence of sarcopenia and obesity in older adults≥65 years diagnosed with osteoporosis and the association with Quality of Life (QoL).

METHODS

A Cross-sectional survey has been performed on a randomized sample of 50 diagnosed osteoporotic elderly people from both sexes (Men=16; Women=34).

MEASUREMENTS

Quantitative ultrasound was conducted to identify osteoporosis and defined with a T score ≤2.5. Validated anthropometric equations were used in order to estimate body fat percentage and skeletal muscle mass so as to detect the reallocation of body fat and lean muscle. 10m gait speed and hand grip strength was measured in order to diagnose sarcopenia according to European Society for Clinical Nutrition and Metabolism (ESPEN) algorithm. The evaluation of QoL was conducted using a QoL questionnaire specific to osteoporosis. The data were analyzed with descriptive statistics and a chi-square test was performed to examine if Osteosarcopenic Obesity (OSO) is sex related and the correlation between OSO and QoL.

RESULTS

From the 50 participants, 40%(n=19) were classified as people with OSO and 60%(n=31) without OSO. From n=19 people that experienced OSO women represent 20% (n=9) and men 18% (n=9); with the latter had a greater decline in muscle mass than women, while women had lower BMD than men according to the z score. OSO is not related with sex (p>.05) and there is no significant association between OSO and QoL (p> .05 for all the domains of QoL questionnaire).

CONCLUSION

Osteoporosis in the elderly often coexists with reduced muscle mass and muscle strength as well as an increase in adiposity and was independently associated with QoL. People that experience OSO presenting lower functionality that increases the risk for falls and bone fractures originated from the decline in bone and muscle mass, and increased adiposity. Increased awareness of OSO may help develop efficient interventions and public health policies for healthier and more active elderly people.

Sarcopenia feature selection and risk prediction using machine learning: A cross-sectional study

The purpose of this study was to verify the usefulness of machine learning (ML) for selection of risk factors and development of predictive models for patients with sarcopenia.We collected medical records from Korean postmenopausal women based on Korea National Health and Nutrition Examination Surveys. A training data set compiled from simple survey data was used to construct models based on popular ML algorithms (e.g., support vector machine, random forest [RF], and logistic regression).A total of 4020 patients ≥65 years of age were enrolled in this study. The study population consisted of 1698 (42.2%) male and 2322 (57.8%) female patients. The 10 most important risk factors in men were body mass index (BMI), red blood cell (RBC) count, blood urea nitrogen (BUN), vitamin D, ferritin, fiber intake (g/d), primary diastolic blood pressure, white blood cell (WBC) count, fat intake (g/d), age, glutamic-pyruvic transaminase, niacin intake (mg/d), protein intake (g/d), fasting blood sugar, and water intake (g/d). The 10 most important risk factors in women were BMI, water intake (g/d), WBC, RBC count, iron intake (mg/d), BUN, high-density lipoprotein, protein intake (g/d), fiber consumption (g/d), vitamin C intake (mg/d), parathyroid hormone, niacin intake (mg/d), carotene intake (μg/d), potassium intake (mg/d), calcium intake (mg/d), sodium intake (mg/d), retinol intake (μg/d), and age. A receiver operating characteristic (ROC) curve analysis found that the area under the ROC curve for each ML model was not significantly different within a gender.The most cost-effective method in clinical practice is to make feature selection using RF models and expert knowledge and to make disease prediction using verification by several ML models. However, the developed prediction model should be validated using additional studies.

Construct and Psychometric Properties of a New Version Quality of Life Scale Based on Choice Theory

BACKGROUND

Choice theory, as a psychopathological model, postulated five basics, genetically and universally, needs. Accordingly, the rate of everybody happiness and quality of life is depended on the number of his needs fulfilling. Although some scales have been constructed to assess basic needs, they have proposed unity of needs for all human.

AIM

The present study was designed to construct a new scale, considering individualisation needs for each person; quality of life scale based on choice theory (QOLSCT).

METHODS

Using cluster sampling, six hundred (49% female and 51% male) postgraduate students were selected. One hundred fifty participants also filled SF-36 and GHQ, and 80 participants refilled QOLSCT with four weeks' interval again.

RESULTS

Cronbach's alpha, split-half and test re-test (one month) reliability scores were 0.78, 0.75, and 0.92 successively. The correlation between items and total scores range from 0.36 to 0.72, all with P values ≥ 0.0001. Confirmatory factor analysis showed satisfactory values of goodness-of-fit indices, RMSEA, CFI, NFI and GFI were, 0.05, 0.99, 0.99 and 0.99 respectively. Convergent and divergent validity also showed significant correlations.

CONCLUSION

The result of the present study showed that the new version of quality of life scale based on choice theory could be confirmed. The good level of reliability, fairly goodness of fit indexes, and very good convergent validity support this idea.

Sarcopenia: revised European consensus on definition and diagnosis

Background

in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.

Objectives

to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.

Recommendations

sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.

Conclusions

EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance.

Cross cultural adaptation of the Greek sarcopenia quality of life (SarQoL) questionnaire

Purpose: To translate and validate into the Greek language and setting the Sarcopenia Quality of Life (SarQoL^®) questionnaire.Methods: A convenience sample of 176 Greek elderly people (136 females, 40 males; aged 71.19 ± 7.95 years) was recruited, 50 of which (36 females, 14 males) were diagnosed sarcopenic. Questionnaire was back-translated and culturally adapted into Greek according to international guidelines. To validate the Greek SarQoL^®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects. Participants were divided into sarcopenic and non-sarcopenic. Sarcopenic subjects apart from the Greek SarQoL (SarQoL^GR) filled out the Greek versions of two generic questionnaires; Short Form-36 and EuroQoL 5-dimension.Results: The Greek SarQoL questionnaire was translated without major difficulties. SarQoL^GR mean scores were 52.12 ± 11.04 (range: 24.74-71.81) for sarcopenic subjects and 68.23 ± 14.1 (range: 24.83-94.81) for non-sarcopenic ones. Results indicated good discriminative power across sarcopenic and non-sarcopenic subjects (p = 0.01), high internal consistency (Cronbach's alpha of 0.96) and excellent test-retest reliability (ICC = 0.96, 95% CI = 0.95-0.97). Neither a floor nor a ceiling effect was observed.Conclusions: The Greek SarQoL was found to be a reliable and valid measure of quality of life for sarcopenic patients. It is therefore, available for use in future clinical research and practice.Implications for rehabilitationThe Greek version of the SarQoL^® questionnaire is a valid and reliable outcome measure for assessing patients with sarcopenia.The Greek SarQoL is recommended to be use in clinical settings and research.The Greek SarQoL^® questionnaire is available online www.sarqol.org.

Evaluation of the Responsiveness of the SarQoL® Questionnaire, a Patient-Reported Outcome Measure Specific to Sarcopenia

INTRODUCTION

The Sarcopenia Quality of Life (SarQoL®) questionnaire was developed to provide a patient-reported outcome measure specific to sarcopenia. Its psychometric properties indicate that it is a valid and reliable instrument. However, until now, its ability to detect change over time has not been examined. Therefore, the objective of this study is to evaluate the responsiveness (also known as sensitivity to change) of the SarQoL® questionnaire in a prospective, longitudinal cohort of community-dwelling, older, sarcopenic subjects.

METHODS

Sarcopenic subjects from the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) study were included. Responsiveness was evaluated with nine pre-specified hypotheses on the correlation between the evolution of the SarQoL® scores after a 2-year interval and the evolution of the scores on the Short Form-36 (SF-36) and the Euroqol 5-dimension (EQ-5D) questionnaires. This technique considers responsiveness to be a form of longitudinal validity. Additionally, standardized response means were also calculated to compare the quantity of change measured by the different questionnaires.

RESULTS

A total of 42 sarcopenic subjects were included. The median age of the sample was 72.9 (68.9-78.8) years, 59.5% were female, and the mean body mass index was 23.3 (20.4-25.7) kg/m2. A good responsiveness was observed, as evidenced by the confirmation of eight out of nine hypotheses, well above the 75% confirmation threshold. The standardized response mean of the Overall SarQoL® score was significantly higher than those of the SF-36 Physical Component Summary (p = 0.005), the EQ-5D Utility Index (p < 0.001) and the Euroqol visual analogue scale (p = 0.003).

CONCLUSION

The first data available on the ability of the SarQoL® questionnaire to detect change over time indicates that the questionnaire has good responsiveness. This, together with the previously established psychometric properties, confirms that the SarQoL® questionnaire is a relevant instrument for the assessment of quality of life in sarcopenic populations.