Chapter 3 Prevention of sarcopenia

Probiotics in Orthopedics: From Preclinical Studies to Current Applications and Future Perspective

In recent years, probiotics have been emerging as an attractive therapeutic strategy for several diseases. In orthopedics, probiotics seem to be a promising supplementation for treatment of osteoporosis, osteoarthritis, muscle loss-related disease, wound and ulcer issues, and prevention of surgical antibiotic prophylaxis side effects. Although probiotics are still not included in guidelines for these conditions, several studies have reported theoretical benefits of their administration. Further high-level clinical trials are necessary to convert research into solid clinical practice. However, probiotics represent a cost-effective future perspective and may play a role in association with traditional orthopedic therapies.

Impact of probiotics on muscle mass, muscle strength and lean mass: a systematic review and meta-analysis of randomized controlled trials

Probiotics have shown potential to counteract sarcopenia, although the extent to which they can influence domains of sarcopenia such as muscle mass and strength in humans is unclear. The aim of this systematic review and meta-analysis was to explore the impact of probiotic supplementation on muscle mass, total lean mass and muscle strength in human adults. A literature search of randomized controlled trials (RCTs) was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until June 2022. Eligible RCTs compared the effect of probiotic supplementation versus placebo on muscle and total lean mass and global muscle strength (composite score of all muscle strength outcomes) in adults (>18 years). To evaluate the differences between groups, a meta-analysis was conducted using the random effects inverse-variance model by utilizing standardized mean differences. Twenty-four studies were included in the systematic review and meta-analysis exploring the effects of probiotics on muscle mass, total lean mass and global muscle strength. Our main analysis (k = 10) revealed that muscle mass was improved following probiotics compared with placebo (SMD: 0.42, 95% CI: 0.10-0.74, I²  = 57%, P = 0.009), although no changes were revealed in relation to total lean mass (k = 12; SMD: -0.03, 95% CI: -0.19 - 0.13, I²  = 0%, P = 0.69). Interestingly, a significant increase in global muscle strength was also observed among six RCTs (SMD: 0.69, 95% CI: 0.33-1.06, I²  = 64%, P = 0.0002). Probiotic supplementation enhances both muscle mass and global muscle strength; however, no beneficial effects were observed in total lean mass. Investigating the physiological mechanisms underpinning different ageing groups and elucidating appropriate probiotic strains for optimal gains in muscle mass and strength are warranted.

Toward the recognition and management of sarcopenia in routine clinical care

Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.

Effects and contents of nutrition education relating to sarcopenia and frailty for Japanese older adults: A systematic review

This systematic review aimed to clarify whether nutrition education relating to sarcopenia and frailty for Japanese older adults has been effective and to identify the content of nutrition education that is provided to participants. We examined relevant studies published before January 2021. The inclusion criteria were as follows: (i) studies on nutrition education provided by experts; (ii) studies on Japanese participants aged 60 years or older; (iii) full papers published in English or Japanese; and (iv) studies with outcomes that include measurement items related to sarcopenia and frailty. A search strategy was designed using keywords such as "Japan" or "Japanese" and "nutrition education." In total, 798 titles and 179 abstracts were examined, and 63 full texts were selected for reading. Ten articles met all the inclusion criteria. Only two studies aimed to determine the effectiveness of nutrition education. We could not clarify whether nutrition education relating to sarcopenia and frailty for Japanese older adults was effective. However, we did identify various nutrition education contents on sarcopenia and frailty for Japanese older adults. Further studies are needed as follows: (i) studies designs that can determine whether nutrition education is effective; (ii) studies in which the content of the cooking training can be reproduced; (iii) studies in which the intervention group and the control group have the same educational content with different duration and frequency; (iv) studies that are written in English; and (v) studies that are conducted on men. Geriatr Gerontol Int 2021; 21: 1084-1092.

Evaluation of and Intervention for Sarcopenia in Hepatology Departments: A Survey of Nurses in Japan

Sarcopenia is associated with poor prognosis and decreased quality of life in patients with chronic liver disease (CLD). The present study aimed to clarify the dissemination of interventions such as evaluations, prevention efforts, and treatments for sarcopenia among patients in hepatology outpatient departments and wards in Japan, as well as examine the factors related to such dissemination. A cross-sectional study was performed involving nurses from hospitals accredited by the Japan Society of Hepatology. Participants completed a questionnaire regarding evaluations and interventions for sarcopenia in their department. Nurses from 72 outpatient departments and 162 wards provided responses to the questionnaire. Overall, 37.9% of outpatient departments and 37.6% of wards performed evaluations or interventions for sarcopenia. Outpatient departments and wards that evaluated sarcopenia or intervened held more workshops or training regarding sarcopenia than departments and wards that did not (outpatient departments: 52.0% vs. 12.2%, wards: 32.1% vs. 12.9%). Holding workshops or training regarding sarcopenia (outpatient departments; OR = 7.51, 95% confidence interval (CI): 2.12–26.6, wards; OR = 2.61, 95% CI: 1.11–6.15) was significantly associated with dissemination practices. These findings suggest that expanding knowledge of sarcopenia and developing practical skills among general nurses may aid in preventing sarcopenia among patients with CLD.

Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.

Clinical Management of Sarcopenia: Secondary Publication of Geriatrics ＆ Gerontology International 2018;18 S1:1-44

In aging societies, sarcopenia is considered to be a significant threat for the elderly and for people with multimorbidities. Although several diagnostic algorithms are currently available, no guidelines are so far available for the prevention and intervention of sarcopenia. Therefore, we decided to publish clinical sarcopenia guidelines by collaboration with the Japanese Association on Sarcopenia and Frailty, the Japan Geriatrics Society, and the National Center for Geriatrics and Gerontology to provide tools for clinical practice. We published a Japanese version in December 2017 and an English version in May 2018. This article is a summary of these clinical sarcopenia guidelines. As the disease code of sarcopenia is available in Japan, these guidelines would be useful for many healthcare professionals and can be used for the prevention of disabilities in the elderly.

Comprehensive geriatric intervention in community-dwelling older adults: a cluster-randomized controlled trial

BACKGROUND

In longevity societies, one of the most serious social issues is sarcopenia and/or frailty. Preventing them is important for maintaining independence and quality of life in the older population. This study investigated the effect of a self-monitoring comprehensive geriatric intervention programme (CGIP) on physical function and muscle size in community-dwelling older adults. We compared the effects of a CGIP using weekly class-styled (CS) sessions and a home-based (HB) programme.

METHODS

The 526 participants were randomized into one of two groups (CS 251, HB 275) based on their residential districts. We conducted a 12 week CGIP, which consisted of low-load resistance exercise, physical activity increments, oral function improvements, and a nutritional guide. All participants were encouraged to attend two 90 min lectures that included instructions on the CGIP. They were provided with exercise materials (triaxial-accelerometers/pedometers, ankle weights, and elastic bands) and diary logs. The CS group attended 90 min weekly sessions and independently executed the programme on other days, whereas the HB group only received instructions on how to execute the programme. Physical functions, such as knee extension strength (KES), normal and maximum walking speed, the timed up-and-go test, and anterior thigh muscle thickness (MT), were measured and analysed using intention-to-treat analysis before and after the 12 week intervention.

RESULTS

Of the 526 participants identified, 517 (CS 243 age 74.0 ± 5.4 women 57.2%, HB 274 age 74.0 ± 5.6 women 58.8%) were enrolled. Nine (CS 8, HB 1) were excluded from the analysis because they did not participate in the pre-intervention measurements. Both interventions significantly improved KES (CS 18.5%, HB 10.6%), normal walking speed (CS 3.7%, HB 2.8%), and MT (CS 3.2%, HB 3.5%). Greater improvement of KES was observed in the CS group (P = 0.003). Maximum walking speed (CS 4.7%, HB 1.8%; P = 0.001) and timed up-and-go (CS -4.7%, HB -0.2%; P < 0.001) significantly improved in the CS group only.

CONCLUSIONS

The intervention was effective in preventing sarcopenia and/or frailty. Most physical functions and MT improved after both interventions. The HB intervention is cost-effective and may help prevent sarcopenia and/or frailty in the large older population.

Association between Food Store Availability and the Incidence of Functional Disability among Community-Dwelling Older Adults: Results from the Japanese Gerontological Evaluation Cohort Study

This study sought to clarify the association between food store availability and the incidence of disability in older adults. This study utilized a population-based cohort study of independent Japanese adults aged ≥65 years, which was a 6 year follow-up of participants in the Japan Gerontological Evaluation Study. A total of 31,273 respondents were extracted. Food store availability was evaluated based on the existence of food stores within 500/1000 m of the home. We utilized participant-reported subjective measurement as well as geographic information system-based objective measurement for the evaluation. The incidence of disability was determined using municipal data on eligibility for long-term care insurance benefits. There were 7643 (24.4%) community-dwelling participants with low subjective food store availability and 5673 (18.1%) with low objective food store availability. During the follow-up period of 6 years, the cumulative incidence of disability was 20.9%, with a significant association between low subjective food store availability and increased disability. Participants who reported low subjective food store availability had a significantly higher likelihood of developing disability (hazard ratio = 1.18, 95% confidence interval: 1.11-1.25) than those who reported high subjective food store availability after adjusting for age, sex, sociodemographic status, environmental status, walking and going out, dietary food intake, body mass index, and comorbidities. Low subjective food store availability was associated with early onset of disability. Accessibility of food stores might contribute to maintaining a disability-free life.

Rapid Geriatric Assessment, Physical Activity, and Sleep Quality in Adults Aged more than 65 Years: A Preliminary Study

OBJECTIVE

(1) To evaluate geriatric syndromes using the Rapid Geriatric Assessment; (2) To investigate possible association of geriatric syndomes with physical activity and sleep quality in adults aged more than 65 years who applied to outpatients physical medicine and rehabilitation clinic.

DESIGN

A cross-sectional study.

SETTING

Outpatient physical medicine and rehabilitation clinic in Edirne, Turkey.

PARTICIPANTS

A total of 56 adults (mean aged 69.7 ± 4.0 (range, 65-80) years, 33 women).

MEASUREMENTS

The Rapid Geriatric Assessment, which includes the FRAIL Questionnaire Screening Tool for frailty, Simplified Nutritional Assessment Questionnaire (SNAQ), SARC-F Screen for Sarcopenia, and Rapid Cognitive Screen (RCS), was used to assess geriatric syndromes. The International Physical Activity Questionnaire (IPAQ) was used to obtain data regarding health-related physical activity. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the past month.

RESULTS

The mean age of the patients was 69.7 ± 4.0 years. Of the 56 patients, 12.5% were frail, 50.0% were pre-frail, 35.7% had sarcopenia, 44.6% had a risk of weight loss, 33.9% had dementia, 57.1% were physically inactive, and 53.6% had poor sleep quality. The total FRAIL and SARC-F scores were positively correlated with the global PSQI score (correlation coefficient (r) = 0.300, p < 0.05; r = 0,327, p < 0.05, respectively) and negatively correlated with the total RCS score (r= -0,267, p < 0.05; r = -0,314, p < 0.05, respectively)). The total FRAIL score was positively correlated with the SARC-F score (r = 0.695, p < 0.001), and the concurrence of frailty and sarcopenia in the same patients was 10.7%. The global PSQI score was negatively correlated with the SNAQ score (r = -0.273, p < 0.05).

CONCLUSION

Frailty and sarcopenia were positively correlated with poor sleep quality and negatively correlated with cognition and physical activity. In clinical practice, the Rapid Geriatric Assessment and determination of physical activity level could assist in disability prevention.

International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management

OBJECTIVES

Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR).

METHODS

To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process.

RECOMMENDATIONS

We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.