Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia

Association between preoperative grip strength and postoperative upper extremity impairments in patients with breast cancer: a retrospective cohort study

BACKGROUND

Upper extremity impairments in patients with breast cancer persist after curative surgery. Although postoperative factors associated with upper extremity impairments have been reported, modifiable factors affecting these impairments preoperatively remain unclear. This study aimed to investigate the relationship between preoperative grip strength and postoperative upper extremity impairments in patients with breast cancer.

METHODS

This retrospective cohort study included patients (age ≥ 18 years) with breast cancer who underwent mastectomy. Maximum grip strength was measured on the day before surgery. Upper extremity impairments were assessed 4-16 months after surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Multiple linear regression analysis was used to evaluate the association between preoperative grip strength and postoperative upper extremity impairments.

RESULTS

In total, 72 patients were included in the analysis. Multiple linear regression analysis showed that preoperative grip strength was significantly associated with the postoperative DASH score after adjusting for confounding factors (β = - 1.27, 95% confidence interval - 2.08 to - 0.48, p = 0.002).

CONCLUSIONS

This study showed that low preoperative grip strength is a risk factor for postoperative upper extremity impairments in patients with breast cancer. Providing prehabilitation to maintain and improve muscle strength immediately after diagnosis is important. Moreover, an individualized follow-up protocol according to preoperative screenings to prevent postoperative upper extremity impairments is necessary.

The impact of 12 weeks combined resistance and balance training on functional Sit-To-Stand muscle power in mobility limited older patients

BACKGROUND

Falls become more frequent with ageing. Improving balance and muscle strength has been shown to reduce the risk of falls in older patients, but the importance of muscle power is less investigated.

OBJECTIVE

To evaluate changes in functional Sit-to-Stand muscle power and the association with dynamic balance in older adults following a 12-week exercise program.

MATERIAL AND METHODS

A retrospective study including 84 (69 women) with a mean age of 79.3 years were included. Based on the 30s-STS performance, relative muscle power (W*kg-1) and allometric muscle power (W*m-2) was calculated, and the Dynamic Gait Index was used for dynamic balance.

RESULTS

The mean (SD) relative- and allometric power increased significantly (p < 0.001) from 2.3 (0.9) W*kg-1 to 2.9 (0.9) W*kg-1 and 58.4 (22.6) W*m-2 to 76.3 (22.6) W*m-2, respectively. Forty-seven out of 70 patients improved their 30s-STS performances by ≥ 2 repetitions, and 44 out of 68 patients showed an improvement of ≥ 3 points in their DGI scores. Relative- and allometric muscle power was significantly correlated with DGI scores before r = 0.398, (0.188-0.573) and r = 0.381 (0.169-0.560) and after r = 0.439 (0.215-0.62) and r = 0.374 (0.215-0.620) the 12-week program for the whole group. Additionally, 45 % of the patients were at reduced risk of falling according to their DGI values.

CONCLUSION

Sit-to-stand performance and DGI scores improved in older adults after participating in a 12-week combined balance and strength training program. Estimates of STS muscle power was associated with DGI scores.

Relationship between myostatin, musclin, nutritional status, and functionality in older Colombian community-dwelling adults: A cross-sectional study

OBJECTIVES

Aging-associated body composition changes lead to a decrease in muscle mass and strength, affecting the functionality of older adults. Myostatin and musclin are myokines that regulate muscle metabolism and may modulate muscle changes during aging. Our objective was to determine the relationship between myostatin, musclin, and nutritional status with physical functionality in older adults.

METHODS

This was a cross-sectional study of a subsample of a stratified random sampling population survey in community-dwelling 60-90-year-old adults of both sexes. Serum myostatin and musclin concentrations were measured using MILLIPLEX technology (Merck Millipore, USA). Trained personnel recorded body mass index (BMI), and waist (WC), calf (CC), and arm (AC) circumferences as indicators of nutritional status. Functionality tests included handgrip strength (GS), walking speed (WS), and Advanced Activities of Daily Living.

RESULTS

Of 101 participants, 55.4% were women, 56.4% were between 60 and 69 years old, 53.5% had abdominal obesity, 23.8% had dynapenia, and 33.7% had low WS. Neither myostatin nor musclin showed significant changes from 60 to 90 years. In a multiple lineal regression model, myostatin showed an inverse correlation with BMI, CC, and AC in men (P < 0.05) but did not explain GS or WS. In a similar analysis, musclin and WC showed an inverse correlation with GS (P < 0.05). Moreover, myostatin was lower in the more physically active men (P < 0.05) but musclin did not show any relationship with the Advanced Activities of Daily Living scale.

CONCLUSIONS

Myostatin and musclin do not decrease with aging and are associated with nutritional and metabolic status. Musclin is associated with dynapenic obesity in older adults.

Assessment of muscle function deterioration in aging populations: Insights from the load-velocity relationship during the loaded sit-to-stand test

Muscle power is a better indicator of musculoskeletal health and functional capacity than muscle strength. The Load-Velocity (L-V) relationship provides a method for assessing muscle function during dynamic multi-joint movements, making it valuable for identifying age-related neuromuscular decline. This study aimed to examine the relationship between variables derived from the L-V relationship (L0, V0, and Aline) obtained during the loaded sit-to-stand test and various muscle performance indices, including knee extension peak force (KEPF) and various muscle quality indices (MQI). A total of 113 participants (49 middle-aged adults and 64 older adults; age = 61 ± 9.92 years) performed the loaded 5-Sit-To-Stand using Functional Electromechanical Dynamometry. L-V variables were calculated, and their relationships with indicators of muscle performance and quality were analyzed. The impact of age on these variables was also evaluated. The results showed a high positive correlation between Aline and KEPF, MQIEquation1, MQIEquation2 and MQIEquation3 (rs = 0.56-0.59, p ≤0.001-0.01), and between V0 and KEFP (rs = 0.51, p < 0.001). Older adults exhibited significantly lower L0 compared to middle-aged adults (76.86 ± 29.74 kg vs. 94.62 ± 35.69 kg, p = 0.007), as well as lower V0 (0.92 ± 0.28 m·s-1 vs. 1.22 ± 0.19 m·s-1, p < 0.001) and Aline values (35.39 ± 18.95 kg·m·s-1 vs. 57.75 ± 23.84 kg·m·s-1, p < 0.001). These findings suggest that L-V variables are valuable indicators for assessing muscle function deterioration and guiding training interventions, providing a more comprehensive and sensitive assessment of muscle quality and functional status in aging populations.

Obesity paradox in coronary artery disease: national inpatient sample analysis

BACKGROUND

Although existing literature highlights obesity as a significant predictor for coronary artery disease (CAD), the impact of BMI on hospital outcomes among CAD patients remains unclear.

METHODS

We extracted data from the National Inpatient Sample database for adult patients with CAD from 2018 to 2020. The study cohort was stratified into six BMI categories: underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity. Using multivariable logistic and linear regression, we assessed the impact of BMI on in-hospital mortality, length of stay (LOS), and inflation-adjusted total charges.

RESULTS

We identified a total of 3 693 570 hospitalizations (mean age: 69 ± 12 years). Underweight individuals had the highest in-hospital mortality rate (6.8%), followed by normal weight (5.2%), overweight (3.2%), class III obese (2.5%), class I obese (1.9%), and class II obese (1.8%) individuals. After adjusting for covariates, underweight patients had higher odds of in-hospital mortality compared to normal-weight individuals [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.31-1.45; P < 0.001], while overweight or obese individuals had lower odds: overweight (OR, 0.75; 95% CI, 0.70-0.79; P < 0.001), obese class I: (OR, 0.54; 95% CI, 0.51-0.57; P < 0.001), obese class II: (OR, 0.56; 95% CI, 0.53-0.59; P < 0.001), obese class III: (OR, 0.78; 95% CI, 0.74-0.82; P < 0.001). Normal weight and underweight patients had the longest median LOS [5 days (3.0-9.0)]. Overweight patients incurred the highest total charges [$53 730 (28 587-105 184)].

CONCLUSION

Underweight patients experienced higher, while overweight and obese patients experienced lower in-hospital mortality than normal-weight patients, suggesting a protective effect of higher BMI against mortality in CAD.

Evaluation of sarcopenia diagnosis strategies in Chinese community-dwelling older adults based on the 2019 Asian Working Group guidelines: a cross-sectional study

BACKGROUND

Most diagnostic studies on sarcopenia in Asia follow the 2019 Asian Working Group for Sarcopenia (AWGS) guidelines, which recommend distinct diagnostic strategies for community and hospital settings due to challenges in measuring muscle mass in community environments. This study evaluates the screening-to-diagnosis process in community-based preventive services.

METHODS

This cross-sectional study utilized a questionnaire survey to evaluate SARC-F and SARC-CalF. Measurements included calf circumference (CC), handgrip strength, gait speed and bioelectrical impedance analysis (BIA). Participants were diagnosed according to the AWGS 2019 criteria. Four scenarios simulating the screening-to-diagnosis process in a community setting were evaluated. Sensitivity, specificity, and the area under the ROC curve (AUC) were calculated to assess diagnostic performance.

RESULTS

A total of 2453 community-dwelling older adults aged ≥60 years were included. The prevalence of sarcopenia was 14.1% (345/2453), with rates of 15.4%(160/1038) in males and 13.1% (185/1415) in females. In the simulated diagnostic scenarios, the number of confirmed cases was 218 (combination,Scenario1), 211 (CC,Scenario2), 60 (SARC-CalF,Scenario3) and 21 (SARC-F,Scenario4), respectively. In the case-finding step, the sensitivity for Scenarios1 to 4 was 0.86,0.84,0.23 and 0.07, respectively; specificity was 0.57,0.58,0.93 and 0.99, respectively; and the AUCs were 0.717,0.710,0.581 and 0.530, respectively. In the assessment step, the sensitivity for Scenarios 1 to 4 was 0.73,0.73,0.74 and 0.88, respectively; specificity was 0.81,0.82,0.68 and 0.24, respectively; and the AUCs were 0.774,0.774,0.712 and 0.557,respectively. The integrated sensitivity of the case-finding and assessment steps for Scenarios 1 to 4 was 0.63,0.61,0.17 and 0.06, respectively; integrated specificity was 0.92,0.92,0.98 and 0.99, respectively; and integrated AUCs were 0.776,0.768,0.575 and 0.523, respectively. The diagnostic performance of the entire procedure was better in females than in males.

CONCLUSIONS

In the case-finding step, the CC tool demonstrated superior performance compared to the combination tool, SARC-CalF, and SARC-F. In the assessment step, the muscle strength test was consistently performed with stability. The integrated performances of the case-finding and assessment steps exhibited moderate accuracy in Scenarios 1 and 2, but low accuracy in Scenarios 3 and 4. There is a pressing need to develop more accurate and user-friendly tools to improve sarcopenia detection among community-dwelling older adults in China.

Diabetes and smoking are associated with dynapenic abdominal obesity in patients with chronic kidney disease: a cross-sectional study

BACKGROUND

No study has reported about the prevalence and factors associated with dynapenic abdominal obesity in patients with pre-dialysis chronic kidney disease (CKD).

OBJECTIVE

Evaluation of the prevalence of dynapenic abdominal obesity and its relationship with sociodemographic, lifestyle, clinical, and nutritional variables in patients with CKD not dependent on dialysis.

DESIGN AND SETTING

A cross-sectional study was conducted at the Nutrition and Nephropathy Outpatient Clinic (public service) in Bahia, Brazil.

METHODS

This cross-sectional study was conducted on 102 patients of both sexes, aged ≥ 20 years. Dynapenic abdominal obesity (DAO) was defined as the simultaneous presence of dynapenia (handgrip strength less than the first tertile of the sample itself, according to sex and age) and increased waist circumference. Differences between groups with and without DAO were assessed using the Student's Mann-Whitney t-test, Pearson's chi-square test, or Fisher's exact test. Associations were tested using bivariate and multivariate models with Poisson regression to calculate the prevalence ratio and 95% confidence intervals (PR; 95% CI).

RESULTS

The mean age of the patients was 58.7 (standard deviation = 11.69); 50.5% were male, 51.6% were elderly, 41.8% had diabetes, 5.5% were smokers, 58.2% were abdominally obese, and 38.5% were dynapenic. DAO was identified in 18.7% of participants and was associated with diabetes mellitus (PR = 2.8; 95% CI = 1.12-6.99) and smoking (PR = 3.22; 95% CI = 1.16-8.96).

CONCLUSION

Non-dialysis dependent patients with CKD showed a significant prevalence of DAO associated with smoking and diabetes mellitus.

Correlation Between Sarcopenia and Oral Health in Patients on Chronic Hemodialysis

Patients on hemodialysis have signs of chronic systemic inflammation and a higher incidence of sarcopenia. Poor oral health can also trigger systemic inflammation and thus affect sarcopenia. The study included 100 patients on chronic hemodialysis who underwent oral status, routine laboratory measurements, bioimpedance analysis, hand grip strength measurement, and two questionnaires regarding oral health and sarcopenia. Data were analyzed using the Fisher exact test and the Mann-Whitney U test. In total, 28.0% of the participants had sarcopenia. The median total number of erupted teeth in all patients was 12.0 (7.0-23.0). A positive correlation of the total number of erupted teeth and erupted premolars with sarcopenia was confirmed (p = 0.035). CRP was significantly elevated in patients with sarcopenia (p = 0.035). Laboratory parameters showed that the blood albumin level was reduced in all patients (p = 0.002). The median overall score of the SarQoL questionnaire for all participants was 60.37 (43.87-70.61), which indicates that patients on hemodialysis are aware of their limitations caused by sarcopenia. Moreover, SarQoL was significantly negatively correlated with sarcopenia. This study confirmed poorer oral health in hemodialysis patients who had sarcopenia. Therefore, intervention studies are needed to improve the oral health of patients on HD, which could possibly influence the incidence of sarcopenia.

Should adrenal incidentaloma patients be evaluated for muscle mass, function, and quality? A cross-sectional study

PURPOSE

Our study evaluated skeletal muscle mass, function and quality among mild autonomous cortisol secretion (MACS) patients and non-functioning adrenal incidentaloma (NFAI) patients in comparison with the control group without adrenal mass.

METHODS

63 NFAI (49 female, 14 male) and 31 MACS (24 female, 7 male) patients were included in the study. As the control group, 44 patients (31 women, 13 men) who were known to have no radiological adrenal pathology on computed tomography or magnetic resonance imaging performed for other reasons were selected. After recording the laboratory parameters of the patients, anthropometric measurements, handgrip strength test with dynamometer, SARC-F survey and bioelectrical impedance analysis (BIA) measurements were performed.

RESULTS

There was no statistical difference among the groups in terms of age, gender, and BMI parameters. Handgrip strength (HGS), skeletal muscle mass (SMM) index (SMM/BMI), and skeletal muscle quality (HGS/SMM), values used to evaluate muscle strength and quality, were found to be significantly lower in both the MACS and NFAI groups compared to the control group (p = 0.004, p = 0.012 and p = 0.034 respectively). This significance was also present in women subgroup analyses (p = 0.002, p = 0.037 and p = 0.039 respectively), but these parameters lost their statistical significance in men. In the correlation analysis of the female subgroup, 24-h free urine cortisol value was inversely proportional to skeletal muscle quality (rs = -0.417, p = 0.008).

CONCLUSION

Our study showed that there is a decrease in muscle mass and function in female AI patients, and this decrease is more severe in MACS patients. These results may suggest that mild cortisol excess also has negative effects on skeletal muscle metabolism.

Moderate anxiety may improve functional balance in older women with low muscle strength: a preliminary observation

BACKGROUND

Anxiety commonly affects older individuals with negative consequences on various physical and motor performances such as balance. When coupled with age-related muscular strength loss, the effects on the ability to perform daily tasks could be particularly detrimental, particularly in older women who are more susceptible to anxiety, muscular strength losses and falls. The study aimed to verify the effects of anxiety on balance performance in relation to muscular strength level in healthy older women.

METHODS

Twenty-six individuals aged over 64 years underwent tests for anxiety, static and dynamic balance, and hand-grip strength. Two-way ANOVA was performed with anxiety (anxious vs. non-anxious) and strength (high vs. low) as independent variables.

RESULTS

A significant main effect of anxiety and a significant interaction anxiety*strength for static balance were observed. The analysis of the interaction revealed a significant effect of anxiety on the non-preferred one-foot balance with differences between low and high strength subjects; for low levels of strength, anxious woman performed significantly better than non-anxious, for high levels of strength, anxiety had no effect.

CONCLUSIONS

Moderate levels of anxiety may support balance performance in low strength condition. These findings if further verified on larger samples could add important information on the role of anxiety on motor performance in aging.

A Pilates Exercise Program as a Therapeutic Strategy in Older Adults with Type 2 Diabetes: Effects on Functional Capacity and Blood Glucose

Background/Objectives: Older adults with type 2 diabetes mellitus (T2DM) often experience impaired physical function and metabolic control. This study aimed to evaluate the effectiveness of a 12-week Pilates-based intervention on blood glucose concentration and physical function in this population. Methods: A randomized controlled trial was conducted with 104 older adults (mean age: 70.6 ± 3.15 years; 70.2% women), all diagnosed with T2DM. The participants were assigned to a control group (CG, n = 52) or a Pilates training group (PG, n = 52). The intervention included 24 Pilates sessions over 12 weeks (2 sessions/week, 60 min each). Outcomes were assessed pre- and post-intervention and included capillary blood glucose, handgrip strength, functional mobility (Timed Up and Go), balance (Berg Balance Scale), and flexibility (Chair Sit-and-Reach Test and Back Scratch Test). Results: Compared to the control group, the Pilates group showed statistically significant improvements in blood glucose levels (-4.06 mg/dL (p < 0.001; d = 0.68)), handgrip strength (+1.76 kg (p < 0.001; d = 0.48)), gait speed (p < 0.001; d = 0.53), balance (Berg score) (+2.37 points (p < 0.001; d = 0.66)), and flexibility (improvements in upper limbs (BST, d = 0.78-0.98) and lower limbs (CSRT, d = 1.07 right; d = 0.63 left)). Conclusions: A 12-week Pilates program led to significant improvements in glycemic control, muscular strength, gait speed, balance, and flexibility in older adults with T2DM. These findings support Pilates as a safe, effective, and adaptable non-pharmacological intervention to promote functional and metabolic health in this population.

Measuring the paraspinal muscles as an important tool for predicting the overall survival period after spine surgery in lung cancer patients with spine metastasis

STUDY DESIGN

Retrospective cohort study BACKGROUND: Metastatic lung cancer in the spine is difficult to determine whether to perform an additional surgical intervention, as patients at the end stage of lung cancer often have low performance status with significant muscle atrophy. This study aimed to demonstrate whether sarcopenia affects the prognosis after spine surgery in lung cancer patients by measuring the paraspinal muscles.

METHODS

A total of 65 lung cancer patients who underwent spine surgery were reviewed. Patients were divided into two groups based on the survival period after surgery (≤ 6 months; n = 33 and > 6 months; n = 32). Based on magnetic resonance imaging, the quantity and quality of the paraspinal muscles (psoas major, quadratus lumborum, erector spinae, and multifidus) were analyzed by an Image J program. Patient- and surgery-related factors were compared between the two groups.

RESULTS

The quantity of the erector spinae muscle was higher in the > 6 months group (11.5 ± 2.8 cm2/m2) than in the ≤ 6 months group (10.0 ± 2.3 cm2/m2, p = 0.013). The logistic regression analysis showed that the muscle quantity of the erector spinae (p = 0.026, odds ratio 1.343) and the number of vertebrae involved in metastasis (p = 0.016, odds ratio 0.199) were the main prognostic factors for the survival period after spine surgery.

CONCLUSIONS

Lung cancer patients with a low quantity of the erector spinae muscles are at a high risk of poor prognosis after spine surgery. Therefore, measuring the erector spinae muscle could be an important tool for distinguishing patients appropriate for palliative treatments and surgical interventions.

Feasibility of conducting a randomized controlled trial to explore the muscular influence of post-operative intravenous iron treatment for anaemia after major abdominal surgery

BACKGROUND AND OBJECTIVES

Iron deficiency anaemia is common in patients recovering from major surgery and is associated with poorer post-operative outcomes. We designed a randomized controlled trial treating post-operative anaemia with iron therapy to observe the influence on post-operative recovery.

MATERIALS AND METHODS

Anaemic patients (haemoglobin [Hb] < 120 g/L for women, Hb < 130 g/L for men) recovering from major abdominal surgery at Fiona Stanley Hospital were recruited. Patients were double-blind randomized 1:1 to ferric carboxymaltose (FCM) or saline administered 4 weeks post-discharge and included in a 12-week exercise programme. Iron indices, quality of life (QoL) questionnaires and muscle function tests were conducted at 4 weeks (baseline), 8-, 12- and 16-weeks post-discharge. This pilot study primarily aimed to assess the feasibility of recruiting 20 patients per intervention arm.

TRIAL REGISTRATION

ACTRN12622001447741.

RESULTS

Of 205 eligible patients screened between 5 May 2023 and 31 August 2023, only four patients were recruited, of which one completed the study. After randomization to FCM, results obtained from the sole participant that completed the trial suggested a trend towards improvement in QoL outcomes, Hb and muscle function.

CONCLUSION

Recruitment to a randomized controlled trial exploring the influence of iron therapy on muscle function after major abdominal surgery was not feasible.

Resistance exercise dose effects on muscle morphology, muscle function and quality of life in advanced-stage ovarian cancer survivors

AIM

Advanced-stage ovarian cancer survivors often have compromised muscle morphology (muscle mass and density), muscle function (muscle strength and physical function), and health-related quality of life (HRQoL). We recently reported improvements in these outcomes following resistance training. Information on the resistance exercise dose required to improve health-related outcomes is still lacking in this cancer group. Here we examined the exercise dose delivered and the effect of the delivered dose on changes in outcomes of interest.

METHODS

Twelve women with stage III or IV ovarian cancer completed a 12-week supervised resistance exercise intervention. Exercise metrics included compliance (exercise dose completed), dose modifications (sessions modified) and tolerance (rating of perceived exertion; RPE). Participants were allocated to lower (< 63%) or higher (> 63%) exercise compliance based on median split. Differences in change to muscle morphology, muscle function and HRQoL between compliance groups were investigated.

RESULTS

Median compliance and session RPE were 63.0% and 13 (somewhat hard), respectively. Dose reductions occurred in 92.7% of sessions. Both groups experienced improvements in muscle morphology and function. Higher compliance was associated with greater improvements in whole body lean mass (+ 1.3 kg vs. + 0.5 kg) and lower body strength (+ 50 kg vs. + 13 kg). Only the lower compliance group experienced a clinically significant improvement in 400-m walk time (-48.4 s vs. -9.4 s). Both groups experienced clinically meaningful improvements in social and cognitive functioning.

CONCLUSION

Relatively lower doses of resistance exercise may benefit advanced-stage ovarian cancer survivors. Exercise programs may need to be flexible and individualized to fit the needs of this cancer group.

A Prospective Controlled Study on the Longitudinal Effects of Rehabilitation in Older Women with Primary Sarcopenia

Sarcopenia, defined as a progressive loss of skeletal muscle mass, strength, and function, is a leading contributor to disability, dependence, and reduced quality of life (HRQoL) in older adults. This study aimed to evaluate the impact of a personalized six-month rehabilitation program, centered on tailored kinetic therapy, on physical performance and HRQoL in older women with primary sarcopenia.

METHODS

This prospective controlled study included 80 women aged ≥65 years, allocated into a Study Group (SG, n = 40), who followed a supervised personalized kinetic program, and a control group (CG, n = 40), who received general advice regarding physical activity and nutrition. Physical performance was measured using the short physical performance battery (SPPB), while HRQoL was assessed with the disease-specific SarQoL questionnaire. Evaluations were conducted at baseline and after six months.

RESULTS

At baseline, both groups had comparable scores (SPPB: SG = 5.75 ± 0.86 vs. CG = 5.8 ± 0.88, p = 0.798; SarQoL: SG = 54.42 ± 8.76 vs. CG = 55.59 ± 4.61, p = 0.457). After six months, the SG showed significant improvements (SPPB = 8.05 ± 0.90, p < 0.001; SarQoL = 62.55 ± 7.00, p < 0.001). Significant gains were observed in domains related to physical and mental health, locomotion, functionality, and leisure activities (p < 0.05). In contrast, the CG showed only minor, non-significant changes (SPPB = 6.17 ± 0.78; SarQoL = 56.51 ± 5.51).

CONCLUSIONS

A structured, personalized kinetic program significantly improves physical performance and HRQoL in older women with primary sarcopenia. These results support the need for individualized, supervised rehabilitation programs in optimizing functional recovery and enhancing patient-centered outcomes in sarcopenia management.

Trends and inequalities in physical fitness and nutritional status among 0.72 million Chinese adults aged 20-59 years: an analysis of five successive national surveillance surveys, 2000-2020

Background

Few comprehensive studies have assessed the long-term trends in physical fitness and nutritional status among Chinese adults, along with the socioeconomic inequalities. This study aimed to bridge this gap by examining the temporal changes and the evolution of socioeconomic disparities in physical fitness and nutritional status among Chinese adults aged 20-59, based on five successive national surveillance surveys.

Methods

We integrated data from five consecutive rounds of National Physical Fitness Surveillance (2000, 2005, 2010, 2014, and 2020) among Chinese adults aged 20-59 years. BMI was categorized into underweight (<18.5 kg/m2), overweight (24.0-27.9 kg/m2), and obesity (≥28.0 kg/m2). Central obesity was defined as a waist circumference ≥90 cm for males and ≥85 cm for females. A composite physical fitness indicator (PFI) was calculated by aggregating the Z-scores of all six components. Provinces were ranked by GDP per capita ($) and stratified into three socioeconomic strata from least (T1) to most developed (T3). Generalized additive models (GAMs), adjusted for age and sex, were employed to assess the associations between nutritional status, PFI, and both per capita GDP and urbanization levels.

Findings

A total of 716,790 Chinese adults aged 20-59 were included in the analysis. The PFI score declined from 0.71 in 2000 to -0.84 in 2020, with a particularly sharp annual decline between 2014 and 2020. The underweight prevalence declined from 5.54% in 2000 to 3.51% in 2020, while the prevalence of overweight, obesity, and central obesity increased to 35.84%, 15.05%, and 32.10% in 2020, respectively. After 2005, the urban-rural disparities in physical fitness narrowed, whereas the gap between most and least developed regions widened, with urban and high-SES regions consistently showing better fitness. The prevalence of overweight, obesity, and central obesity in urban and economically developed regions was higher than in less economically developed and rural regions in earlier years, but this pattern reversed over time. The underweight prevalence showed the opposite trend. With increasing GDP per capita, PFI initially rose before declining at higher levels, and it showed a positive correlation with urbanization. Overweight prevalence increased with GDP per capita but slowed at higher levels, while obesity and central obesity exhibited an N-shaped relationship with GDP per capita. Moreover, prevalence of overweight, obesity, and central obesity were positively correlated with urbanization.

Interpretation

During the first two decades of the 21st century, China experienced rapid economic growth accompanied by declining physical fitness and rising prevalence of overweight, obesity, and central obesity among adults aged 20-59 years. Inequalities in nutritional status between urban and rural areas and across socioeconomic strata reversed. Less developed and rural regions may face dual challenges of deteriorating physical fitness and the growing burden of overnutrition, which requires urgent attention. The complex interplay between socioeconomic development, urbanization, and physical health further emphasizes the need for health policies tailored to diverse socioeconomic contexts and subpopulations.

Funding

National Natural Science Foundation of China (72474005, 72122001) and the Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health (PKUWF-Y12).

Padua Days on Muscle and Mobility Medicine, March 25-29, 2025, Hotel Petrarca, Euganean Thermae, Italy: Program and Abstracts

Medium-sized scientific conferences held in hotels large enough to accommodate all participants increase opportunities for constructive discussion during breaks, and for evenings that bring together young and senior experts of basic sciences and clinical specialties. Time for group discussions offer opportunities for new collaborations and for jobs for young researchers. Since 1991 the Padova Muscle Days have offered collaborative opportunities that have matured into innovative multidisciplinary results to the point that it came naturally for us to underline it with a neologism now included in the title of the 2025 event: "Mobility Medicine". It is a discipline which developed naturally when we brought together fragmented areas of knowledge into one meeting. The Padua Days on Muscle and Mobility Medicine 2025 (2025Pdm3) will be hosted at the Hotel Petrarca, Euganean Thermae (Padua, Italy) from 25 to 29 March 2025. The list of unique sessions within the included program and the following Collection of Abstracts testify that it is possible to organize valid countermeasures to the inevitable tendencies towards hyper-specialization that the explosive increase in scientific progress brings. The European Journal of Translational Myology and Mobility Medicine (Ejtm3) will accept typescripts on results presented at the 2025Pdm3. Furthermore, an additional option for publication of full original Articles or Reviews is the Special "New Trends in Musculoskeletal Imaging" of the MDPI Journal Diagnostics, because diagnosis is essential to manage and follow-up neuro- metabolic- muscular- disorder and the decay of performances in aging. We hope that many will share our dreams and we make them come true at the 2025 Pdm3 Conference.

Reliability and Clinical Validity of the SARC-Global Questionnaire for Sarcopenia and Sarcopenic Obesity in Spanish Older Adults

BACKGROUND/OBJECTIVES

Sarcopenia and sarcopenic obesity (SO) are related to an increased risk of adverse outcomes. The objective of this study was to assess the internal and clinical validation of the Spanish version of the SARC-Global questionnaire, a sarcopenia risk screening tool, and its ability to detect sarcopenia, severe sarcopenia, and SO in adults aged ≥ 60 years.

METHODS

A total of 167 participants (73.22 ± 6.70 years, 71.26% women) completed the study. First, reliability was assessed by the inter-rater and the test-retest analyses. For the clinical validation, the risk of sarcopenia (SARC-Global) was compared to sarcopenia diagnosed using three operational definitions. The SARC-Global's ability to detect severe sarcopenia (SS) and sarcopenic obesity assessed with body mass index (SO-BMI) and body fat percentage (SO-BFP), considering nutritional status and physical activity level, was also analyzed.

RESULTS

The Spanish SARC-Global questionnaire showed a substantial to excellent inter-rater and test-retest reliability. Regarding the clinical validation, sensitivity/specificity values to detect cases of sarcopenia were 85.71%/64.38% (EWGSOP2), 83.33%/65.81% (FNIH), and 54.55%/63.46% (AWGS-2019). Diagnostic accuracy ranged from 67.07% (FNIH) to 62.87% (AWGS-2019). The analysis also indicated that SARC-Global cutoff of 13.5 was the optimal score for severe sarcopenia (100.00% sensitivity and 80.49% specificity), SO-BMI (100% sensitivity and 80.49% specificity), and SO-PBF (80.00% sensitivity and 80.86% specificity).

CONCLUSIONS

The Spanish version of the SARC-Global questionnaire is a reliable and clinically valid instrument for identifying people at the risk of sarcopenia, severe sarcopenia, and sarcopenic obesity in Spanish older adults.

A Novel Anthropometry-Based Model to Estimate Appendicular Muscle Mass in Brazilian Older Women

Background: The assessment of appendicular skeletal muscle mass (ASM) is central to the diagnosis of sarcopenia (SA). We developed an anthropometric model for estimating ASM and tested its validity to identify SA and associated risk of disability (RSA) in older women. Methods: The equation was developed with 89 women (60-88 years, 72 ± 6 years), with a cross-validation sample of 12 women (60-84 years, 67 ± 5 years). Validity was determined through concordance between actual versus estimated ASMs, correlations between actual/estimated ASM versus peak torque (PT) and total work (TW) during isokinetic knee extension/flexion and handgrip strength, and agreement of patients classified with SA and RSA. Results: The predictive equation was ASM (kg) = 0.177 (body mass, kg)-0.075 (arm circumference, cm) + 0.020 (thigh circumference, cm) + 5.376 (R = 0.905; R 2 = 0.819; R 2ad = 0.809; F = 86.96; p < 0.0001; SEE = 1.35 kg). Agreement between actual and estimated ASMs was confirmed by validation (ICC = 0.81; p < 0.0001) and cross-validation samples (ICC = 0.72, p < 0.035). Regression characteristics in PRESS statistics (R 2 PRESS = 0.79; SEE-PRESS = 1.61) were compatible with the original model. Percent agreements for the classification of SA and RSA from indices calculated using actual/estimated ASM were 98% (gamma = 0.98, p = 0.015) and 68% (gamma = 0.89, p < 0.0001) in validation and 67% (gamma = 1.0, p = 0.032) and 70% (gamma = 0.84, p < 0.001) in cross-validation samples. Correlations between actual/estimated ASM versus PT (range 0.57-0.76, p < 0.05), TW (range 0.51-0.75, p < 0.05), and handgrip (range 0.67-0.74, p < 0.001) were theoretically consistent, being moderate and similar in both samples. Conclusion: This new anthropometric model has satisfactory prediction qualities and could be applied as a simple and practical method for estimating ASM in Brazilian older women.

Low gait speed is better than frailty and sarcopenia at identifying the risk of disability in older adults

OBJECTIVE

To compare frailty, sarcopenia and their respective components to determine which is more effective in identifying the risk of disability in basic and instrumental activities of daily living (BADL and IADL, respectively).

METHODS

A longitudinal study involving 3,637 individuals without disabilities concerning BADL and 3,696 individuals without disabilities regarding IADL at baseline. Frailty was defined using the phenotype. Sarcopenia was determined according to the criteria proposed by the EWGSOP2: low strength (grip strength <27 kg for men and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m2 for men and <6.73 kg/m2 for women) and low physical performance (gait speed ≤0.8 m/s). In addition to the complete constructs, each component was assessed. Poisson mixed models were utilised, with the outcome identified as incident cases of disability over 8 years, adjusted for covariates. Results: Pre-frailty was associated with a 17% and 18% annual increase in the risk of disability for BADL and IADL, respectively. These figures were 27% and 28% for individuals classified as frail. Sarcopenia was not associated with an increased risk of disability. Amongst the components of frailty and sarcopenia, low physical performance, assessed by gait speed ≤0.8 m/s, was the most effective for identifying the risk of disability (12% per year for BADL and 14% per year for IADL).

CONCLUSION

In clinical practice, low physical performance (gait speed ≤0.8 m/s) may be the preferred tool for screening the risk of functional decline in older adults.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Relationship between physical function and sarcopenia in the older adults from Amazonas: A cross-sectional study

BACKGROUND

Physical functioning refers to the ability to perform daily living activities, namely basic activities, instrumental, and advanced activities. Poorer performance in these areas may indicate the potential presence of sarcopenia.

OBJECTIVES

To analyze the differences in physical function between older people with and without sarcopenia and to investigate the associations between physical function tests and sarcopenia.

METHODS

A cross-sectional study based on data from older people from the Northern region of Brazil in the year 2018 was conducted. Study participants included 312 older people aged ≥  60 years (64.1% female). Sarcopenia was defined using the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Physical functioning was measured using functional physical fitness tests (30-second chair stand test, chair sit-and-reach test, 8-foot Up-and-Go Test, 6-minute walk test, 4-meter gait speed, and the Fullerton Advanced Balance Scale).

RESULTS

Confirmed sarcopenia was detected in 29.2% of participants, but no participant had severe sarcopenia. Most physical function parameters in the crude analysis were associated with confirmed sarcopenia (all p < 0.05), except for the back scratch test. In a model adjusted for sex, age and body mass index, slower 4-meter gait speed (OR = 1.29, 95%CI = 1.08 to 1.54), slower 8-foot up-and-go test time (OR = 1.32, 95%CI = 1.16 to 1.49), greater chair sit-and-reach test (OR = 0.97, 95%CI = 0.94 to 0.99) and higher self-reported Composite Physical Function scores (OR = 0.94, 95%CI = 0.89 to 0.99) were significantly associated with confirmed sarcopenia status.

CONCLUSIONS

EWGSOP2 confirmed sarcopenia is prevalent in older people residing in Brazil's Northern region and is independently associated with slower walking speed and chair rising ability, reduced trunk and lower-limb flexibility, as well as poorer self-reported physical function.

Trends in knee osteoarthritis prevalence over a 10-year period in Japan: The ROAD study 2005-2015

Objective

This study aimed to clarify the trends in the prevalence of knee osteoarthritis (OA) and symptomatic knee OA among the general population using population-based cohort data from baseline and a survey 10 years later.

Design

The baseline survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted from 2005 to 2007; 3040 participants (1061 men and 1979 women; mean age 70.3 years) completed all OA examinations, including a questionnaire of medical information in the present/past and radiographic examination. The fourth survey was performed from 2015 to 2016; 2893 individuals (895 men and 1998 women, mean age 68.9 years) completed assessments identical to those at the baseline survey. Knee OA was defined using the Kellgren-Lawrence grading system.

Results

The prevalence of knee OA was 54.6 ​% (men, 42.0 ​%; women, 61.5 ​%) at the baseline survey and 39.3 ​% (men, 26.9 ​%; women, 44.9 ​%) at the fourth survey, with a significant decrease (p ​< ​0.0001). The prevalence of symptomatic knee OA was 24.3 ​% (men, 16.9 ​%; women, 28.3 ​%) at the baseline survey and 20.6 ​% (men, 14.2 ​%; women, 23.5 ​%) at the fourth survey, showing a similar decrease (p ​< ​0.0001). Thus, the prevalence of knee OA and symptomatic knee OA was lower at the fourth survey than at the baseline survey (p ​< ​0.01).

Conclusions

In the population-based survey with a 10-year interval, the prevalence of knee OA and symptomatic knee OA decreased significantly. This preferable change in OA may suggest rejuvenation in the current population and could contribute to a decrease in the occurrence of disabilities in the future.

Prevalence and Risk of Sarcopenia in Patients with Chronic Pancreatitis: Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Sarcopenia is a condition marked by a continuous decline in skeletal muscle strength and volume, often leading to significant health complications. According to several articles, sarcopenia is highly prevalent in chronic pancreatitis (CP) due to exocrine pancreatic insufficiency. The aim of this meta-analysis was to determine the pooled prevalence and risk of sarcopenia among CP patients.

METHODS

The search process adhered to the PRISMA 2020 guidelines and was registered in PROSPERO under the identification number CRD42025637059. The search was conducted in the following databases: MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, and the Russian Science Citation Index (RSCI). It covered studies published between 1 January 1985 and 20 December 2024. Only studies published in English or Russian with detailed comprehensive statistics and adult CP were included. Studies with specific patient populations affecting data objectivity were excluded. Sensitivity analyses were conducted (first, only studies with more than 50 CP patients were considered. Second, the analysis was restricted to full articles, excluding abstracts from conferences).

RESULTS

In total, 16 studies with 1556 participants (1398 CP patients and 158 controls) met the criteria. The pooled prevalence of sarcopenia was 39.117% (95% CI: 28.891-49.852) in CP patients and 7.745% (95% CI: 2.154-42.622) in the control group. An association was found between sarcopenia and CP using the fixed-effects model when compared to the control group (RR = 2.194, 95% CI: 1.502-3.203).

CONCLUSIONS

Sarcopenia is underdiagnosed in CP patients despite its significant clinical impact. Management strategies, including pancreatic enzyme replacement therapy, nutritional support, and resistance training show potential in the treatment of this state. Further research is needed to establish standardized diagnostic criteria and unified treatment approaches. Early detection and comprehensive care are essential to improving outcomes in CP patients with sarcopenia.

The Italian version of the extended Barcelona Music Reward Questionnaire (eBMRQ): a validation study and association with age, gender, and musicianship

Background

Music is a primary source of pleasure for humans. Nevertheless, there is large interindividual variability in how individuals experience and derive pleasure from music and music-related activities. With this study we propose and validate the Italian version of the extended Barcelona Music Reward Questionnaire (eBMRQ), the most in-depth and comprehensive tool for investigating the diverse characterization of individual sensitivity to pleasure in music. In addition, we aim to investigate eBMRQ scores as a function of age, gender, and musicianship across Italian population.

Methods

For the validation process of the Italian eBMRQ, we first conducted forward and backward translation from the original English eBMRQ version. The new Italian version was then administered to 1,012 participants who were fluent in Italian from the north and the south of Italy through online surveys (age range 18-86 years old; M = 34.9, SD = 16.9, females 74%). Unrestricted confirmatory analysis was computed for both six-factor and single-factor models. The effect of gender, age, and musicianship on eBMRQ scores was analyzed through analysis of variance (ANOVA).

Results

The quality assessment of the factor solution indicated that the Italian eBMRQ demonstrated acceptable quality and reliability, making it a valid tool for assessing sensitivity to music reward. All factors were significantly correlated with each other, in line with previous adaptations of the BMRQ. Our findings indicate that females reported higher music reward sensitivity compared to males, except for Social Reward subscale. Moreover, individual reward sensitivity was significantly higher among musicians and amateurs compared to non-musicians, although this trend did not emerge for Sensory-motor and Mood Regulation subscales. Also, overall musical reward sensitivity was negatively associated with age.

Conclusions

The results obtained suggest the feasibility of applying the Italian version of eBMRQ as a reliable tool in the field of affective and clinical music-related research. Furthermore, the significant associations we have highlighted between eBMRQ scores, gender, age, and musicianship contribute to emphasizing the significant impact of individual factors on music reward sensitivity.

Association of skeletal muscle quantity and quality with mortality in women with nonmetastatic breast cancer

Women with breast cancer are predisposed to muscle mass loss, to compromised muscle quality, and to decreased strength, and these abnormalities may serve as important predictors of adverse outcomes, including mortality. The aim of this study was to evaluate the possible associations between muscle mass markers, assessed by computed tomography with the phase angle (PhA) obtained by Bioelectrical impedance analysis (BIA), and health outcomes in women with breast cancer.

METHODS

retrospective study with 54 women newly diagnosed with breast cancer, aged ≥ 18 years and < 65 years; histologically confirmed diagnosis of early breast cancer (stage I-III range), and in the first chemotherapy-cycled treatment. Measurements performed: anthropometric assessments, BIA, third lumbar vertebra by computed tomography (CT) and physical function (handgrip strength, gait speed test 4 m, fatigue assessment), and blood biochemical analysis.

RESULTS

Lower skeletal muscle index were correlated with reduced PhA values (R² = 0.222, p = 0.0047), suggesting a worse prognosis. Logistic regression analysis showed that individuals with low muscle mass had a significantly lower likelihood of survival compared to those with normal muscle mass regardless of age and cancer stage.

CONCLUSION

low muscle mass negatively affected patient survival and was associated with lower PhA values. Phase angle emerges as a promising marker of overall health and could be a valuable clinical tool in assessing prognosis.

The association between sarcopenic obesity and malnutrition in community-dwelling older adults

BACKGROUND

The increase in fat tissue and the decrease in muscle mass with advancing age have prompted researchers to explore the coexistence of sarcopenia and obesity, i.e. sarcopenic obesity (SO). SO may lead to malnutrition due to poor diet quality, while malnutrition may contribute to SO by causing further muscle loss and metabolic imbalances.

OBJECTIVES

The aims were to investigate: (i) the prevalence of SO in community-dwelling older adults, (ii) the diagnostic ability of two different malnutrition methods, and (iii) the association between SO and malnutrition.

METHODS

Community-dwelling older adults (≥65 years) were invited to participate. SO assessment was conducted based on the ESPEN/EASO consensus criteria. Malnutrition was evaluated based on both the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Mini-Nutritional Assessment (MNA).

RESULTS

Five hundred and ninety older adults (69.3% women, mean age: 74.31 ± 6.55 years) were included in the study. The overall prevalence of SO was 5.9% (n = 35). The prevalence of malnutrition was 23.9% according to the GLIM criteria, while it was 3.1% according to MNA. The agreement between the two measurements was ĸ = 0.32. There was no association between SO and malnutrition based on either GLIM (P: .06, OR: 1.971, 95% CI: 0.966-4.024) or MNA (P: .948, OR: 1.934, 95% CI: 0.119-7.306).

CONCLUSIONS

Even though the agreement for diagnosing malnutrition between GLIM criteria and MNA was fair, the number of participants diagnosed with malnutrition by GLIM criteria was almost eight times higher than MNA. No association was established between SO and malnutrition defined by GLIM or MNA.

CLINICAL TRIAL NUMBER

NCT05122104.

Prospective associations of genetic susceptibility to high blood pressure and muscle strength with incident cardiovascular disease outcomes

BACKGROUND

This study explored the prospective associations of genetic susceptibility to high blood pressure (BP) and muscle strength with cardiovascular disease (CVD) mortality, incident coronary heart disease (CHD) and incident stroke.

METHODS

This study included 349 085 white British individuals from the UK Biobank study. Genetic risk of high BP was estimated using a weighted polygenic risk score that incorporated 136 and 135 nonoverlapping single-nucleotide polymorphisms for systolic BP and diastolic BP, respectively. Muscle strength was assessed using a hand dynamometer and expressed relative to fat-free mass. Sex- and age-specific tertiles were used to classify muscle strength into three categories. Cox regressions with age as the underlying timescale were fit for CVD mortality ( n  = 8275), incident CHD ( n  = 14 503), and stroke ( n  = 7518).

RESULTS

Compared with the lowest genetic risk of high BP (bottom 20%), the highest (top 20%) had greater hazards of each outcome. Low muscle strength was associated with higher hazards of CVD mortality [hazard ratio (HR): 1.51, 95% confidence interval (CI): 1.43-1.59], incident CHD (HR: 1.16, 95% CI: 1.11-1.21), and stroke (HR: 1.20, 95% CI: 1.14-1.27), independently of confounders and genetic predisposition to high BP, compared with high muscle strength. Joint analyses revealed that the estimated 10-year absolute risks of each outcome were lower for high muscle strength combined with high genetic risk, compared with low muscle strength combined with low or medium genetic risk.

CONCLUSION

Individuals who are genetically predisposed to high BP but have high muscle strength could have lower risk of major CVD events, compared with those who have low or medium genetic risk but low muscle strength.

Why are we not exploring the potential of lower limb muscle power to identify people with sarcopenia?

Sarcopenia refers to a neuromuscular disease characterized by age-related declines in muscle mass and function. Since Professor Rosenberg first introduced the concept of sarcopenia in 1989, numerous operational paradigms have been proposed, tested, and validated against negative outcomes. The most recent recommendations advocate that dynapenia, or reduced of muscle strength, should be used alongside low muscle mass for the identification of sarcopenia. This approach is based on the understanding that impairments in muscle strength are a major consequence of muscle failure. However, empirical evidence has yielded conflicting results regarding the ability of current sarcopenia definitions to identify individuals at higher risk of adverse health-related events. Muscle power - the capacity to generate strength rapidly - has emerged as a critical domain of physical performance in old age. Not only does it decline earlier and more drastically than other measures (e.g., muscle strength), but it is also more strongly associated with adverse outcomes. In this view point, we provide an appraisal of muscle power as a more reliable indicator of muscle failure, compared with other measures (e.g., strength), for identifying individuals with sarcopenia in both geriatric and non-geriatric settings. We also discuss major challenges hindering the conduct of meaningful investigations on this subject.

Development and validation of a frailty risk model for patients with mild cognitive impairment

The study aims to develop and validate an effective model for predicting frailty risk in individuals with mild cognitive impairment (MCI). The cross-sectional analysis employed nationally representative data from CHARLS 2013-2015. The sample was randomly divided into training (70%) and validation sets (30%). The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression model were used to identify independent predictors and establish a nomogram to predict the occurrence of frailty. The receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis (DCA) were used to evaluate the performance of the nomogram. A total of 3,196 MCI patients were analyzed, and 803 (25.1%) exhibited symptoms of frailty. Multivariate logistic regression analysis revealed that age, activities of daily living (ADL) score, depression score, grip strength, cardiovascular disease (CVD), liver disease, pain, hearing, and vision were associated factors for frailty in MCI patients. The nomogram based on these factors achieved AUC values of 0.810 (95% CI 0.780, 0.840) in the training set and 0.791 (95% CI 0.760, 0.820) in the validation set. Calibration curves showed good agreement between the nomogram and the observed values. The Hosmer-Lemeshow test results for the training and validation sets were P = 0.396 and P = 0.518, respectively. The ROC curve and decision curve analysis further validated the robust predictive ability of the nomogram. The application of this model may facilitate early clinical interventions, thereby potentially reducing the incidence of frailty among patients with MCI and significantly enhancing their long-term health outcomes.

Role for neurological and immunological resilience in the pathway of the aging muscle powerpenia: InCHIANTI study longitudinal results

The neuromuscular junction shows several degenerative changes with aging, resulting in a reduction of transmission efficacy. These changes, paired with low-grade chronic inflammation, were considered triggers of the aging muscle processes. The main objective of this study is to assess the role of leukocyte count-derived ratios, nerve conduction velocity (NCV), and compound muscle action potential (CMAP) in determining time-dependent reduction in lower limb muscle explosive strength, a condition that has been defined as powerpenia. The InCHIANTI study enrolled a representative sample from the registry lists of two towns in Tuscany, Italy. Baseline data were collected in 1998, with follow-up visits every 3 years. For the purpose of this analysis, we used 1229 subjects and 3814 follow-up assessments. Subjects with lower values of monocyte-to-lymphocyte ratio (ML-ratio) had higher nerve conduction velocity and higher proximal and distal action potential values; moreover, considering the interaction between age for ML-ratio effect, a statistically significant direct association is found with all the electromyography-parameters. Lower limb muscle power shows a gender dimorphism, male subjects having higher values at baseline, but experiencing steeper decline rate during the follow-up, compared to females. Muscle power was inversely associated with ML-ratio, proximal CMAP, distal CMAP, and NCV. Moreover, we found a direct and statistically significant second-order interaction (age for ML-ratio), meaning that at the same age, increasing ML-ratio increases lower limb muscle power. Lastly, also body composition variation across aging is directly associated with lower limb muscle power. Reduced immunological and neurological homeostasis affects the powerpenia phenotype in a large representative sample of Italian men and women.

Frailty or sarcopenia: which is a better indicator of mortality risk in older adults?

BACKGROUND

Despite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the sarcopenia using different cut-off points for low grip strength to determine which better identifies mortality risk over a 14-year follow-up period.

METHODS

4597 participants in the English Longitudinal Study of Ageing. Frailty was measured using the Fried phenotype. Sarcopenia (European Working Group on Sarcopenia in Older People 2) was defined using different cut-off points for low grip strength (<36, <32, <30, <27 and <26 kg for men and <23, <21, <20 and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m² for men and<6.73 kg/m² for women) and slowness (gait speed: ≤0.8 m/s). Cox models were run and adjusted for sociodemographic, behavioural and clinical factors.

RESULTS

When the coexistence of frailty and sarcopenia is considered, only the cut-off points <36 kg for men and <23 kg for women to define low grip strength identified the risk of mortality among individuals classified as having probable sarcopenia (HR=1.17, 95% CI 1.02 to 1.34), sarcopenia (HR=1.31, 95% CI 1.07 to 1.60) and severe sarcopenia (HR=1.62, 95% CI 1.33 to 1.96). In this situation, frailty identified the mortality risk (HR=1.49, 95% CI 1.22 to 1.81), whereas pre-frailty did not. Sarcopenia using other cut-off points for defining low grip strength did not identify mortality risk.

CONCLUSION

Sarcopenia using <36 kg for men and <23 kg for women as cut-off points seems to be better than the frailty phenotype for identifying the risk of mortality in older adults.

Stair climbing ability and postoperative activity in patient-reported outcomes after CR-TKA are more related to handgrip strength than sagittal knee stability

INTRODUCTION

Stair ascent and descent are physically demanding tasks requiring higher functional ability of the lower extremity muscles and joint range of motion than level walking, and are associated with patient satisfaction after total knee arthroplasty (TKA). This study aimed to investigate stair ascent and descent ability after cruciate-retaining (CR)-TKA using the patient-reported outcomes, and to examine the role of knee sagittal stability and handgrip strength in postoperative stair ascent and descent ability.

MATERIALS AND METHODS

This study included 84 female patients who underwent primary unilateral CR-TKA for knee osteoarthritis at our institute between April 2015 and February 2019. Patients were classified according to ascending and descending stair difficulty using the New Knee Society Score into those with (group D) and those without difficulty ascending and descending stairs (group A). The two groups were compared for age, height, weight, body mass index, postoperative grip strength, pre-operative and postoperative knee range of motion, anterior and posterior tibial drawer on stress radiography, and the New Knee Society Score (KSS).

RESULT

Group D and A consisted of 48 and 36 patients, respectively. The mean follow-up period was 2.9 years (range 1-5 years). Group D was significantly older (74.1 vs. 70.0 years old, p = 0.01) and shorter (148.6 vs. 153.3 cm, p = 0.017) than group A. The two groups demonstrated no significant differences in the range of motion preoperatively and postoperatively and in the amount of anterior tibial drawer at 20°, anterior and posterior drawer at 90°, and total anterior-posterior movement at 90°. Postoperative handgrip strength (19.6 vs. 24.1, p < 0.01) and New KSS score (107 vs. 137, p < 0.01) were lower in group D than in group A.

CONCLUSIONS

Handgrip strength was associated with stair ascent and descent ability and postoperative activity in the patient-reported outcomes, rather than CR-TKA knee sagittal stability.

Mediating role of fruit and vegetable intake and social interaction between oral function and mental health in older adults aged ≥75 years: The SONIC study

PURPOSE

This study aimed to explore the association between oral function and mental health status in older adults and to determine the potential mediating roles of fruit and vegetable intake and social interaction.

METHODS

This cross-sectional study included 478 community-dwelling older adults aged ≥75 years in Japan. Oral functions (occlusal force, masticatory performance, tongue pressure, tongue-lip motor function, and swallowing function), mental health status, dietary assessment, frequency of outings and interactions with others, and the following confounders were evaluated: educational level, financial satisfaction, residential status, comorbidities, and cognitive function. Structural equation modeling was used to assess the following: (a) a basic model, which hypothesized that oral function has a direct effect on mental health status, and (b) a mediation model, which hypothesized that fruit and vegetable intake and social interaction have potential mediating effects on the association between oral function and mental health status.

RESULTS

The basic model revealed a positive direct association between oral function and mental health status (standardized coefficient = 0.10, P = 0.04). Fruit and vegetable intake and social interactions were identified as mediators; however, no direct association with oral function was observed in the mediation model (P = 0.28), indicating that oral function was indirectly associated with mental health status through the mediating effects of fruit and vegetable intake and social interactions.

CONCLUSIONS

Oral function showed a significant association with mental health status in community-dwelling older adults. Fruit and vegetable intake along with social interactions mediate this relationship.

Cross-sectional associations between dietary intake of polyunsaturated fatty acids, physical function, and sarcopenia in community-dwelling older adults

OBJECTIVES

The present study examined the associations between the dietary intake of polyunsaturated fatty acids (PUFAs), physical function, and the prevalence of sarcopenia in Italian community-dwelling older adults.

DESIGN

Cross-sectional study.

SETTING

Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns).

PARTICIPANTS

Older adults (65+ years) who provided a written informed consent.

METHODS

Physical function was evaluated according to isometric handgrip strength (IHG) and 5-time sit-to-stand (5STS) performances. Muscle power parameters were estimated based on 5STS values. Sarcopenia was operationalized according to the presence of low physical function (IHG or 5STS) plus low appendicular skeletal muscle mass (ASM), estimated according to calf circumference. A 12-item food questionary was used to estimate the dietary intake of PUFAs, which included omega-3 (α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid) and omega-6 fatty acids.

RESULTS

Multiple linear regression results indicate negative and significant associations between the dietary intake of α-linolenic acid and muscle power, and between docosahexaenoic acid consumption and ASM. No significant associations were found between PUFAs-related variables and sarcopenia.

CONCLUSIONS

Results of the present study indicate that PUFAs-related variables were negatively and significantly associated with physical function and body composition in older adults. Nevertheless, no significant associations were found with sarcopenia. These findings suggest that a more detailed analysis of covariates should be conducted in future investigations that aim to examine the associations between the dietary intake of PUFAs and sarcopenia-related parameters.

Mobility Medicine: A call to unify hyper-fragmented specialties by abstracts sent to 2025Pdm3, and typescripts to Ejtm3, and Diagnostics

Mega scientific conferences increasingly suffer from the need for short and poster presentations without discussion. An alternative is to organize workshops in hotels large enough to accommodate all participants. This significantly increases the opportunities for constructive discussion during breakfasts, lunches, dinners and long evenings that can bring together experts of scientific and clinical sub-specialties and young fellows. Time for groups' discussions and new collaborations are increased so as the job opportunities for the young researchers. The Padova Muscle Days have offered in the previous thirty-five years these opportunities, which have matured into innovative and multidisciplinary results to the point that it came naturally to underline it with a neologism now included in the title of the 2025 event: "Mobility Medicine", a discipline not yet officially recognised, that makes explicit the call for rejoining knowledges dispersed in sub-specialisations. The included program of the Padua Days on Muscle and Mobility Medicine 2025 (2025Pdm3) will be hosted at the Hotel Petrarca in Euganean Thermae (Padua, Italy) from 25 to 29 March 2025. It further testifies by listing unique Sessions that it is possible to organize valid countermeasures to the inevitable tendencies towards hyperspecialization that the explosive increase in scientific progress brings with it. Furthermore, the European Journal of Translational Myology and Mobility Medicine (Ejtm3) will accept typescripts on results presented at the 2025Pdm3, together with the Special Section: New Trends in Musculoskeletal Imaging of the MDPI (Basel) Journal Diagnostics, because diagnosis is essential to prevent, manage and follow-up not only neuro-metabolic-muscular disorders, but the unavoidable physiologicical decay of performances in early and late aging. Hoping many others share our dreams, we look forward to meeting you at 2025Pdm3 conference.

Diagnostic accuracy of isometric knee extension strength as a sarcopenia criteria in older women

BACKGROUND

Muscle strength is one of the most reliable measures used for the identification of sarcopenia. The European Working Group on Sarcopenia in Older People update (EWGSOP2) proposed the use of grip strength and chair stand tests, while clarifying that isometric torque methods can be used when performing the grip strength test is impossible. This study aims to evaluate the diagnostic accuracy of isometric knee extension strength in screening for sarcopenia.

METHODS

This cross-sectional study included community-dwelling women aged 70 years and over. IKE and sarcopenia criteria (EWGSOP2) were assessed. Skeletal muscle mass was assessed by bioelectrical impedance analysis; muscle mass strength by handgrip; and physical performance by the 5 times sit-to-stand test, the Short Physical Performance Battery, and gait speed. The diagnostic accuracy for each sarcopenia criterion was calculated using sensitivity, specificity, positive and negative predictive value, and the area under the curve (AUC). Cutoff points for sarcopenia from IKE were defined with the ROC curve.

RESULTS

The sample comprised 94 women with a mean age of 75.9 years (standard deviation 5.6, range 70-92), of whom 25.5% (n = 24) met criteria for sarcopenia-mainly severe sarcopenia (73.8%, n = 17). Correlations were observed between IKE and each individually analyzed sarcopenia criterion except skeletal muscle mass, with AUC values exceeding 0.70 in all cases. The IKE cutoff showing the highest accuracy for the diagnosis of sarcopenia was 12.5 kg or less (AUC 0.76, 95% confidence interval [CI] 0.64-0.88; sensitivity: 65.2%, 95% CI 45.7-84.7; specificity 77.4%, 95% CI 60.3-94.5; positive predictive value 62.5%, 95 CI% 42.7-82.3; negative predictive value 88.8%, 95% CI 75.9-100).

CONCLUSIONS

IKE could be a suitable tool for measuring muscular strength in sarcopenia when other strength parameters cannot be assessed or in people with walking difficulties.

Pleiotropic effects on Sarcopenia subphenotypes point to potential molecular markers for the disease

Sarcopenia is a progressive age-related muscle disease characterized by low muscle strength, quantity and quality, and low physical performance. The clinical overlap between these subphenotypes (reduction in muscle strength, quantity and quality, and physical performance) was evidenced, but the genetic overlap is still poorly investigated. Herein, we investigated whether there is a genetic overlap amongst sarcopenia subphenotypes in the search for more effective molecular markers for this disease. For that, a Bioinformatics approach was used to identify and characterize pleiotropic effects at the genome, loci and gene levels using Genome-wide association study results. As a result, a high genetic correlation was identified between gait speed and muscle strength (rG=0.5358, p=3.39 × 10-8). Using a Pleiotropy-informed conditional and conjunctional false discovery rate method we identified two pleiotropic loci for muscle strength and gait speed, one of them was nearby the gene PHACTR1. Moreover, 11 pleiotropic loci and 25 genes were identified for muscle mass and muscle strength. Lastly, using a gene-based GWAS approach three candidate genes were identified in the overlap of the three Sarcopenia subphenotypes: FTO, RPS10 and CALCR. The current study provides evidence of genetic overlap and pleiotropy among sarcopenia subphenotypes and highlights novel candidate genes and molecular markers associated with the risk of sarcopenia.

Factors associated with handgrip strength across the life course: A systematic review

BACKGROUND

Muscle strength is essential for healthy ageing. Handgrip strength (HGS) has been recommended by expert bodies as the preferred measure of muscle strength, in addition to being considered a strong predictor of overall health. Cross-sectional studies have shown several potential factors associated with HGS, but a systematic review of factors predicting HGS over time has not previously been conducted. The aim of this study is to systematically review the literature on the factors associated with adult HGS [at follow-up(s) or its rate of change] across the life course.

METHODS

Searches were performed in MEDLINE via Ebsco, Embase and SPORTDiscus databases. Longitudinal studies assessing potential factors impacting adult HGS over time were included in the analyses. Based on previously established definitions of consistency of results, a semiquantitative analysis was conducted using the proportions of studies supporting correlations with HGS.

RESULTS

A total of 117 articles were included in this review. Factors associated with HGS were grouped into 11 domains: demographic, socioeconomic, genetic, early life, body composition, health markers/biomarkers, health conditions, psychosocial, lifestyle, reproductive and environmental determinants. Overall, 103 factors were identified, of which 10 showed consistent associations with HGS over time (i.e., in at least four studies with ≥60% agreement in the direction of association). Factors associated with greater declines in HGS included increasing age, male sex, higher levels of inflammatory markers and the presence of cardiovascular diseases. Education level, medication use, and self-rated health were not associated with the rate of change in HGS. Increased birth weight was associated with a stronger HGS over time, whereas depressive symptoms were linked to a weaker HGS, and smoking habits showed null associations.

CONCLUSIONS

Comparison between studies and estimation of effect sizes were limited due to the heterogeneity in methods. Although sex and age may be the main drivers of HGS decline, it is crucial to prioritize modifiable factors such as inflammation and cardiovascular diseases in health interventions to prevent greater losses. Interventions to improve birth weight and mental health are also likely to produce positive effects on muscle strength. Our results point to the complexity of processes involving muscle strength and suggest that the need to better understand the determinants of HGS remains.

Mitochondrial quality control measures, systemic inflammation, and lower-limb muscle power in older adults: a PROMPT secondary analysis

OBJECTIVES

The study was conducted to explore associations between markers of mitochondrial quality control (MQC) from vastus lateralis muscle biopsies, serum inflammatory markers, and measures of muscle power assessed by two different tools in a sample of older adults.

DESIGN

Secondary analysis of data collected in the PeppeR develOpMental ProjecT (PROMPT) at the University of Florida (Gainesville, FL, USA).

METHODS

Forty-three older adults (n = 20 women) were included in the study. Muscle volume of the calf and thigh was quantified by three-dimensional magnetic resonance imaging. Lower-limb muscle power was estimated using 5-time sit-to-stand (5STS) muscle power equations and isokinetic test. Protein markers of MQC were measured in muscle samples by Western immoblotting (n = 12-23), while type I and II fiber cross-sectional area (CSA) and their proportion were quantified using immunohistochemistry (n = 12). Cytochrome C oxidase enzyme activity was measured spectrophotometrically. Finally, inflammatory markers were quantified in the serum using a multiplex immunoassay (n = 39).

RESULTS

Mean age of participants was 78.1 ± 5.5 years, and the average body mass index was 26.2 ± 4.5 kg/m2. Markers of mitochondrial biogenesis (i.e., PGC-1α), mitochondrial import proteins (i.e., cHsp70 and mtHsp70), and type I fiber CSA were significantly associated with muscle power estimated via both 5STS muscle power equations and isokinetic test (p < 0.05). Specific associations were also found according to the muscle power assessment method. 5STS muscle power measures were negatively correlated with ClvCasp3, P-AMPK, T-AMPK, P-p38, GM-CSF, INF-γ, IL1b, IL6, IL8, and TNF-α, whereas positive associations were found with BAX (p < 0.05). In contrast, isokinetic measures were significantly and positively correlated with RIP140, Hsp60, and type II muscle fiber CSA (p < 0.05).

CONCLUSIONS

Markers of mitochondrial biogenesis (PGC-1α), mitochondrial import proteins (cHsp70 and mtHsp70), and type I muscle fiber CSA were significantly linked to lower-limb muscle power in older adults. These results suggest that muscle power is influenced by mitochondrial signaling. We also found that the relationship between mitochondrial mediators, inflammatory markers, and muscle power varied according to the assessment tool used.

Thresholds of handgrip strength for all-cause mortality in patients with chronic kidney disease: a secondary systematic review with dose-response meta-analysis

BACKGROUND

Although handgrip strength is associated with all-cause mortality in patients with chronic kidney disease (CKD), whether this relationship is dose-related is unknown. Therefore, we examined dose-response relationships between handgrip strength and all-cause mortality in CKD patients based on previous studies by meta-analysis.

METHODS

Data sources included three electronic databases (PubMed, Web of Science, and Embase) from inception through October 2023. The included cohort was a CKD population not limited to disease stage, and their handgrip strength was objectively measured. Two researchers independently screened studies, extracted data, and assessed the risk of bias. We utilized estimates of handgrip strength categories using robust-error meta-regression (REMR), pooled study-specific estimates, and established dose-response relationships. Outcomes of interest included only all-cause mortality.

RESULTS

A total of 18 studies with 4810 participants (aged 47-71 years) were included. REMR modeling showed a U-shaped trend of association between handgrip strength and all-cause mortality in patients with CKD. Higher handgrip strength values, from 10 kg to approximately 28 kg, were associated with lower mortality risk. After that, the risk of death increased slightly.

CONCLUSION

A U-shaped association exists between handgrip strength and all-cause mortality risk in CKD patients. Future studies with quantitative measurements for each CKD stage will help to determine precise relative risk estimates between handgrip strength and mortality risk in patients with different stages of CKD.

Sarcopenia and sleep in individuals with chronic obstructive pulmonary disease

OBJECTIVE

To verify the relationship between sarcopenia and sleep in individuals with chronic obstructive pulmonary disease (COPD).

METHODS

Individuals with COPD were cross-sectionally assessed for lung function (spirometry), sleep (both subjectively [Pittsburgh Sleep Quality Index, PSQI] and objectively [Actiwatch sleep monitor]) and the presence of sarcopenia (handgrip strength by dynamometry). All tests were carried out in accordance with international standards.

RESULTS

Twenty-nine individuals with COPD were analyzed (16 women; 69 ± 7 years; BMI 27 ± 5 kg/m2; FEV1 59 ± 19% predicted). Upon division in groups according to the presence or absence of sarcopenia, individuals with sarcopenia (in comparison to those without sarcopenia) had shorter sleep time (81 [75-85] vs. 86 [81-90] %; p = 0.043), lower sleep efficiency (77 [69-83] vs. 85 [75-87] %; p = 0.038), longer time awake after sleep onset (92 [71-120] vs. 58 [47-83] minutes; p = 0.0012) and more marked sleep fragmentation, represented by a higher number of sleep blocks/night (46 [41-49] vs. 34 [26-48]; p = 0.018), higher number of awake blocks/night (45 [40-49] vs. 34 [26-48]; p = 0.018) and shorter duration of sleep blocks/night (9 [8-10] vs. 14 [8-58] minutes; p = 0.043). There was no statistical difference when comparing the PSQI variables between the groups. However, handgrip strength was negatively associated with PSQI components 2 [R= -0.51, p = 0.005] and 5 [R= -0.39, p = 0.037].

CONCLUSION

Individuals with COPD and sarcopenia (as measured by handgrip strength) have worse objectively measured sleep outcomes. This was not the case regarding a self-reported perception of worse sleep quality, although there was weak-to-moderate association between handgrip strength and subjective sleep.

Minimum Electromyography Sensor Set Needed to Identify Age-Related Impairments in the Neuromuscular Control of Walking Using the Dynamic Motor Control Index

The dynamic motor control index is an emerging biomarker of age-related neuromuscular impairment. To date, it has been computed by quantifying the co-activity of eleven lower limb muscles. Because clinics that routinely employ electromyography typically collect from fewer muscles, a reduced muscle sensor set may improve the clinical usability of this metric of motor control. This study aimed to test if commonly used eight- and five-muscle electromyography (EMG) sensor sets produce similar dynamic motor control indices as the previously examined eleven-muscle sensor set and similarly differentiate across age subgroups. EMG data were collected during treadmill walking from 36 adults separated into young (N = 18, <35 yrs.), young-old (N = 13, 65-74 yrs.), and old-old (N = 5, ≥75 yrs.) subgroups. Dynamic motor control indices generated using the sensor set with eleven muscles correlated with the eight-muscle set (R2 = 0.70) but not the five-muscle set (R2 = 0.30). Regression models using the eleven-muscle (χ2(4) = 10.62, p = 0.031, Nagelkerke R2 = 0.297) and eight-muscle (χ2(4) = 9.418, p = 0.051, Nagelkerke R2 = 0.267) sets were significant and approaching significance, respectively, whereas the model for the five-muscle set was not significant (p = 0.663, Nagelkerke R2 = 0.073). In both the eleven-muscle (Wald χ2 = 5.16, p = 0.023, OR = 1.26) and eight-muscle models (Wald χ2 = 4.20, p = 0.04, OR = 1.19), a higher index significantly predicted being in the young group compared to the old-old group. Age-related differences in the neuromuscular control of walking can be detected using dynamic motor control indices generated using eleven- and eight-muscle sensor sets, increasing clinical usability of the dynamic motor control index.

Dynapenia and sarcopenia identify walking speed decline in women but not in men

OBJECTIVE

To determine the best indicator of mobility decline between dynapenia, low skeletal muscle mass index (SMMI), and sarcopenia defined by the EWGSOP2 using different cutoff points for grip strength.

METHODS

A longitudinal study was conducted with a follow-up of eight years, involving 2,680 individuals aged 60 and older who participated in the ELSA study with a walking speed greater than 0.8 m/s at baseline. Dynapenia was defined using different cutoff points for grip strength. SMMI was defined by the 20th percentile of the entire ELSA sample distribution and sarcopenia was defined based on the EWGSOP2, using different cutoff points for grip strength. Mobility was analysed using the walking speed test.

RESULTS

Over time, the greatest decline in walking speed occurred in dynapenic women with grip strength < 17 kg (-0.005 m/s per year; 95 % CI: -0.01 to -0.001) and < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001). With regards to sarcopenia, the greatest walking speed decline occurred in women with probable sarcopenia when defined by grip strength < 17 kg [(-0.006 m/s per year; 95 % CI: -0.01 to -0.001) or grip strength < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001)]. Dynapenia in men as well as low SMMI and sarcopenia in men and women did not enable identifying the risk of mobility decline.

CONCLUSION

Dynapenia and probable sarcopenia defined by grip strength < 17 kg and < 20 kg enabled identifying walking speed decline over time only in women.

Long-Term Physical Activity Mitigates Inflammaging Progression in Older Adults Amidst the COVID-19 Pandemic

BACKGROUND

Inflammaging and physical performance were investigated in older adults before and after the COVID-19 pandemic.

METHODS

Older women (n = 18) and men (n = 7) (mean age = 73.8 ± 7.1) were evaluated before the COVID-19 pandemic (PRE), 12 months after the lockdown (POST), and 10 months after resuming exercise training (POST-TR). Physical tests [gait speed (GS) and timed-up-and-go (TUG)]; muscle strength (handgrip-HG); and serum cytokine levels were assessed.

RESULTS

Older women showed higher GS and TUG at POST than PRE and POST-TR but lower HG at POST-TR than PRE, whereas older men exhibited lower HG at POST and POST-TR than PRE. Both groups presented (1) lower IL-10 and IL-12p70 values in contrast to higher IL-6/IL-10 and IL-8/IL-10 ratios at POST than PRE; (2) higher IL-10 values and lower IL-8/IL-10 ratio at POST-TR than POST; (3) higher IL-12p70/IL-10 ratio at POST-TR than PRE and POST. Particularly, older women showed (4) lower IL-6 values at POST and POST-TR than PRE; (5) lower IL-8 and IL-10 values at POST-TR than POST; (6) and higher TNF-α/IL-10 and IFN-γ/IL-10 ratios at POST than PRE and POST-TR. Significant correlations between the variables were found in both groups.

DISCUSSION

During the COVID-19 pandemic, detraining and resumption of exercise training promoted distinct alterations in physical capacity and inflammaging among older women and older men.

Cerebral small vessel disease and its relationship with all-cause mortality risk: Results from the Amsterdam Ageing cohort

INTRODUCTION

Cerebral Small-Vessel Disease (CSVD) is a complex condition affecting the brain's vascular network, linked to cognitive and physical decline, cerebrovascular disease, and death. This study assesses the relationship between CSVD (composite and individual features) and all-cause mortality in a large cohort of geriatric outpatients.

METHODS

Data from 1305 geriatric outpatients (mean age 78 ± 7; 51 % female) in the Amsterdam Ageing cohort were analysed. CSVD presence was based on brain imaging (MRI or CT), defined by a Fazekas score ≥ 2, presence of ≥1 lacunes, or (in MRI) ≥ 3 microbleeds. Mortality data (February 2016 - January 2024) was sourced from the Dutch Municipality Register. The relationship between CSVD and all-cause mortality was evaluated using a Cox proportional-hazards model, adjusting for key confounders.

RESULTS

At baseline, 835 (64 %) of the 1305 patients had CSVD. During a median follow-up of 3.1 years (IQR 1.6-4.6 years), all-cause mortality was 40 % (333 patients) in the CSVD group and 26 % (121 patients) in the non-CSVD group, corresponding with incidence rates of 137 and 78 per 1000 patient-years, respectively. The age- and sex-adjusted hazard ratio for mortality in the CSVD group was 1.6 (95 % CI: 1.3-2.0). This association remained significant after adjusting for cardiovascular disease and its risk factors, physical function (gait speed), and cognitive function (MMSE).

CONCLUSION

Radiographic CSVD presence is prevalent and its integration into daily care is important as it is independently linked to increased all-cause mortality in geriatric outpatients.

The impact of nutritional intervention on quality of life and outcomes in patients with head and neck cancers undergoing chemoradiation

Introduction

Chemoradiotherapy in head and neck cancer patients has a curative intent but often deteriorates nutritional status leading to sarcopenia and cachexia.

Methods

In this observational and single-centered study, a prospective evaluation of several biochemical and anthropometrical parameters, weight loss, handgrip strength, visual analogue scale of appetite, questionnaires associated with malnutrition & quality of life and body composition (obtained by Bioelectrical Impedance Vector Analysis) was performed before and after high-dose cisplatin chemotherapy combined with radiotherapy in 60 patients affected by head and neck cancer. Oral nutritional supplements were used to reach the correct number of daily calories and proteins.

Results and discussion

All patients completed radiotherapy as planned and the 96,4% of them did not interrupt chemotherapy for toxicity, reaching a total dose of at least 200mg/m2. Despite a rapid deterioration of body composition during treatment, nutritional support helped patients to maintain (or in some cases improve) anthropometric parameters from the end of chemoradiotherapy to the following 3 months. Low prealbumin and albumin pre-treatment led to higher risk of toxicities with consequent reduction of cisplatin dose intensity, whereas weight at the end of the treatment seems to be an interesting predicting factor for disease free and overall survival (p=0.007; p=0.015).

Increased knee-extension strength and steps per day after a novel post-hospitalization rehabilitative program in older adults (65+): Secondary analyses of a randomized controlled single-blinded trial using an expanded sample size

INTRODUCTION

Older adults are at risk of developing new or worsened disability when hospitalized for acute medical illness. This study is a secondary analysis of the STAND-Cph trial on the effect of a simple strength training intervention initiated during hospitalization and continued after discharge. We investigated the between-group difference in change in functional performance outcomes, the characteristics of patients who experienced a relevant effect of the intervention, and the characteristics of those who were compliant with the intervention, using an expanded sample size as protocolized.

METHODS

The STAND-Cph was a randomized controlled trial conducted at a major Danish university hospital. Acutely admitted older adult patients (65+) from the Emergency Department were randomized to the intervention group receiving progressive strength training and a protein supplement during and after hospitalization (12 sessions over 4 weeks) or control group receiving usual care. The primary outcome was the de Morton Mobility Index assessed at baseline and 4 weeks after discharge. The secondary outcomes were 24-h mobility (assessed by ActivPAL accelerometers), isometric knee-extension strength, 30 s. sit-to-stand performance, and habitual gait speed.

RESULTS

Between September 2013 and September 2018, a total of 158 patients were included and randomized to either the intervention group (N = 80; mean age 79.9 ± 7.6 years) or the control group (N = 78; mean age 80.8 ± 7.4 years). We found no significant between-group difference in change in our primary outcome (p > 0.05). Both the intention-to-treat (difference in change 0.14 Nm/kg (95 % CI 0.03;0.24), p = 0.01) and the per protocol (difference in change 0.16 Nm/kg (95 % CI 0.04;0.29), p = 0.008) analyses showed that between baseline and 4 weeks, knee-extension strength increased significantly more in the intervention group than in the control group. Also, the per protocol analysis showed that the intervention group increased their daily number of steps significantly more than the control group (difference in change 1088 steps (95 % CI 44; 2132); p = 0.04). When examining subgroups of patients, we found no significant differences neither between those who experienced a clinically relevant improvement in the de Morton Mobility Index and those who did not, nor between those who were compliant and those who were not.

CONCLUSION

This exploratory analysis indicates that while simple progressive strength training and protein supplementation does not improve functional performance assessed by the de Morton Mobility Index, it can benefit specific facets of physical activity and muscle strength among geriatric patients.

Application of a new definition of sarcopenic obesity in middle-aged and older adults and association with cognitive function: Findings from the National Health and Nutrition Examination Survey 1999-2002

BACKGROUND & AIMS

The role of sarcopenic obesity (SO) in impaired cognitive function has been investigated in several observational studies, but results have been mixed. This study applied the proposed European Society for Clinical Nutrition and Metabolism (ESPEN)-European Association for the Study of Obesity (EASO) definition of SO to a representative population aged ≥50 years to identify the association between SO and cognitive function.

METHODS

Data from the National Health and Nutrition Examination Survey 1999-2002 waves were used. At the screening phase, body mass index or waist circumference were used to evaluate obesity; sarcopenia was identified using the SARC-F questionnaire. At the diagnostic phase I and II, sarcopenia was assessed using knee extensor isometric strength and appendicular lean mass, and fat mass percent was used to assess obesity. Cognitive function in older participants (60-85 years) was assessed using the Digit Symbol Substitution Test. A self-reported memory question was used in middle-aged individuals (50-59 years).

RESULTS

The sample included 2356 participants (men, 44.7%). The prevalence of SO was 32.3%, 21.2% and 15.0% at the screening, diagnosis I, and diagnosis II, respectively. Significant associations between SO and cognitive impairment were observed in individuals aged 60-85 at diagnosis I (OR: 2.3, 95%CI 1.4-3.8, P = 0.007) and diagnosis II (OR: 2.7, 95%CI 1.5-4.9, P = 0.004).

CONCLUSION

The new ESPEN-EASO definition of SO identified a high prevalence of SO cases. A significant association between SO and poor cognitive function in older individuals was observed.

Comparison of the masses and amounts of intramuscular non-contractile tissue of the lower extremity muscles, mobility and balance ability, and cognitive function between older adults with and without low back pain: A pilot study

INTRODUCTION

This study compared the masses and amounts of intramuscular non-contractile tissue of multiple lower extremity muscles measured using an ultrasound imaging device, as well as the mobility and balance ability and cognitive function between community-dwelling older adults with and without low back pain (LBP).

METHODS

Twenty-five community-dwelling older adults were classified into control (CTR) (n = 17, asymptomatic) and LBP (n = 8) groups. The current LBP status in the LBP group was as follows: duration period: 99.4 ± 81.3 months, Numerical Rating Scale: 4.8 ± 0.9, and Oswestry Disability Index: 15.3 ± 10.4%. The thicknesses and the echo intensities of various muscles (gluteus maximus, medius, and minimus; rectus femoris; vastus intermedius and lateralis; long and short heads of the biceps femoris; semitendinosus; semimembranosus; tibialis anterior; medial head of the gastrocnemius; soleus; and tibialis posterior) were measured using an ultrasound imaging device. Mobility and balance ability were assessed by measuring the usual and maximal walking speeds, timed up-and-go time, five-chair-stand time, and one-legged stance time. Mini-Mental State Examination scores were also assessed.

RESULTS

The gluteus medius muscle thickness was significantly lower in the LBP group than in the CTR group. The thicknesses and echo intensities of the other lower extremity muscles did not differ significantly between the CTR and LBP groups. The usual walking speed was also significantly slower in the LBP group than in the CTR group. Balance ability and cognitive function did not differ significantly between the two groups.

CONCLUSION

The results of the present study demonstrated lower gluteus medius muscle mass and slower usual walking speed in community-dwelling older adults with LBP compared to those in older adults without LBP; however, other variables did not differ significantly between these groups.