Sarcopenia: Aging-Related Loss of Muscle Mass and Function

Improved skeletal muscle mass and strength through Protamex-mediated hydrolysis of perilla seed cake: Elevated rosmarinic acid levels as a contributing factor

Perilla seed cake (PSC) is a byproduct of oil extraction from perilla seeds. It is rich in proteins and bioactive compounds. PSC was enzymatically hydrolyzed to form PSC hydrolysate (PSCH) to enhance the absorption of PSC, and their effects on muscle health in mice were compared. High performance liquid chromatography-tandem mass spectrometry analysis revealed that PSC contains several polyphenols, including rosmarinic acid (RA), caffeic acid, apigenin, and luteolin. The hydrolysate showed 1.44- and 7.04-fold increases in RA and caffeic acid contents, respectively, compared to those of PSC. The intake of PSC, PSCH, and RA significantly improved muscle mass and exercise performance in mice by upregulating protein synthesis, myogenic differentiation, oxidative muscle fiber formation, fatty acid oxidation, and mitochondrial biogenesis; however, PSCH had better promoting effects than PSC. In conclusion, PSCH improves muscle health through its bioactive compounds (particularly RA), indicating the potential of PSCH and RA in functional foods.

The influence of workload on muscle fatigue, tissue properties, and postural stability in older and younger workers

Demographic aging and extended working lives have prompted interest in the physiological changes that occur with age, particularly in the lumbar spine. Age-related declines in muscle quality and intervertebral disc alterations may reduce muscular endurance, strength, and postural stability, potentially increasing the risk of musculoskeletal injuries in older workers. As experienced workers play an important role in addressing labor shortages, understanding the impact of age-related physiological changes on the biomechanical properties of the lumbar spine is key to ensure safe and sustainable employment for aging individuals. This study aimed to compare the impact of daily work-related physical efforts on lumbar muscular endurance and fatigue, spine tissue properties, and postural stability between older and younger workers. A total of 40 participants, 20 in Group 1 (young workers: ≤50 years; mean age: 28.89 ± 7.23) and 20 in Group 2 (older workers: >50 years; mean age: 59.40 ± 5.29) were recruited. Measurements taken at the beginning and end of the workday included lumbar muscle endurance, maximal voluntary contraction, disc height and postural stability. Age groups were compared using repeated measures ANOVA across the two measurement times. No significant interaction between age and time of day was observed, indicating that, for similar workload, both age groups experienced similar changes. Despite age-related effects on maximal force production and postural stability, incorporating weight as a covariate revealed that these differences were partially explained by the weight discrepancy between older and younger workers. The study suggests that age may not be the primary determinant of the impact of a workday on older workers.

Automatic assessment of body composition in children with lymphoma: results of a [18F]FDG-PET/MR study

OBJECTIVES

To use Dixon-MR images extracted from [18F]FDG-PET/MR scans to perform an automatic, volumetric segmentation and quantification of body composition in pediatric patients with lymphoma.

MATERIALS AND METHODS

Pediatric patients with lymphoma examined by [18F]FDG-PET/MR at diagnosis and restaging were included. At each time point, axial fat and water Dixon T1w images of the thighs were automatically segmented and muscle volume, subcutaneous, intramuscular, and intermuscular fat volume were quantified. The metabolic activity of the largest nodal lesion and of muscles and subcutaneous fat was recorded. The paired samples t-test and Spearman's correlation coefficient were applied to evaluate potential differences between the two time points and the relationship between metabolic and body composition metrics, respectively. By logistic regression analysis, the prognostic role of the investigated variables was assessed. The applied significance level was p < 0.05 for all analyses.

RESULTS

Thirty-seven patients (mean age ± SD 14 ± 3-years-old; 20 females) matched the inclusion criteria. After chemotherapy (interval between the two PET/MR scans, 56-80 days; median 65 days), muscle volume significantly decreased (629 ± 259 cm3 vs 567 ± 243 cm3, p < 0.001) while subcutaneous, intramuscular and intermuscular fat increased (476 ± 255 cm3 vs 607 ± 254 cm3, p < 0.001; 63 ± 20 cm3 vs 76 ± 26 cm3, p < 0.001; 58 ± 19 cm3 vs 71 ± 23 cm3, p < 0.001); the metabolic activity of the main nodal lesion, muscles, and subcutaneous fat significantly decreased (p < 0.05, each). None of the examined variables acted as predictors of the response to treatment (p = 0.283). A strong correlation between BMI and subcutaneous fat volume at diagnosis (r = 0.675, p < 0.001) and restaging (r = 0.600, p < 0.001) emerged.

CONCLUSIONS

The proposed method demonstrated that pediatric patients with lymphoma undergo muscle loss and an increase of subcutaneous fat during treatment.

CLINICAL RELEVANCE STATEMENT

The proposed automatic and volumetric MR-based assessment of body composition in children with lymphoma can be used to monitor the effect of chemotherapy and may guide tailored exercise programs during chemotherapy.

KEY POINTS

T1w Dixon images can be used for the automatic segmentation and quantification of body composition. Muscle and subcutaneous fat volume do not act as predictors of the response to treatment in children with lymphoma. Chemotherapy induces changes in body composition in children with lymphoma.

Alterations in neuromuscular junction morphology with ageing and endurance training modulate neuromuscular transmission and myofibre composition

Both ageing and exercise training affect the neuromuscular junction (NMJ) structure. Morphological alterations in the NMJ have been considered to influence neuromuscular transmission and myofibre properties, but the direct link between the morphology and function has yet to be established. We measured the neuromuscular transmission, myofibre composition and NMJ structure of 5-month-old (young) and 24-month-old untrained (aged control) and trained (aged trained) mice. Aged trained mice were subjected to 2 months of endurance training before the measurement. Neuromuscular transmission was evaluated in vivo as the ratio of ankle plantar flexion torque evoked by the sciatic nerve stimulation to that by direct muscle stimulation. The torque ratio was significantly lower in aged mice than in young and aged trained mice at high-frequency stimulations, showing a significant positive correlation with voluntary grip strength. The degree of pre- to post-synaptic overlap of the NMJ was also significantly lower in aged mice and positively correlated with the torque ratio. We also found that the proportion of fast-twitch fibres in the soleus muscle decreased with age, and that age-related denervation occurred preferentially in fast-twitch fibres. Age-related denervation and a shift in myofibre composition were partially prevented by endurance training. These results suggest that age-related deterioration of the NMJ structure impairs neuromuscular transmission and alters myofibre composition, but these alterations can be prevented by structural amelioration of NMJ with endurance training. Our findings highlight the importance of the NMJ as a major determinant of age-related deterioration of skeletal muscles and the clinical significance of endurance training as a countermeasure. KEY POINTS: The neuromuscular junction (NMJ) plays an essential role in neuromuscular transmission and the maintenance of myofibre properties. We show that neuromuscular transmission is impaired with ageing but recovered by endurance training, which contributes to alterations in voluntary strength. Neuromuscular transmission is associated with the degree of pre- to post-synaptic overlap of the NMJ. Age-related denervation of fast-twitch fibres and a shift in myofibre composition toward a slower phenotype are partially prevented by endurance training. Our study provides substantial evidence that age-related and exercise-induced alterations in neuromuscular transmission and myofibre properties are associated with morphological changes in the NMJ.

Effects of education given in the menopausal period on the day-to-day impact of vaginal aging, self-efficacy in sexual abstinence and sexual distress: A randomized clinical trial

Despite physiological differences, women have to struggle with many problems related to menopause. It is the responsibility of nurses to provide women with the information and guidance they need during this period. Study was carried out to investigate the effects of education given in the menopausal period on the day-to-day impact of vaginal aging, self-efficacy in sexual abstinence, and sexual distress. This randomized controlled study was conducted at a center operated by a local municipality that provides services only to women, between 01.09.2023-10.12.2023 with 62 women (experimental:31, control:31). The data were collected using a "Personal Information Form," the "Day-to-Day Impact of Vaginal Aging Questionnaire-DIVA," the "Self-Efficacy Scale for Sexual Abstinence-SESSA," and the "Female Sexual Distress Scale-FSDS." ANOVA, independent-samples t-tests, paired-samples t-tests, and regression analyses were used to analyze the data. After the pretest, the experimental group were given education by the researcher in weekly sessions lasting 50/min. each for 5 weeks. In the posttest, the forms were administered 45 days after the last education session. There were significant differences between the experimental group in terms of their mean posttest DIVA (11.10 ± 2.65; 8.94 ± 1.65), FSDS (39.11 ± 9.07; 31.48 ± 10.27) and SESSA (17.85 ± 5.36; 21.25 ± 10.49 total scores (p < .001), while there was no significant difference between the pre-posttest of the control group (p < .05). Additionally, age was found to be a significant predictor of DIVA, whereas education level and marital satisfaction status were significant predictors of their SESSA. Education provided to women reduced the day-to-day impact of vaginal aging and sexual distress levels of the women and increased their self-efficacy in sexual abstinence.

Irisin alters D-galactose-induced apoptosis by increasing caveolin-1 expression in C2C12 myoblasts and skeletal muscle fibroblasts

Muscle atrophy and skeletal muscle fibrosis are significant pathological manifestations of primary sarcopenia. The regulation of C2C12 myoblast and skeletal muscle fibroblast apoptosis is associated with these pathological changes. Previous studies have indicated that irisin, the cleaved form of fibronectin type III domain-containing protein 5 (FNDC5), can alleviate primary sarcopenia. However, the mechanisms of the effect of irisin in age-related apoptosis remain unknown. Our present research aimed to explore the effect of irisin and the underlying mechanism of D-galactose (D-gal)-induced apoptosis in skeletal muscle fibroblasts and C2C12 myoblasts. We found the opposite effects of D-gal on C2C12 myoblasts and fibroblasts. We also found that irisin suppressed C2C12 cell apoptosis and promoted fibroblast apoptosis. Mechanistically, irisin altered D-gal-induced apoptosis by increasing caveolin-1 expression. Taken together, these findings further demonstrated that irisin is a potential agent that can treat aged-relative muscle atrophy and fibrosis.

The relationship between thigh circumference and sarcopenia in Chinese community-dwelling elderly aged ≥60 years

Background

There has been a growing body of research demonstrating that thigh circumference is closely associated with the development of various chronic disease. However, limited evidence has been obtained regarding the relationship between thigh circumference and sarcopenia.

Objective

The aim of this study was to investigate the relationship between thigh circumference and sarcopenia, and explore the potential role of thigh circumference for sarcopenia screening among community-dwelling older adults.

Methods

The investigation was carried out in six rural communities located in northwestern China with participants aged ≥60 years old. We collected variables related to sarcopenia, including function, muscle mass, and strength. The thigh circumference was categorized into four groups based on quartiles, with the first quartile (≤46.65 cm); the second quartile (46.66-48.50 cm); the third quartile (48.51-50.55 cm); and the fourth quartile (>50.55 cm). The associations and screening effect were estimated with multivariate logistics regression and ROC curves.

Results

Of the 1000 participants aged 70.72 ± 4.68 years. Compared with the first quartile (≤46.65 cm), the odds ratios for the second, third, and fourth quartiles of thigh circumference were 0.465 (95%CI: 0.281-0.770, p = 0.003), 0.199 (95%CI: 0.097-0.407, p < 0.001), and 0.059 (95%CI: 0.016-0.220, p < 0.001), respectively. The regression results were consistent across different sexes. The AUC and cutoff values of thigh circumference for sarcopenia were 0.873 (95 % CI 0.836-0.909, p < 0.001) and 48.83 cm for men and 0.861 (95 % CI 0.822-0.900, p < 0.001) and 46.78 cm for women. There was a positive correlation between thigh circumference and skeletal muscle mass (r = 0.747, p < 0.001), hand grip strength (r = 0.337, p < 0.001), and gait speed (r = 0.142, p < 0.001), while a negative correlation was observed with five-times-sit-to-stand test (r = -0.073, p = 0.021).

Conclusion

There was a negative correlation between thigh circumference and sarcopenia, suggesting that thigh circumference may serve as a potential useful indicator for sarcopenia screening in the elderly.

Plasma biomarkers in patients with age-related sarcopenia: a proteomic exploration and experimental validation

BACKGROUND

Various biomarkers associated with sarcopenia have been identified. However, there is a scarcity of studies exploring and validating biomarkers in individuals with age-related sarcopenia.

AIMS

This study aimed to investigate the proteome and identify potential biomarkers for age-related sarcopenia.

METHODS

Proteomic analysis and experimental validation were conducted using plasma from hospitalized older adults. Sarcopenia diagnosis was based on the Asian Working Group for Sarcopenia 2019 criteria. Data-independent acquisition-based proteomics was performed on plasma from 60 participants, with 30 diagnosed with sarcopenia and 30 without sarcopenia. Differentially expressed proteins (DEPs) were selected and evaluated by Receiver Operating Characteristic (ROC) analysis. Biomarker candidates were further quantitatively validated by enzyme-linked immunosorbent assay (ELISA) utilizing plasma from 6 participants with sarcopenia and 6 without sarcopenia.

RESULTS

A total of 39 DEPs were identified and 12 DEPs were selected for ROC analysis. 8 DEPs were included for ELISA validation based on their predictive performance. Paraoxonase-3 (PON3) consistently showed down-regulation in the sarcopenic group across both methodologies. Insulin-like growth factor-binding protein-2 (IGFBP2) showed inconsistency in the sarcopenic group, with up-regulation observed in proteomic analysis but down-regulation in ELISA.

DISCUSSION

Decline in PON3 may result in an overload of oxidative stress in skeletal muscles and contribute to sarcopenia. Protein modifications of IGFBP2 might exhibit during sarcopenia pathogenesis.

CONCLUSIONS

Plasma proteins are implicated in sarcopenia pathogenesis. PON3 is highlighted as a potential biomarker for patients with age-related sarcopenia. Further studies are imperative to gain an in-depth understanding of PON3 and IGFBP2.

Poor sleep quality is associated with probable sarcopenia in community-dwelling older adults: Results from the longevity check-up (lookup) 8

BACKGROUND

Poor sleep quality may contribute to sarcopenia, but evidence remains sparse. This retrospective cross-sectional study investigated the association between subjective sleep quality and probable sarcopenia in a cohort of community-dwelling older adults enrolled in the Longevity Check-Up 8+ study.

METHODS

Participants were asked about their sleep quality over the past month, with four possible options ("very good", "quite good", "quite bad", very bad"). For the analysis, participants were grouped into good or bad sleep quality categories. Probable sarcopenia was operationalized according to handgrip strength values < 27 kg for men and < 16 kg for women. Logistic regression models were used to explore the relationship between sleep quality and probable sarcopenia.

RESULTS

1971 participants were included in the analysis (mean age 73.4 ± 6.2 years, 50.0 % women). Bad sleep quality was reported by 28.3 % of participants and was more prevalent among women, physically inactive individuals, and those with dyslipidemia. Probable sarcopenia was more prevalent in participants with bad sleep quality (23.8 % vs. 18.7 %, p = 0.012). Logistic regression revealed that bad sleep quality was significantly associated with increased odds of probable sarcopenia in both unadjusted (odds ratio [OR] 1.36, 95 % confidence interval [CI] 1.07-1.72, p = 0.010) and fully adjusted models (OR 1.40, 95 % CI 1.08-1.81, p = 0.011).

CONCLUSIONS

Poor sleep quality is associated with increased likelihood of probable sarcopenia in older adults. This finding highlights the importance of addressing sleep quality in interventions aimed at preventing sarcopenia and promoting healthy aging.

The relationship between body mass index changes and mortality in geriatric peritoneal dialysis patients: a case-control study

BACKGROUND

The prevalence of chronic kidney disease (CKD) is increasing, reflecting the rising incidence of chronic diseases. With the continuous growth of the global geriatric population, a significant portion of individuals with CKD consists of those aged over 65. Regardless of the chosen treatment method, protein-energy loss in patients undergoing renal replacement therapy (RRT) has been associated with elevated morbidity and mortality rates.

METHODS

This is a retrospective, single-center study of incident adult PD patients on peritoneal dialysis (PD) from 1998 to 2022. We aimed to compare the survival outcomes of geriatric patients on PD with changing BMI measurements.

RESULTS

In the geriatric patient group exhibiting a reduced BMI after dialysis initiation, BMI significantly and negatively influenced survival (p = 0.01). The negative effect of BMI on survival was independent of known risk factors such as diabetes mellitus, a history of cardiovascular disease, gender, residual renal function, and history of hemodialysis before peritoneal dialysis (HD before PD) (p = 0.04).

CONCLUSION

Although BMI is easy and extensively measured, it is not considered the perfect monitoring parameter for dialysis patients. However, regular follow-up of BMI, especially in geriatric cases, can be a guiding tool for estimating patients' prognoses.

Association of chronic exercise with markers of cardiometabolic health: a systematic review and meta-analysis

BACKGROUND

The impact of chronic exercise on cardiometabolic risk is a crucial aspect of public health. However, limited knowledge exists regarding differences in cardiometabolic parameters between older athletes, older controls, and sedentary or active young controls.

METHODS

A comprehensive search in major databases until October 2024 was conducted for studies comparing older athletes with older controls or with both sedentary and active younger adults. Mean differences (MDs) with 95 % confidence intervals were used for data reporting.

RESULTS

From 25,910 screened studies, 61 studies including 75 cohorts were deemed of good quality, encompassing 1393 older athletes, 1369 older controls, 402 young sedentary controls, and 283 young active individuals. In comparison to older controls, older athletes exhibited significantly improved vascular parameters (systolic [MD=-5.04 mmHg] and diastolic [MD=-2.03 mmHg] blood pressure), cardiac (heart rate frequency [MD=-10.41 bpm]), and metabolic parameters (serum cholesterol profile). Conversely, when compared to young sedentary controls, older athletes displayed a less favorable blood pressure and metabolic (cholesterol, glucose) profile. Similar trends were observed when comparing older athletes to young active controls. Sensitivity and meta-regression analyses suggested that exercise lasting over 30 years might offer partial benefits for several markers of cholesterol and VO2max.

CONCLUSIONS

Long-term exercise is linked to a more optimal cardiometabolic profile, although it may not fully replicate the metabolic and cardiovascular health markers observed in younger individuals.

Systematic Review of Sarcopenia Biomarkers in Hip Fracture Patients as a Potential Tool in Clinical Evaluation

Hip fractures are associated with high morbidity and mortality. Sarcopenia is a significant factor contributing to poor prognosis; however, the clinical diagnosis of sarcopenia remains difficult in surgical patients. This systematic review aims to identify the biomarkers of sarcopenia as diagnostic and predictive tools in patients admitted for hip fracture surgery. A systematic search was conducted in the MEDLINE, EMBASE, and Google Scholar databases according to the PRISMA guidelines. Biomarker study quality was assessed using the BIOCROSS score. A total of 7 studies met the inclusion criteria and 515 patients were included, of whom 402 (78%) were female and 113 (22%) were male. The mean age of the participants was 83.1 years (SD: 5.9). Skeletal muscle biopsies were used for biomarker assessment in 14% (1/7) of studies and venous blood samples were used in the remaining 86% (6/7). The highlighted sarcopenia biomarkers included the low expression of insulin-like growth factor (IGF-I) and tumor necrosis factor-α (TNF-α), along with high serum myostatin and low serum vitamin D levels. Overall, the BIOCROSS score was satisfactory, with all studies obtaining at least a score of 13/20. The orthopedic literature is limited; however, the highlighted biomarkers in this review could be used as adjuncts in the diagnosis of sarcopenia in surgical patients.

Bibliometric Analysis of Comprehensive Geriatric Assessment from 2004 to 2023

Background

The global aging population necessitates specialized tools for complex geriatric health issues. Comprehensive Geriatric Assessment (CGA) provides multidimensional evaluations of elderly, integrating inputs from various professionals to create individualized care plans. This study aims to visually assess the research trends and hotspots in the field of CGA, review mainstream perspectives in this field, and provide a foundation for future research and treatment.

Methods

Original and review articles related to comprehensive geriatric assessment, published from 2004 to December 2023, were extracted from the Web of Science database. Four different software tools-CiteSpace, VOSviewer, Bibliometrix R package, and the Online Analysis Platform of Bibliometrics-were utilized for this comprehensive analysis.

Results

According to our retrieval strategy, we found a total of 4,411 related literatures. There has been a substantial increase in the research on comprehensive geriatric assessment in the past 20 years. These publications have been cited 157,366 times, with a mean of 35.68 citations per publication. The largest number of publications were from the US, and Italy ranked second (14.98%). Keyword burst and concurrence showed that "randomized trial", "adjuvant chemotherapy" and "breast cancer" were the top 3 most frequently occurring keywords.

Conclusion

Our bibliometric analysis reveals significant growth in CGA research over the past two decades, with a shift from cancer-focused studies to chronic conditions like frailty and sarcopenia. These findings highlight evolving priorities in geriatric care and underscore the need for future research to integrate technological advancements, such as AI, to enhance the precision, scalability, and cost-effectiveness of CGA in diverse settings.

Association of sarcopenia, ambient air pollution and cognitive function in a community-dwelling middle-aged and elderly Korean population: a community-based cohort study

OBJECTIVES

To investigate the association of sarcopenia, exposure to medium-term to long-term ambient particulate matter 2.5 µm and 10 µm (PM2.5 and PM10) pollution and cognitive function in a community-dwelling cohort of middle-aged and older adults in South Korea.

DESIGN

A community-based prospective cohort study.

SETTING

In the Korean Genome and Epidemiology Study (KoGES).

PARTICIPANTS

The participants were drawn from the seventh follow-up visit conducted between 2015 and 2016 in the KoGES community-based Ansung cohort who had participated in an ageing substudy.

OUTCOME MEASURES

Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination (K-MMSE) and decreased cognitive function was defined as a K-MMSE score of 23 or less.

RESULTS

Of the 2274 participants (mean age 70.1 years, 58.3% women and mean annual PM2.5 and PM10 levels of 30.7 and 52.2 μg/m3, respectively), 8.7% (n=197) were sarcopenic, 35.8% (n=814) were possible sarcopenic and 55.5% (n=1263) were non-sarcopenic. The predictors of sarcopenia included body mass index, cognitive function, age, marital status, hypertension and physical activity. Exposure to PM2.5 and PM10 for an average duration of 1 month to 3 years was not selected as a predictor of sarcopenia. Participants with sarcopenia were associated with lower cognitive scores (β=-1.51, p<0.0001) and decreased cognitive function compared with those without sarcopenia (OR 2.34, 95% CI 1.56 to 3.52). Exposure to medium-term and long-term PM2.5 or PM10 was not associated with sarcopenia. The effect modification of PM exposure on the association between sarcopenia and cognitive function was generally not detected.

CONCLUSIONS

In this community-based observational cohort study of KoGES participants aged 50 years and older, sarcopenia was associated with decreased cognitive function. However, medium-term to long-term exposure to PM2.5 or PM10 was not associated with sarcopenia and did not modify the relationship between sarcopenia and cognitive function.

Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis

PURPOSE

This study aimed to investigate the sequential changes in patient-reported outcome measures (PROMs) and the satisfaction rate during long-term follow-up after total knee arthroplasty (TKA).

METHODS

Studies published until December 2023 were searched in MEDLINE, EMBASE, SCOPUS and Cochrane Library. The inclusion criteria were TKA as the primary procedure, a final post-operative follow-up period of at least seven years and reporting of PROMs data. The exclusion criteria were studies not reporting serial data of the same patient cohort, studies without mid-term data, comparative studies and reviews, comments or practice guidelines. Heterogeneity was assessed with the I2 and tau2 statistics. The quality of each study was evaluated using the methodological index for non-randomized studies (MINORS) criteria. The follow-up periods were divided into short-term, mid-term and long-term. Data were synthesised by narrative reviews and random-effects meta-analysis using standardised mean difference.

RESULTS

Among the 13 studies included in the review, six were included in the meta-analysis. The overall PROMs were maintained until the mid-term (0.14; 95% CI [confidence interval], -0.05 to 0.34; I2 = 96%; tau2 = 0.10; P = 0.16), but declined in the long-term (-0.23; 95% CI -0.34 to -0.13; I2 = 88%; tau2 = 0.04; P < 0.0001). According to the subgroup analysis, pain improved from the short-term to mid-term (0.21; 95% CI 0.14 to 0.29; I2 = 0%; tau2 = 0). Subscales including function (-0.28; 95% CI -0.52 to -0.03; I2 = 94%; tau2 = 0.09) and objective measure (-0.23; 95% CI -0.31 to -0.15; I2 = 62%; tau2 = 0.01) declined from the mid-term to long-term. The patient satisfaction rate remained consistent throughout the study period.

CONCLUSIONS

The overall PROMs after TKA were maintained, with improvement observed in the pain subscale until the mid-term follow-up. However, in the long-term, overall PROMs, including function and objective measure, declined compared with those in the mid-term. Despite the decline in the physical aspects of PROMs over the long-term follow-up period, the patient satisfaction rate remained consistently high throughout the study period. Providing this information to patient pre-operatively may assist in establishing realistic expectations. Trial Registration This research was registered at PROSPERO (registration number: CRD42024578579).

Lower extremity muscle hypertrophy in response to resistance training in older adults: Systematic review, meta-analysis, and meta-regression of randomized controlled trials

OBJECTIVES

This study aimed to investigate the effects of resistance training (RT) on knee extensor muscle hypertrophy in adults 65 years and older.

METHODS

A systematic search was carried out in PubMed, Embase, and Scopus to review randomized controlled trials that assessed the effects of supervised RT on 1) muscle size, 2) fiber area, and 3) leg lean mass (LLM). Random-effects meta-analyses of standardized mean difference (SMD) and raw mean difference (RMD) for LLM were calculated. We performed a meta-regression to examine the interference of age, training volume, and duration on the results related to hypertrophy at muscle and fiber levels.

RESULTS

Thirty-two studies were included in the review, and 28 were meta-analyzed. The meta-analysis found a significant effect of RT on muscle size (SMD = 0.34; 95 % CI: 0.16-0.52; p < 0.001) and fiber area (SMD = 0.54; 95 % CI: 0.24-0.84; p < 0.001), but not on LLM (RMD = 0.22; 95 % CI: -0.22-0.66 p = 0.321). A subanalysis of studies that assessed quadriceps femoris size (excluding isolated quadriceps femoris muscles from the analysis) also revealed a significant effect of RT (95 % CI: 0.20-0.69; p < 0.001). Regression analysis indicated a significant influence of intervention duration on type II fiber area (p = 0.034), while no significant influence was detected for weekly sets or age for any outcome measure.

CONCLUSIONS

RT promotes muscle hypertrophy in older adults at both whole-muscle and fiber levels, with training duration potentially influencing the response. Measures of leg lean mass may not capture RT-induced adaptation.

Unacylated Ghrelin Protects Against Age-Related Loss of Muscle Mass and Contractile Dysfunction in Skeletal Muscle

Sarcopenia, the progressive loss of muscle mass and function, universally affects older adults and is closely associated with frailty and reduced quality of life. Despite the inevitable consequences of sarcopenia and its relevance to healthspan, no pharmacological therapies are currently available. Ghrelin is a gut-released hormone that increases appetite and body weight through acylation. Acylated ghrelin activates its receptor, growth hormone secretagogue receptor 1a (GHSR1a), in the brain by binding to it. Studies have demonstrated that acyl and unacylated ghrelin (UnAG) both have protective effects against acute pathological conditions independent of receptor activation. Here, we investigated the long-term effects of UnAG in age-associated muscle atrophy and contractile dysfunction in mice. Four-month-old and 18-month-old mice were subjected to either UnAG or control treatment for 10 months. UnAG did not affect food consumption or body weight. Gastrocnemius and quadriceps muscle weights were reduced by 20%-30% with age, which was partially protected against by UnAG. Specific force, force per cross-sectional area, measured in isolated extensor digitorum longus muscle was diminished by 30% in old mice; however, UnAG prevented the loss of specific force. UnAG also protected from decreases in mitochondrial respiration and increases in hydrogen peroxide generation of skeletal muscle of old mice. Results of bulk mRNA-seq analysis and our contractile function data show that UnAG reversed neuromuscular junction impairment that occurs with age. Collectively, our data revealed the direct role of UnAG in mitigating sarcopenia in mice, independent of food consumption or body weight, implicating UnAG treatment as a potential therapy against sarcopenia.

Sarcopenia: recent advances for detection, progression, and metabolic alterations along with therapeutic targets

Sarcopenia, a disorder marked by muscle loss and dysfunction, is a global health concern, particularly in aging populations. Sarcopenia is intricately related to various health conditions, including obesity, dysphagia, and frailty, which underscores the complexity. Despite recent advances in metabolomics and other omics data for early detection and treatment, the precise characterization and diagnosis of sarcopenia remains challenging. In the present review we provide an overview of the complex metabolic mechanisms that underlie sarcopenia, with particular emphasis on protein, lipid, carbohydrate, and bone metabolism. The review highlights the importance of leucine and other amino acids in promoting muscle protein synthesis and clarifies the critical role played by amino acid metabolism in preserving muscular health. In addition, the review provides insights regarding lipid metabolism on sarcopenia, with an emphasis on the effects of inflammation and insulin resistance. The development of sarcopenia is largely influenced by insulin resistance, especially with regard to glucose metabolism. Overall, the review emphasizes the complex relationship between bone and muscle health by highlighting the interaction between sarcopenia and bone metabolism. Furthermore, the review outlines various therapeutic approaches and potential biomarkers for diagnosing sarcopenia. These include pharmacological strategies such as hormone replacement therapy and anabolic steroids as well as lifestyle modifications such as exercise, nutrition, and dietary changes.

DKK3 as a diagnostic marker and potential therapeutic target for sarcopenia in chronic obstructive pulmonary disease

Sarcopenia, characterized by the progressive loss of muscle mass and function, significantly affects patients with chronic obstructive pulmonary disease (COPD) and worsens their morbidity and mortality. The pathogenesis of muscle atrophy in patients with COPD involves complex mechanisms, including protein imbalance and mitochondrial dysfunction, which have been identified in the muscle tissues of patients with COPD. DKK3 (Dickkopf-3) is a secreted glycoprotein involved in the process of myogenesis. However, the role of DKK3 in the regulation of muscle mass is largely unknown. This study investigated the role of DKK3 in COPD-related sarcopenia. DKK3 was found to be overexpressed in cigarette smoking-induced muscle atrophy and in patients with COPD. Importantly, plasma DKK3 levels in COPD patients with sarcopenia were significantly higher than those without sarcopenia, and plasma DKK3 levels could effectively predict sarcopenia in patients with COPD based on two independent cohorts. Mechanistically, DKK3 is secreted by skeletal muscle cells that acts in autocrine and paracrine manners and interacts with the cell surface-activated receptor cytoskeleton-associated protein 4 (CKAP4) to induce mitochondrial dysfunction and myotube atrophy. The inhibition of DKK3 by genetic ablation prevented cigarette smoking-induced skeletal muscle dysfunction. These results suggest that DKK3 is a potential target for the diagnosis and treatment of sarcopenia in patients with COPD.

Role of AMBRA1 in mitophagy regulation: emerging evidence in aging-related diseases

Aging is a gradual and irreversible physiological process that significantly increases the risks of developing a variety of pathologies, including neurodegenerative, cardiovascular, metabolic, musculoskeletal, and immune system diseases. Mitochondria are the energy-producing organelles, and their proper functioning is crucial for overall cellular health. Over time, mitochondrial function declines causing an increased release of harmful reactive oxygen species (ROS) and DNA, which leads to oxidative stress, inflammation and cellular damage, common features associated with various age-related pathologies. The impairment of mitophagy, the selective removal of damaged or dysfunctional mitochondria by autophagy, is relevant to the development and progression of age-related diseases. The molecular mechanisms that regulates mitophagy levels in aging remain largely uncharacterized. AMBRA1 is an intrinsically disordered scaffold protein with a unique property of regulating the activity of both proliferation and autophagy core machineries. While the role of AMBRA1 during embryonic development and neoplastic transformation has been extensively investigated, its functions in post-mitotic cells of adult tissues have been limited due to the embryonic lethality caused by AMBRA1 deficiency. Recently, a key role of AMBRA1 in selectively regulating mitophagy in post-mitotic cells has emerged. Here we summarize and discuss these results with the aim of providing a comprehensive view of the mitochondrial roles of AMBRA1, and how defective activity of AMBRA1 has been functionally linked to mitophagy alterations observed in age-related degenerative disorders, including muscular dystrophy/sarcopenia, Parkinson diseases, Alzheimer diseases and age-related macular degeneration.Abbreviations: AD: Alzheimer disease; AMD: age-related macular degeneration; AMBRA1: autophagy and beclin 1 regulator 1; APOE4: apolipoprotein E4; ATAD3A: ATPase family AAA domain containing 3A; ATG: autophagy related; BCL2: BCL2 apoptosis regulator; BH3: BCL2-homology-3; BNIP3L/NIX: BCL2 interacting protein 3 like; CDK: cyclin dependent kinase; CHUK/IKKα: component of inhibitor of nuclear factor kappa B kinase complex; CRL2: CUL2-RING ubiquitin ligase; DDB1: damage specific DNA binding protein 1; ER: endoplasmic reticulum; FOXO: forkhead box O; FUNDC1: FUN14 domain containing 1; GBA/β-glucocerebrosidase: glucosylceramidase beta; HUWE1: HECT, UBA and WWE domain containing E3 ubiquitin protein ligase 1; IDR: intrinsically disordered region; LIR: LC3-interacting region; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MAVS: mitochondrial antiviral signaling protein; MCL1: MCL1 apoptosis regulator, BCL2 family member; MFN2: mitofusin 2; MTOR: mechanistic target of rapamycin kinase; MSA: multiple system atrophy; MYC: MYC proto-oncogene, bHLH transcription factor; NUMA1: nuclear mitotic apparatus protein 1; OMM; mitochondria outer membrane; PD: Parkinson disease; PHB2: prohibitin 2; PINK1: PTEN induced kinase 1; PIK3C3/VPS34: phosphatidylinositol 3-kinase catalytic subunit type 3; PTK2/FAK: protein tyrosine kinase 2; ROS: reactive oxygen species; RPE: retinal pigment epithelium; SAD: sporadic AD; SOCS3: suppressor of cytokine signaling 3; SRC, SRC proto-oncogene, non-receptor tyrosine kinase; STAT3: signal transducer and activator of transcription 3; STING1: stimulator of interferon response cGAMP interactor 1; SQSTM1/p62: sequestosome 1; TBK1: TANK binding kinase 1; TGFB/TGFβ: transforming growth factor beta; TOMM: translocase of outer mitochondrial membrane; TRAF6: TNF receptor associated factor 6; TRIM32: tripartite motif containing 32; ULK1: unc-51 like autophagy activating kinase 1.

Neoadjuvant immunotherapy strategies for resectable non-small cell lung cancer (NSCLC): Current evidence among special populations and future perspectives

About one third of patients with Non-Small Cell Lung Cancer (NSCLC) presents at diagnosis with localized or locally advanced disease amenable to curative surgical resection. Surgical operability refers to stage I to IIIA and selected stage IIIB NSCLC. One of the main challenges in the management of early-stage resectable NSCLC is the optimization of available therapeutic strategies to prevent local and distant disease relapse, thus improving survival outcomes. There is evidence supporting the clinical use of both adjuvant and neoadjuvant immunotherapy-based strategies for resected/resectable, stage IB-IIIA NSCLC. Available data from randomized phase III trials have led to the incorporation of several immune checkpoint blockers (ICBs) into the international guidelines for early-stage NSCLC. Preclinical rationale of targeting specific subsets of T-cells by acting early on immune checkpoint receptors (e.g., PD-(L)1 and CTLA-4) is strong. Recent evidence is in favor of the neoadjuvant approach alone or as a part of perioperative strategy, demonstrating survival benefit. Combining neoadjuvant chemotherapy and immunotherapy before surgery results in both pathologic complete response (pCR) and major pathologic response (MPR) improvement, and survival outcomes, with no major safety issues. In this review, we summarize the rationale behind neoadjuvant/perioperative immunotherapy strategies and, due to the clinical relevance of immunotherapy in resectable NSCLC, we provide current evidence of this cutting-edge approach among special populations including older adults, women, and oncogene addicted NSCLC. To conclude, we present future perspectives in the use of immunotherapy for operable NSCLC with a special focus on novel investigational combinations underway.

Muscle quality index comparisons between Hispanics and non-Hispanic Caucasians using dual energy X-ray absorptiometry and handgrip strength

BACKGROUND & AIMS

Muscle quality index (MQI) can be computed in various ways. Also, many studies have evaluated MQI in older adults and non-Hispanic populations. The aim of this study was to compare various muscle quality indexes between Hispanics and non-Hispanic Caucasians when stratifying grip strength and appendicular lean mass measurements.

METHODS

235 participants (aged 25.5 ± 9.5 for males and 26.4 ± 9.9 for females) completed a dual energy X-ray absorptiometry (DXA) scan to assess appendicular lean mass (ALM). Handgrip strength (HGS) was assessed using a handheld dynamometer. MQI was computed using four different models: 1). MQIRA: ALM and HGS of right arm and hand, respectively; 2). MQILA: ALM and HGS of left arm and hand, respectively; 3). MQIARMS: ALM and HGS of both arms and hands, respectively; and 4). MQITOTAL: ALM of upper and lower-limbs and HGS of left and right hand.

RESULTS

Hispanic males and females exhibited lower HGS compared to Caucasians with effect sizes ranging from trivial (d = 0.17) to moderate (d = 0.80). Females demonstrated higher MQI values compared to males for MQIARMS (d = 0.70), MQIRA (d = 0.75), and MQILA (d = 0.57). However, MQITOTAL yielded a small practical effect (d = 0.33) in favor of males (3.2 ± 0.5 kg/kg vs. 3.1 ± 0.5 kg/kg). After factoring by sex and ethnicity, Hispanic males and females, compared to non-Hispanic Caucasians males and females, showed trivial-to-small practical differences (d values ranging from 0.03 to 0.39).

CONCLUSIONS

These results demonstrate MQI models vary across sex, particularly when utilizing models that account for upper extremity strength and ALM (i.e., MQIARMS, MQIRA, and MQILA). Lastly, to establish consistency in future research, the present study recommends using MQI models that account for ALM of upper- and lower-limbs (i.e., MQITOTAL). However, research measuring muscular strength via one upper-limb (e.g., left hand) might consider measuring ALM of the corresponding arm (e.g., left arm) when computing muscle quality (e.g., MQILA).

Fibin is a crucial mitochondrial regulatory gene in skeletal muscle development

Fin bud initiation factor homolog (Fibin) is a secreted protein that is relatively conserved among species. It is closely related to fin bud development and can regulate a variety of cellular processes. In our previous high-throughput chromosome conformation capture (Hi-C) study of pig embryonic muscle development, it was found that Fibin has high expression and activity during the development of pig primary muscle fibers. Therefore, we speculated Fibin participated in myogenesis severely. Specific deletion of Fibin in mouse skeletal muscle resulted in abnormal primary muscle fiber development during the embryonic period and a substantial decrease in skeletal muscle mass in adulthood. In vitro, knocking out Fibin in C2C12 cells promoted cell proliferation; however, after myogenic induction, cells lacking Fibin had almost no ability to differentiate into myotubes. During myogenic differentiation, loss of Fibin disrupts the normal function of mitochondria and impairs oxidative phosphorylation, resulting in decrease of NADH and FADH in the electron transport chain. Transmission electron microscopy also showed that mitochondrial morphology of Fibin-deficient C2C12 was impaired. In conclusion, our research has unveiled a novel mechanism of myogenesis regulation in mitochondrial function and potential target Fibin, and improved understanding of a broad range of mitochondrial muscle diseases.

Iron homeostasis and neurodegeneration in the ageing brain: Insight into ferroptosis pathways

Ageing is a major risk factor for various chronic diseases and offers a potential target for developing novel and broadly effective preventatives or therapeutics for age-related conditions, including those affecting the brain. Mechanisms contributing to ageing have been summarized as the hallmarks of ageing, with iron imbalance being one of the major factors. Ferroptosis, an iron-mediated lipid peroxidation-induced programmed cell death, has recently been implicated in neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD) and Huntington's disease (HD). Addressing ferroptosis offers both opportunities and challenges for treating neurodegenerative diseases, though the specific mechanisms remain unclear. This research explores the key processes behind how ferroptosis contributes to brain ageing, with a focus on the complex signaling networks that are involved. The current article aims to uncover that how ferroptosis, a specific type of cell death, may drive age-related changes in the brain. Additionally, the article also unveils its role in neurodegenerative diseases, discussing how understanding these mechanisms could open up new therapeutic avenues.

The impact of weight loss on fat-free mass, muscle, bone and hematopoiesis health: Implications for emerging pharmacotherapies aiming at fat reduction and lean mass preservation

Similar to bariatric surgery, incretin receptor agonists have revolutionized the treatment of obesity, achieving up to 15-25 % weight loss in many patients, i.e., at a rate approaching that achieved with bariatric surgery. However, over 25 % of total weight lost from both surgery and pharmacotherapy typically comes from fat-free mass, including skeletal muscle mass, which is often overlooked and can impair metabolic health and increase the risk of subsequent sarcopenic obesity. Loss of muscle and bone as well as anemia can compromise physical function, metabolic rate, and overall health, especially in older adults. The myostatin-activin-follistatin-inhibin system, originally implicated in reproductive function and subsequently muscle regulation, appears to be crucial for muscle and bone maintenance during weight loss. Activins and myostatin promote muscle degradation, while follistatins inhibit their activity in states of negative energy balance, thereby preserving lean mass. Novel compounds in the pipeline, such as Bimagrumab, Trevogrumab, and Garetosmab-which inhibit activin and myostatin signaling-have demonstrated promise in preventing muscle loss while promoting fat loss. Either alone or combined with incretin receptor agonists, these medications may enhance fat loss while preserving or even increasing muscle and bone mass, offering a potential solution for improving body composition and metabolic health during significant weight loss. Since this dual therapeutic approach could help address the challenges of muscle and bone loss during weight loss, well-designed studies are needed to optimize these strategies and assess long-term benefits. For the time being, considerations like advanced age and prefrailty may affect the choice of suitable candidates in clinical practice for current and emerging anti-obesity medications due to the associated risk of sarcopenia.

Skeletal muscle as a pro- and anti-inflammatory tissue: insights from children to adults and ultrasound findings

Previously regarded as a movement and posture control agent, the skeletal muscle is now recognized as an endocrine organ that may affect systemic inflammation and metabolic health. The discovery of myokines such as IL-6, released from skeletal muscle in response to physical exercise, is now one of the most recent insights. Myokines are the mediators of the balance between the pro-inflammatory and anti-inflammatory responses. This underscores the muscle function as a determinant of good health and prevention of diseases. Advances in ultrasound technology improved evaluation of muscle thickness, composition, and determining fat distribution. Combining imaging with molecular biology, researchers discovered the complicated interplay between muscle function, cytokine production and general health effects.The production of myokines with exercise showcasing the adaptability of muscles to high-stress conditions and contributing to metabolism and inflammation regulation. These findings have significant implications in order to provide improvement in metabolic and inflammatory diseases.

Diet and exercise in frailty and sarcopenia. Molecular aspects

Function declines throughout life although phenotypical manifestations in terms of frailty or disability are only seen in the later periods of our life. The causes underlying lifelong function decline are the aging process "per se", chronic diseases, and lifestyle factors. These three etiological causes result in the deterioration of several organs and systems which act synergistically to finally produce frailty and disability. Regardless of the causes, the skeletal muscle is the main organ affected by developing sarcopenia. In the first section of the manuscript, as an introduction, we review the quantitative and qualitative age-associated skeletal muscle changes leading to frailty and sarcopenia and their impact in the quality of life and independence in the elderly. The reversibility of frailty and sarcopenia are discussed in the second and third sections of the manuscript. The most effective intervention to delay and even reverse frailty is exercise training. We review the role of different training programs (resistance exercise, cardiorespiratory exercise, multicomponent exercise, and real-life interventions) not only as a preventive but also as a therapeutical strategy to promote healthy aging. We also devote a section in the text to the sexual dimorphic effects of exercise training interventions in aging. How to optimize the skeletal muscle anabolic response to exercise training with nutrition is also discussed in our manuscript. The concept of anabolic resistance and the evidence of the role of high-quality protein, essential amino acids, creatine, vitamin D, β-hydroxy-β-methylbutyrate, and Omega-3 fatty acids, is reviewed. In the last section of the manuscript, the main genetic interventions to promote robustness in preclinical models are discussed. We aim to highlight the molecular pathways that are involved in frailty and sarcopenia. The possibility to effectively target these signaling pathways in clinical practice to delay muscle aging is also discussed.

Melatonin ameliorates age-related sarcopenia by inhibiting fibrogenic conversion of satellite cell

The fibrogenic conversion of satellite cells contributes to the atrophy and fibrosis of skeletal muscle, playing a significant role in the pathogenesis of age-related sarcopenia. Melatonin, a hormone secreted by the pineal gland, exhibits anti-aging and anti-fibrotic effects in various conditions. However, the effect of melatonin on satellite cell fate and age-related sarcopenia remains under-explored. Here, we report that melatonin treatment mitigated the loss of muscle mass and strength in aged mice, replenished the satellite cell pool and curtailed muscle fibrosis. When primary SCs were cultured in vitro and subjected to aging induction via D-galactose, they exhibited a diminished myogenic potential and a conversion from myogenic to fibrogenic lineage. Notably, melatonin treatment effectively restored the myogenic potential and inhibited this lineage conversion. Furthermore, melatonin attenuated the expression of the fibrogenic cytokine, transforming growth factor-β1, and reduced the phosphorylation of its downstream targets Smad2/3 both in vivo and in vitro. In summary, our findings show melatonin's capacity to counteract muscle decline and inhibit fibrogenic conversion in aging SCs and highlight its potential therapeutic value for age-related sarcopenia.

Reactive oxygen species in the pathogenesis of sarcopenia

One of the most critical factors impacting healthspan in the elderly is the loss of muscle mass and function, clinically referred to as sarcopenia. Muscle atrophy and weakness lead to loss of mobility, increased risk of injury, metabolic changes and loss of independence. Thus, defining the underlying mechanisms of sarcopenia is imperative to enable the development of effective interventions to preserve muscle function and quality in the elderly and improve healthspan. Over the past few decades, understanding the roles of mitochondrial dysfunction and oxidative stress has been a major focus of studies seeking to reveal critical molecular pathways impacted during aging. In this review, we will highlight how oxidative stress might contribute to sarcopenia by discussing the impact of oxidative stress on the loss of innervation and alteration in the neuromuscular junction (NMJ), on muscle mitochondrial function and atrophy pathways, and finally on muscle contractile function.

The cross-talk between the cGAS-STING signaling pathway and chronic inflammation in the development of musculoskeletal disorders

Musculoskeletal disorders (MSDs) comprise diverse conditions affecting bones, joints, and muscles, leading to pain and loss of function, and are one of the most prevalent and major global health concerns. One of the hallmarks of MSDs is DNA damage. Once accumulated in the cytoplasm, the damaged DNA is sensed by the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) pathway, which triggers the induction of type I interferons and inflammatory cytokines. Thus, this pathway connects the musculoskeletal and immune systems. Inhibitors of cGAS or STING have shown promising therapeutic effects in the pre-clinical models of several MSDs. Systemic, chronic, low-grade inflammation (SCLGI) underlies the development and maintenance of many MSDs. Failure to resolve SCLGI has been hypothesized to play a critical role in the development of chronic diseases, suggesting that the successful resolution of SCLGI will result in the alleviation of their related symptomatology. The process of inflammation resolution is feasible by specialized pro-resolving mediators (SPMs), which are enzymatically generated from dietary essential polyunsaturated fatty acids (PUFAs). The supplementation of SPMs or their stable, small-molecule mimetics and receptor agonists has revealed beneficial effects in inflammation-related animal models, including arthropathies, osteoporosis, and muscle dystrophy, suggesting a translational potential in MSDs. In this review, we substantiate the hypothesis that the use of cGAS-STING signaling pathway inhibitors together with SCLG-resolving compounds may serve as a promising new therapeutic approach for MSDs.

Climbing the longevity pyramid: overview of evidence-driven healthcare prevention strategies for human longevity

Longevity medicine is an emerging and iterative healthcare discipline focusing on early detection, preventive measures, and personalized approaches that aim to extend healthy lifespan and promote healthy aging. This comprehensive review introduces the innovative concept of the "Longevity Pyramid." This conceptual framework delineates progressive intervention levels, providing a structured approach to understanding the diverse strategies available in longevity medicine. At the base of the Longevity Pyramid lies the level of prevention, emphasizing early detection strategies and advanced diagnostics or timely identification of potential health issues. Moving upwards, the next step involves lifestyle modifications, health-promoting behaviors, and proactive measures to delay the onset of age-related conditions. The Longevity Pyramid further explores the vast range of personalized interventions, highlighting the importance of tailoring medical approaches based on genetic predispositions, lifestyle factors, and unique health profiles, thereby optimizing interventions for maximal efficacy. These interventions aim to extend lifespan and reduce the impact and severity of age-related conditions, ensuring that additional years are characterized by vitality and wellbeing. By outlining these progressive levels of intervention, this review offers valuable insights into the evolving field of longevity medicine. This structured framework guides researchers and practitioners toward a nuanced strategic approach to advancing the science and practice of healthy aging.

Exploring the association between muscle mass and thyroid function in Chinese community subjects over 45 years old with normal thyroid function: a cross-sectional analysis

Background

Currently, nothing is known about the connection between muscle mass and thyroid hormone levels in middle-aged and elderly Chinese with normal thyroid function. The purpose of this study was to determine the potential association between muscle mass and thyroid function status in middle-aged and elderly Chinese subjects with normal thyroid function.

Methods

A cohort of 1868 participants in China were included in this retrospective study; their mean age was 53.97 years, and their skeletal muscle mass index was 7.44 kg/m2. Of them, 60.97% were men. Thyroid hormone concentrations, standard biochemical indices, and the frequency of chronic illnesses were among the many factors that were evaluated. Bioelectrical impedance analysis (BIA) was used to assess the patients' body composition. The skeletal muscle index (SMI) was calculated using the following formula: SMI = ASM (kg)/height 2 (m2), where ASM stands for appendicular skeletal muscle mass. To identify the correlations between the variables, the Spearman correlation coefficient was used. Binary logistic regression analysis was conducted to investigate the potential linkages between thyroid hormone levels and diminished muscle mass.

Results

In this investigation, a significant correlation was observed between low muscle mass and FT3/FT4 (OR=0.044, 95% CI: 0.004-0.440, P=0.008), as well as FT3 (OR=0.697, 95% CI: 0.508-0.957, P=0.025). Conversely, no discernible correlation trend was detected with TSH (OR=0.972, 95% CI: 0.814-1.160, P=0.753) and FT4 (OR=1.97, 95% CI=0.983-1.224, P=0.1). Following adjustment for various confounding factors, including age, vitamin D levels, triglycerides, HDL-C, LDL-C, total protein, hypertension, diabetes, hyperuricemia, and overweight/obesity, across the entire study population, a positive correlation between SMI and FT3/FT4 was identified. Subsequent gender, age, and weight-stratified analyses revealed consistent correlation trends between SMI and FT3/FT4, with all interactions yielding P-values > 0.05.

Conclusion

Our study has revealed that among middle-aged and elderly Chinese individuals exhibiting normal thyroid function, a reduction in the free T3 to free T4 ratio is associated with a decline in muscle mass.

Health and Well-Being Coaching Adjuvant to GLP-1 Induced Weight Loss

Glucagon-like peptide agonists (GLP-1) are highly effective anti-obesity medications. However, sustained effectiveness is potentially plagued by lack of adherence to the drug and resumption of pre-weight loss behaviors. Side effects are primarily severe gastrointestinal distress but can occasionally be more serious. Health and well-being coaching (HWC) is an important obesity intervention that can be used alongside GLP-1 prescription. HWC is documented to improve medication adherence and promote healthy behavior change. A coach who understands the complexities of rapid weight loss, specifically with GLP-1, can help the patient persist with the treatment. Moreover, the coach can assist in navigating GLP-1 side effects including undesirable loss of skeletal muscle during the weight loss period. A patient-centric and collaborative relationship seem essential to the HWC process. Specific coaching techniques are suggested for working with patients losing weight. The logical, but yet to be tested, expectation is that HWC as an adjuvant intervention to GLP-1 prescription will improve medication adherence and encourage sustained weight loss and health benefits in patients with obesity.

Multi-channel EMG manifestations of upper-extremity muscle coordination imbalance among community-dwelling sarcopenic seniors

BACKGROUND

Sarcopenia is an age-related, insidious, crippling but curable degenerative disease if diagnosed and treated early. However, no accessible and accurate early screening method is available for community settings that does not require specialized personnel. One of the hallmarks of sarcopenia is the pathological changes of muscle fiber type composition and motor unit firing patterns. Surface electromyography (sEMG) may serve as an effective tool for detecting differences between healthy and sarcopenic individuals due to its superior wearability and accessibility compared to other screening methods such as medical imaging and bioimpedance measurements, making it ideal for community-based sarcopenic screening. Our study aims to explore sEMG biomarkers that can be used for screening or diagnosis of sarcopenia.

RESULTS

We collected multi-channel sEMG signals from six forearm muscles of 98 healthy and 55 sarcopenic community-dwelling older adults. Participants performed grasp tasks at 20% and 50% of maximum voluntary contraction (MVC). Hexagons created by various EMG features, normalized with respect to respective MVC, and symmetry analyses were performed to estimate multi-muscle coordination patterns. An innovative index, namely incenter-circumcenter distance of muscle coordination (ICDMC), is proposed to discriminate between the healthy and sarcopenic groups. We utilized non-parametric tests to compare the ICDMC between the two groups, considering a p-value less than 0.05 statistically significant. The results showed that at 20% MVC, ICDMCs from root mean square (RMS), mean absolute value (MAV), slope sign changes (SSC) and wavelength (WL) showed statistically significant differences. More insights of this sEMG manifestation of sarcopenia were revealed by gender- and age-stratifications analyses.

CONCLUSIONS

Our results demonstrated that there are clear sEMG manifestations of altered muscle coordination in sarcopenic patients. More consistent force generation patterns were observed in the sarcopenic group, especially at lower contraction intensities. The novel ICDMC can quantify differences between sarcopenic and healthy muscle. These results warrant further research to further develop more accessible sarcopenia screening strategies in community settings based on electrophysiological measurements such as sEMG.

Adverse childhood experiences and falls in older adults: The mediating role of depression

OBJECTIVES

To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations.

METHODS

This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults.

RESULTS

The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males.

CONCLUSIONS

Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults.

Age and sex-related differences in elastic properties of the gastrocnemius muscle-tendon unit: an observational prospective study

Introduction

Changes in the mechanical properties of the gastrocnemius muscle-tendon unit can lead to abnormal biomechanics of lower limbs, which is a risk factor for the development of many diseases. However, fewer studies have explored physiological changes in the gastrocnemius muscle-tendon unit stiffness. This study aimed to investigate the age- and sex-related differences in the gastrocnemius muscle-tendon unit stiffness.

Methods

The study included 20 older women, 20 young women, and 20 older men. Shear wave elastography (SWE) was used to measure the stiffness of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and Achilles tendon (AT) in all subjects in relaxed, neutral, and standing positions.

Results

The results showed no significant differences in the MG, LG, and AT stiffness between the dominant and non-dominant sides (p > 0.05). The MG, LG, and AT stiffness changed with positions (p < 0.05). The LG stiffness in older women was lower than in older men and young women in any position (p < 0.05). The MG stiffness in older men was greater than that in older women in any position, and age-related changes were found only in the relaxed and standing positions (p < 0.05). The AT stiffness was higher in older men only in the relaxed position (p < 0.05). There was no significant difference in AT stiffness between older and younger women at any position (p > 0.05).

Discussion

These results suggest that the bilateral gastrocnemius muscle-tendon unit stiffnesses were similar regardless of sex, age, and position. The stiffness of the gastrocnemius in women decreased with age. However, the effect of aging on AT stiffness was slight. Men have greater gastrocnemius stiffness in older adults.

Identifying genetic determinants of sarcopenia-related traits: a Mendelian randomization study of druggable genes

BACKGROUND

Sarcopenia, characterized by progressive muscle mass and function loss, particularly affects the elderly, and leads to severe consequences such as falls and mortality. Despite its prevalence, targeted pharmacotherapies for sarcopenia are lacking. Utilizing large-sample genome-wide association studies (GWAS) data is crucial for cost-effective drug discovery.

METHODS

Herein, we conducted four studies to understand the putative causal effects of genetic components on muscle mass and function. Study 1 employed a two-sample Mendelian randomization (MR) on 15,944 potential druggable genes, investigating their potential causality with muscle quantity and quality in a European population (N up to 461,089). Study 2 validated MR results through sensitivity analyses and colocalization analyses. Study 3 extended validation across other European cohorts, and study 4 conducted quantitative in vivo verification.

RESULTS

MR analysis revealed significant causality between four genes (BLOC-1 related complex subunit 7, BORCS7; peptidase m20 domain containing 1, PM20D1; nuclear casein kinase and cyclin dependent kinase substrate 1, NUCKS1 and ubiquinol-cytochrome c reductase complex assembly factor 1, UQCC1) and muscle mass and function (p-values range 5.98 × 10-6 to 9.26 × 10-55). To be specific, BORCS7 and UQCC1 negatively regulated muscle quantity and quality, whereas enhancing PM20D1 and NUCKS1 expression showed promise in promoting muscle mass and function. Causal relationships remained robust across sensitivity analyses, with UQCC1 exhibiting notable colocalization effects (PP·H4 93.4 % to 95.8 %). Further validation and in vivo replication verified the potential causality between these genes and muscle mass as well as function.

CONCLUSIONS

Our druggable genome-wide MR analysis identifies BORCS7, PM20D1, NUCKS1, and UQCC1 as causally associated with muscle mass and function. These findings offer insights into the genetic basis of sarcopenia, paving the way for these genes to become promising drug targets in mitigating this debilitating condition.

Associations between meeting 24-h movement guidelines and sarcopenia risk among adults aged ≥ 55 years in five low- and middle-income countries

OBJECTIVE

To diminish the negative influence of sarcopenia on senior adults, the study aimed to investigate the association between adherence to 24-h movement behavior guidelines (physical activity, sedentary behavior, sleep duration) and the risk of sarcopenia among individuals aged ≥55 years in five low- and middle-income countries (LMICs).

METHODS

A total of 16,503 adults aged ≥55 years were included in this cross-sectional study. The study utilized data from Global Aging and Adult Health Survey (SAGE). Participants reported their information about physical activity, sedentary behavior, and sleep duration using the questionnaire. Sarcopenia was identified as low skeletal muscle mass with a diminished gait speed or weakened handgrip strength. Multiple logistic regression models were used to investigate the association between adherence to 24-h movement behavior guidelines and the risk of sarcopenia.

RESULTS

Merely 32.73 % of participants met all three 24-h movement behavior guidelines (physical activity, less sedentary behavior, sleep). Meeting all three guidelines (p < 0.01) was significantly associated with a lower risk of sarcopenia. Meeting physical activity only (p < 0.05), or meeting both physical activity and sedentary behaivor (p < 0.05), or meeting both physical activity and sleep duration (p < 0.01) guidelines were also associated with a reduced risk of sarcopenia. Moreover, adults aged 65+ years who adhered to 24-h movement behavior guidelines exhibited a significantly reduced risk of developing sarcopenia.

CONCLUSION

The findings suggest that the adherence to 24-h movement behavior guidelines for regular physical activity, limited sedentary behavior, and sufficient sleep duration was associated with a reduced risk of sarcopenia in adults aged ≥55 years in five LMICs.

Experimental models as a tool for research on sarcopenia: A narrative review

Sarcopenia is a musculoskeletal disorder related to muscle mass and function; as the worldwide population ages, its growing prevalence means a decline in quality of life and an increased burden for public health systems. As sarcopenia is a reversible condition, its early diagnosis is of utmost importance. Consensus definitions and diagnosis protocols for sarcopenia have been evolving for a long time, and the identification of molecular pathways subjacent to sarcopenia is a growing research area. The use of liquid biopsies to identify circulating molecules does not provide information about specific regulatory pathways or biomarkers in relevant tissue, and the use of skeletal muscle biopsies from older people has many limitations. Complementary tools are therefore necessary to advance the knowledge of relevant molecular aspects. The development of experimental models, such as animal, cellular, or bioengineered tissue, together with knock-in or knock-out strategies, could therefore be of great interest. This narrative review will explore experimental models of healthy muscle and aged muscle cells as a tool for research on sarcopenia. We will summarize the literature and present relevant experimental models in terms of their advantages and disadvantages. All of the presented approaches could potentially contribute to the accurate and early diagnosis, follow-up, and possible treatment of sarcopenia.

Impact of sarcopenia on the prognosis of patients with advanced non-small cell lung cancer treated with antiangiogenic therapy: A propensity score matching analysis

BACKGROUND

Limited information is available regarding the impact of sarcopenia on the prognosis of antiangiogenic therapy in individuals with advanced non-small cell lung cancer (NSCLC). This study primarily sought to examine the prognostic significance of sarcopenia in individuals with advanced NSCLC undergoing antiangiogenic therapy.

METHODS

We retrospectively enrolled all patients who met the inclusion and exclusion criteria from 2019 to 2021 at Nantong University Hospital. Patients were grouped according to the presence or absence of sarcopenia. After propensity score matching (PSM), progression-free survival (PFS), overall survival (OS), and adverse event rates were compared between the two groups. Factors associated with prognosis were screened using univariate and multivariate analyses.

RESULTS

A total of 267 patients were included, with a total of 201 matched at baseline after PSM (77 in the sarcopenia group and 124 in the non-sarcopenia group). The sarcopenia group had lower PFS (p = 0.043) and OS (p = 0.011) than the non-sarcopenia group and a higher incidence of adverse events (p = 0.044). Multivariate analysis suggested that sarcopenia is an independent prognostic risk factor for OS in advanced NSCLC patients receiving antiangiogenic therapies (p = 0.009). Results of subgroup analyses showed some differences in the impact of sarcopenia on survival prognosis in populations with different characteristics.

CONCLUSION

Patients with advanced NSCLC with comorbid sarcopenia exhibit a worse prognosis when treated with antiangiogenic therapy, and preventing and ameliorating sarcopenia may lead to better survival outcomes in patients with advanced NSCLC.

Exploring the Relationship Between Gut Microbiota and Sarcopenia Based on Gut-Muscle Axis

Sarcopenia, as a disease characterized by progressive decline of quality, strength, and function of muscles, has posed an increasingly significant threat to the health of middle-aged and elderly individuals in recent years. With the continuous deepening of studies, the concept of gut-muscle axis has attracted widespread attention worldwide, and the occurrence and development of sarcopenia are believed to be closely related to the composition and functional alterations of gut microbiota. In this review, combined with existing literatures and clinical reports, we have summarized the role and impacts of gut microbiota on the muscle, the relevance between gut microbiota and sarcopenia, potential mechanisms of gut microbiota in the modulation of sarcopenia, potential methods to alleviate sarcopenia by modulating gut microbiota, and relevant advances and perspectives, thus contributing to adding more novel knowledge to this research direction and providing certain reference for future related studies.

Mechanisms of cancer cachexia and targeted therapeutic strategies

Tumor cachexia is a multifactorial syndrome characterized by systemic dysfunction, including anorexia and severe weight loss that is resistant to standard nutritional interventions. It is estimated that approximately 20 % of cancer patients succumb to cachexia in the later stages of their disease. Thus, understanding its pathogenesis is vital for improving therapeutic outcomes. Recent research has focused on the imbalance between energy intake and expenditure in cachexia. Clinically, cachexia presents with anorexia, adipose tissue atrophy, and skeletal muscle wasting, each driven by distinct mechanisms. Anorexia arises primarily from tumor-secreted factors and cancer-induced hormonal disruptions that impair hypothalamic regulation of appetite. Adipose tissue atrophy is largely attributed to enhanced lipolysis, driven by increased activity of enzymes such as adipose triglyceride lipase and hormone-sensitive lipase, coupled with decreased lipoprotein lipase activity. The browning of white adipose tissue, facilitated by uncoupling protein 1, further accelerates fat breakdown by increasing energy expenditure. Skeletal muscle atrophy, a hallmark of cachexia, results from dysregulated protein turnover via the ubiquitin-proteasome and autophagy-lysosomal pathways, as well as mitochondrial dysfunction. Additionally, chemotherapy can exacerbate cachexia. This review examines the molecular mechanisms underlying cancer cachexia and discusses current therapeutic strategies, aiming to inform future research and improve treatment approaches.

Interrelationships of cervical spine sagittal alignment and whole spinopelvic alignment under implications of musculoskeletal health among independent elderly women in Taiwan: A cross-sectional study

INTRODUCTION

Older women are at increased risk of spinal misalignment and its associated complications. This study investigated the influence of age, grip strength, and various sagittal spinal parameters on spinal alignment. The results indicate the need for comprehensive management strategies.

METHODS

This cross-sectional study included 200 older women who underwent bone health evaluations at the orthopedic department of a hospital. The study participants underwent dual-energy X-ray absorptiometry, grip strength measurement, and full-length spine radiography. Clinical and radiographic parameters were analyzed through Pearson correlation and linear regression analyses.

RESULTS

Significant correlations were identified between grip strength and spinal parameters such as C7 slope and global tilt, indicating that muscle strength affects spinal alignment. Advanced age was associated with changes in sagittal spinal parameters, indicating that changes occur in body compensation over time. Furthermore, pelvic parameters such as pelvic tilt and sacral slope were significantly correlated with spinal curvature, indicating their critical roles in maintaining spinal stability.

CONCLUSIONS

This study revealed the critical roles of muscle strength and pelvic alignment in the management of spinal health in older women with low bone mass. Targeted interventions for increasing muscle strength, correcting posture, and achieving hormonal balance can notably improve spinal stability and reduce the risk of associated complications. Longitudinal studies should be conducted to validate and refine the intervention strategies and to extend the study findings.

Association between dietary vitamin D intake and low muscle mass in US adults: results from NHANES 2011-2018

Purpose

To investigate the association between dietary vitamin D intake and low muscle mass (LMM) in a representative adult population, accounting for total energy intake and other potential confounders.

Materials and methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) involving 8,443 participants. Dietary vitamin D intake was assessed using 24-h dietary recalls, and LMM was defined based on appendicular lean mass (ALM) adjusted for body mass index (BMI). Multivariable logistic regression models were used to examine the association between quartiles of dietary vitamin D intake and the odds of LMM, adjusting for age, gender, race/ethnicity, BMI, total energy intake, and additional covariates.

Results

In Model 1, after adjusting for age, gender, race/ethnicity, BMI, and poverty-to-income ratio, participants in the highest quartile of vitamin D intake had an odds ratio (OR) of 0.54 (95% CI: 0.37-0.79) compared to the lowest quartile, with a p for trend <0.001. In Model 2, after further adjustment for total energy intake and several covariates, the association was attenuated but remained borderline significant (p for trend = 0.051). In Model 3, after adjusting for additional health-related factors, the OR for the highest quartile was 0.70 (95% CI: 0.47-1.05), with a significant p for trend of 0.029.

Conclusion

This study suggests that higher dietary vitamin D intake may be associated with a reduced risk of LMM. Further longitudinal research is needed to confirm these findings and explore potential interactions between vitamin D and other dietary factors in muscle mass preservation.

Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women

Telomere length is an index of cellular aging. Healthy lifestyles are associated with reduced oxidative stress and longer telomeres, whereas unhealthy behaviors are related to shorter telomeres and greater biological aging. This investigation was designed to determine if strength training accounted for differences in telomere length in a random sample of 4814 US adults. Data from the National Health and Nutrition Examination Survey (NHANES) were employed to answer the research questions using a cross-sectional design. Time spent strength training was calculated by multiplying days of strength training per week by minutes per session. Participation in other forms of physical activity was also calculated based on reported involvement in 47 other activities. Weighted multiple regression and partial correlation were used to calculate the mean differences in telomere length across levels of strength training, adjusting for differences in potential confounders. With the demographic covariates controlled, strength training and telomere length were linearly related (F = 14.7, p = 0.0006). Likewise, after adjusting for all the covariates, the linear association remained strong and significant (F = 14.7, p = 0.0006). In this national sample, 90 min per week of strength training was associated with 3.9 years less biological aging, on average. Regular strength training was strongly related to longer telomeres and less biological aging in 4814 US adults.

Six Weeks to Wellness: The Role of Breathing Exercises Based on Motor Development Pattern in Improving Fitness and Quality of Life in Overweight Elderly Women

Background: Being overweight is a major global health epidemic of the 20th and 21st centuries, which can affect the movement system function of older adult women. This study evaluated the effects of a breathing exercise based on motor development patterns on functional fitness and quality of life in overweight older adult women. Methods: A randomized controlled trial was conducted with 40 community-dwelling women aged 65-75. Participants were randomly assigned to an intervention group, which completed a 6-week breathing exercise program (three supervised and three home-based sessions per week), or a control group, which maintained usual routines. Outcome measures included cardiovascular fitness, upper and lower body flexibility, muscle strength, dynamic balance, and quality of life, assessed at baseline and post-intervention. Results: The intervention group showed significant improvements in cardiovascular fitness (p < .001, ES = 0.652), upper body flexibility (p < .001, ES = 0.652), lower body flexibility (p < .001, ES = 0.538), upper body strength (p < .001, ES = 0.538), lower body strength (p < .001, ES = 0.538), and dynamic balance (p < .001, ES = 0.475) compared to the control group. Quality of life also significantly improved in the intervention group (p < .001, ES = 0.475). Conclusion: Breathing exercises based on motor development patterns significantly enhance functional fitness and quality of life in overweight older adult women. Incorporating these exercises into regular physical activity routines may promote health and independence in older adults. Further research should explore long-term benefits and optimal exercise parameters for older adults.

The Physical Activity Paradox in Low Muscle Mass in Middle-Aged and Older Adults

INTRODUCTION

Physical activity is widely accepted as a therapeutic approach to age-related muscle mass loss. However, it is unclear whether all physical activity domains benefit muscle mass maintenance. This study investigated the association between low muscle mass and domain-specific physical activity, including leisure-time and occupational moderate-to-vigorous physical activity (MVPA).

METHODS

This study included 27,357 middle-aged and older individuals (≥40 years) whose data were collected from 2014 to 2022 and analyzed in 2024. Low muscle mass was defined as a muscle mass index 2 SDs below the sex-specific average of 9,426 young individuals (aged 20-39 years). Leisure-time and occupational MVPA were assessed using the Global Physical Activity Questionnaire and categorized as 0 min/wk, 1-149 min/wk, and ≥150 min/wk. Logistic regression analysis focused on all participants, and additional analyses stratified by sex, age, sedentary time, and transfer time were performed.

RESULTS

For leisure-time MVPA, participants with 1-149 min/wk and ≥150 min/wk had significantly lower odds of low muscle mass compared to those with no MVPA, with ORs of 0.795 (95% CI=0.691, 0.914) and 0.740 (95% CI=0.649, 0.843), respectively (p<0.01 for both). No significant association was found between occupational MVPA and low muscle mass. These findings were consistent across different strata of sex, age, sedentary time, and transfer time.

CONCLUSIONS

Leisure-time MVPA is inversely associated with low muscle mass, whereas occupational MVPA shows no association, highlighting the importance of dynamic movements of sufficient intensity and recuperation time in maintaining muscle mass.