Sarcopenia and smoking: a possible cellular model of cigarette smoke effects on muscle protein breakdown

Associations between sarcopenia and depression in middle-aged and older adults: the moderating effect of smoking

The aim of this study were to estimate associations of sarcopenic status with depressive symptoms. We used mixed-effects linear model to estimate longitudinal association between sarcopenic status and rate of change in 10-item Center for Epidemiologic Studies Depression (CES-D) scores, and used Cox regression model to estimate the association between sarcopenic status and incident depression (CES-D ≥ 10). Stratification analyses were performed when the interactions between sarcopenic status and covariates were significant. A total of 6522 participants were ultimately included. After adjusting for covariates, participants with possible sarcopenia (β = 0.117; 95% CI 0.067 to 0.166; P < 0.001) and sarcopenia (β: 0.093; 95% CI 0.027-0.159; P < 0.001) had a faster increase in CES-D scores compared with normal individuals. Interactions between smoking and sarcopenic status were significant (Pinteraction < 0.05). We found significantly positive associations of sarcopenic status with CES-D scores in nonsmokers, but not in current and past smokers. Besides, compared with normal participants, those with possible sarcopenia (HR 1.15; 95% CI 1.05 to 1.27) and sarcopenia (HR 1.28; 95% CI 1.12 to 1.46) (Ptrend < 0.001) had elevated risks of incident depression. Sarcopenia is associated with a faster increase in CES-D scores and increased risks of depression among Chinese middle-aged and older adults. Stronger associations between sarcopenia and trajectory of CES-D scores were found in nonsmokers than in smokers.

Effects of cigarette smoking associated with sarcopenia in persons 60 years and older: a cross-sectional study in Zhejiang province

PURPOSE

Smoking is a risk factor for sarcopenia. Nevertheless, few studies analyzed the independent effects of various smoking dimensions (duration, intensity, cumulative dose) on sarcopenia risk. This is a cross-sectional study based on an older population in Zhejiang Province to determine which smoking dimensions are mainly important for sarcopenia risk and to explore the dose-response relationship between them.

METHODS

Our study included 783 patients with sarcopenia and 4918 non-sarcopenic individuals. Logistic regression and restricted cubic with logistic regression (for nonlinear dose effects) were used to obtain odds ratios (ORs) and 95% confidence intervals as well as restricted cubic splines (RCS) curves.

RESULTS

Compared with never-smokers, current smokers had an increased risk of sarcopenia (OR = 1.786; 95% CI 1.387-2.301) after adjusting for confounders such as age, sex, education, alcohol consumption, disease history, etc. There was no significant association between smoking intensity and sarcopenia after more than 20 cigarettes per day (OR = 1.484; 95% CI 0.886-2.487), whereas the risk of sarcopenia increased significantly with increasing duration of smoking after more than 40 years (OR = 1.733; 95% CI 1.214-2.473). Meanwhile, there was a significant non-linear dose-response relationship between smoking duration or intensity and the risk of sarcopenia. However, the risk of sarcopenia increased linearly with the number of pack-years of smoking, which is not a significant nonlinear dose-response relationship.

CONCLUSIONS

This study indicated the association between smoking and sarcopenia. Both smoking duration and cumulative dose were significantly and positively associated with sarcopenia. These findings reflect the important role of the number of years of smoking in increasing the risk of sarcopenia and provide scientific evidence that different smoking dimensions may influence the risk of the sarcopenia.

Associations between life's essential 8 and sarcopenia in US adults: a cross-sectional analysis

Cardiovascular disease (CVD) is closely associated with sarcopenia. We aimed to examine the relationship between Life's Essential 8 (LE8) and the incidence of sarcopenia among adults in the United States. In this study, a cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey from 2013 to 2018 and included 5999 adult participants. LE8 score was categorized into low (< 49), moderate (49-79), and high CVH (≥ 79) groups and consisted of health behavior score and health factor score based on American Heart Association definitions. Sarcopenia was defined according to The Foundation for the National Institutes of Health Sarcopenia Project. Multivariate logistic regressions, restricted cubic spline regressions, and subgroup analyses were used to assess the association between LE8 and sarcopenia. LE8 and its subscales score were negatively associated with the incidence of sarcopenia in US adults.

Chronic obstructive pulmonary disease as a risk factor for sarcopenia: A systematic review and meta-analysis

Sarcopenia prevalence and its risk factors in chronic obstructive pulmonary disease (COPD) vary partly due to definition criteria. This systematic review aimed to identify the prevalence and risk factors of sarcopenia in COPD patients. This review was registered in PROSPERO (CRD42022310750). Nine electronic databases were searched from inception to September 1st, 2022, and studies related to sarcopenia and COPD were identified. Study quality was assessed using a validated scale matched to study designs, and a meta-analysis was performed to evaluate sarcopenia prevalence. COPD patients with sarcopenia were compared to those without sarcopenia for BMI, smoking, and mMRC. The current meta-analysis included 15 studies, with a total of 7,583 patients. The overall sarcopenia prevalence was 29% [95% CI: 22%-37%], and the OR of sarcopenia in COPD patients was 1.51 (95% CI: 1.19-1.92). The meta-analysis and systematic review showed that mMRC (OR = 2.02, P = 0.04) and age (OR = 1.15, P = 0.004) were significant risk factors for sarcopenia in COPD patients. In contrast, no significant relationship was observed between sarcopenia and smoking and BMI. Nursing researchers should pay more attention to the symptomatic management of COPD and encourage patients to participate in daily activities in the early stages of the disease.

Quality of life, household income, and dietary habits are associated with the risk of sarcopenia among the Chinese elderly

BACKGROUND

Health-related quality of life (HRQoL), which can be influenced by various aspects, especially socioeconomic status and lifestyle, has been identified as an important predictor of the prognosis of older adults. Dietary habit, a major part of lifestyle, can affect the nutritional status, which is closely correlated with the development of geriatric syndromes in the elderly.

AIMS

The aim of the study was to examine the association of HRQoL, socioeconomic status, and lifestyle with the risk and severity of sarcopenia, a geriatric syndrome characterized by progressive loss of skeletal muscle mass, strength and function.

METHODS

A cross-sectional retrospective study with 2877 participants aged ≥65 years was performed. HRQoL was assessed using EuroQoL Five Dimensions questionnaire. Socioeconomic status was assessed by the educational attainment, occupation, and household income. Lifestyle was assessed using 12 items closely related to Chinese living habits. The information of daily dietary habits including tea, alcohol, type of diet, and volume of drinking water were collected. The associations of HRQoL, socioeconomic status, and lifestyle with the risk of sarcopenia were examined by multivariate regression logistical analysis. The potential causal role of age, body mass index, and waist circumference in the effect of HRQoL on sarcopenia risk was analyzed by causal mediation analysis.

RESULTS

High HRQoL [adjusted odds ratio (OR) =0.85, 95% confidence interval (CI) =0.69-0.95, P=0.034] and household income levels (adjusted OR =0.74, 95% CI =0.57-0.95, P=0.019) were inversely associated with the risk of sarcopenia. Meanwhile, more consumption of spicy food (adjusted OR =1.34, 95% CI =1.09-1.81, P =0.037) and occasionally drinking (adjusted OR =1.46, 95% CI =1.07-2.00, P =0.016, as compared to those never drinking) were associated with higher risk of sarcopenia, while skipping breakfast occasionally (adjusted OR =0.37, 95% CI =0.21-0.64, P <0.001, as compared to those eating breakfast every day) and less consumption of salt (adjusted OR =0.71, 95% CI =0.52-0.96, P =0.026, as compared to those consuming high amount of salt) were associated with lower risk of sarcopenia. Further causal mediation analysis aimed to explore how much age, body mass index, and waist circumference might explain the effect of HRQoL on the risk of sarcopenia showed that the estimated proportion that mediated the effect of HRQoL on the risk of sarcopenia by age was 28.0%.

CONCLUSIONS

In summary, our findings demonstrate that low levels of HRQoL and household income, more intake of salt and spicy food, and occasional intake of alcohol are correlated with higher risk of sarcopenia, while skipping breakfast occasionally is associated with lower risk of sarcopenia in a Chinese population of older adults.

Deep learning-based pectoralis muscle volume segmentation method from chest computed tomography image using sagittal range detection and axial slice-based segmentation

The pectoralis muscle is an important indicator of respiratory muscle function and has been linked to various parenchymal biomarkers, such as airflow limitation severity and diffusing capacity for carbon monoxide, which are widely used in diagnosing parenchymal diseases, including asthma and chronic obstructive pulmonary disease. Pectoralis muscle segmentation is a method for measuring muscle volume and mass for various applications. The segmentation method is based on deep-learning techniques that combine a muscle area detection model and a segmentation model. The training dataset for the detection model comprised multichannel images of patients, whereas the segmentation model was trained on 7,796 cases of the computed tomography (CT) image dataset of 1,841 patients. The dataset was expanded incrementally through an active learning process. The performance of the model was evaluated by comparing the segmentation results with manual annotations by radiologists and the volumetric differences between the CT image datasets of the same patients. The results indicated that the machine learning model is promising in segmenting the pectoralis major muscle, with good agreement between the automatic segmentation and manual annotations by radiologists. The training accuracy and loss values of the validation set were 0.9954 and 0.0725, respectively, and for segmentation, the loss value was 0.0579. This study shows the potential clinical usefulness of the machine learning model for pectoralis major muscle segmentation as a quantitative biomarker for various parenchymal and muscular diseases.

Overall and abdominal obesity and risks of all-cause and cause-specific mortality in Korean adults: a pooled analysis of three population-based prospective cohorts

BACKGROUND

Studies found a J-shaped association between body mass index (BMI) and mortality. However, it is unclear whether the association is driven by biases, particularly confounding by fat-free mass.

METHODS

We conducted an individual-level pooled analysis of three cohorts of Korean adults (aged ≥ 40 years; n = 153 248). Mortality was followed up through December 2019. Anthropometric data were directly measured at baseline. Fat and fat-free mass were predicted using validated prediction models. Using Cox proportional hazards models, we estimated the associations of BMI and waist circumference (WC) with all-cause and cause-specific mortality. To account for biases, we excluded participants aged ≥ 70 years, deaths that occurred within 5 years of follow-up and ever smokers, and adjusted for fat-free mass index (FFMI).

RESULTS

During the follow-up of up to 18 years, 6061 deaths were identified. We observed J-shaped association of BMI (nadir at 22-26) and monotonically positive association of WC with all-cause, cardiovascular, and cancer mortality among Korean adults without a history of cancer or cardiovascular disease. In the BMI analysis, excluding ever smokers and adjusting for FFMI attenuated the excess mortality in underweight participants and transformed the J-shaped association into a monotonically positive shape, suggesting an increased mortality at BMI > 22.0. Excluding participants aged ≥ 70 years and deaths that occurred within 5 years of follow-up did not change the results. In the WC analysis, the monotonic positive associations did not change after the control. Similar results were observed among participants with a history of cancer or cardiovascular disease.

CONCLUSIONS

Our data suggest that both overall and abdominal body fat are associated with increased mortality in Korean adults.

Development and validation of risk prediction model for sarcopenia in patients with colorectal cancer

Objectives

Sarcopenia is associated with a poor prognosis in patients with colorectal cancer. However, the clinical factors that lead to colorectal cancer patients with sarcopenia are still unclear. The objective of this study is to develop and validate a nomogram for predicting the occurrence of sarcopenia and to provide healthcare professionals with a reliable tool for early identification of high-risk patients with colorectal cancer associated sarcopenia.

Methods

A total of 359 patients diagnosed with colorectal cancer from July 2021 to May 2022 were included. All patients were randomly divided into a training (n = 287) cohort and a validation cohort (n = 72) at the ratio of 80/20. Univariate and multivariate logistic analysis were performed to evaluate the factors associated with sarcopenia. The diagnostic nomogram of sarcopenia in patients with colorectal cancer was constructed in the training cohort and validated in the validation cohort. Various evaluation metrics were employed to assess the performance of the developed nomogram, including the ROC curve, calibration curve, and Hosmer-Lemeshow test.

Results

Smoking history, drinking history, diabetes, TNM stage, nutritional status, and physical activity were included in the nomogram for the prediction of sarcopenia. The diagnostic nomograms demonstrated excellent discrimination, with AUC values of 0.971 and 0.922 in the training and validation cohorts, respectively. Moreover, the calibration performance of the nomogram is also excellent, as evidenced by the Hosmer-Lemeshow test result of 0.886.

Conclusions

The nomogram consisting of preoperative factors was able to successfully predict the occurrence of sarcopenia in colorectal cancer patients, aiding in the early identification of high-risk patients and facilitating timely implementation of appropriate intervention measures.

Air pollution weaken your muscle? Evidence from a cross-sectional study on sarcopenia in central China

BACKGROUND

As the world experiences a demographic shift towards aging populations, there will be a significant surge in the number of sarcopenia patients, along with an unprecedented expansion in the associated economic burden. The multitudinous risk factors for sarcopenia have been reported, but evidence for air pollution remains rare.

METHODS

This cross-sectional study employed multi-stage random sampling to select 1592 participants over 40 years of age from Hubei Province. Daily mean concentrations of air pollutants were collected ChinaHighAirPollutants dataset. Unconditional logistic regression models were utilized to investigate the associations between air pollution and sarcopenia.

RESULTS

For each 1 μg/m³ increase in PM_2.5, PM₁₀, SO₂ and O₃, there were corresponding elevations of 11.1% [95% confidence interval (CI): 4.9, 17.7], 4.3% (95% CI: 1.4, 7.2), 22.6% (95% CI: 7.2, 40.1) and 9.3% (95% CI: 0.7, 18.7) in the risk of sarcopenia, respectively. The associations of PM_2.5/PM₁₀/O₃-sarcopenia were more pronounced in females, with corresponding odds ratios (ORs) and 95% CIs of 1.179 (1.062, 1.310), 1.079 (1.027, 1.135) and 1.180 (1.026, 1.358), separately. Additionally, individuals residing in rural areas were more susceptible to the effects of PM_2.5 and PM₁₀. Current/ever smokers or drinkers were also at higher risk of developing sarcopenia caused by PM_2.5, PM₁₀ and O₃ exposure. Mixture analyses show a surge of 48.4% (95% CI: 3.6%, 112.5%) in the likelihood of suffering from sarcopenia, and the joint impacts of the air pollution were mainly driven by PM_2.5.

CONCLUSIONS

Our results produced evidence for a relationship between air pollution exposure and the increased prevalence of sarcopenia in China. Public health and relevant departments should make efforts to prevent sarcopenia, particularly in China experiencing rapid demographic aging.

Rice Germ Attenuates Chronic Unpredictable Mild Stress-Induced Muscle Atrophy

Chronic stress leads to hypothalamic-pituitary-adrenal axis dysfunction, increasing cortisol levels. Glucocorticoids (GCs) promote muscle degradation and inhibit muscle synthesis, eventually causing muscle atrophy. In this study, we aimed to evaluate whether rice germ supplemented with 30% γ-aminobutyric acid (RG) attenuates muscle atrophy in an animal model of chronic unpredictable mild stress (CUMS). We observed that CUMS raised the adrenal gland weight and serum adrenocorticotropic hormone (ACTH) and cortisol levels, and these effects were reversed by RG. CUMS also enhanced the expression of the GC receptor (GR) and GC-GR binding in the gastrocnemius muscle, which were attenuated by RG. The expression levels of muscle degradation-related signaling pathways, such as the Klf15, Redd-1, FoxO3a, Atrogin-1, and MuRF1 pathways, were enhanced by CUMS and attenuated by RG. Muscle synthesis-related signaling pathways, such as the IGF-1/AKT/mTOR/s6k/4E-BP1 pathway, were reduced by CUMS and enhanced by RG. Moreover, CUMS raised oxidative stress by enhancing the levels of iNOS and acetylated p53, which are involved in cell cycle arrest, whereas RG attenuated both iNOS and acetylated p53 levels. Cell proliferation in the gastrocnemius muscle was reduced by CUMS and enhanced by RG. The muscle weight, muscle fiber cross-sectional area, and grip strength were reduced by CUMS and enhanced by RG. Therefore, RG attenuated ACTH levels and cortisol-related muscle atrophy in CUMS animals.

Smoking Intensity Increases Diaphragm Muscle Injury: A Clinicopathologic Study

BACKGROUND

Studying the effects of smoking intensity is important to evaluate the risk of tobacco use on a range of illnesses, such as as sarcopenia among the elderly. Thus, this study aimed to analyze the effects of pack-years of cigarette smoking on the diaphragm muscle (DIAm) histopathology of postmortem samples.

METHODS

Subjects were divided into three groups: never-smoker (n = 46); less than 30 pack-years of smoking (n = 12); and more than 30 pack-years of smoking (n = 30). Diaphragm samples were stained with Picrosirius red and hematoxylin and eosin stain for general structure.

RESULTS

Participants with more than 30 pack-years of cigarette smoking had a significant increase in adipocytes, blood vessels and collagen deposit, as well as an increase in histopathological alterations.

CONCLUSIONS

Pack-years of smoking was associated with DIAm injury. However, further clinicopathological studies are needed to confirm our findings.

Low muscle mass is associated with a higher risk of all-cause and cardiovascular disease-specific mortality in cancer survivors

OBJECTIVES

Individuals with prior cancer diagnosis are more likely to have low muscle mass (LMM) than their cancer-free counterparts. Understanding the effects of LMM on the prognosis of cancer survivors can be clinically important. The aim of this study was to investigate whether risks for all-cause and cardiovascular disease (CVD)-specific mortality differ by status of LMM in cancer survivors and a matched cohort without cancer history.

METHODS

We used cohort data from the 1999-2006 and 2011-2014 National Health and Nutrition Examination Survey. Participants included 946 adults surviving for ≥1 since cancer diagnosis and a matched cohort (by age, sex, and race) without cancer history (N = 1857). LMM was defined by appendicular lean mass and body height (men <7.26 kg/m2, women <5.45 kg/m2). Death was ascertained via the National Death Index and cause of death was assessed via International Classification of Diseases, Tenth Revision. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI) of LMM.

RESULTS

The mean age of cancer survivors and matched cohort was 60.6 y (SD 15) and 60.2 y (SD 14.9), respectively. The median follow-up was 10.5 y for survivors and 10.9 y for matched cohort. Overall, 22.2% of cancer survivors and 19.7% of the matched cohort had LMM, respectively. In all, 321 survivors (33.9%) and 495 participants (26.7%) in the matched cohort died during follow-up. CVD-specific deaths were identified in 58 survivors (6.1%) and 122 participants in the matched cohort (6.6%). The multivariable Cox model suggested that LMM was positively associated with all-cause (aHR, 1.73; 95% CI, 1.31-2.29) and CVD-specific (aHR, 2.13; 95% CI, 1.14-4.00) mortality in cancer survivors. The associations between LMM and risk for all-cause (aHR, 1.24; 95% CI, 0.98-1.56) and CVD-specific (aHR, 1.21; 95% CI, 0.75-1.93) mortality were not statistically significant in the matched cohort.

CONCLUSION

Cancer survivors with LMM have an increased risk for all-cause and CVD-specific mortality. This increase appears to be larger than that in counterparts without cancer history.

Characterization and cluster analyses of elderly asthma in comparison with nonelderly patients with asthma in Japan

BACKGROUND

Asthma is a heterogeneous disease with multiple phenotypes that are useful in precision medicine. As the population ages, the elderly asthma (EA, aged ≥ 65 years) population is growing, and EA is now a major health problem worldwide.

OBJECTIVE

To characterize EA and identify its phenotypes.

METHODS

In adult patients with asthma (aged ≥ 18 years) who had been diagnosed with having asthma at least 1 year before study enrollment, 1925 were included in the NHOM-Asthma (registered in UMIN-CTR; UMIN000027776), and the data were used for this study, JFGE-Asthma (registered in UMIN-CTR; UMIN000036912). Data from EA and non-EA (NEA) groups were compared, and Ward's minimum-variance hierarchical clustering method and principal component analysis were performed.

RESULTS

EA was characterized by older asthma onset, longer asthma duration and smoking history, more comorbidities, lower pulmonary function, less atopic, lower adherence, and more hospital admissions because of asthma. In contrast, the number of eosinophils, total immunoglobulin E level, oral corticosteroid use, and asthma control questionnaire scores were equivalent between EA and NEA. There were 3 distinct phenotypes in EA, which are as follows: EA1: youngest, late onset, short duration, mild; EA2: early onset, long duration, atopic, low lung function, moderate; and EA3: oldest, eosinophilic, overweight, low lung function, most severe. The classification factors of the EA phenotypes included the age of onset and asthma control questionnaire-6. Similarities were observed between EA and NEA phenotypes after principal component analysis.

CONCLUSION

The EA in Japan may be unique because of the population's high longevity. Characterization of EA phenotypes from the present cohort indicated the need for distinct precision medicine for EA.

TRIAL REGISTRATION

JFGE-Asthma registered in UMIN-CTR (https://www.umin.ac.jp/ctr/); UMIN000036912.

Understanding the role of smoking and chronic excess alcohol consumption on reduced caloric intake and the development of sarcopenia

This narrative review provides mechanistic insight into the biological link between smoking and/or chronic excess alcohol consumption, and increased risk of developing sarcopenia. Although the combination of excessive alcohol consumption and smoking is often associated with ectopic adipose deposition, this review is focused on the context of a reduced caloric intake (leading to energy deficit) that also may ensue due to either lifestyle habit. Smoking is a primary cause of periodontitis and chronic obstructive pulmonary disease that both induce swallowing difficulties, inhibit taste and mastication, and are associated with increased risk of muscle atrophy and mitochondrial dysfunction. Smoking may contribute to physical inactivity, energy deficit via reduced caloric intake, and increased systemic inflammation, all of which are factors known to suppress muscle protein synthesis rates. Moreover, chronic excess alcohol consumption may result in gut microbiota dysbiosis and autophagy-induced hyperammonemia, initiating the up-regulation of muscle protein breakdown and down-regulation of muscle protein synthesis via activation of myostatin, AMPK and REDD1, and deactivation of IGF-1. Future research is warranted to explore the link between oral healthcare management and personalised nutrition counselling in light of potential detrimental consequences of chronic smoking on musculoskeletal health outcomes in older adults. Experimental studies should investigate the impact of smoking and chronic excess alcohol consumption on the gut-brain axis, and explore biomarkers of smoking-induced oral disease progression. The implementation of behavioural change interventions and health policies regarding smoking and alcohol intake habits may mitigate the clinical and financial burden of sarcopenia on the healthcare system.

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

Chronic obstructive pulmonary disease (COPD) is a burdensome condition affecting a growing number of people worldwide, frequently related to major comorbidities and functional impairment. In these patients, several factors might have a role in promoting both bone and muscle loss, including systemic inflammation, corticosteroid therapies, sedentary behaviours, deconditioning, malnutrition, smoking habits, and alcohol consumption. On the other hand, bone and muscle tissues share several linkages from functional, embryological, and biochemical points of view. Osteosarcopenia has been recently defined by the coexistence of osteoporosis and sarcopenia, but the precise mechanisms underpinning osteosarcopenia in patients with COPD are still unknown. In this scenario, a deeper understanding of the molecular basis of osteosarcopenia might guide clinicians in a personalized approach integrating skeletal muscle health with the pulmonary rehabilitation framework in COPD. Taken together, our results summarized the currently available evidence about the multilevel interactions between osteosarcopenia and COPD to pave the way for a comprehensive approach targeting the most common risk factors of these pathological conditions. Further studies are needed to clarify the role of modern clinical strategies and telemedicine solutions to optimize healthcare delivery in patients with COPD, including osteopenia, osteoporosis, and sarcopenia screening in these subjects.

Prevalence and Determinants of Sarcopenic Obesity in Older Adults: Secondary Data Analysis of the Longitudinal Ageing Study in India (LASI) Wave 1 Survey (2017-18)

INTRODUCTION

Sarcopenic obesity (SO) represents the confluence of two epidemics-an aging population and an increasing rate of obesity. The two diseases may act synergistically, and SO may significantly affect morbidity and mortality. However, the burden is not defined to drive the policy changes. Hence the present study was done to estimate the prevalence and predictors of SO in India.

METHODS

We did a secondary data analysis of the 72,250 older adults who participated in the first wave of the Longitudinal Aging Study in India (2017-18). Possible sarcopenia was defined as per the guidelines by the Asian Working Group for Sarcopenia (AWGS) criteria. The modified criterion of overweight and obesity for Asian adults was used to categorize obesity. Presence of both sarcopenia and obesity depicted SO. Weighted analysis was done to estimate the prevalence of SO, and multinomial bivariate logistics regression was used to identify the predictors of SO.

RESULTS

The overall prevalence of obesity, sarcopenia, and SO was 27.1%, 41.9%, and 8.7%, respectively. The mean age, weight, body mass index (BMI), and blood pressure of adults with SO were significantly higher compared to others. Higher age, urban residence, west and south regions of India, consumption of tobacco or alcohol, no physical activity, and presence of diabetes contribute to SO.

CONCLUSION

The burden of SO seems to be less but amounts to a massive number in an aging country. We stress increased screening of the geriatric age group and advocate increased physical activity and dietary modifications to realize the concept of healthy aging.

Prevalence of sarcopenia was higher in women than in men: a cross-sectional study from a rural area in eastern China

Background

There were limited studies specifically evaluating whether the difference of the prevalence of sarcopenia exists in men and women in older adults from rural areas in China. The aim of this study was to compare the prevalence of sarcopenia between men and women in a rural area in eastern China and to explore the underlying causes.

Methods

This study included 1,105 participants aged 60-89 years. Muscle mass was measured by bio-electrical impedance analysis. Hand grip strength was measured by Jamar Hydraulic Hand Dynamometer. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia-2019 Consensus. Data were analyzed using log-binomial and linear regression.

Results

The prevalence of sarcopenia was 21.7% in women and 12.9% in men among the study cohort. After adjusting for age, education level, number of diseases, income level, smoking, drinking, and eating habits, proportion of people with sarcopenia was 1.49-fold greater in women than in men (PR = 1.49, 95% CI [1.01-2.26], P = 0.055).

Conclusions

The prevalence of sarcopenia in elderly women in this rural area of eastern China is higher than in men, suggesting that women in rural areas in China seem to be more vulnerable for sarcopenia, thus early screening and prevention need to be provided for them to address such gender disparity in health.

Interaction between cigarette smoke exposure and physical training on inflammatory and oxidative profile in mice muscle

Regular physical training and cigarette smoke exposure (CSE) have opposite effects on physical performance, antioxidant, and inflammatory profile. However, the interaction between these events is not well studied. We aimed to investigate how regular physical training and CSE interact, and in what is the outcome of this interaction on the physical performance, skeletal muscle antioxidant defense and molecular profile response of pro and anti-inflammatory cytokines. Male C57BL/6 mice were randomly divided into 4 groups (n = 8/group): 1) Sedentary group (SED); 2) 4 weeks of control, followed by 4 weeks of CSE (SED + CSEG); 3) Physically active (PA) along 8 weeks (forced swim training, 5 times a week); 4) Physically active and exposed to the cigarette smoke (PA + CSEG), group submitted to forced swim training for 4 weeks, followed by 4 weeks of concomitant training and CSE. Physical performance was evaluated before and after the experimental period (8 weeks), total peroxidase and glutathione peroxidase (GPx) activities, expression of genes encoding TNF-α, MCP-1, IL1β, IL-6, IL-10, TGF-β, HO-1 and the TNF-α/IL-10 ratio were determined from gastrocnemius muscle at the end of experimental period. The CSE attenuated the aerobic capacity adaptation (time to exhaustion in swimming forced test) promoted by physical training and inhibit the improvement in local muscle resistance (inverted screen test). The regular physical training enhanced the antioxidant defense, but the CSE abrogated this benefit. The CSE induced a harmful pro-inflammatory profile in skeletal muscle from sedentary animals whereas the regular physical training induced an opposite adaptation. Likewise, the CSE abolished the protective effect of physical training. Together, these results suggest a negative effect of CSE including, at least in part, the inhibition/attenuation of beneficial adaptations from regular physical training.

Association of urinary phthalate metabolites with sarcopenia in US adults: NHANES 1999-2006

Phthalates have been extensively detected in environmental and biological matrices. Exposure to phthalates is implicated in various human diseases. In this study, we conducted a cross-sectional study to determine whether urinary phthalate metabolite concentrations were correlated with prevalence of sarcopenia in US adult population. We included 3562 participants with detailed information on skeletal muscle mass and urinary phthalate metabolites based on National Health and Nutrition Examination Survey (NHANES) 1999-2006 data. A total of 7 main phthalate metabolites were analyzed in the urine sample of each participant. Appendicular skeletal muscle mass (ASM) was measured using dual-energy X-ray absorptiometry. Multivariable linear regression models were conducted following adjustment for multiple covariates. ASM adjusted by body mass index (ASM/BMI) was calculated, and sarcopenia was defined as the lowest quintile for ASM/BMI value. Compared with participants in quartile 1, those in quartile 2 of urinary mono-n-butyl phthalate (MnBP) and quartile 4 of urinary monobenzyl phthalate (MBzP) had decreased ASM/BMI. Urinary MnBP in quartile 4, as well as urinary MBzP in quartile 2, was shown to be significantly correlated with higher sarcopenia prevalence. In subgroup analysis, negative association of MBzP with ASM/BMI was observed in both males and females, while this negative association was only observed in males for MnBP. Females with higher urinary monoethyl phthalate (MEP) concentrations had higher sarcopenia risk. Taken together, the present study found several urinary phthalate metabolites were positively associated with sarcopenia prevalence in US adult population. These findings indicated phthalate exposure might be an important environmental risk factor contributing to sarcopenia development.

Prevalence of sarcopenia and associated factors in patients in hemodialysis

Objective: To assess the prevalence of sarcopenia and associated factors in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Methods: This cross-sectional study evaluated patients with CKD undergoing HD from January to October 2016 in two dialysis centers located in Recife, Pernambuco. For the diagnosis of sarcopenia, the criteria proposed by the 2019 European Consensus on Sarcopenia, which advocates low muscle strength as the main criterion, were considered. Demographic, clinical, anthropometric, and behavioral covariates were evaluated. Results: 108 patients were included, with a mean age of 51.4 ± 17.0 years and homogeneous distribution between the sexes.Sarcopenia was present in 38.9% of the population, of which 69% had severe sarcopenia. A higher prevalence of sarcopenia was observed among men (60% vs. 17%; p < 0.001), in those without a partner (48.1% vs. 30.4%; p < 0.045), in smokers (50% vs. 30%; p < 0.034), with low weight (underweight 73.3%, eutrophic 33.9%, overweight 32.4%; p = 0.001) and those with normal albumin levels (47.5% vs. 28.6%; p = 0.045). Conclusion: Approximately one in three nephropathic patients on hemodialysis presented sarcopenia and, among these, most had the severe form of this condition.Uremic sarcopenia was more prevalent in males, in individuals without partners, underweight, in smokers, and among those with normal albumin levels.

Sarcopenia as a comorbidity of cardiovascular disease

Sarcopenia, the lowered skeletal muscle mass, weakened skeletal muscle strength, and reduced physical performance with aging, is a component of frailty and high-risk factor for falls, resulting in an increase in mortality. In cardiovascular disease (CVD) patients, systemic inflammation, oxidative stress, overactivation of ubiquitin-proteasome system, endothelial dysfunction, lowering muscle blood flow, impaired glucose tolerance, hormonal changes, and physical inactivity possibly contribute to CVD-related sarcopenia. Prevalence of sarcopenia and osteosarcopenia, which is osteopenia and sarcopenia coexisting together, seems to be higher in CVD patients than in community-dwelling adults, suggesting the necessity of early diagnosis and prevention of CVD-related sarcopenia. Atrial stiffness, coronary artery calcification score, and serum vitamin D levels may be of help as the biomarkers to suspect sarcopenia, and renin-angiotensin-aldosterone system inhibitors may play a role in the medical prevention and treatment of CVD-related sarcopenia. There are few reports to convince the efficacies of dietary and antioxidant supplementation on sarcopenia at present, whereas aerobic and resistance training exercises have been recognized as an effective strategy to prevent and treat sarcopenia.

Effects of cigarette smoke exposure on pulmonary physiology, muscle strength and exercise capacity in a retrospective cohort with 30,000 subjects

BACKGROUND

The effects of long-term cigarette smoke exposure on pulmonary physiology and how those effects lead to reduced exercise capacity are not well established.

METHODS

We retrospectively analyzed the spirometry, single-breath gas transfer (DLCO), peripheral muscle strength, and maximum exercise capacity data in patients referred to McMaster University Medical Centre for cardiopulmonary exercise testing between 2000 and 2012.

RESULTS

29,441 subjects underwent CPET and had a recorded smoking history [58% male, mean age 51.1 years (S.D.±19.6), BMI 27.4 kg/m2(±5.8)]. 7081 (24%) were current or former smokers and were divided into 4 categories by packs years (mean ±S.D.): <10 (5.8±3.3), 10-20 (17.1±2.9), 20-30 (27.1±2.8), 30-40 (37.3±2.8), and >40 (53.9±12.8). Patients with greater cigarette smoke exposure had lower expiratory flow rates (FEV1, FEF50, FEF75, PEFR), DLCO, and maximum power output (MPO) during exercise. There was no association between smoke exposure and muscle strength. Modeling MPO (kpm/min) output as a function of demographic and physiologic variables showed that the data are well explained by muscle strength (kg), FEV1 (L), and DLCO (mmHg/min/mL) in similar magnitude (MPO = 42.7*Quads0.34*FEV10.34 * DLCO0.43; r = 0.84).

CONCLUSIONS

Long-term cigarette smoke exposure is associated with small airway narrowing and impaired diffusion capacity but not with peripheral muscle weakness. The effects of smoking, age, and gender on maximum power output are mediated by reductions in FEV1, muscle strength and DLCO. Exercise capacity in smokers may benefit from therapies targeting all 3 variables.

Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic

Cigarette smoking has a negative impact on the skeletal system, as it reduces bone mass and increases fracture risk through its direct or indirect effects on bone remodeling. Recent evidence demonstrates that smoking causes an imbalance in bone turnover, making bone vulnerable to osteoporosis and fragility fractures. Moreover, cigarette smoking is known to have deleterious effects on fracture healing, as a positive correlation between the daily number of cigarettes smoked and years of exposure has been shown, even though the underlying mechanisms are not fully understood. It is also well known that smoking causes several medical/surgical complications responsible for longer hospital stays and a consequent increase in the consumption of resources. Smoking cessation is, therefore, highly advisable to prevent the onset of bone metabolic disease. However, even with cessation, some of the consequences appear to continue for decades afterwards. Based on this evidence, the aim of our review was to evaluate the impact of smoking on the skeletal system, especially on bone fractures, and to identify the pathophysiological mechanisms responsible for the impairment of fracture healing. Since smoking is a major public health concern, understanding the association between cigarette smoking and the occurrence of bone disease is necessary in order to identify potential new targets for intervention.

A cross-sectional study about the relationship between physical activity and sarcopenia in Taiwanese older adults

To the best of our knowledge, none of Taiwanese studies on the relationship between physical activity (PA) and sarcopenia by the latest 2019 Asian Working Group for Sarcopenia (AWGS) cutoff points of sarcopenia has been published. We used the Taiwan version of international physical activity questionnaire-short version and the 2019 AWGS diagnostic criteria of sarcopenia to examine the relationship between PA and sarcopenia in older adults. Volunteers in this cross-sectional study were recruited from those attending senior health checkup program held at a regional hospital in Taipei City from May 2019 to Sep 2019. Muscle strength was assessed by grip strength, physical performance was assessed by usual gait speed on a 6-m course, and muscle mass was measured by bioelectrical impedance analysis. Multiple logistic regression was used to analyze the relationship between PA and sarcopenia. Odds ratios and corresponding 95% confidence intervals were calculated. 565 participants were recruited and data from 500 participants were used. The study participants had a mean age of 73.87 years old, with 47% men and 53% women. 138 (27.6%) participants were classified as having sarcopenia, among which 48 (45.3%) in low PA participants and 90 (22.8%) in moderate to high PA participants. Compared with those with low PA, moderate to high PA protected against the risk of sarcopenia with the odds ratio (OR) 0.46 (95% CI 0.27–0.79, p-value = 0.005). A significant protective effect of PA on sarcopenia was found among the older adults after adjusting for sex, institutionalization, age, BMI, albumin, hemoglobin, HDL-C levels, history of cardiovascular disease, education level and alcohol drinking.

Healthy Behaviors Associated with Changes in Mental and Physical Strength in Urban African American and White Adults

Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p < 0.05) and in SF-12 PCS (p < 0.05) and for men, in change in SF-12 PCS (p < 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction

In adult smokers without airflow obstruction, the contributions of pulmonary and skeletal muscle functions to reduced exercise capacity are unclear. We found that non-COPD smokers had decreased exercise capacity and muscle endurance although strength was preserved compared with never-smoking controls. Exercise endurance was associated with quadriceps endurance and CO transfer factor. Despite similar physical activity levels, smokers developed leg fatigue, breathlessness, and displayed increased ventilation with reduced ventilatory efficiency at lower workloads, without exhibiting ventilatory constraint.

Relationship between smoking and the incidence of sarcopenia: The SarcoPhAge cohort

INTRODUCTION

The association of tobacco use and incidence of muscle impairments has not been extensively explored in research. In this study, the relationship between smoking and the incidence of sarcopenia is investigated.

METHODS

The present longitudinal study used data from the Sarcopenia and Physical Impairment with advancing Age (SarcoPhAge) cohort, which includes older adults aged ≥65 years. All individuals with follow-up data on muscle health were included in this post hoc analysis. A diagnosis of sarcopenia was established, at each year of follow-up, according to the European Working Group on Sarcopenia in older People 2 (EWGSOP2) criteria. A sensitivity analysis was performed using other diagnostic criteria for sarcopenia. The smoking status and the number of cigarettes smoked per day were self-reported. The relationship between smoking status or the number of cigarettes smoked per day and the incidence of sarcopenia/severe sarcopenia throughout the 5 years of follow-up was evaluated using the Cox proportional hazards model.

RESULTS

In total, the study population included 420 participants, with a median age of 71.7 years (P25-P75 = 67.7-76.9 years) and 59.8% were female. Over the 5 years of follow-up, 78 participants (18.6%) became sarcopenic as per the EWGSOP2 criteria and 41 individuals (9.8%) developed severe sarcopenia. There were significantly more smokers than non-smokers who developed sarcopenia (35.9% vs 16.8%, P-value = 0.003). A fully adjusted Cox model confirmed this observation, yielding a hazard ratio of 2.36 (95% confidence interval [CI]: 1.31-4.26), meaning that smokers have a 2.36-fold higher risk of developing sarcopenia. Furthermore, individuals who smoked had a 2.68 times increased risk of developing severe sarcopenia (95% CI: 1.21-5.93) than those who did not smoke. Sensitivity analyses globally confirmed these findings when applying other diagnostic criteria for sarcopenia.

DISCUSSION

Smoking seems to be an important predictor for the onset of sarcopenia, highlighting, once again, that tobacco use is a major public health problem.

Nutrition status mediates the association between cognitive decline and sarcopenia

In this study, we investigated whether nutrition status mediates the relationship between cognitive decline and sarcopenia. Sarcopenia was assessed in 4023 community-dwelling older adults from West China using the AWGS 2014 diagnostic criteria. Cognitive function and nutrition status were assessed using the 10-item Short Portable Mental Status Questionnaire (SPMSQ) and Mini Nutrition Assessment-Short Form (MNA-SF) scale, respectively. Mediation model regression analysis demonstrated that nutrition status was negatively associated with sarcopenia (β = -0.521; 95% CI: -0.583 to -0.459). The indirect effects of cognitive decline on sarcopenia were significant after adjusting for age, sex, and ethnicity (β = 0.015; 95% CI: 0.012 to 0.017), but the direct effects of cognitive decline on sarcopenia were not statistically significant after adding nutrition status as a parameter in the mediation model analysis (β = -0.001; 95% CI: -0.008 to 0.005). Structural equation model (SEM) framework pathway analysis confirmed the association between nutrition status, cognitive decline, and sarcopenia. These findings demonstrate that the negative effects of cognitive decline on sarcopenia were mediated by nutrition status. We therefore postulate that maintaining a good nutrition status delays the negative effects of cognitive decline on sarcopenia in older adults.

Food, Nutrition, Physical Activity and Microbiota: Which Impact on Lung Cancer?

Lung cancer still represents the leading cause of cancer-related death, globally. Likewise, malnutrition and inactivity represent a major risk for loss of functional pulmonary capacities influencing overall lung cancer severity. Therefore, the adhesion to an appropriate health lifestyle is crucial in the management of lung cancer patients despite the subtype of cancer. This review aims to summarize the available knowledge about dietary approaches as well as physical activity as the major factors that decrease the risk towards lung cancer, and improve the response to therapies. We discuss the most significant dietary schemes positively associated to body composition and prognosis of lung cancer and the main molecular processes regulated by specific diet schemes, functional foods and physical activity, i.e., inflammation and oxidative stress. Finally, we report evidence demonstrating that dysbiosis of lung and/or gut microbiome, as well as their interconnection (the gut–lung axis), are strictly related to dietary patterns and regular physical activity playing a key role in lung cancer formation and progression, opening to the avenue of modulating the microbiome as coadjuvant therapy. Altogether, the evidence reported in this review highlights the necessity to consider non-pharmacological interventions (nutrition and physical activity) as effective adjunctive strategies in the management of lung cancer.

Skeletal Muscle Density and Cognitive Function: A Cross-Sectional Study in Men

We aimed to investigate cross-sectional associations between skeletal muscle density, a proxy measure for fatty infiltration into muscle, and cognition. Contributions from body fat mass, systemic inflammation and lifestyle were explored, as these factors have been identified in both muscle and cognitive deterioration. For 281 men (60-95 year) from the Geelong Osteoporosis Study, radial and tibial muscle density were measured using peripheral quantitative computed tomography. Body fat and appendicular lean mass were measured using dual-energy X-ray absorptiometry. Cognitive function was assessed for psychomotor function (DET), visual identification/attention (IDN), visual learning (OCL) and working memory (OBK) (CogState Brief Battery). Composite scores signified overall cognitive function (OCF). Higher scores represent poorer performance except for OCL and OCF. Regression analyses examined associations between muscle density and cognition; potential confounders included age, muscle cross-sectional area (CSA), body composition, lifestyle and serum markers of inflammation. Negative associations with age were evident for muscle density, all cognitive domains and OCF. Muscle density at both sites was positively associated with DET, OCL and OCF. After adjustment for age, the association persisted for DET (radius: B =  - 0.006, p = 0.02; tibia: B =  - 0.003, p = 0.04) and OCL (radius B =  + 0.004, p = 0.02; tibia: B =  + 0.005, p < 0.001). At the radius, further adjustment for serum TNF-α explained the association between muscle density (B =  - 0.002, p = 0.66) and DET. Education and physical activity contributed to the model for radial muscle density and DET. There were no contributions from muscle CSA, appendicular lean mass, body fat mass, other markers of inflammation or other potential confounders. At the tibia, the association between muscle density and DET (B =  - 0.003, p = 0.04) was independent of TNF-α. There was an age-adjusted association between muscle density and OCL at both sites (radius: B =  + 0.004, p = 0.02; tibia: B =  + 0.005, p < 0.001). None of the potential confounders contributed to the models. Muscle density was associated with cognitive function in the DET and OCL domains. However, there was little evidence that this was explained by inflammation or body fat mass. No associations were identified between muscle density and IDN or OBK.

The relationship between body-mass index and overall survival in non-small cell lung cancer by sex, smoking status, and race: A pooled analysis of 20,937 International lung Cancer consortium (ILCCO) patients

INTRODUCTION

The relationship between Body-Mass-Index (BMI) and lung cancer prognosis is heterogeneous. We evaluated the impact of sex, smoking and race on the relationship between BMI and overall survival (OS) in non-small-cell-lung-cancer (NSCLC).

METHODS

Data from 16 individual ILCCO studies were pooled to assess interactions between BMI and the following factors on OS: self-reported race, smoking status and sex, using Cox models (adjusted hazard ratios; aHR) with interaction terms and adjusted penalized smoothing spline plots in stratified analyses.

RESULTS

Among 20,937 NSCLC patients with BMI values, females = 47 %; never-smokers = 14 %; White-patients = 76 %. BMI showed differential survival according to race whereby compared to normal-BMI patients, being underweight was associated with poor survival among white patients (OS, aHR = 1.66) but not among black patients (aHR = 1.06; pinteraction = 0.02). Comparing overweight/obese to normal weight patients, Black NSCLC patients who were overweight/obese also had relatively better OS (pinteraction = 0.06) when compared to White-patients. BMI was least associated with survival in Asian-patients and never-smokers. The outcomes of female ever-smokers at the extremes of BMI were associated with worse outcomes in both the underweight (pinteraction<0.001) and obese categories (pinteraction = 0.004) relative to the normal-BMI category, when compared to male ever-smokers.

CONCLUSION

Underweight and obese female ever-smokers were associated with worse outcomes in White-patients. These BMI associations were not observed in Asian-patients and never-smokers. Black-patients had more favorable outcomes in the extremes of BMI when compared to White-patients. Body composition in Black-patients, and NSCLC subtypes more commonly seen in Asian-patients and never-smokers, may account for differences in these BMI-OS relationships.

Skeletal Muscle Health and Cognitive Function: A Narrative Review

Sarcopenia is the loss of skeletal muscle mass and function with advancing age. It involves both complex genetic and modifiable risk factors, such as lack of exercise, malnutrition and reduced neurological drive. Cognitive decline refers to diminished or impaired mental and/or intellectual functioning. Contracting skeletal muscle is a major source of neurotrophic factors, including brain-derived neurotrophic factor, which regulate synapses in the brain. Furthermore, skeletal muscle activity has important immune and redox effects that modify brain function and reduce muscle catabolism. The identification of common risk factors and underlying mechanisms for sarcopenia and cognition may allow the development of targeted interventions that slow or reverse sarcopenia and also certain forms of cognitive decline. However, the links between cognition and skeletal muscle have not been elucidated fully. This review provides a critical appraisal of the literature on the relationship between skeletal muscle health and cognition. The literature suggests that sarcopenia and cognitive decline share pathophysiological pathways. Ageing plays a role in both skeletal muscle deterioration and cognitive decline. Furthermore, lifestyle risk factors, such as physical inactivity, poor diet and smoking, are common to both disorders, so their potential role in the muscle-brain relationship warrants investigation.

Habitual Miso (Fermented Soybean Paste) Consumption Is Associated with a Low Prevalence of Sarcopenia in Patients with Type 2 Diabetes: A Cross-Sectional Study

Insulin resistance is a risk of sarcopenia, and the presence of sarcopenia is high in patients with type 2 diabetes (T2DM). It has been reported that habitual miso soup consumption was associated with lower insulin resistance. However, the association between habitual miso consumption and the presence of sarcopenia in patients with T2DM, especially sex difference, was unclear. In this cross-sectional study, 192 men and 159 women with T2DM were included. Habitual miso consumption was defined as consuming miso soup regularly. Having both low skeletal muscle mass index (<28.64% for men, <24.12% for women) and low adjusted hand grip strength (<51.26% for men, <35.38% for women) was defined as sarcopenia. The proportions of sarcopenia were 8.7% in men and 22.6% in women. The proportions of habitual miso consumption were 88.0% in men and 83.6% in women. Among women, the presence of sarcopenia was lower in the group with habitual miso consumption (18.8% versus 42.3%, p = 0.018); however, there was no association between habitual miso consumption and the presence of sarcopenia in men. Habitual miso consumption was negatively associated with the presence of sarcopenia in women (adjusted odds ratio (OR), 0.20 (95% confidence interval (CI): 0.06-0.62), p = 0.005) but not in men. This study indicated that habitual miso consumption was associated with the presence of sarcopenia in women but not in men.

Cigarette Smoking Increased Risk of Overall Mortality in Patients With Non-alcoholic Fatty Liver Disease: A Nationwide Population-Based Cohort Study

Background: The evidence suggests a detrimental effect of cigarette smoking on the progression of chronic liver disease. However, the impact of cigarette smoking on mortality among patients with non-alcoholic fatty liver disease (NAFLD) remain unclear. Methods: We used the National Health Examination Survey data collected during 2008-2009 to link the National Death Index to follow-up respondent survival. Diagnosis of NAFLD was based on a lipid accumulation product in participants without significant alcohol use or other liver diseases. Results: During 64,116 person-years of follow-up, 928 of 7,529 participants with NAFLD died, and the cumulative all-cause mortality was 14.5 per 1,000 person-years. In a Cox regression model adjusted for age, body mass index, alcohol intake, exercise, comorbidities, lipid profiles, and handgrip strength, current smoking increased the risk of mortality by 109% (adjusted hazard ratio (aHR): 2.09, 95% confidence interval [CI]: 1.18-3.71) compared with never smoker status in women, but showed only a trend toward harm among men (aHR: 1.41, 95% CI: 0.96-2.08). After controlling for potential confounders, smoking ≥10 pack-years continued to show a significant harmful effect on all-cause mortality among women (aHR: 5.40, 95% CI: 2.19-13.4), but not in men. Among women who drink alcohol ≥10 grams per day, current smoking (aHR: 13.8, 95% CI: 1.66-145) and smoking ≥10 pack-years (aHR: 310, 95% CI: 78-1,296) also significantly increased risk of death. Conclusion: This nationwide population-based study highlight a detrimental effect of cigarette smoking on mortality, with a similar but more definite association in women than in men with NAFLD.

Inverse association between triglyceride glucose index and muscle mass in Korean adults: 2008-2011 KNHANES

Background

Since sarcopenia is an important risk factor for falls or cardiovascular disease, early detection and prevention of sarcopenia are being increasingly emphasized. Emerging evidence has indicated relationships between sarcopenia, insulin resistance, and inflammation. The triglyceride glucose (TyG) index, a novel surrogate marker of insulin resistance and systemic inflammation, has not yet been shown to be associated with sarcopenia. This study aimed to examine the relationship between the TyG index and muscle mass in Korean adults.

Methods

This study included 15,741 non-diabetic adults over 19 years old using data from the 2008–2011 Korea National Health and Nutrition Examination Survey. Participants were divided into three groups according to tertiles of the TyG index. A low skeletal muscle mass index (LSMI) was defined by the Foundation for the National Institutes of Health Sarcopenia Project criteria. A weighted multivariate logistic regression model was used to analyze relationships between TyG index tertiles and LSMI.

Results

The ORs (95% CIs) for LSMI in the second and third TyG tertiles, compared to the first tertile, were 1.463 (1.131–1.892) and 1.816 (1.394–2.366), respectively, after adjusting for confounding factors. Higher TyG index values were also associated with increased odds of LSMI in adults under 65 years who did not exercise regularly, who consumed less than 30 g of alcohol per day, who did not currently smoke, and who ate less than 1.5 g of protein/kg/day.

Conclusion

The TyG index was significantly and positively associated with LSMI in Korean adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-020-01414-4.

Upper Limb Extremity Muscle-Dysfunction in Chronic Obstructive Pulmonary Disease: A Narrative Review

Background:

Peripheral muscle dysfunction is one of the major comorbidities seen in chronic obstructive pulmonary disease. Focusing more on upper extremity, unsupported elevation of arms results in a change in the recruitment pattern of the respiratory muscles. Over the years, many tests were developed to assess the upper limb capacity and include them in various rehabilitation protocol.

Objective:

To review the evidence on mechanism, tests, and rehabilitation protocol for the upper limb extremity muscle-dysfunction occurring in chronic obstructive pulmonary disease.

Methods:

PubMed and Google scholar databases were searched. Based on the inclusion criteria’s:- Chronic Obstructive Pulmonary Diseases patients, any Randomized Controlled or clinical trials, systematic reviews, explaining upper limb extremity muscle dysfunction, various tests to assess upper limb functional capacity and different ways of upper limb extremity training, a total of 15 articles were retrieved.

Results:

The mechanism of upper extremity muscle dysfunction is now well understood. Various tests were designed in order to assess arm strength, arm endurance and functional capacity. All the studies which included upper limb extremity training as a part of the rehabilitation program, showed beneficial results in terms of reduction of dyspnoea and arm fatigue, as well as improving the activity performing capacity.

Conclusion:

This review concluded that the alteration in the upper limb extremity muscles is an inevitable consequence of chronic obstructive pulmonary diseases, which can be confirmed by various upper extremity tests, with patients responding positively to the upper limb training incorporated during pulmonary rehabilitation protocols.

What are the factors associated with sarcopenia-related variables in adult women with severe obesity?

BACKGROUND

Understanding the association between sarcopenia-related variables and several risk factors may help to implement interventions aimed at preventing its occurrence by reducing or controlling the identified risk factors. Although changes in body composition occur in both sexes, in women, muscle loss is accentuated due to decreased estrogen levels following menopause. This study aims to determine the factors associated with sarcopenia-related parameters in middle-aged women identified with class II/III obesity (body mass index [BMI] ≥ 35 kg/m2).

METHODS

The study included 104 women with severe obesity (40.23 ± 8.49 years) with an average body fat percentage of 52.45 ± 4.14%. Sarcopenia was assessed using total appendicular skeletal muscle mass (ASMM), appendicular skeletal muscle mass index (ASMMI), and appendicular skeletal muscle mass adjusted by BMI (ASMM/BMI) as evaluated using dual energy X-ray absorptiometry (DXA). Hand grip strength (HGS) and HGS adjusted by BMI (HGS/BMI) were evaluated using dynamometry. Functional performance was assessed using the walking speed test (WS). The explanatory variables were age, lifestyle, comorbidities, food consumption, and metabolic parameters. A multivariate linear regression was performed.

RESULTS

Factors associated with sarcopenia-related variables in 104 severely obese women with a mean BMI of 43.85 kg/m2 were as follows: ASMMI negatively correlated with serum levels of tetraiodothyronine (T4) and tobacco use; ASMM/BMI negatively correlated with age, serum T4 levels, and diabetes; ASMM negatively correlated with T4 serum levels and diabetes; HGS negatively correlated with age and hypercholesterolemia, and positively correlated with low-density lipoprotein cholesterol (LDL-c); HGS/BMI negatively correlated with age and hypercholesterolemia and positively correlated with LDL-c; and WS negatively correlated with hypothyroidism and diabetes.

CONCLUSION

In severely obese women, muscle mass and function were inversely associated with age, smoking status, endocrine parameters, hypercholesterolemia, and comorbidities such as diabetes. Thus, the results of this investigation are relevant in supporting the development of clinical interventions to aid in the prevention of sarcopenia in adult women with severe obesity.

Association of smoking with abdominal adipose deposition and muscle composition in Coronary Artery Risk Development in Young Adults (CARDIA) participants at mid-life: A population-based cohort study

BACKGROUND

Smokers have lower risk of obesity, which some consider a "beneficial" side effect of smoking. However, some studies suggest that smoking is simultaneously associated with higher central adiposity and, more specifically, ectopic adipose deposition. Little is known about the association of smoking with intermuscular adipose tissue (IMAT), an ectopic adipose depot associated with cardiovascular disease (CVD) risk and a key determinant of muscle quality and function. We tested the hypothesis that smokers have higher abdominal IMAT and lower lean muscle quality than never smokers.

METHODS AND FINDINGS

We measured abdominal muscle total, lean, and adipose volumes (in cubic centimeters) and attenuation (in Hounsfield units [HU]) along with subcutaneous (SAT) and visceral adipose tissue (VAT) volumes using computed tomography (CT) in 3,020 middle-aged Coronary Artery Risk Development in Young Adults (CARDIA) participants (age 42-58, 56.3% women, 52.6% white race) at the year 25 (Y25) visit. The longitudinal CARDIA study was initiated in 1985 with the recruitment of young adult participants (aged 18-30 years) equally balanced by female and male sex and black and white race at 4 field centers located in Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA. Multivariable linear models included potential confounders such as physical activity and dietary habits along with traditional CVD risk factors. Current smokers had lower BMI than never smokers. Nevertheless, in the fully adjusted multivariable model with potential confounders, including BMI and CVD risk factors, adjusted mean (95% CI) IMAT volume was 2.66 (2.55-2.76) cm3 in current smokers (n = 524), 2.36 (2.29-2.43) cm3 in former smokers (n = 944), and 2.23 (2.18-2.29) cm3 in never smokers (n = 1,552) (p = 0.007 for comparison of former versus never smoker, and p < 0.001 for comparison of current smoker versus never and former smoker). Moreover, compared to participants who never smoked throughout life (41.6 [41.3-41.9] HU), current smokers (40.4 [39.9-40.9] HU) and former smokers (40.8 [40.5-41.2] HU) had lower lean muscle attenuation suggesting lower muscle quality in the fully adjusted model (p < 0.001 for comparison of never smokers with either of the other two strata). Among participants who had ever smoked, pack-years of smoking exposure were directly associated with IMAT volume (β [95% CI]: 0.017 [0.010-0.025]) (p < 0.001). Despite having less SAT, current smokers also had higher VAT/SAT ratio than never smokers. These findings must be viewed with caution as residual confounding and/or reverse causation may contribute to these associations.

CONCLUSIONS

We found that, compared to those who never smoked, current and former smokers had abdominal muscle composition that was higher in adipose tissue volume, a finding consistent with higher CVD risk and age-related physical deconditioning. These findings challenge the belief that smoking-associated weight loss or maintenance confers a health benefit.

Evaluation of nutritional status in COPD according to the GOLD-2015 staging system: a prospective observational study

OBJECTIVES

This study aimed to assess nutritional statuses of chronic obstructive pulmonary disease (COPD) patients in four categories of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015 classification and to evaluate associations of body mass index (BMI) and fat-free mass index with respiratory and skeletal muscle strengths.

METHODS

This prospective observational study included COPD patients (≥40 years old) who were followed-up for at least 1 year. Medical histories, smoking status, and anthropometric, spirometry, and hand grip strength measurements were recorded.

RESULTS

This study included 463 COPD patients. They were classified as Group A (n = 119), Group B (n = 58), Group C (n = 117), and Group D (n = 169) according to GOLD. Group D was older (p = 0.001) than other groups. No difference was found among the groups regarding sex (p = 0.163). Fat-free body mass was significantly decreased in Group D compared with Group A (p = 0.014) and BMI were lower in Groups C and D than in other groups (p = 0.001). Spirometry and hand grip strength showed a significant decreasing trend toward Group D (p < 0.001 for both).

CONCLUSIONS

Patients with COPD in advanced-stages had decreased BMI, fat-free body mass, hand grip strength, and respiratory and skeletal muscle functions. Nutritional status should be routinely monitored and considered an important indicator in COPD.

Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy

BACKGROUND

Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery.

METHODS

Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm²/m² for men and SMI <35 cm²/m² for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models.

RESULTS

According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively).

CONCLUSIONS

We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.

Corticotropin releasing factor-overexpressing mouse is a model of chronic stress-induced muscle atrophy

Chronic stress and continually high glucocorticoid levels can induce muscle atrophy. Unfortunately, there is a lack of appropriate animal models for stress-induced muscle atrophy research. Corticotropin releasing factor-overexpressing (CRF-OE) mice are a transgenic model of chronic stress that exhibit increased plasma corticosterone levels and Cushing’s syndrome; however, the skeletal muscle pathology of the CRF-OE mouse has not been well studied. We observed that male, 19-week-old CRF-OE mice had significantly lower skeletal muscle mass, average cross-sectional myofiber area, and total muscle protein content than their wild type (WT) littermates. Muscle function determined by grip strength, wire-hang, and open field tests showed that 19-week-old male CRF-OE mice had impaired physical ability. Additionally, the skeletal muscles of CRF-mice exhibited decreased expression of factors involved in the IGF-1/AKT/mTOR protein synthesis pathway and increased ubiquitin proteasome pathway activity compared to the WT control mice. In conclusion, 19-week-old CRF-OE mice display numerous features of muscle atrophy and thus serve as a model for investigating stress-induced muscle atrophy and interventions to target the deleterious effects of stress on skeletal muscle.

Relationship between visual acuity and muscle mass in the Korean older population: a cross-sectional study using Korean National Health and Nutrition Examination Survey

OBJECTIVES

We aimed to assess the effects of visual acuity on muscle mass, which is an important indicator of health in older populations.

DESIGN

Pooled-sample cross-sectional study.

SETTING

Nationally representative population survey data.

PARTICIPANTS

The present study analysed men aged 65 years or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2011).

PRIMARY AND SECONDARY OUTCOME MEASURES

Muscle mass was measured by dual-energy X-ray absorptiometry scan, and low muscle mass was defined as appendicular skeletal mass divided by height squared (kg/m2) <6.43 kg/m2 (lowest quintile of the older population in KNHANES, 2008-2011). Visual acuity was evaluated based on best-corrected visual acuity of the better eye.

RESULTS

Of the 1733 participants, 89.9% had good visual acuity. After adjusting for age, the height-adjusted appendicular skeletal muscle mass values were 7.16 and 7.00 kg/m2 in the good and poor vision groups, respectively (p=0.042). According to our criterion for low muscle mass, the prevalence of low muscle mass was 16.4% and 34.7% in the good and poor vision groups, respectively. After adjusting for age, smoking status, alcohol consumption status, frequency of physical activity, educational level, the status of basic livelihood recipient and history of stroke, the poor visual acuity group had higher odds of low muscle mass than the good visual acuity group (OR=1.60; 95% CI 1.02 to 2.50; p=0.040).

CONCLUSIONS

Older men with decreased visual acuity have low muscle mass. Poor vision might be an indicator of low muscle mass.

Predicted lean body mass, fat mass and risk of lung cancer: prospective US cohort study

An inverse association between body mass index (BMI) and risk of lung cancer has been reported. However, the association of body composition such as fat mass (FM) and lean body mass (LBM) with risk of lung cancer has not been fully investigated. Using two large prospective cohort studies (Nurses' Health Study, 1986-2014; Health Professionals Follow-up Study, 1987-2012) in the United States, we included 100,985 participants who were followed for occurrence of lung cancer. Predicted FM and LBM derived from validated anthropometric prediction equations were categorized by sex-specific deciles. During an average 22.3-year follow-up, 2615 incident lung cancer cases were identified. BMI showed an inverse association with lung cancer risk. Participants in the 10th decile of predicted FM and LBM had a lower risk of lung cancer compared with those in the 1st decile, but when mutually adjusted for each other, predicted FM was not associated with lung cancer risk (adjusted hazard ratio [aHR] = 0.98, 95% confidence interval [CI] 0.72-1.35; P(trend) = 0.97) whereas predicted LBM had an inverse association (aHR = 0.73, 95% CI 0.53-1.00; P(trend) = 0.03), especially among participants who were current smokers or had smoked in the previous 10 years (aHR = 0.55, 95% CI 0.36-0.84; P(trend) = 0.008). In conclusion, BMI was inversely associated with lung cancer risk. Based on anthropometric prediction equations, low LBM rather than low FM accounted for the inverse association between BMI and lung cancer risk.

Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O₂) delivery to muscle mitochondria. Although peripheral muscular factors, O₂ transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease - two devastating smoking related diseases - might prove instrumental to fight their ever-growing burden.

Sarcopenia and its association with changes in socioeconomic, behavioral, and health factors: the EpiFloripa Elderly Study

This study aimed to verify the prevalence of sarcopenia and its association with changes in socioeconomic, behavioral, and health factors in the elderly. The longitudinal population-based study included 598 elderly (≥ 60 years) in Florianópolis, Santa Catarina State, in the South of Brazil. Sarcopenia was defined on the basis of appendicular skeletal mass index (ASMI) according to gender (ASMI < 7.26kg/m² for men and < 5.5kg/m² for women). We assessed changes that occurred between the two study waves (2009/2010 and 2013/2014) in relation to socioeconomic, behavioral, and health factors. Crude and adjusted logistic regression analyses were performed. Prevalence of sarcopenia was 17% in women (95%CI: 12.4-22.9) and 28.8% in men (95%CI: 21.3-37.7). In the final model, women that continued to consume or that started consuming alcohol (OR = 0.31; 95%CI: 0.11-0.91) showed lower odds of sarcopenia. Women who continued to smoke or that started smoking (OR = 2.55; 95%CI: 1.16-5.58) and/or that remained inactive or became insufficiently active (OR = 2.90; 95%CI: 1.44-5.84) showed higher odds of sarcopenia. For men, no change variable was associated with sarcopenia. The results suggest that continuing or starting to smoke and remaining or becoming physically inactive are preventable and modifiable risk factors for sarcopenia.

Improving the comprehension of sarcopenic state determinants: An multivariate approach involving hormonal, nutritional, lifestyle and genetic variables

It is known that sarcopenia is a multifaceted phenomenon, which involves genetic, nutritional, hormonal and living habits aspects. Then, an integrated analysis, as a multivariate approach, could improve the comprehension about the determinants of sarcopenic state in old adults. The present study aimed to investigate the interaction among serum vitamin D, daily caloric and protein intake, lifestyle habits, ACE I/D gene polymorphism and sarcopenic state in community-dwelling old adults. One hundred one community-dwelling old adults were clinically stratified as sarcopenic or non-sarcopenic. Serum vitamin D, daily caloric and protein intake, lifestyle habits (smoking, physical activity level and sedentary behavior) and ACE I/D gene polymorphism were recorded. A multivariate logistic regression technique was applied to investigate the interaction among the selected independent variables and the sarcopenic state. The independent variables age, smoking, serum Vitamin D and ACE I/D polymorphism achieved the statistical criteria to be inserted in the multivariate analysis. After a stepwise procedure from the multivariate logistic regression, the variables age, serum Vitamin D and ACE I/D polymorphism remained, together, in the final model. Sarcopenic state was significantly associated to older age, II-genotype and low serum Vitamin D in old adults from 60 years old.

Nutritional status and muscle dysfunction in chronic respiratory diseases: stable phase versus acute exacerbations

Nutritional abnormalities are frequent in different chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), interstitial fibrosis and lung cancer, having important clinical consequences. However, nutritional abnormalities often remained underdiagnosed due to the relative lack of awareness of health professionals. Therefore, systematic anthropometry or even better, assessment of body composition, should be performed in all patients with chronic respiratory conditions, especially following exacerbation periods when malnutrition becomes more accentuated. Nutritional abnormalities very often include the loss of muscle mass, which is an important factor for the occurrence of muscle dysfunction. The latter can be easily detected with the specific assessment of muscle strength and endurance, and also negatively influences patients' quality of life and prognosis. Both nutritional abnormalities and muscle dysfunction result from the interaction of several factors, including tobacco smoking, low physical activity-sedentarism, systemic inflammation and the imbalance between energy supply and requirements, which essentially lead to a negative balance between protein breakdown and synthesis. Therapeutic approaches include improvements in lifestyle, nutritional supplementation and training. Anabolic drugs may be administered in some cases.

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

Background

The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship.

Methods

Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999–2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality.

Results

At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30–40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity.

Conclusions

Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox.