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Volbeda M, Zijlstra HW, Post A, Kootstra-Ros JE, van der Voort PHJ, Franssen CFM, Nijsten MW. Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients. BMC Nephrol 2024; 25:330. [PMID: 39358684 PMCID: PMC11446022 DOI: 10.1186/s12882-024-03760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION In patients admitted to the intensive care unit (ICU), muscle mass is inversely associated with mortality. Although muscle mass can be estimated with 24-h urinary creatinine excretion (UCE), its use for risk prediction in individual patients is limited because age-, sex-, weight- and length-specific reference values for UCE are lacking. The ratio between measured creatinine clearance (mCC) and estimated glomerular filtration rate (eGFR) might circumvent this constraint. The main goal was to assess the association of the mCC/eGFR ratio in ICU patients with all-cause hospital and long-term mortality. METHODS The mCC/eGFR ratio was determined in patients admitted to our ICU between 2005 and 2021 with KDIGO acute kidney injury (AKI) stage 0-2 and an ICU stay ≥ 24 h. mCC was calculated from UCE and plasma creatinine and indexed to 1.73 m2. mCC/eGFR was analyzed by categorizing patients in mCC/eGFR quartiles and as continuous variable. RESULTS Seven thousand five hundred nine patients (mean age 61 ± 15 years; 38% female) were included. In-hospital mortality was 27% in the lowest mCC/eGFR quartile compared to 11% in the highest quartile (P < 0.001). Five-year post-hospital discharge actuarial mortality was 37% in the lowest mCC/eGFR quartile compared to 19% in the highest quartile (P < 0.001). mCC/eGFR ratio as continuous variable was independently associated with in-hospital mortality in multivariable logistic regression (odds ratio: 0.578 (95% CI: 0.465-0.719); P < 0.001). mCC/eGFR ratio as continuous variable was also significantly associated with 5-year post-hospital discharge mortality in Cox regression (hazard ratio: 0.27 (95% CI: 0.22-0.32); P < 0.001). CONCLUSIONS The mCC/eGFR ratio is associated with both in-hospital and long-term mortality and may be an easily available index of muscle mass in ICU patients.
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Affiliation(s)
- Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands.
| | - Hendrik W Zijlstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands
| | - Adrian Post
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Peter H J van der Voort
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands
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Evans WJ, Hellerstein M, Butterfield RJ, Smith E, Guglieri M, Katz N, Nave B, Branigan L, Thera S, Vordos KL, Behar L, Schiava M, James MK, Field T, Mohammed H, Shankaran M. Reductions in functional muscle mass and ability to ambulate in Duchenne muscular dystrophy from ages 4 to 24 years. J Physiol 2024; 602:4929-4939. [PMID: 39216089 DOI: 10.1113/jp287069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
Duchenne muscular dystrophy (DMD) results in a progressive loss of functional skeletal muscle mass (MM) and replacement with fibrofatty tissue. Accurate evaluation of MM in DMD patients has not previously been available. Our objective was to measure MM using the D3creatine (D3Cr) dilution method and determine its relationship with strength and functional capacity in patients with DMD over a wide range of ages. Subjects were recruited for participation in a 12 month, longitudinal, observational study. Here, we report the baseline data. A 20 mg dose of D3Cr dissolved in water was ingested by 92 patients with DMD (ages 4-25 years) followed later with a fasting urine sample. Enrichment of D3creatinine was determined by liquid chromatography-mass spectrometry analysis. The North Star Ambulatory Assessment (NSAA) total score was determined for ambulatory participants, and the Performance of Upper Limb (PUL 2.0) total score and grip strength for all participants. We observed a significant age-associated increase in body weight along with a substantial decrease in MM/body weight (%MM). MM and %MM were associated with PUL score (r = 0.517, P < 0.0001 and r = 0.764, P < 0.0001 respectively). The age-associated decrease in MM and %MM was strongly associated with ambulatory status. We observed very little overlap in %MM between ambulant and non-ambulant subjects, suggesting a threshold of 18-22% associated with loss of ambulation. MM is substantially diminished with advancing age and is highly related to clinically meaningful functional status. The D3Cr dilution method may provide a biomarker of disease progression and therapeutic efficacy in patients with DMD or other neuromuscular disorders. KEY POINTS: The non-invasive D3creatine dilution method provides novel data on whole body functional muscle mass (MM) in a wide range of ages in patients with DMD and reveals profoundly low functional MM in older non-ambulant patients. The difference in %MM between ambulant and non-ambulant subjects suggests a threshold for loss of ambulatory ability between 18 and 22% MM. The data suggest that as functional MM declines with age, maintaining a lower body weight may help to conserve ambulatory ability.
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Affiliation(s)
- William J Evans
- Department Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Marc Hellerstein
- Department Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
| | | | - Edward Smith
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Natalie Katz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Brittany Nave
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Branigan
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Stephanie Thera
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Kalista L Vordos
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Laura Behar
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Meredith K James
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tyler Field
- Department Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Hussein Mohammed
- Department Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Mahalakshmi Shankaran
- Department Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
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McKendry J, Coletta G, Nunes EA, Lim C, Phillips SM. Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure. Exp Physiol 2024; 109:1650-1662. [PMID: 39106083 PMCID: PMC11442788 DOI: 10.1113/ep091937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
The gradual deterioration of physiological systems with ageing makes it difficult to maintain skeletal muscle mass (sarcopenia), at least partly due to the presence of 'anabolic resistance', resulting in muscle loss. Sarcopenia can be transiently but markedly accelerated through periods of muscle disuse-induced (i.e., unloading) atrophy due to reduced physical activity, sickness, immobilisation or hospitalisation. Periods of disuse are detrimental to older adults' overall quality of life and substantially increase their risk of falls, physical and social dependence, and early mortality. Disuse events induce skeletal muscle atrophy through various mechanisms, including anabolic resistance, inflammation, disturbed proteostasis and mitochondrial dysfunction, all of which tip the scales in favour of a negative net protein balance and subsequent muscle loss. Concerningly, recovery from disuse atrophy is more difficult for older adults than their younger counterparts. Resistance training (RT) is a potent anabolic stimulus that can robustly stimulate muscle protein synthesis and mitigate muscle losses in older adults when implemented before, during and following unloading. RT may take the form of traditional weightlifting-focused RT, bodyweight training and lower- and higher-load RT. When combined with sufficient dietary protein, RT can accelerate older adults' recovery from a disuse event, mitigate frailty and improve mobility; however, few older adults regularly participate in RT. A feasible and practical approach to improving the accessibility and acceptability of RT is through the use of resistance bands. Moving forward, RT must be prescribed to older adults to mitigate the negative consequences of disuse atrophy.
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Affiliation(s)
- James McKendry
- Exercise Metabolism Research Group, Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | - Giulia Coletta
- Exercise Metabolism Research Group, Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | - Everson A. Nunes
- Exercise Metabolism Research Group, Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | - Changhyun Lim
- Exercise Metabolism Research Group, Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | - Stuart M. Phillips
- Exercise Metabolism Research Group, Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
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Yuan JH, Rifkin DE, Ginsberg C, Cawthon PM, Kado DM, Bauer SR, Ensrud KE, Hoffman AR, Potok OA. Difference between kidney function by cystatin C versus creatinine and association with muscle mass and frailty. J Am Geriatr Soc 2024; 72:3163-3170. [PMID: 38819605 PMCID: PMC11461133 DOI: 10.1111/jgs.19014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND A higher difference in estimated glomerular filtration rate by cystatin C versus creatinine (eGFRDiff = eGFRCys - eGFRCreat) is associated with decreased frailty risk. Since eGFRCreat is influenced by muscle more than eGFRCys, muscle mass may explain this association. Previous work could not account for this when considering regional muscle measures by imaging. Deuterated creatine (D3Cr) dilution measures whole body muscle mass (kilograms). We aimed to determine whether eGFRDiff is associated with D3Cr muscle mass and whether muscle mass explains the association between eGFRDiff and frailty. METHODS Cross-sectional analysis within the multicenter MrOS Study at Year 14 (visit 4). 490 men of the original cohort of 5994 MrOS participants (aged ≥65 at enrollment) were included. Exposure was eGFRDiff (= eGFRCys - eGFRCreat), calculated using CKD-EPI equations 2012/2021. Primary outcome was D3Cr muscle mass. Secondary outcome was phenotypic pre-frailty (one or two criteria) and frailty (≥three criteria) including the following: weight loss, weakness, slow gait, physical activity, poor energy. The association of eGFRDiff with D3Cr muscle mass was examined by linear regression, that with prefrailty / frailty by multinomial logistic regression. RESULTS Mean ± SD age was 84 ± 4 years, eGFRCreat 68 ± 16, eGFRCys 52 ± 16, eGFRDiff -15 ± 12 mL/min/1.73 m2 and D3Cr muscle mass 24 ± 4 kg. For each SD increment in eGFRDiff, D3Cr muscle mass was 1.4 kg higher on average, p < 0.0001 (fully adjusted). Higher eGFRDiff was associated with lower odds of frailty (OR = 0.63 95% CI [0.45;0.89]), but this was partially attenuated and insignificant after additionally adjusting for D3Cr muscle mass (OR = 0.85 95% CI [0.58; 1.24]). CONCLUSIONS Higher eGFRDiff is associated with lower odds of frailty among late-life men. D3Cr muscle mass accounts for some of this association. This suggests that non-GFR determinants of creatinine and cystatin C, such as muscle mass, play a role in explaining the association of eGFRDiff with frailty. Future studies are needed to confirm.
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Affiliation(s)
- Julia H. Yuan
- University of California San Diego, San Diego, CA, United States
| | - Dena E. Rifkin
- University of California San Diego, San Diego, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Charles Ginsberg
- University of California San Diego, San Diego, CA, United States
| | - Peggy M. Cawthon
- University of California San Francisco, San Francisco, CA, United States and Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Deborah M. Kado
- Geriatric Research Education and Clinical Center (GRECC), Veterans Healthcare Administration, Palo Alto, CA, United States
- Stanford University, Stanford, CA, United States
| | - Scott R. Bauer
- University of California San Francisco, San Francisco, CA, United States
- San Francisco VA Medical Center, San Francisco, CA, United States
| | | | | | - O. Alison Potok
- University of California San Diego, San Diego, CA, United States
- Veterans Affairs San Diego Healthcare System, San Diego, California
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Ilonze OJ, Parsly Read-Button L, Cogswell R, Hackman A, Breathett K, Saltzman E, Vest AR. Controversies and Conundrums in Cardiac Cachexia: Key Questions About Wasting in Patients With HFrEF. JACC. HEART FAILURE 2024; 12:1645-1660. [PMID: 38727650 DOI: 10.1016/j.jchf.2024.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/06/2024] [Accepted: 03/12/2024] [Indexed: 10/11/2024]
Abstract
Cardiac cachexia is characterized by unintentional catabolic weight loss, decreased appetite, and inflammation and is common in patients with stage D (advanced) heart failure with reduced ejection fraction (HFrEF). Cardiac cachexia and related muscle-wasting syndromes are markers of, and a consequence of, the heart failure (HF) syndrome. Although many potential modalities for identifying cardiac cachexia exist, the optimal definition, diagnostic tools, and treatment options for cardiac cachexia remain unclear. Furthermore, it remains unclear whether attempts to reverse muscle wasting prior to advanced HF surgeries, such as left ventricular assist devices and heart transplantation, can improve outcomes. It is important that HF clinicians and dietitians are aware of the pathophysiology and mechanisms of muscle-wasting syndromes in patients with HF, to aid in the recognition and risk stratification of advanced HFrEF. Although the opportunities and rationale for attempting to address cardiac cachexia prior to advanced HF surgeries are uncertain, recent publications suggest that control of the neurohumoral syndrome of advanced HF may be important to permit the recovery of skeletal muscle mass.
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Affiliation(s)
- Onyedika J Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Rebecca Cogswell
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy Hackman
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edward Saltzman
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA
| | - Amanda R Vest
- CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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de Lima EP, Tanaka M, Lamas CB, Quesada K, Detregiachi CRP, Araújo AC, Guiguer EL, Catharin VMCS, de Castro MVM, Junior EB, Bechara MD, Ferraz BFR, Catharin VCS, Laurindo LF, Barbalho SM. Vascular Impairment, Muscle Atrophy, and Cognitive Decline: Critical Age-Related Conditions. Biomedicines 2024; 12:2096. [PMID: 39335609 PMCID: PMC11428869 DOI: 10.3390/biomedicines12092096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/22/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
The triad of vascular impairment, muscle atrophy, and cognitive decline represents critical age-related conditions that significantly impact health. Vascular impairment disrupts blood flow, precipitating the muscle mass reduction seen in sarcopenia and the decline in neuronal function characteristic of neurodegeneration. Our limited understanding of the intricate relationships within this triad hinders accurate diagnosis and effective treatment strategies. This review analyzes the interrelated mechanisms that contribute to these conditions, with a specific focus on oxidative stress, chronic inflammation, and impaired nutrient delivery. The aim is to understand the common pathways involved and to suggest comprehensive therapeutic approaches. Vascular dysfunctions hinder the circulation of blood and the transportation of nutrients, resulting in sarcopenia characterized by muscle atrophy and weakness. Vascular dysfunction and sarcopenia have a negative impact on physical function and quality of life. Neurodegenerative diseases exhibit comparable pathophysiological mechanisms that affect cognitive and motor functions. Preventive and therapeutic approaches encompass lifestyle adjustments, addressing oxidative stress, inflammation, and integrated therapies that focus on improving vascular and muscular well-being. Better understanding of these links can refine therapeutic strategies and yield better patient outcomes. This study emphasizes the complex interplay between vascular dysfunction, muscle degeneration, and cognitive decline, highlighting the necessity for multidisciplinary treatment approaches. Advances in this domain promise improved diagnostic accuracy, more effective therapeutic options, and enhanced preventive measures, all contributing to a higher quality of life for the elderly population.
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Affiliation(s)
- Enzo Pereira de Lima
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
| | - Masaru Tanaka
- HUN-REN-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Hungarian Research Network, University of Szeged (HUN-REN-SZTE), Tisza Lajos Krt. 113, H-6725 Szeged, Hungary
| | - Caroline Barbalho Lamas
- Department of Gerontology, Universidade Federal de São Carlos, UFSCar, São Carlos 13565-905, SP, Brazil
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
| | - Claudia Rucco P. Detregiachi
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
| | - Adriano Cressoni Araújo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Elen Landgraf Guiguer
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Virgínia Maria Cavallari Strozze Catharin
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Marcela Vialogo Marques de Castro
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Department of Odontology, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Edgar Baldi Junior
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Marcelo Dib Bechara
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | | | | | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Marília 17525-902, SP, Brazil
- Department of Administration, Associate Degree in Hospital Management, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil (M.D.B.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Research Coordination, UNIMAR Charity Hospital (HBU), University of Marília (UNIMAR), Marília 17525-902, SP, Brazil
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Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab 2024; 26 Suppl 4:16-27. [PMID: 38937282 DOI: 10.1111/dom.15728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
Weight loss induced by glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucagon-like peptide-1 receptor (GLP-1R)/glucose-dependent insulinotropic polypeptide receptor agonists is coming closer to the magnitudes achieved with surgery. However, with greater weight loss there is concern about potential side effects on muscle quantity (mass), health and function. There is heterogeneity in the reported effects of GLP-1-based therapies on lean mass changes in clinical trials: in some studies, reductions in lean mass range between 40% and 60% as a proportion of total weight lost, while other studies show lean mass reductions of approximately 15% or less of total weight lost. There are several potential reasons underlying this heterogeneity, including population, drug-specific/molecular, and comorbidity effects. Furthermore, changes in lean mass may not always reflect changes in muscle mass as the former measure includes not only muscle but also organs, bone, fluids, and water in fat tissue. Based on contemporary evidence with the addition of magnetic resonance imaging-based studies, skeletal muscle changes with GLP-1RA treatments appear to be adaptive: reductions in muscle volume seem to be commensurate with what is expected given ageing, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function. Nevertheless, factors such as older age and severity of disease may influence the selection of appropriate candidates for these therapies due to risk of sarcopenia. To further improve muscle health during weight loss, several pharmacological treatments to maintain or improve muscle mass designed in combination with GLP-1-based therapies are under development. Future research on GLP-1-based and other therapies designed for weight loss should focus on more accurate and meaningful assessments of muscle mass, composition, as well as function, mobility or strength, to better define their impact on muscle health for the substantial number of patients who will likely be taking these medications well into the future.
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Affiliation(s)
- Ian J Neeland
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jennifer Linge
- AMRA Medical AB, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Diabetology, Endocrinology, and Nephrology, University Clinic Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Diabetes, Life Sciences & Medicine Cardiovascular Medicine & Sciences, Kings College London, London, UK
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8
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Evans WJ, Ferrucci L. A simplified definition of sarcopenia: muscle mass/body weight. J Nutr Health Aging 2024; 28:100302. [PMID: 38908131 DOI: 10.1016/j.jnha.2024.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
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9
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Hetherington-Rauth M, Johnson E, Migliavacca E, Langsetmo L, Hepple RT, Ryan TE, Ferrucci L, Breuillé D, Corthesy J, Lane NE, Feige JN, Napoli N, Tramontana F, Orwoll ES, Cawthon PM. The Mediating Role of Kynurenine Pathway Metabolites on the Relationship Between Inflammation and Muscle Mass in Oldest-Old Men. J Gerontol A Biol Sci Med Sci 2024; 79:glae131. [PMID: 38761087 PMCID: PMC11163921 DOI: 10.1093/gerona/glae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 05/20/2024] Open
Abstract
Tryptophan (TRP) metabolites along the kynurenine (KYN) pathway (KP) have been found to influence muscle. Proinflammatory cytokines are known to stimulate the degradation of TRP down the KP. Given that both inflammation and KP metabolites have been connected with loss of muscle, we assessed the potential mediating role of KP metabolites on inflammation and muscle mass in older men. Five hundred and five men (85.0 ± 4.2 years) from the Osteoporotic Fractures in Men cohort study with measured D3-creatine dilution (D3Cr) muscle mass, KP metabolites, and inflammation markers (C-reactive protein [CRP], alpha-1-acid glycoprotein [AGP] and a subsample [n = 305] with interleukin [IL-6, IL-1β, IL-17A] and tumor necrosis factor-α [TNF-α]) were included in the analysis. KP metabolites and inflammatory markers were measured using liquid chromatography-tandem mass spectrometry and immunoassays, respectively. 23%-92% of the inverse relationship between inflammatory markers and D3Cr muscle mass was mediated by KP metabolites (indirect effect p < .05). 3-hydroxyanthranilic acid (3-HAA), quinolinic acid (QA), TRP, xanthurenic acid (XA), KYN/TRP, 3-hydroxykynurenine (3-HK)/3-HAA, QA/3-HAA, and nicotinamide (NAM)/QA mediated the AGP relationship. 3-HAA, QA, KYN/TRP, 3-HK/XA, HKr ratio, 3-HK/3-HAA, QA/3-HAA, and NAM/QA mediated the CRP. KYN/TRP, 3-HK/XA, and NAM/QA explained the relationship for IL-6 and 3-HK/XA and QA/3-HAA for TNF-α. No mediation effect was observed for the other cytokines (indirect effect p > .05). KP metabolites, particularly higher ratios of KYN/TRP, 3-HK/XA, 3-HK/3-HAA, QA/3-HAA, and a lower ratio of NAM/QA, mediated the relationship between inflammation and low muscle mass. Our preliminary cross-sectional data suggest that interventions to alter D3Cr muscle mass may focus on KP metabolites rather than inflammation per se.
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Affiliation(s)
| | - Eileen Johnson
- California Pacific Medical Center, Research Institute, San Francisco, California, USA
| | | | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Gaithersburg, Maryland, USA
| | - Denis Breuillé
- Nestlé Institute of Food Safety and Analytical Sciences, Nestlé Research, Lausanne, Switzerland
| | - John Corthesy
- Nestlé Institute of Food Safety and Analytical Sciences, Nestlé Research, Lausanne, Switzerland
| | - Nancy E Lane
- Division of Rheumatology, Department of Medicine, University of California, Davis, Davis, California, USA
| | - Jérôme N Feige
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Flavia Tramontana
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Eric S Orwoll
- Department of Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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10
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Ford KL, Sawyer MB, Ghosh S, Trottier CF, Disi IR, Easaw J, Mulder K, Koski S, Porter Starr KN, Bales CW, Arends J, Siervo M, Deutz N, Prado CM. Feasibility of two levels of protein intake in patients with colorectal cancer: findings from the Protein Recommendation to Increase Muscle (PRIMe) randomized controlled pilot trial. ESMO Open 2024; 9:103604. [PMID: 38935990 PMCID: PMC11260369 DOI: 10.1016/j.esmoop.2024.103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Low muscle mass (MM) predicts unfavorable outcomes in cancer. Protein intake supports muscle health, but oncologic recommendations are not well characterized. The objectives of this study were to evaluate the feasibility of dietary change to attain 1.0 or 2.0 g/kg/day protein diets, and the preliminary potential to halt MM loss and functional decline in patients starting chemotherapy for stage II-IV colorectal cancer. PATIENTS AND METHODS Patients were randomized to the diets and provided individualized counseling. Assessments at baseline, 6 weeks, and 12 weeks included weighed 3-day food records, appendicular lean soft tissue index (ALSTI) by dual-energy X-ray absorptiometry to estimate MM, and physical function by the Short Physical Performance Battery (SPPB) test. RESULTS Fifty patients (mean ± standard deviation: age, 57 ± 11 years; body mass index, 27.3 ± 5.6 kg/m2; and protein intake, 1.1 ± 0.4 g/kg/day) were included at baseline. At week 12, protein intake reached 1.6 g/kg/day in the 2.0 g/kg/day group and 1.2 g/kg/day in the 1.0 g/kg/day group (P = 0.012), resulting in a group difference of 0.4 g/kg/day rather than 1.0 g/kg/day. Over one-half (59%) of patients in the 2.0 g/kg/day group maintained or gained MM compared with 44% of patients in the 1.0 g/kg/day group (P = 0.523). Percent change in ALSTI did not differ between groups [2.0 g/kg/day group (mean ± standard deviation): 0.5% ± 4.6%; 1.0 g/kg/day group: -0.4% ± 6.1%; P = 0.619]. No differences in physical function were observed between groups. However, actual protein intake and SPPB were positively associated (β = 0.37; 95% confidence interval 0.08-0.67; P = 0.014). CONCLUSION Individualized nutrition counselling positively impacted protein intake. However, 2.0 g/kg/day was not attainable using our approach in this population, and group contamination occurred. Increased protein intake suggested positive effects on MM and physical function, highlighting the potential for nutrition to attenuate MM loss in patients with cancer. Nonetheless, muscle anabolism to any degree is clinically significant and beneficial to patients. Larger trials should explore the statistical significance and clinical relevance of protein interventions.
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Affiliation(s)
- K L Ford
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton
| | - M B Sawyer
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - S Ghosh
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - C F Trottier
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton
| | - I R Disi
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton; Department of Postgraduate Program of Anaesthesiology, Surgical Sciences and Perioperative Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J Easaw
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - K Mulder
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - S Koski
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - K N Porter Starr
- Durham VA Medical Centre, Durham; Department of Medicine, Duke University, Durham, USA
| | - C W Bales
- Durham VA Medical Centre, Durham; Department of Medicine, Duke University, Durham, USA
| | - J Arends
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - M Siervo
- School of Population Health, Curtin University, Perth, Australia
| | - N Deutz
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, USA
| | - C M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton.
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11
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Westbury LD, Harvey NC, Beaudart C, Bruyère O, Cauley JA, Cawthon P, Cruz-Jentoft AJ, Curtis EM, Ensrud K, Fielding RA, Johansson H, Kanis JA, Karlsson MK, Lane NE, Lengelé L, Lorentzon M, McCloskey E, Mellström D, Newman AB, Ohlsson C, Orwoll E, Reginster JY, Ribom E, Rosengren BE, Schousboe JT, Dennison EM, Cooper C. Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts. Aging Clin Exp Res 2024; 36:126. [PMID: 38842791 PMCID: PMC11156728 DOI: 10.1007/s40520-024-02783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited. AIM We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors. METHODS Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index). RESULTS Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed. CONCLUSIONS Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors.
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Affiliation(s)
- Leo D Westbury
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Charlotte Beaudart
- Department of Biomedical Sciences, Clinical Pharmacology and Toxicology Research Unit, Namur Research Institute for Life Sciences (NARILIS), Faculty of Medicine, University of Namur, 5000, Namur, Belgium
| | - Olivier Bruyère
- Division of Epidemiology, Public Health and Health Economics, Department of Public Health, University of Liège, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Kristine Ensrud
- Medicine and Epidemiology & Community Health, University of Minnesota, Minnesota, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, USA
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Nancy E Lane
- Division of Rheumatology, Department of Internal Medicine, UC Davis Health, 4625 Second Avenue, Sacramento, CA, 95917, USA
| | - Laetitia Lengelé
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, 1200 Sint-Lambrechts-Woluwe, Belgium
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Center for Osteoporosis Research, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eugene McCloskey
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Eric Orwoll
- Oregon Health & Science University, Portland, Oregon, USA
| | - Jean-Yves Reginster
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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12
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El Assar M, Rodríguez-Sánchez I, Álvarez-Bustos A, Rodríguez-Mañas L. Biomarkers of frailty. Mol Aspects Med 2024; 97:101271. [PMID: 38631189 DOI: 10.1016/j.mam.2024.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain.
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13
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Lukasiewicz CJ, Tranah GJ, Evans DS, Coen PM, Barnes HN, Huo Z, Esser KA, Zhang X, Wolff C, Wu K, Lane NE, Kritchevsky SB, Newman AB, Cummings SR, Cawthon PM, Hepple RT. Higher expression of denervation-responsive genes is negatively associated with muscle volume and performance traits in the study of muscle, mobility, and aging (SOMMA). Aging Cell 2024; 23:e14115. [PMID: 38831622 PMCID: PMC11166368 DOI: 10.1111/acel.14115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 06/05/2024] Open
Abstract
With aging skeletal muscle fibers undergo repeating cycles of denervation and reinnervation. In approximately the 8th decade of life reinnervation no longer keeps pace, resulting in the accumulation of persistently denervated muscle fibers that in turn cause an acceleration of muscle dysfunction. The significance of denervation in important clinical outcomes with aging is poorly studied. The Study of Muscle, Mobility, and Aging (SOMMA) is a large cohort study with the primary objective to assess how aging muscle biology impacts clinically important traits. Using transcriptomics data from vastus lateralis muscle biopsies in 575 participants we have selected 49 denervation-responsive genes to provide insights to the burden of denervation in SOMMA, to test the hypothesis that greater expression of denervation-responsive genes negatively associates with SOMMA participant traits that included time to walk 400 meters, fitness (VO2peak), maximal mitochondrial respiration, muscle mass and volume, and leg muscle strength and power. Consistent with our hypothesis, increased transcript levels of: a calciumdependent intercellular adhesion glycoprotein (CDH15), acetylcholine receptor subunits (CHRNA1, CHRND, CHRNE), a glycoprotein promoting reinnervation (NCAM1), a transcription factor regulating aspects of muscle organization (RUNX1), and a sodium channel (SCN5A) were each negatively associated with at least 3 of these traits. VO2peak and maximal respiration had the strongest negative associations with 15 and 19 denervation-responsive genes, respectively. In conclusion, the abundance of denervationresponsive gene transcripts is a significant determinant of muscle and mobility outcomes in aging humans, supporting the imperative to identify new treatment strategies to restore innervation in advanced age.
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Affiliation(s)
| | - Gregory J. Tranah
- California Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Daniel S. Evans
- California Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Paul M. Coen
- Translational Research Institute, Advent HealthOrlandoFloridaUSA
| | - Haley N. Barnes
- California Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
| | - Zhiguang Huo
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Karyn A. Esser
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Xiping Zhang
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Christopher Wolff
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Kevin Wu
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Nancy E. Lane
- Department of Medicine, Division of RheumatologyUniversity of California Davis HealthSacramentoCaliforniaUSA
| | - Steven B. Kritchevsky
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Anne B. Newman
- School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Steven R. Cummings
- California Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Peggy M. Cawthon
- California Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Russell T. Hepple
- Department of Physical TherapyUniversity of FloridaGainesvilleFloridaUSA
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
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14
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Mao Z, Cawthon PM, Kritchevsky SB, Toledo FGS, Esser KA, Erickson ML, Newman AB, Farsijani S. The association between chrononutrition behaviors and muscle health among older adults: The study of muscle, mobility and aging. Aging Cell 2024; 23:e14059. [PMID: 38059319 PMCID: PMC11166361 DOI: 10.1111/acel.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. To determine the associations between chrononutrition behaviors and muscle health in older adults. Dietary data from 828 older adults (76 ± 5 years) recorded food/beverage amounts and their clock time over the past 24 h. Studied chrononutrition behaviors included: (1) The clock time of the first and last food/beverage intake; (2) Eating window (the time elapsed between the first and last intake); and (3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D3-creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity. Average eating window was 11 ± 2 h/day; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β ± SE: 0.18 ± 0.09; 0.27 ± 0.11, respectively, p < 0.05). The longer eating window was also marginally associated with higher leg power (p = 0.058). An earlier intake time was associated with higher grip strength (-0.38 ± 0.15; p = 0.012). Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.
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Affiliation(s)
- Ziling Mao
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Peggy M. Cawthon
- California Pacific Medical Center Research InstituteUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Section on Gerontology & Geriatric Medicine and the Sticht Center for Healthy Aging and Alzheimer's PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Frederico G. S. Toledo
- Department of Medicine, Division of Endocrinology and MetabolismUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Karyn A. Esser
- Department of Physiology and AgingUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | | | - Anne B. Newman
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Samaneh Farsijani
- Department of EpidemiologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Aging and Population HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
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15
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Pagano AP, Montenegro J, Oliveira CLP, Desai N, Gonzalez MC, Cawthon PM, Evans WJ, Prado CM. Estimating Muscle Mass Using D3-Creatine Dilution: A Narrative Review of Clinical Implications and Comparison With Other Methods. J Gerontol A Biol Sci Med Sci 2024; 79:glad280. [PMID: 38135279 PMCID: PMC10959434 DOI: 10.1093/gerona/glad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The D3-creatine (D3-Cr) dilution method is of emerging interest for estimating total-body skeletal muscle mass. This review explores the association of muscle mass estimated via D3-Cr with various clinical outcomes and provides a summary of the literature comparing D3-Cr with other body composition techniques. METHODS A literature search was conducted on PubMed/MEDLINE and Web of Science for studies using D3-Cr to measure muscle in adult populations (ie, ≥18 years old) from inception until September 2023. RESULTS Out of the 23 included studies, 15 investigated the correlation between D3-Cr and clinical outcomes. More consistent associations were reported for mortality (100%, n = 2), mobility disability (100%; n = 5), falls and fractures (100%; n = 3), physical performance (63.3%; n = 11), muscle strength (44.4%; n = 9), and muscle composition (33.3%; n = 3). However, conflicting findings were also reported for such correlations. Among the 23 studies, 14 compared D3-Cr-estimated muscle with other body composition techniques, including magnetic resonance imaging (MRI) as a reference method. Strong and positive correlations were found between D3-Cr and MRI. Nonetheless, variations in muscle measurements were noted, with differences in D3-Cr values ranging from 0.62 kg lower to 13.47 kg higher compared to MRI. CONCLUSIONS D3-Cr-estimated muscle mass may be a valuable predictor of clinical outcomes showing consistent associations with falls and fractures, mobility disability, and mortality. However, less consistent associations were found with muscle strength and composition, and physical performance. Although a strong correlation exists between D3-Cr-estimated muscle mass and MRI measurements, under- or overestimation may occur.
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Affiliation(s)
- Ana Paula Pagano
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Julia Montenegro
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Camila L P Oliveira
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Nidhi Desai
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, State of Rio Grande do Sul, Brazil
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California Berkeley, Berkeley, California, USA
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, Edmonton, Alberta, Canada
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16
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Cummings SR, Lui LY, Glynn NW, Mau T, Cawthon PM, Kritchevsky SB, Coen PM, Goodpaster B, Marcinek DJ, Hepple RT, Patel S, Newman AB. Energetics and clinical factors for the time required to walk 400 m: The Study of Muscle, Mobility and Aging (SOMMA). J Am Geriatr Soc 2024; 72:1035-1047. [PMID: 38243364 DOI: 10.1111/jgs.18763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/31/2023] [Accepted: 12/16/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Walking slows with aging often leading to mobility disability. Mitochondrial energetics has been found to be associated with gait speed over short distances. Additionally, walking is a complex activity but few clinical factors that may be associated with walk time have been studied. METHODS We examined 879 participants ≥70 years and measured the time to walk 400 m. We tested the hypothesis that decreased mitochondrial energetics by respirometry in muscle biopsies and magnetic resonance spectroscopy in the thigh and is associated with longer time to walk 400 m. We also used cardiopulmonary exercise testing to assess the energetic costs of walking: maximum oxygen consumption (VO2peak) and energy cost-capacity (the ratio of VO2, at a slow speed to VO2peak). In addition, we tested the hypothesis that selected clinical factors would also be associated with 400-m walk time. RESULTS Lower Max OXPHOS was associated with longer walk time, and the association was explained by the energetic costs of walking, leg power, and weight. Additionally, a multivariate model revealed that longer walk time was also significantly associated with lower VO2peak, greater cost-capacity ratio, weaker leg power, heavier weight, hip and knee stiffness, peripheral neuropathy, greater perceived exertion while walking slowly, greater physical fatigability, less moderate-to-vigorous exercise, less sedentary time, and anemia. Significant associations between age, sex, muscle mass, and peripheral artery disease with 400-m walk time were explained by other clinical and physiologic factors. CONCLUSIONS Lower mitochondrial energetics is associated with needing more time to walk 400 m. This supports the value of developing interventions to improve mitochondrial energetics. Additionally, doing more moderate-to-vigorous exercise, increasing leg power, reducing weight, treating hip and knee stiffness, and screening for and treating anemia may reduce the time required to walk 400 m and reduce the risk of mobility disability.
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Affiliation(s)
- Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Li-Yung Lui
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Theresa Mau
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul M Coen
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- AdventHealth, Translational Research Institute, Orlando, Florida, USA
| | - Bret Goodpaster
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - David J Marcinek
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Sheena Patel
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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17
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Mau T, Barnes HN, Blackwell TL, Kramer PA, Bauer SR, Marcinek DJ, Ramos SV, Forman DE, Toledo FGS, Hepple RT, Kritchevsky SB, Cummings SR, Newman AB, Coen PM, Cawthon PM. Lower muscle mitochondrial energetics is associated with greater phenotypic frailty in older women and men: the Study of Muscle, Mobility and Aging. GeroScience 2024; 46:2409-2424. [PMID: 37987886 PMCID: PMC10828481 DOI: 10.1007/s11357-023-01002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Phenotypic frailty syndrome identifies older adults at greater risk for adverse health outcomes. Despite the critical role of mitochondria in maintaining cellular function, including energy production, the associations between muscle mitochondrial energetics and frailty have not been widely explored in a large, well-phenotyped, older population. METHODS The Study of Muscle, Mobility and Aging (SOMMA) assessed muscle energetics in older adults (N = 879, mean age = 76.3 years, 59.2% women). 31Phosporous magnetic resonance spectroscopy measured maximal production of adenosine triphosphate (ATPmax) in vivo, while ex vivo high-resolution respirometry of permeabilized muscle fibers from the vastus lateralis measured maximal oxygen consumption supported by fatty acids and complex I- and II-linked carbohydrates (e.g., Max OXPHOSCI+CII). Five frailty criteria, shrinking, weakness, exhaustion, slowness, and low activity, were used to classify participants as robust (0, N = 397), intermediate (1-2, N = 410), or frail (≥ 3, N = 66). We estimated the proportional odds ratio (POR) for greater frailty, adjusted for multiple potential confounders. RESULTS One-SD decrements of most respirometry measures (e.g., Max OXPHOSCI+CII, adjusted POR = 1.5, 95%CI [1.2,1.8], p = 0.0001) were significantly associated with greater frailty classification. The associations of ATPmax with frailty were weaker than those between Max OXPHOSCI+CII and frailty. Muscle energetics was most strongly associated with slowness and low physical activity components. CONCLUSIONS Our data suggest that deficits in muscle mitochondrial energetics may be a biological driver of frailty in older adults. On the other hand, we did observe differential relationships between measures of muscle mitochondrial energetics and the individual components of frailty.
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Affiliation(s)
- Theresa Mau
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Haley N Barnes
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Terri L Blackwell
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Philip A Kramer
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Scott R Bauer
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Department of Medicine and Urology, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, San Francisco VA Healthcare System, San Francisco, CA, USA
| | - David J Marcinek
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sofhia V Ramos
- AdventHealth, Translational Research Institute, Orlando, FL, USA
| | - Daniel E Forman
- Department of Medicine-Division of Geriatrics and Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Geriatrics Research, Education, and Clinical Care (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Frederico G S Toledo
- Department of Medicine-Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Russell T Hepple
- Department of Physical Therapy, Department of Physiology and Aging, University of Florida, Gainesville, FL, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine-Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul M Coen
- AdventHealth, Translational Research Institute, Orlando, FL, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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18
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Liao CD, Huang SW, Chen HC, Huang MH, Liou TH, Lin CL. Comparative Efficacy of Different Protein Supplements on Muscle Mass, Strength, and Physical Indices of Sarcopenia among Community-Dwelling, Hospitalized or Institutionalized Older Adults Undergoing Resistance Training: A Network Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:941. [PMID: 38612975 PMCID: PMC11013298 DOI: 10.3390/nu16070941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Aging-related sarcopenia exerts harmful impacts on muscle mass, strength, and physical mobility. Protein supplementation has been demonstrated to augment efficacy of resistance training (RT) in elderly. This study compared the relative effects of different protein supplements on muscle mass, strength, and mobility outcomes in middle-aged and older individuals undergoing RT. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of protein supplement plus RT in untrained community-dwelling adults, hospitalized, or institutionalized residents who suffered acute or chronic health conditions. Network meta-analysis (NMA) was performed using a frequentist method for all analyses. Treatment effects for main outcomes were expressed as standard mean difference (SMD) with 95% confidence interval (CI). We used the surface-under-the cumulative-ranking (SUCRA) scores to rank probabilities of effect estimation among all identified treatments. Meta-regression analyses were performed to identify any relevant moderator of the treatment efficacy and results were expressed as β with 95% credible interval (CrI). We finally included 78 RCTs (5272 participants) for analyses. Among the six protein sources identified in this NMA, namely whey, milk, casein, meat, soy, and peanut, whey supplement yielded the most effective treatments augmenting efficacy of RT on muscle mass (SMD = 1.29, 95% CI: 0.96, 1.62; SUCRA = 0.86), handgrip strength (SMD = 1.46, 95% CI: 0.92, 2.00; SUCRA = 0.85), and walking speed (SMD = 0.73, 95% CI: 0.39, 1.07; SUCRA = 0.84). Participant's health condition, sex, and supplementation dose were significant factors moderating the treatment efficacy on muscle mass (β = 0.74; 95% CrI: 0.22, 1.25), handgrip strength (β = -1.72; 95% CrI: -2.68, -0.77), and leg strength (β = 0.76; 95% CrI: 0.06, 1.47), respectively. Our findings suggest whey protein yields the optimal supplements to counter sarcopenia in older individuals undergoing RT.
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Affiliation(s)
- Chun-De Liao
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, New Taipei City 110301, Taiwan;
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (S.-W.H.); (H.-C.C.); (T.-H.L.)
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (S.-W.H.); (H.-C.C.); (T.-H.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 110301, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (S.-W.H.); (H.-C.C.); (T.-H.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 110301, Taiwan
| | - Mao-Hua Huang
- Department of Biochemistry, University of Washington, Seattle, WA 98015, USA;
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (S.-W.H.); (H.-C.C.); (T.-H.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 110301, Taiwan
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 11031, Taiwan
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19
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Hetherington-Rauth M, Webber K, Roe LS, Hoffman AR, Kado D, Langsetmo L, Orwoll ES, Cawthon P. Replacing sedentary time for physical activity: Does intensity matter for body composition in oldest-old adults? J Sports Sci 2024; 42:537-546. [PMID: 38696674 PMCID: PMC11134203 DOI: 10.1080/02640414.2024.2348911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
To assess the independent and combined relationships among objectively measured sedentary time (ST), light intensity PA (LPA), and moderate-to-vigorous intensity PA (MVPA) with muscle mass and fat mass (FM) and how theoretical displacement of these inter-dependent behaviours relates to body composition in oldest-old men. A total of 1046 men participating in the year 14 visit of the prospective Osteoporotic Fractures in Men (MrOS) cohort study with complete data for accelerometry, dual x-ray absorptiometry, and deuterated creatine dilution (D3Cr) muscle mass were included in the analysis (84.0 ± 3.8 yrs.). Single, partition, and isotemporal substitution models were used to assess the interrelationships between PA intensities and ST with body composition measures, while controlling for relevant confounders. Replacing 30-min of ST with 30-min of MVPA was associated with lower FM (β =-0.17, p < 0.001) and higher D3Cr muscle mass, although this was of borderline significance (β = 0.07, p = 0.05). Replacing 30-min of ST for LPA was associated with lower FM (β =-0.15, p < 0.001), but there was no effect on D3Cr muscle mass (p > 0.05). Exchanging ST with any intensity of PA is associated with benefits for FM in oldest-old adult men, although substitution with MVPA may be more beneficial than LPA for maintaining/improving skeletal muscle mass.
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Affiliation(s)
| | - Katey Webber
- California Pacific Medical Center Research Institute, San Francisco, CA USA
| | - Lauren S. Roe
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Andrew R. Hoffman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Deborah Kado
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Geriatric Research Education and Clinical Center (GRECC), VA Health Care System, Palo Alto, CA
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
- Department of Medicine, University of Minnesota
| | | | - Peggy Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA USA
- University of California, Department of Epidemiology and Biostatistics, San Francisco, CA
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20
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Dawson-Hughes B, Barger K, Reitshamer E, Fielding RA, Evans W, Ceglia L. Effect of Anamorelin, a Ghrelin Receptor Agonist, on Muscle and Bone in Adults With Osteosarcopenia. J Clin Endocrinol Metab 2024; 109:e945-e955. [PMID: 38057159 DOI: 10.1210/clinem/dgad702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
CONTEXT Anamorelin, a ghrelin receptor agonist known to stimulate the pulsatile release of GH from the pituitary, has the potential to improve musculoskeletal health in adults with osteosarcopenia. OBJECTIVE To determine the effect of anamorelin treatment for 1 year on muscle mass and strength and on biochemical markers of bone turnover in adults with osteosarcopenia (OS). DESIGN Randomized, placebo-controlled, 1-year anamorelin intervention trial. SETTING The Bone Metabolism Laboratory at the USDA Nutrition Center at Tufts University. PARTICIPANTS 26 men and women, age 50 years and older, with OS. MAIN OUTCOME MEASURES Muscle mass by D3-creatine dilution and lean body mass (LBM) and bone mineral density (BMD) by dual-energy X-ray absorptiometry, muscle strength, serum IGF-1, and bone turnover markers, serum procollagen 1 intact N-terminal (P1NP), and C-terminal telopeptide (CTX). RESULTS Anamorelin did not have a significant effect on muscle mass or LBM; it significantly increased knee flexion torque at 240°/s by 20% (P = .013) and had a similar nonstatistically significant effect on change in knee extension; it increased bone formation (P1NP) by 75% (P = .006) and had no significant effect on bone resorption (CTX) or BMD. Serum IGF-1 increased by 50% in the anamorelin group and did not change in the placebo group (P = .0001 for group difference). CONCLUSION In this pilot study, anamorelin did not significantly alter muscle mass; however, it may potentially improve lower extremity strength and bone formation in addition to increasing circulating IGF-1 levels in adults with OS. Further study of anamorelin in this population is warranted.
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Affiliation(s)
- Bess Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - Elise Reitshamer
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - William Evans
- Department of Nutritional Sciences and Toxicology, University of California Berkeley, Berkeley, CA 94720, USA
| | - Lisa Ceglia
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
- Tufts Medical Center, Tufts University, Boston, MA 02111, USA
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21
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Evans WJ, Guralnik J, Cawthon P, Appleby J, Landi F, Clarke L, Vellas B, Ferrucci L, Roubenoff R. Sarcopenia: no consensus, no diagnostic criteria, and no approved indication-How did we get here? GeroScience 2024; 46:183-190. [PMID: 37996722 PMCID: PMC10828356 DOI: 10.1007/s11357-023-01016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
In addition to the role of skeletal muscle in movement and locomotion, muscle plays a critical role in a broad array of metabolic processes that can contribute to improved health or risk of disease. The age-associated loss of muscle has been termed sarcopenia. The muscle is the primary site of insulin-stimulated glucose disposal and the largest component of basal metabolic rate, directly and indirectly affects bone density, produces myokines with pleiotropic effect on muscle and other tissues including the brain, and stores essential amino acids essential for the maintenance of protein synthesis during periods of reduced food intake and stress. As such, not surprisingly deterioration of skeletal muscle health, typically operationalized as decline of muscle mass and muscle strength is both a powerful risk factor and main consequence of chronic diseases, disability, and loss of independence, and it is one of the strongest risk factors for mortality. However, skeletal muscle remains one of the most plastic of all tissues, with rapid changes in rates of protein synthesis and degradation in response to physical activity and inactivity, inflammation, and nutritional and hormonal status. This has made the development of pharmacological therapies to increase muscle mass (or prevent loss), an important goal for decades. However, while remarkable advances in the understanding of molecular and cellular regulation of muscle protein metabolism have occurred recently, there are no approved drugs for the treatment of sarcopenia, the loss of skeletal muscle affecting millions of older people. The goal of this paper is to describe the possible reasons for the lack of new and effective pharmacotherapies to treat one of the most important risk factors for age-associated disease and loss of independence.
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Affiliation(s)
| | - Jack Guralnik
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peggy Cawthon
- California Pacific Medical Center, San Francisco, CA, USA
| | - James Appleby
- Gerontological Society of America, Washington, DC, USA
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22
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Hetherington-Rauth M, Johnson E, Migliavacca E, Parimi N, Langsetmo L, Hepple RT, Grzywinski Y, Corthesy J, Ryan TE, Ferrucci L, Feige JN, Orwoll ES, Cawthon PM. Nutrient Metabolites Associated With Low D3Cr Muscle Mass, Strength, and Physical Performance in Older Men. J Gerontol A Biol Sci Med Sci 2024; 79:glad217. [PMID: 37694554 PMCID: PMC10809040 DOI: 10.1093/gerona/glad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The relationship between amino acids, B vitamins, and their metabolites with D3-creatine (D3Cr) dilution muscle mass, a more direct measure of skeletal muscle mass, has not been investigated. We aimed to assess associations of plasma metabolites with D3Cr muscle mass, as well as muscle strength and physical performance in older men from the Osteoporotic Fractures in Men cohort study. METHODS Out of 1 425 men (84.2 ± 4.1 years), men with the lowest D3Cr muscle mass (n = 100), slowest walking speed (n = 100), lowest grip strength (n = 100), and a random sample (n = 200) serving as a comparison group to the low groups were included. Metabolites were analyzed using liquid chromatography-tandem mass spectrometry. Metabolite differences between the low groups and random sample and their relationships with the muscle outcomes adjusted for confounders and multiple comparisons were assessed using t-test/Mann-Whitney-Wilcoxon and partial correlations, respectively. RESULTS For D3Cr muscle mass, significant biomarkers (p < .001) with ≥10% fold difference and largest partial correlations were tryptophan (Trp; r = 0.31), kynurenine (Kyn)/Trp; r = -0.27), nicotinamide (Nam)/quinolinic acid (Quin; r = 0.21), and alpha-hydroxy-5-methyl-tetrahydrofolate (hm-THF; r = -0.25). For walking speed, hm-THF, Nam/Quin, and Quin had the largest significance and fold difference, whereas valine (r = 0.17), Trp (r = 0.17), HKyn/Xant (r = -0.20), neopterin (r = -0.17), 5-methyl-THF (r = -0.20), methylated folate (r = -0.21), and thiamine (r = -0.18) had the strongest correlations. Only hm-THF was correlated with grip strength (r = -0.21) and differed between the low group and the random sample. CONCLUSIONS Future interventions focusing on how the Trp metabolic pathway or hm-THF influences D3Cr muscle mass and physical performance declines in older adults are warranted.
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Affiliation(s)
| | - Eileen Johnson
- California Pacific Medical Center, Research Institute, San Francisco, California, USA
| | | | - Neeta Parimi
- California Pacific Medical Center, Research Institute, San Francisco, California, USA
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Yohan Grzywinski
- Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, Lausanne, Switzerland
| | - John Corthesy
- Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, Lausanne, Switzerland
| | - Terence E Ryan
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Gaithersburg, Maryland, USA
| | - Jérôme N Feige
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Eric S Orwoll
- Oregon Health and Science University, Portland, Oregon, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, Research Institute, San Francisco, California, USA
- University of California, Department of Epidemiology and Biostatistics, San Francisco, California, USA
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23
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Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, McDermott MM, Swift DL, Webel AR, Lane A. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e217-e231. [PMID: 38059362 PMCID: PMC11209834 DOI: 10.1161/cir.0000000000001189] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.
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24
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Evans WJ, Cawthon PM. D 3Creatine Dilution as a Direct, Non-invasive and Accurate Measurement of Muscle Mass for Aging Research. Calcif Tissue Int 2024; 114:3-8. [PMID: 37594505 PMCID: PMC10791786 DOI: 10.1007/s00223-023-01124-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Initial definitions of sarcopenia included the age-associated loss of skeletal muscle mass that was presumed to be associated with late-life reduced functional capacity, disability and loss of independence. Because no method for determination of muscle mass was available for large cohort studies of aging men and women, lean body mass determined by dual X-ray absorptiometry or bioelectrical impedance was used as a surrogate measure of muscle mass. The data from these studies showed either no or a poor relationship between LBM and functional capacity and health related outcomes, leading to the conclusion of many that the amount of muscle may not be associated with these age-associated outcomes. It was assumed that some undefined index of muscle quality is the critical contributor. These studies also consistently showed that muscle strength is lost more quickly than lean mass. Total body muscle mass can now be measured directly, accurately and non-invasively using the D3creatine (D3Cr) dilution method. D3Cr muscle mass, but not DXA derived LBM, is strongly associated with functional capacity, falls and insulin resistance in older men and women. In addition, D3Cr muscle mass is associated with risk of disability, hip fracture and mortality. New and emerging data demonstrate that low muscle mass may serve as a diagnostic criterion for sarcopenia.
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Affiliation(s)
- William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Morgan Hall, Berkeley, CA, USA.
- Division of Geriatrics, Duke University Medical Center, Durham, NC, USA.
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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25
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Heng MWY, Chan AWD, Man REK, Fenwick EK, Chew STH, Tay L, Sien NY, Ng D, Koh FH, Yong EL, Gupta P, Lamoureux EL. Individual and combined associations of sarcopenia, osteoporosis and obesity with frailty in a multi-ethnic asian older adult population. BMC Geriatr 2023; 23:802. [PMID: 38053025 PMCID: PMC10696759 DOI: 10.1186/s12877-023-04500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND We explored the relationships between sarcopenia (SP), osteoporosis (OP), obesity (OB), (alone and in combination) with physical frailty (PF) in a multi-ethnic, population-based study of Asians aged ≥ 60 years. METHODS Participants were enrolled from the PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study (PIONEER) study. PF was defined using the modified Fried phenotype; SP using the Asian Working Group for Sarcopenia 2019; OP using bone mineral density scores; and OB using the fat mass index. Modified Poisson regression models investigated the associations between exposures and PF, and the relative excess rates of PF due to interactions (RERI) to determine synergistic or antagonistic interactions. RESULTS Of the 2643 participants, 54.8% was female; and 49.8%, 25.1%, 25.0% were Chinese, Indians, and Malays, respectively. 25%, 19.0% and 6.7% participants had OB only, SP only, and OP only, respectively. A total of 356 (17.5%), 151 (7.4%) and 97 (4.8%) had osteosarcopenia (OSP), sarcopenic obesity (SOB) and osteo-obesity (OOB), respectively; while 70 (3.5%) had all 3 morbid conditions (osteosarcopenic obesity, OSO). Both SP only and OB only were strongly associated with increased rates of PF (RR: 2.53, 95% CI: 1.95, 3.29; RR: 2.05, 95% CI: 1.58, 2.66 respectively); but not OP. Those with OSP, OOB and SOB were also associated with high risks of PF (RR: 2.82, 95% CI: 2.16, 3.68; RR: 2.34, 95% CI: 1.69, 3.23; and RR: 2.58, 95% CI: 1.95, 3.41, respectively) compared to robust individuals. Critically, individuals with OSO had the highest relative risk of having PF (RR: 3.06, CI: 2.28, 4.11). Only the sarcopenia-obesity interaction was significant, demonstrating negative synergism (antagonism). The concurrent presence of SP and OB was associated with a 100% lower rate of PF compared to the sum of the relatively rates of SP only and OB only. CONCLUSION The prevalence of SP, OB and OP, alone and combined, is substantial in older Asians and their early identification is needed to mitigate the risk of frailty. OB may interact with SP in an antagonistic manner to moderate rates of frailty. Further longitudinal studies are needed to address causality and mechanistic underpinnings our findings.
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Affiliation(s)
- Matthew Wong Yu Heng
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- University of Cambridge, Cambridge, England
| | - Aurora W D Chan
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Samuel T H Chew
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Laura Tay
- Department of Geriatric Medicine, Sengkang General Hospital, Sengkang, Singapore
| | - Ng Yee Sien
- Rehabilitation Medicine, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - David Ng
- Department of Nuclear Medicine, Singapore General Hospital, Singapore, Singapore
| | - Frederick H Koh
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Eu-Leong Yong
- Department of Obstetrics & Gynecology, National University of Singapore, Singapore, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute (SERI), The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
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Zanker J, Scott D, Szoeke C, Vogrin S, Patel S, Blackwell T, Bird S, Kirk B, Center J, Alajlouni DA, Gill T, Jones G, Pasco JA, Waters DL, Cawthon PM, Duque G. Predicting Slow Walking Speed From a Pooled Cohort Analysis: Sarcopenia Definitions, Agreement, and Prevalence in Australia and New Zealand. J Gerontol A Biol Sci Med Sci 2023; 78:2415-2425. [PMID: 37428864 PMCID: PMC10692428 DOI: 10.1093/gerona/glad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. METHODS Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK). RESULTS Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC. CONCLUSIONS Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Cassandra Szoeke
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Jacqueline Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Pasco
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon HealthDeakin University, Geelong, Victoria, Australia
| | - Debra L Waters
- Department of Medicine, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- Department of Internal Medicine/Geriatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Cheng E, Caan BJ, Cawthon PM, Evans WJ, Hellerstein MK, Shankaran M, Campbell KL, Binder AM, Sternfeld B, Meyerhardt JA, Schmitz KH, Cespedes Feliciano EM. D3-creatine dilution, computed tomography and dual-energy X-ray absorptiometry for assessing myopenia and physical function in colon cancer: A cross-sectional study. J Cachexia Sarcopenia Muscle 2023; 14:2768-2778. [PMID: 37899757 PMCID: PMC10751410 DOI: 10.1002/jcsm.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Low skeletal muscle mass (myopenia) is common in cancer populations and is associated with functional decline and mortality, but prior oncology studies did not assess total body skeletal muscle mass. Instead, they measured surrogates such as cross-sectional area (CSA) of skeletal muscle at L3 from computed tomography (CT) or appendicular lean mass (ALM) from dual-energy X-ray absorptiometry (DXA). D3-creatine (D3Cr) dilution is a non-invasive method to assess total body skeletal muscle mass, which has been examined in a variety of populations but not in cancer. To compare the associations of D3Cr muscle mass, CT CSA, and DXA ALM with myopenia and physical function, we conducted a cross-sectional study among 119 patients with colon cancer (2018-2022). METHODS For each technique (D3Cr, CT and DXA), myopenia was defined as the lowest sex-specific quartile of its measurement. Physical function was measured by the short physical performance battery and grip strength. We calculated Pearson correlations (r) among three techniques, computed Cohen's kappa coefficients (κ) to assess the agreement of myopenia, and estimated Pearson correlations (r) of three techniques with physical function. All analyses were sex-specific. RESULTS Sixty-one (51.3%) participants were male, the mean (standard deviation) age was 56.6 (12.9) years, and most (68.9%) had high physical function (short physical performance battery: ≥11 points). Correlations and myopenia agreement among three techniques were greater in men than women; for example, regarding D3Cr muscle mass versus CT CSA, r was 0.73 (P < 0.001) for men versus 0.45 (P < 0.001) for women, and κ was 0.82 (95% CI: 0.65, 0.99) for men versus 0.24 (95% CI: -0.08, 0.52) for women. Among men, higher D3Cr muscle mass was significantly correlated with faster gait speed (r = 0.43, P < 0.01) and stronger grip strength (r = 0.32, P < 0.05); similar correlations were observed for CT CSA and DXA ALM. However, among women, no measure of muscle or lean mass was significantly associated with physical function. CONCLUSIONS This is the first study using D3-creatine dilution method to assess muscle mass in a cancer population. Regardless of the techniques used for muscle or lean mass assessment, we observed stronger correlations, greater myopenia agreement, and more significant associations with physical function in men with colon cancer than women. D3Cr, CT and DXA are not interchangeable methods for assessing myopenia and physical function, especially in women with colon cancer. Future studies should consider relative advantages of these techniques and examine the D3-creatine dilution method in other cancer types.
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Affiliation(s)
- En Cheng
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Peggy M. Cawthon
- San Francisco Coordinating CenterCalifornia Pacific Medical Center Research InstituteSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - William J. Evans
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
- Division of GeriatricsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Marc K. Hellerstein
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Kristin L. Campbell
- Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Alexandra M. Binder
- Population Sciences in the Pacific ProgramUniversity of Hawaii Cancer CenterHonoluluHawaiiUSA
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Barbara Sternfeld
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Kathryn H. Schmitz
- Division of Hematology and OncologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Mao Z, Cawthon PM, Kritchevsky SB, Toledo FGS, Esser KA, Erickson ML, Newman AB, Farsijani S. The association between chrononutrition behaviors and muscle health among older adults: The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.13.23298454. [PMID: 38014276 PMCID: PMC10680884 DOI: 10.1101/2023.11.13.23298454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Emerging studies highlight chrononutrition's impact on body composition through circadian clock entrainment, but its effect on older adults' muscle health remains largely overlooked. Objective To determine the associations between chrononutrition behaviors and muscle health in older adults. Methods Dietary data from 828 older adults (76±5y) recorded food/beverage amounts and their clock time over the past 24 hours. Studied chrononutrition behaviors included: 1) The clock time of the first and last food/beverage intake; 2) Eating window (the time elapsed between the first and last intake); and 3) Eating frequency (Number of self-identified eating events logged with changed meal occasion and clock time). Muscle mass (D 3 -creatine), leg muscle volume (MRI), grip strength (hand-held dynamometer), and leg power (Keiser) were used as outcomes. We used linear regression to assess the relationships between chrononutrition and muscle health, adjusting for age, sex, race, marital status, education, study site, self-reported health, energy, protein, fiber intake, weight, height, and moderate-to-vigorous physical activity. Results Average eating window was 11±2 h/d; first and last intake times were at 8:22 and 19:22, respectively. After multivariable adjustment, a longer eating window and a later last intake time were associated with greater muscle mass (β±SE: 0.18±0.09; 0.27±0.11, respectively, P <0.05). The longer eating window was also marginally associated with higher leg power ( P =0.058). An earlier intake time was associated with higher grip strength (-0.38±0.15; P =0.012). Conclusions Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults. GRAPHICAL ABSTRACT Key findings Chrononutrition behaviors, including longer eating window, later last intake time, and earlier first intake time were associated with better muscle mass and function in older adults.
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30
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Cawthon PM, Blackwell TL, Kritchevsky SB, Newman AB, Hepple RT, Coen PM, Goodpaster BH, Duchowny K, Hetherington-Rauth M, Mau T, Shankaran M, Hellerstein M, Evans WJ, Cummings SR. Associations between D 3Cr muscle mass and MR thigh muscle volume with strength, power, physical performance, fitness, and limitations in older adults in the SOMMA study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.09.23298303. [PMID: 37986809 PMCID: PMC10659521 DOI: 10.1101/2023.11.09.23298303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Different measures to assess muscle size - magnetic resonance (MR) derived thigh muscle volume and d3-creatine dilution derived muscle mass (D3Cr muscle mass) - may have similar associations with strength, power, physical performance, fitness, and functional limitations in older adults. Methods Men (N=345) and women (N=482) aged ≥70 years from the Study of Muscle, Mobility and Aging completed exams including leg extension strength (1-repetition max) and cardiopulmonary exercise testing to assess fitness (VO2peak). Correlations and adjusted regression models stratified by sex were used to assess the association between muscle size measures and study outcomes; we tested for sex interactions. Results D3Cr muscle mass and MR thigh muscle volume were correlated (men: r=0.62, women: r=0.51, p<.001). Lower D3Cr muscle mass and lower MR thigh muscle volume were associated with lower strength and lower VO2peak in both men and women; D3Cr muscle mass was more strongly associated with strength in men than in women (p-int<0.05). There were correlations, though less consistent, between muscle size or mass with physical performance and function. Associations between the muscle size measures and the study outcomes occasionally varied by sex, and associations of MR thigh muscle volume were, at times, slightly more strongly associated with the study outcomes than was D3Cr muscle mass. Conclusions Less muscle -measured by either D3Cr muscle mass or MR thigh muscle volume - was associated with lower strength and worse performance. Varied associations by sex and assessment method suggest consideration be given to which measurement to use in future studies.
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Affiliation(s)
- Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Terri L Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine: Gerontology & Geriatric Medicine and The Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, FL USA
| | - Paul M Coen
- Translational Research Institute, AdventHealth, Orlando, FL, USA
| | | | - Kate Duchowny
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | | | - Theresa Mau
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Marc Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, USA
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Cummings SR, Lui LY, Glynn NW, Mau T, Cawthon PM, Kritchevsky SB, Coen PM, Goodpaster B, Marcinek DJ, Hepple RT, Patel S, Newman AB. Energetics and Clinical Factors for the Time Required to Walk 400 Meters The Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.10.23298299. [PMID: 37986884 PMCID: PMC10659495 DOI: 10.1101/2023.11.10.23298299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Walking slows with aging often leading to mobility disability. Mitochondrial energetics has been found to influence gait speed over short distances. Additionally, walking is a complex activity but few clinical factors that may influence walk time have been studied. Methods We examined 879 participants ≥70 years and measured the time to walk 400m. We tested the hypothesis that decreased mitochondrial energetics by respirometry in muscle biopsies and magnetic resonance spectroscopy in the thigh, is associated with longer time to walk 400m. We also used cardiopulmonary exercise testing to assess the energetic costs of walking: maximum oxygen consumption (VO 2 peak) and energy cost-capacity (the ratio of VO2, at a slow speed to VO 2 peak). In addition, we tested the hypothesis that selected clinical factors would also be associated with 400m walk time. Results Lower Max OXPHOS was associated with longer walk time and the association was explained by the energetics costs of walking, leg power and weight. Additionally, a multivariate model revealed that longer walk time was also significantly associated with lower VO 2 peak, greater cost-capacity ratio, weaker leg power, heavier weight, hip and knee stiffness, peripheral neuropathy, greater perceived exertion while walking slowly, greater physical fatigability, less moderate-to-vigorous exercise, less sedentary time and anemia. Significant associations between age, sex, muscle mass, and peripheral artery disease with 400m walk time were explained by other clinical and physiologic factors. Conclusions Lower mitochondrial energetics is associated with needing more time to walk 400m. This supports the value of developing interventions to improve mitochondrial energetics. Additionally, doing more moderate-to-vigorous exercise, increasing leg power, reducing weight, treating hip and knee stiffness, and screening for and treating anemia may reduce the time required to walk 400m and reduce the risk of mobility disability.
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Lukasiewicz CJ, Tranah GJ, Evans DS, Coen PM, Barnes HN, Huo Z, Esser KA, Lane NE, Kritchevsky SB, Newman AB, Cummings SR, Cawthon PM, Hepple RT. Higher Expression of Denervation-responsive Genes is Negatively Associated with Muscle Volume and Performance Traits in the Study of Muscle, Mobility and Aging (SOMMA). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.04.23298090. [PMID: 37961531 PMCID: PMC10635277 DOI: 10.1101/2023.11.04.23298090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
With aging skeletal muscle fibers undergo repeating cycles of denervation and reinnervation. In approximately the 8 th decade of life reinnervation no longer keeps pace, resulting in the accumulation of persistently denervated muscle fibers that in turn cause an acceleration of muscle dysfunction. The significance of denervation in important clinical outcomes with aging is poorly studied. The Study of Muscle, Mobility and Aging (SOMMA) is a large cohort study with the primary objective to assess how aging muscle biology impacts clinically important traits. Using transcriptomics data from vastus lateralis muscle biopsies in 575 participants we have selected 49 denervation-responsive genes to provide insights to the burden of denervation in SOMMA, to test the hypothesis that greater expression of denervation-responsive genes negatively associates with SOMMA participant traits that included time to walk 400 meters, fitness (VO 2peak ), maximal mitochondrial respiration, muscle mass and volume, and leg muscle strength and power. Consistent with our hypothesis, increased transcript levels of: a calcium-dependent intercellular adhesion glycoprotein (CDH15), acetylcholine receptor subunits (Chrna1, Chrnd, Chrne), a glycoprotein promoting reinnervation (NCAM1), a transcription factor regulating aspects of muscle organization (RUNX1), and a sodium channel (SCN5A) were each negatively associated with at least 3 of these traits. VO 2peak and maximal respiration had the strongest negative associations with 15 and 19 denervation-responsive genes, respectively. In conclusion, the abundance of denervation-responsive gene transcripts is a significant determinant of muscle and mobility outcomes in aging humans, supporting the imperative to identify new treatment strategies to restore innervation in advanced age.
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Zanker J, Scott D, Alajlouni D, Kirk B, Bird S, DeBruin D, Vogrin S, Bliuc D, Tran T, Cawthon P, Duque G, Center JR. Mortality, falls and slow walking speed are predicted by different muscle strength and physical performance measures in women and men. Arch Gerontol Geriatr 2023; 114:105084. [PMID: 37290229 DOI: 10.1016/j.archger.2023.105084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Different measures of muscle strength, physical performance and body size/composition are used in various sarcopenia definitions. This study investigated which baseline measures best predict incident mortality and falls, and prevalent slow walking speed in older women and men. MATERIALS AND METHODS Data for 899 women (mean age±standard deviation, 68.7 ± 4.3 years) and 497 men (69.4 ± 3.9 years) from the Dubbo Osteoporosis Epidemiology Study 2, comprising sixty variables for muscle strength (quadriceps strength), physical performance (walking speed, timed up and go (TUG) test, sit to stand (STS) test), body size (weight, height, body mass index) and body composition (lean mass, body fat) were included. Sex-stratified Classification and Regression Tree (CART) analyses calculated baseline variable accuracy for predicting incident mortality and falls, and prevalent slow walking speed (<0.8 m/s). RESULTS Over 14.5 years, 103/899 (11.5%) women and 96/497 (19.3%) men died, 345/899 (38.4%) women and 172/497 (34.6%) men had ≥1 fall, and 304/860 (35.3%) women and 172/461 (31.7%) had baseline slow walking speed (<0.8 m/s). CART models identified age and walking speed adjusted for height as the most important predictors for mortality in women, and quadriceps strength (with adjustments) as the most important predictor for mortality in men. In both sexes, STS (with adjustments) was the most important predictor for incident falls, and TUG test was the most important predictor for prevalent slow walking speed. Body composition measures were not important predictors for any outcome. CONCLUSIONS Muscle strength and physical performance variables and cut points predict falls and mortality differently in women and men, suggesting targeted sex-specific application of selected measures may improve outcome prediction in older adults.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia.
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dima Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Danielle DeBruin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Institute of Health and Sport (IHeS), Victoria University, Melbourne, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Dana Bliuc
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Thach Tran
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia; Department of Medicine - Western Health, The University of Melbourne, St. Albans, Victoria, Australia; Research Institute of the McGill University Health Centre, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia; Clinical School, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
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Newman AB, Visser M, Kritchevsky SB, Simonsick E, Cawthon PM, Harris TB. The Health, Aging, and Body Composition (Health ABC) Study-Ground-Breaking Science for 25 Years and Counting. J Gerontol A Biol Sci Med Sci 2023; 78:2024-2034. [PMID: 37431156 PMCID: PMC10613019 DOI: 10.1093/gerona/glad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The Health, Aging, and Body Composition Study is a longitudinal cohort study that started just over 25 years ago. This ground-breaking study tested specific hypotheses about the importance of weight, body composition, and weight-related health conditions for incident functional limitation in older adults. METHODS Narrative review with analysis of ancillary studies, career awards, publications, and citations. RESULTS Key findings of the study demonstrated the importance of body composition as a whole, both fat and lean mass, in the disablement pathway. The quality of the muscle in terms of its strength and its composition was found to be a critical feature in defining sarcopenia. Dietary patterns and especially protein intake, social factors, and cognition were found to be critical elements for functional limitation and disability. The study is highly cited and its assessments have been widely adopted in both observational studies and clinical trials. Its impact continues as a platform for collaboration and career development. CONCLUSIONS The Health ABC provides a knowledge base for the prevention of disability and promotion of mobility in older adults.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Eleanor Simonsick
- National Institute on Aging, Translational Gerontology Branch Biomedical Research Center, Baltimore, Maryland, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, University of California, San Francisco, California, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program NIA, NIH, Bethesda, Maryland, USA
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Cawthon PM, Patel S, Newman AB, Bhasin S, Peng L, Tracy RP, Kizer JR, Lee SJ, Ferrucci L, Ganz P, LeBrasseur NK, Cummings SR. Evaluation of Associations of Growth Differentiation Factor-11, Growth Differentiation Factor-8, and Their Binding Proteins, Follistatin and Follistatin-Like Protein-3, With Measures of Skeletal Muscle Mass, Muscle Strength, and Physical Function in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:2051-2059. [PMID: 36752218 PMCID: PMC10613016 DOI: 10.1093/gerona/glad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Based on studies from animal models, growth differentiation factor-11 (GDF-11) may have rejuvenating effects in humans. GDF-11 has high sequence homology with GDF-8 (also known as myostatin); follistatin and follistatin-like protein-3 (FSTL-3) are inhibitory proteins of both GDF-8 and GDF-11. METHODS Using highly specific liquid chromatography with tandem mass spectrometry assays for GDF-11 and GDF-8 and immunoassays for follistatin and FSTL-3, we quantified the association of these factors with muscle size, strength, and physical performance in 2 prospective cohort studies of community-dwelling older adults (Health, Aging, and Body Composition study [Health ABC] and Cardiovascular Health Study [CHS]). RESULTS GDF-8 levels were positively associated with thigh muscle cross-sectional area and density in Health ABC (data not available in CHS). GDF-8 levels were positively associated with lean mass (a surrogate of muscle mass) in Health ABC but not CHS, and grip strength in CHS but not Health ABC. FSTL-3 (and perhaps follistatin) was negatively associated with lean mass and had variable associations with other variables. In contrast, GDF-11 was not significantly associated with strength or performance. CONCLUSIONS GDF-8 and its binding proteins, follistatin and FSTL-3, may constitute a counterregulatory system (chalones) to restrain age-related loss of muscle mass and strength.
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Affiliation(s)
- Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania,USA
| | - Shalender Bhasin
- Research Program in Men’s Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liming Peng
- Research Program in Men’s Health: Aging and Metabolism; Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont,USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,USA
| | - Se-Jin Lee
- The Jackson Laboratory and University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Luigi Ferrucci
- Office of the Scientific Director, National Institute on Aging, Bethesda, Maryland,USA
| | - Peter Ganz
- Cardiology Division, Zuckerberg San Francisco General Hospital and Department of Medicine, University of California San Francisco, San Francisco, California,USA
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Andrews JS, Gold LS, Reed MJ, Hough CL, Garcia JM, McClelland RL, Fitzpatrick AL, Covinsky KE, Crane PK, Yaffe K, Cawthon PM. Appendicular Lean Mass, Grip Strength, and the Incidence of Dementia Among Older Adults in the Health ABC Study. J Gerontol A Biol Sci Med Sci 2023; 78:2070-2076. [PMID: 36548124 PMCID: PMC10613012 DOI: 10.1093/gerona/glac254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identification of novel risk factors for dementia in older adults could facilitate development of methods to identify patients most at risk and improve their cognitive outcomes. We aimed to determine whether lower appendicular lean mass (ALM), assessed by dual-energy x-ray absorptiometry (DXA), and lower grip strength are associated with a greater likelihood of incident dementia among older adults in the Health Aging and Body Composition Study (Health ABC). METHODS Health ABC data from 1997 to 2008 were analyzed (n = 2 704). Baseline ALM to body mass index (BMI) ratio (ALMBMI) was assessed by DXA. Baseline grip strength was assessed by hand-held dynamometry. Incident dementia diagnosis was defined as either (i) dementia-related hospitalization plus a Modified Mini-Mental State Examination (3MS) score of ≤ 90; or (ii) record of prescription for anti-dementia medication; or (iii) decline of at least 1.5 SDs on the 3MS score compared to baseline. Cox proportional hazard models estimated associations of ALMBMI and grip strength with incident dementia over follow-up with and without adjusting for covariates, stratified by sex. RESULTS Among older men, each standard deviation decrement in ALMBMI (adjusted hazard ratio [aHR]: 1.33; 95% confidence interval [CI]: 1.07, 1.65) or grip strength (aHR 1.22; 95% CI: 1.06, 1.41) was associated with increased likelihood of incident dementia. CONCLUSIONS Lower ALMBMI and grip strength may be important risk factors for the development of dementia among older men. How these factors may belong to a causal pathway of dementia must be elucidated in future work.
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Affiliation(s)
- James S Andrews
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Laura S Gold
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - May J Reed
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jose M Garcia
- Department of Medicine, University of Washington, Seattle, Washington, USA
- GRECC, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Annette L Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, Washington, USA
| | - Ken E Covinsky
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, and University of California San Francisco, San Francisco, California, USA
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Muraki I. Muscle Mass Assessment in Sarcopenia: A Narrative Review. JMA J 2023; 6:381-386. [PMID: 37941710 PMCID: PMC10628318 DOI: 10.31662/jmaj.2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/01/2023] [Indexed: 11/10/2023] Open
Abstract
Sarcopenia is a condition characterized by age-related muscle loss and dysfunction. Over the past decade, several working groups have developed diagnostic criteria for sarcopenia, including muscle mass, grip strength, and gait speed measurements. However, there is debate over which muscle mass indicator is the most appropriate. Some groups used appendicular lean mass divided by height squared, whereas others used appendicular lean mass divided by body mass index. In addition, the association between muscle mass and long-term health outcomes is inconsistent. As a result, some experts question the necessity of using muscle mass as a diagnostic criterion for sarcopenia. This review summarizes the measurement methods and muscle mass indicators of previous studies, highlighting issues with past muscle mass assessments.
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Affiliation(s)
- Isao Muraki
- Public Health, Osaka University Graduate School of Medicine, Suita, Japan
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de Lima AB, Torres-Costoso A, Zymbal V, Gouveia ÉR, Baptista F. Risk phenotype for sarcopenia in older adults from Amazonas, Brazil; a cross-sectional study. PLoS One 2023; 18:e0292801. [PMID: 37844034 PMCID: PMC10578578 DOI: 10.1371/journal.pone.0292801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND There are several markers for the suspicion, identification, and confirmation of sarcopenia. OBJECTIVES To analyse the importance of several markers for assessing sarcopenia by classifying phenotypes based on five domains: symptomatology, muscle function, muscle mass, physical performance, and physical function. METHODS A cross-sectional study analysing 312 older adults (72.6±7.8 yrs) was conducted in Novo Aripuanã, Amazonas, Brazil. Symptoms of sarcopenia were determined with the SARC-Calf; muscle function was assessed using the 30-Chair Stand test (CST), 30-CST power, and handgrip strength (HGS) with and without normalisation for body mass/height; the skeletal muscle mass index (SMMI) was estimated from anthropometry; physical performance was determined through the 4-m gait speed (GS) and 6-min walking test (6MWT); and physical function was determined with the Composite Physical Function Scale (CPF). RESULTS Cluster analysis revealed two phenotypes (at risk vs not at risk for sarcopenia) and the contribution of each marker (ranged from 0 to 1). In men, the contribution of each marker was: 1 for SARC-Calf, 0.18 for SMMI, 0.09 for 30-CST power and 0.06 for HGS; in women: 1 for SARC-Calf, 0.25 for 30-CST power, 0.22 for SMMI, 0.06 for GS, 0.04 for HGS, and 0.03 for CPF. Considering the cutoff values proposed by Rikli and Jones (2013) for physical function and Cruz-Jentoft et al. (2019) for the other domains, the risk profile for sarcopenia was characterized by: high SARC-Calf in both sexes (men:51.8 vs 3.6%, p<0.001; women:71.2 vs 1.1%, p<0.001), low SMMI (men:73.2 vs 44.6%, p<0.002; women:44.1 vs 23.6%, p = 0.002); in women, low GS (38.7 vs 12.4%, p<0.001) and low CPF (29.7 vs 15.7%, p = 0.020), and no differences in HGS between groups in both sexes. CONCLUSIONS SARC-Calf, SMMI, and 30-CST were more relevant markers for sarcopenia risk in older adults of both sexes, GS and CPF played also an important role in women.
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Affiliation(s)
- Alex Barreto de Lima
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Torres-Costoso
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Vera Zymbal
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
- ESS, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Élvio Rúbio Gouveia
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal
- LARSYS, Interactive Technologies Institute, Funchal, Portugal
| | - Fátima Baptista
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Beavers KM, Avery AE, Shankaran M, Evans WJ, Lynch SD, Dwyer C, Howard M, Beavers DP, Weaver AA, Lenchik L, Cawthon PM. Application of the D 3 -creatine muscle mass assessment tool to a geriatric weight loss trial: A pilot study. J Cachexia Sarcopenia Muscle 2023; 14:2350-2358. [PMID: 37668075 PMCID: PMC10570063 DOI: 10.1002/jcsm.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Traditionally, weight loss (WL) trials utilize dual energy X-ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non-bone and non-fat tissue, is a reasonable proxy for muscle mass. In contrast, the D3 -creatine (D3 Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D3 Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength. METHODS The INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three-armed, 12-month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D3 Cr tracer dose, provided a fasted urine sample 3-6 days post-dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid-thigh and trunk muscle/intermuscular fat areas) scans, and performed 400-m walk, stair climb, knee extensor strength, and grip strength tests. RESULTS Participants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m2 ). Six month total body WL was -10.3 (95% confidence interval, CI: -12.7, -7.9) kg. All DXA and computed tomography-derived body composition measures were significantly decreased from baseline, yet D3 Cr muscle mass did not change [+0.5 (95% CI: -2.0, 3.0) kg]. Of muscle function and strength measures, only grip strength significantly changed [+2.5 (95% CI: 1.0, 4.0) kg] from baseline. CONCLUSIONS Among 24 older adults, significant WL with or without weighted vest use or resistance training over a 6-month period was associated with significant declines in all bioimaging metrics, while D3 Cr muscle mass and muscle function and strength were preserved. Treatment assignment for the trial remains blinded; therefore, full interpretation of these findings is limited. Future work in this area will assess change in D3 Cr muscle mass by parent trial treatment group assignment in all study participants.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Allison E. Avery
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | | | | | - S. Delanie Lynch
- Department of Biomedical EngineeringWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Caitlyn Dwyer
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Marjorie Howard
- Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Daniel P. Beavers
- Department of Statistical SciencesWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Ashley A. Weaver
- Department of Biomedical EngineeringWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Leon Lenchik
- Department of RadiologyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCaliforniaUSA
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Glynn NW, Qiao YS. Measuring and Understanding the Health Impact of Greater Fatigability in Older Adults: A Call to Action and Opportunities. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2023; 11:188-201. [PMID: 38074079 PMCID: PMC10707490 DOI: 10.1080/21641846.2023.2252612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Different from fatigue, an instantaneous state of tiredness, weakness and lack of energy, fatigability is a trait that contextualizes whole-body fatigue to the level of activity (i.e., intensity and duration) with which the fatigue is associated. Fatigability can be perceived or performance-related. Measuring fatigability improves upon traditional fatigue measures by accounting for self-pacing as older adults likely slow down or limit their daily activity to maintain fatigue in a tolerable range. Anchoring fatigue to activities/tasks improves sensitivity and allows for meaningful comparisons across individuals/between studies, as well as evaluating change over time and treatment effects. Two well-validated approaches are utilized to measure perceived fatigability: 1) a 5-minute slow-paced (1.5 mph/0.67 m/s, 0% grade) treadmill walk immediately followed by Borg rating of perceived exertion; and 2) a self-administered 10-item questionnaire, Pittsburgh Fatigability Scale, with both physical and mental subscales. Many walking-based performance fatigability measures are based on certain lap time or distance, while the Pittsburgh Performance Fatigability Index uses raw accelerometry data to quantify percent of cadence decline over the entire long distance walking tasks. Perceived fatigability prevalence ranges from 20-90% in older adults varying by assessment tool, and is higher with advancing age and in women compared to men. Fatigability is associated with physical and cognitive function, fall risk, mobility decline, and mortality. Unfortunately, the available research lacks representativeness in terms of racial and ethnic diversity. The time is now to incorporate our established sensitive and validated fatigability measures into global research and clinical practice to better understand mechanistic underpinnings and reveal intervention effects to reduce the burden and lessen the consequences of greater fatigability worldwide.
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Affiliation(s)
- Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA 15261
| | - Yujia Susanna Qiao
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA 15261
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Kirk B, Harrison SL, Zanker J, Burghardt AJ, Orwoll E, Duque G, Cawthon PM. Interactions Between HR-pQCT Bone Density and D 3 Cr Muscle Mass (or HR-pQCT Bone Structure and HR-pQCT Muscle Density) in Predicting Fractures: The Osteoporotic Fractures in Men Study. J Bone Miner Res 2023; 38:1245-1257. [PMID: 37351915 PMCID: PMC10528106 DOI: 10.1002/jbmr.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 06/24/2023]
Abstract
We examined if an interaction exists between bone and muscle in predicting fractures in older men. Prospective data from the Osteoporotic Fractures in Men study was used to build Cox proportional hazards models. Predictors included HR-pQCT total volumetric BMD (Tt.BMD), trabecular BMD (Tb.BMD), cortical BMD (Ct.BMD) and cortical area (Ct.Ar) at distal radius/tibia, HR-pQCT muscle volume and density (diaphyseal tibia), D3 -creatine dilution (D3 Cr) muscle mass, and grip strength and leg force, analyzed as continuous variables and as quartiles. Incident fractures were self-reported every 4 months via questionnaires and centrally adjudicated by physician review of radiology reports. Potential confounders (demographics, comorbidities, lifestyle factors, etc.) were considered. A total of 1353 men (mean age 84.2 ± 4.0 years, 92.7% white) were followed for 6.03 ± 2.11 years. In the unadjusted (continuous) model, there were no interactions (p > 0.05) between any muscle variable (D3 Cr muscle mass, muscle volume, muscle density, grip strength or leg force) and Tt.BMD at distal radius/tibia for fractures (all: n = 182-302; nonvertebral: n = 149-254; vertebral: n = 27-45). No consistent interactions were observed when interchanging Tt.BMD for Tb.BMD/Ct.BMD or for Ct.Ar (bone structure) at the distal radius/tibia in the unadjusted (continuous) models. Compared with men in quartiles (Q) 2-4 of D3 Cr muscle mass and Q2-4 of distal tibia Tt.BMD, men in Q1 of both had increased risk for all fractures (hazard ratio (HR) = 2.00; 95% confidence interval [CI] 1.24-3.23, p = 0.005) and nonvertebral fractures (HR = 2.10; 95% CI 1.25-3.52, p < 0.001) in the multivariable-adjusted model. Confidence intervals overlapped (p > 0.05) when visually inspecting other quartile groups in the multivariable-adjusted model. In this prospective cohort study of older men, there was no consistent interactions between bone and muscle variables on fracture risk. Larger sample sizes and longer follow-up may be needed to clarify if there is an interaction between bone and muscle on fracture risk in men. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | | | - Jesse Zanker
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Andrew J. Burghardt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University, Montreal, QC, Canada
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Sidiqi A, Fariha F, Shanta SS, Dasiewicz A, Mahmud AA, Moore DR, Shankaran M, Hellerstein MK, Evans WJ, Gernand AD, Islam MM, Abrams SA, Harrington J, Nyangau E, Roth DE, O'Callaghan KM. Estimation of skeletal muscle mass in 4-year-old children using the D 3-creatine dilution method. Pediatr Res 2023; 94:1195-1202. [PMID: 37037953 PMCID: PMC10444613 DOI: 10.1038/s41390-023-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh. METHODS Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer. RESULTS SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91). CONCLUSIONS The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach. IMPACT The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.
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Affiliation(s)
- Aysha Sidiqi
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alison Dasiewicz
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel R Moore
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Jennifer Harrington
- Department of Pediatrics, Women's and Children's Health Network and University of Adelaide, Adelaide, SA, Australia
| | - Edna Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, King's College London, London, UK.
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Balachandran AT, Evans W, Cawthon P, Wang Y, Shankaran M, Hellerstein M, Qiu P, Manini T. Comparing D3-Creatine Dilution and Dual-Energy X-ray Absorptiometry Muscle Mass Responses to Strength Training in Low-Functioning Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1591-1596. [PMID: 36752568 PMCID: PMC10848235 DOI: 10.1093/gerona/glad047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In contrast to dual-energy x-ray absorptiometry (DXA), the D3-creatine (D3Cr) dilution method provides a direct measure of skeletal muscle mass and in a cohort of older men has been strongly associated with health-related outcomes. However, sensitivity to detect changes in D3Cr-derived muscle mass due to an intervention is limited. METHODS Twenty-one older adults (≥70 years) with low-to-moderate physical function were randomized to a 15-week high-intensity strength training (ST) or a health education (HE) group. Full-body progressive intensity ST was performed 3 days per week. RESULTS The mean age was 82.1 years, with 64% females. After 15 weeks, both D3Cr muscle mass (MM; 2.29 kg; 95% CI: 0.22, 4.36) and DXA appendicular lean mass (ALM; 1.04 kg; 95% CI: 0.31, 1.77) were greater in ST group compared to HE. Baseline correlations between D3Cr MM and DXA ALM (r = 0.79; 95% CI: 0.53, 0.92) or total lean body mass (LBM; r = 0.79; 95% CI: 0.52, 0.91) were high. However, longitudinal changes in D3Cr MM were weakly correlated with changes in DXA ALM (r = 0.19; 95% CI: -0.35, 0.64) and LBM (r = 0.40; 95% CI: -0.13, 0.76). More participants showed positive response rates, defined as a >5% increase from baseline, with D3Cr MM (80%) than DXA measures (14%-43%). CONCLUSIONS A progressive ST intervention in low-functioning older adults increased D3Cr MM and DXA ALM. These data suggest that the D3Cr dilution is potentially sensitive to detect changes in muscle mass in response to resistance exercise training. These results are preliminary and could be used for planning larger trials to replicate these results.
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Affiliation(s)
- Anoop T Balachandran
- Department of Family, Nutrition, and Exercise Sciences, Queens College, The City University of New York, Flushing, New York, USA
| | - William J Evans
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, California, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Yipeng Wang
- Department of Biostatistics, University of Florida, Gainesville, Florida,USA
| | - Mahalakshmi Shankaran
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Marc K Hellerstein
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Peihua Qiu
- Department of Biostatistics, University of Florida, Gainesville, Florida,USA
| | - Todd Manini
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida, USA
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Wimer L, Goncharova E, Galkina S, Nyangau E, Shankaran M, Davis A, Prado L, Munoz MC, Epstein S, Patterson C, Shaum N, Hellerstein M, Evans W, Melov S. The D 3 -creatine dilution method non-invasively measures muscle mass in mice. Aging Cell 2023; 22:e13897. [PMID: 37272263 PMCID: PMC10410001 DOI: 10.1111/acel.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023] Open
Abstract
Developing accurate methods to quantify age-related muscle loss (sarcopenia) could greatly accelerate development of therapies to treat muscle loss in the elderly, as current methods are inaccurate or expensive. The current gold standard method for quantifying sarcopenia is dual-energy X-ray absorptiometry (DXA) but does not measure muscle directly-it is a composite measure quantifying "lean mass" (muscle) excluding fat and bone. In humans, DXA overestimates muscle mass, which has led to erroneous conclusions about the importance of skeletal muscle in human health and disease. In animal models, DXA is a popular method for measuring lean mass. However, instrumentation is expensive and is potentially limited by anesthesia concerns. Recently, the D3 -creatine (D3 Cr) dilution method for quantifying muscle mass was developed in humans and rats. This method is faster, cheaper, and more accurate than DXA. Here, we demonstrate that the D3 Cr method is a specific assay for muscle mass in mice, and we test associations with DXA and body weight. We evaluated the D3 Cr method compared to DXA-determined lean body mass (LBM) in aged mice and reported that DXA consistently overestimates muscle mass with age. Overall, we provide evidence that the D3 Cr dilution method directly measures muscle mass in mice. Combined with its ease of use, accessibility, and non-invasive nature, the method may prove to more quickly advance development of preclinical therapies targeting sarcopenia.
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Affiliation(s)
- Lauren Wimer
- Buck Institute for Research on AgingNovatoCaliforniaUSA
| | | | | | - Edna Nyangau
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Asia Davis
- Buck Institute for Research on AgingNovatoCaliforniaUSA
| | - Leandro Prado
- Buck Institute for Research on AgingNovatoCaliforniaUSA
| | | | | | | | | | - Mark Hellerstein
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - William Evans
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Simon Melov
- Buck Institute for Research on AgingNovatoCaliforniaUSA
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Barreto de Lima A, Dos Santos Ribeiro G, Henriques-Neto D, Rúbio Gouveia É, Baptista F. Diagnostic performance of SARC-F and SARC-CalF in screening for sarcopenia in older adults in Northern Brazil. Sci Rep 2023; 13:11698. [PMID: 37474595 PMCID: PMC10359260 DOI: 10.1038/s41598-023-39002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023] Open
Abstract
To compare the performance of SARC-F and SARC-CalF as screening tools for sarcopenia. Cross-sectional study with a convenience sample of 312 community-dwelling older people. Sarcopenia was defined as low handgrip strength (HGS) or low gait speed (GS ≤ 0.8 m/s). HGS was measured by dynamometry and GS by the 4-m walking speed test. For HGS, six criteria (C) were used to identify sarcopenia in men/women: CI: < 27 kg/16 kg; CII: < 35.5 kg/20.0 kg; CIII: grip over body mass index < 1.05/< 0.79; CIV: grip strength over total body fat < 1.66/< 0.65; CV: grip over bodyweight < 0.45/< 0.34; CVI: < 27 kg/16 kg and low skeletal muscle mass index (SMMI); CI and CVI defined according to the European Working Group on sarcopenia in older people and the rest according to the sarcopenia definition and outcomes Consortium. For sarcopenia screening, the SARC-F (≥ 4 points) and the SARC-CalF (≥ 11 points) were used. The kappa analysis revealed no agreement between the SARC-F and the various criteria for the identification of sarcopenia in men. The same lack of agreement was observed in women with some exceptions: CI = 0.161 ± 0.074, p = 0.020; GS = 0.209 ± 0.076, p = 0.003. Concerning the Cohen's kappa between the SARC-Calf and the reference criteria of sarcopenia, the following coefficients were observed as significant for women: CI = 0.201 ± 0.069, p = 0.003; CII = 0.186 ± 0.064, p = 0.005; GS = 0.273 ± 0.068, p = 0.0001; and for men: CII = 0.139 ± 0.053, p = 0.021; GS = 0.223 ± 0.099, p = 0.011. ROC curves revealed the SARC-Calf with acceptable discrimination and reasonable sarcopenia predictive capacity considering a cutoff value of 10.5 in both men (AUC: 67.5%, p = 0.022; Se = 52.9%; Sp = 76.8%) and women (AUC: 72.4%, p < 0.001; Se = 63%; Sp = 68.5%) concerning GS. The SARC-CalF performed better than the SARC-F for screening sarcopenia in the population ≥ 60 years of age in the Amazonas, measured through walking slowness.
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Affiliation(s)
- Alex Barreto de Lima
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.
- Universidade do Estado do Amazonas, Amazonas, Brazil.
| | - Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Duarte Henriques-Neto
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Maia, Portugal
| | - Élvio Rúbio Gouveia
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal
- LARSYS, Interactive Technologies Institute, Funchal, Portugal
| | - Fátima Baptista
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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46
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Newman AB. The Epidemiology and Societal Impact of Aging-Related Functional Limitations: A Looming Public Health Crisis. J Gerontol A Biol Sci Med Sci 2023; 78:4-7. [PMID: 37325965 PMCID: PMC10272977 DOI: 10.1093/gerona/glad021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Indexed: 06/17/2023] Open
Abstract
Functional impairment and disability become increasingly common with aging. As more people are reaching old age, the number of people needing care will rise, creating a crisis of need for care. Population studies and clinical trials have demonstrated the importance of the detection of early loss of strength and walking speed in predicting disability and in designing interventions to prevent functional decline. There is a large societal burden linked to age-related disorders. Physical activity is to date the only intervention that has prevented disability in a long-term clinical trial, but is difficult to sustain. Novel interventions are needed to maintain function in late life.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania,USA
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47
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Wang Y, Luo D, Liu J, Song Y, Jiang B, Jiang H. Low skeletal muscle mass index and all-cause mortality risk in adults: A systematic review and meta-analysis of prospective cohort studies. PLoS One 2023; 18:e0286745. [PMID: 37285331 DOI: 10.1371/journal.pone.0286745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The relationship between low skeletal muscle mass index (SMI) and all-cause mortality risk in the general adults remains unclear. Our study was conducted to examine and quantify the associations between low SMI and all-cause mortality risks. METHODS PubMed, Web of Science, and Cochrane Library for primary data sources and references to relevant publications retrieved until 1 April 2023. A random-effect model, subgroup analyses, meta-regression, sensitivity analysis, and publication bias were conducted using STATA 16.0. RESULTS Sixteen prospective studies were included in the meta-analysis of low SMI and the risk of all-cause mortality. A total of 11696 deaths were ascertained among 81358 participants during the 3 to 14.4 years follow-up. The pooled RR of all-cause mortality risk was 1.57 (95% CI, 1.25 to 1.96, P < 0.001) across the lowest to the normal muscle mass category. The results of meta-regression showed that BMI (P = 0.086) might be sources of heterogeneity between studies. Subgroup analysis showed that low SMI was significantly associated with an increased risk of all-cause mortality in studies with a body mass index (BMI) between 18.5 to 25 (1.34, 95% CI, 1.24-1.45, P<0.001), 25 to 30 (1.91, 95% CI, 1.16-3.15, P = 0.011), and over 30 (2.58, 95% CI, 1.20-5.54 P = 0.015). CONCLUSIONS Low SMI was significantly associated with the increased risk of all-cause mortality, and the risk of all-cause mortality associated with low SMI was higher in adults with a higher BMI. Low SMI Prevention and treatment might be significant for reducing mortality risk and promoting healthy longevity.
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Affiliation(s)
- Yahai Wang
- College of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Donglin Luo
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Jiahao Liu
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Yu Song
- College of Arts and Physical Education, Nanchang Normal College of Applied Technology, Nanchang, Jiangxi, China
| | - Binggang Jiang
- Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Haichao Jiang
- Faculty of Health Service, Naval Medical University, Shanghai, China
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48
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Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, Bahrainy S, Ji Kwak M, Batchelor WB, Forman DE, Rich MW, Kirkpatrick J, Krishnaswami A, Alexander KP, Gerstenblith G, Cawthon P, deFilippi CR, Goyal P. Sarcopenia and Cardiovascular Diseases. Circulation 2023; 147:1534-1553. [PMID: 37186680 PMCID: PMC10180053 DOI: 10.1161/circulationaha.123.064071] [Citation(s) in RCA: 102] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.
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Affiliation(s)
- Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Maha Alfaraidhy
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Noora AlHajri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates (N.A.)
| | | | | | | | | | | | - Wayne B. Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Daniel E. Forman
- University of Pittsburgh and the Pittsburgh Geriatric Research Education and Clinical Center, PA (D.E.F.)
| | | | | | | | | | - Gary Gerstenblith
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | | | - Christopher R. deFilippi
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Parag Goyal
- University of Arizona, Tucson (N.N.R., P.G.)
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49
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Shah UA, Ballinger TJ, Bhandari R, Dieli-Conwright CM, Guertin KA, Hibler EA, Kalam F, Lohmann AE, Ippolito JE. Imaging modalities for measuring body composition in patients with cancer: opportunities and challenges. J Natl Cancer Inst Monogr 2023; 2023:56-67. [PMID: 37139984 PMCID: PMC10157788 DOI: 10.1093/jncimonographs/lgad001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 05/05/2023] Open
Abstract
Body composition assessment (ie, the measurement of muscle and adiposity) impacts several cancer-related outcomes including treatment-related toxicities, treatment responses, complications, and prognosis. Traditional modalities for body composition measurement include body mass index, body circumference, skinfold thickness, and bioelectrical impedance analysis; advanced imaging modalities include dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and positron emission tomography. Each modality has its advantages and disadvantages, thus requiring an individualized approach in identifying the most appropriate measure for specific clinical or research situations. Advancements in imaging approaches have led to an abundance of available data, however, the lack of standardized thresholds for classification of abnormal muscle mass or adiposity has been a barrier to adopting these measurements widely in research and clinical care. In this review, we discuss the different modalities in detail and provide guidance on their unique opportunities and challenges.
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Affiliation(s)
- Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tarah J Ballinger
- Department of Medicine, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Rusha Bhandari
- Department of Pediatrics, City of Hope, Duarte, CA, USA
- Department of Population Science, City of Hope, Duarte, CA, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kristin A Guertin
- Department of Public Health Sciences, University of Connecticut Health, Farmington, CT, USA
| | - Elizabeth A Hibler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faiza Kalam
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ana Elisa Lohmann
- Department of Medical Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Joseph E Ippolito
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO, USA
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50
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Kirk B, French C, Gebauer M, Vogrin S, Zanker J, Sales M, Duque G. Diagnostic power of relative sit-to-stand muscle power, grip strength, and gait speed for identifying a history of recurrent falls and fractures in older adults. Eur Geriatr Med 2023:10.1007/s41999-023-00778-x. [PMID: 37058233 DOI: 10.1007/s41999-023-00778-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To compare the diagnostic value of relative sit-to-stand muscle power with grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. METHODS Data from an outpatient clinic included anthropometry (height/weight), bone density, 5 times sit-to-stand time (stopwatch and standardized chair), grip strength (hydraulic dynamometer), and gait speed (4 m). Relative sit-to-stand muscle power (W.kg-1, normalised to body mass) was calculated using a validated equation. Outcomes of falls (past 1 year) and fractures (past 5 years) were self-reported and verified by medical records wherever possible. Binary logistic regression considering for potential confounders (age, sex, BMI, Charlson comorbidity index, femoral neck bone density) and receiver operating characteristics (ROC) curves were used in statistical analysis. RESULTS 508 community-dwelling older adults (median age: 78 years, interquartile range: 72, 83, 75.2% women) were included. Compared to greater relative sit-to-stand muscle power (1.62-3.78W.kg-1 for women; 2.03-3.90W.kg-1 for men), those with extremely low relative sit-to-stand muscle power were 2.35 (95% CI 1.54, 3.60, p < 0.001) and 2.41 (95% CI 1.25, 4.65, p = 0.009) times more likely to experience recurrent falls and fractures, respectively, in fully adjusted model. Compared to grip strength or gait speed, relative sit-to-stand muscle power showed the highest area under the ROC curve for identifying recurrent falls (AUC: 0.64) and fractures (AUC: 0.62). All tests showed low diagnostic power (AUC: < 0.7). CONCLUSION Relative sit-to-stand muscle power performed slightly (but not statistically) better than grip strength or gait speed for identifying a history of recurrent falls and fractures in older adults. However, all tests showed low diagnostic power.
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Affiliation(s)
- Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Chloe French
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Maria Gebauer
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Myrla Sales
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, 3021, Australia.
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, 3021, Australia.
- Research Institute of the McGill University Health Centre, Montreal, QC, H4A 3J1, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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