1
|
de Luis Román D, Gómez JC, García-Almeida JM, Vallo FG, Rolo GG, Gómez JJL, Tarazona-Santabalbina FJ, Sanz-Paris A. Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document. Rev Endocr Metab Disord 2024; 25:651-661. [PMID: 38315411 PMCID: PMC11294263 DOI: 10.1007/s11154-023-09871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice. METHOD A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm. RESULTS The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.
Collapse
Affiliation(s)
- Daniel de Luis Román
- Center Investigación of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain.
| | | | - José Manuel García-Almeida
- Clinical Management Unit of Endocrinology and Nutrition, Virgen de la Victoria Clinical Hospital, Málaga, Spain
| | | | | | - Juan José López Gómez
- Endocrinology and Nutrition Department, University Clinical Hospital of Valladolid, Valladolid, Spain
| | | | | |
Collapse
|
2
|
de Luis Roman D, García Almeida JM, Bellido Guerrero D, Guzmán Rolo G, Martín A, Primo Martín D, García-Delgado Y, Guirado-Peláez P, Palmas F, Tejera Pérez C, García Olivares M, Maíz Jiménez M, Bretón Lesmes I, Alzás Teomiro CM, Guardia Baena JM, Calles Romero LA, Prior-Sánchez I, García-Luna PP, González Pacheco M, Martínez-Olmos MÁ, Alabadí B, Alcántara-Aragón V, Palma Milla S, Martín Folgueras T, Micó García A, Molina-Baena B, Rendón Barragán H, Rodríguez de Vera Gómez P, Riestra Fernández M, Jiménez Portilla A, López-Gómez JJ, Pérez Martín N, Montero Madrid N, Zabalegui Eguinoa A, Porca Fernández C, Tapia Guerrero MJ, Ruiz Aguado M, Velasco Gimeno C, Herrera Martínez AD, Novo Rodríguez M, Iglesias Hernández NC, de Damas Medina M, González Navarro I, Vílchez López FJ, Fernández-Pombo A, Olveira G. Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk. Nutrients 2024; 16:1552. [PMID: 38892486 PMCID: PMC11174631 DOI: 10.3390/nu16111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.
Collapse
Affiliation(s)
- Daniel de Luis Roman
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - José Manuel García Almeida
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
| | - Diego Bellido Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
| | - Germán Guzmán Rolo
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - Andrea Martín
- Medical Department, Abbott Laboratories, 28050 Madrid, Spain; (G.G.R.); (A.M.)
| | - David Primo Martín
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Yaiza García-Delgado
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
| | - Fiorella Palmas
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Tejera Pérez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
| | - María García Olivares
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Surgery, Malaga University, 29010 Malaga, Spain
| | - María Maíz Jiménez
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
| | - Irene Bretón Lesmes
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | | | - Juan Manuel Guardia Baena
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | - Laura A. Calles Romero
- Endocrinology and Nutrition Service, Basurto University Hospital, 48903 Bilbao, Spain; (L.A.C.R.); (N.C.I.H.)
| | | | - Pedro Pablo García-Luna
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - María González Pacheco
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Miguel Ángel Martínez-Olmos
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
- Molecular Endocrinology Research Group, Health Research Institute of Santiago de Compostela-IDIS, 15706 Santiago de Compostela, Spain
- CIBERObn, National Health Institute Carlos III, 28031 Madrid, Spain
| | - Blanca Alabadí
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario of Valencia, 46010 Valencia, Spain;
- INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - Valeria Alcántara-Aragón
- Endocrinology and Nutrition Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Samara Palma Milla
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Service, University Hospital of La Paz, 28046 Madrid, Spain;
| | - Tomás Martín Folgueras
- Endocrinology and Nutrition Service, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Andrea Micó García
- Endocrinology and Nutrition Service, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Begoña Molina-Baena
- Deparment of Endocrinology and Nutrition, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain;
| | - Henry Rendón Barragán
- Endocrinology and Nutrition, FEA Endocrinology and Nutrition, Navarra University Hospital, 31008 Pamplona, Spain;
| | | | - María Riestra Fernández
- Endocrinology Service, Cabueñes University Hospital, 33394 Gijón, Spain;
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Ana Jiménez Portilla
- Endocrinology and Nutrition Service, Consorci Hospital General Universitari de València, 46014 Valencia, Spain;
| | - Juan J. López-Gómez
- Endocrinology and Nutrition Department, Clinical Universitary Hospital of Valladolid, 47003 Valladolid, Spain; (D.P.M.); (J.J.L.-G.)
- Investigation Centre Endocrinology and Nutrition, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Nuria Pérez Martín
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.G.-D.); (N.P.M.)
| | - Natalia Montero Madrid
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (J.M.G.A.); (P.G.-P.); (N.M.M.)
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
| | - Alba Zabalegui Eguinoa
- Endocrinology and Nutrition Department, Hospital Universitari Vall D’Hebron, 08036 Barcelona, Spain; (F.P.); (A.Z.E.)
| | - Cristina Porca Fernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol (CHUF), 15405 Ferrol, A Coruña, Spain; (C.T.P.); (C.P.F.)
- Epigenomics in Endocrinology and Nutrition Group, Santiago Health Research Institute (IDIS), 34113 Santiago de Compostela, Spain
- Professor Novoa Santos Foundation, 15405 A Coruña, Spain
| | - María José Tapia Guerrero
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Marta Ruiz Aguado
- Department of Endocrinology and Nutrition, University Hospital 12 de Octubre, 28041 Madrid, Spain; (M.M.J.); (M.R.A.)
- i+12 Research Institute, 28041 Madrid, Spain
| | - Cristina Velasco Gimeno
- Endocrinology and Nutrition Unit, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.B.L.); (C.V.G.)
| | - Aura D Herrera Martínez
- Reina Sofía University Hospital, 14004 Córdoba, Spain; (C.M.A.T.); (A.D.H.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - María Novo Rodríguez
- Service of Endocrinology and Nutrition, University Hospital Virgen de las Nieves, 41013 Granada, Spain; (J.M.G.B.); (M.N.R.)
| | | | - María de Damas Medina
- Endocrinology Service, Complejo Hospitalario de Jaén, 23007 Jaén, Spain; (I.P.-S.); (M.d.D.M.)
| | - Irene González Navarro
- Endocrinology and Nutrition Clinical Management Unit, Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain; (P.P.G.-L.); (I.G.N.)
| | - Francisco Javier Vílchez López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain; (M.G.P.); (F.J.V.L.)
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (M.Á.M.-O.); (A.F.-P.)
| | - Gabriel Olveira
- Institute of Biomedical Research in Malaga (IBIMA)-Bionand Platform, University of Malaga, 29590 Málaga, Spain; (M.G.O.); (M.J.T.G.); (G.O.)
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Málaga, Spain
- CIBER of Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, 28029 Madrid, Spain
| |
Collapse
|
3
|
Short T, Yamada PM. Maximal Running Speed and Critical Speed Are Positively Related to Phase Angle in Healthy Young Adults. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:405-417. [PMID: 38665855 PMCID: PMC11042853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Phase Angle (PhA), derived from bioelectrical impedance analysis, is a measurement of cellular resistance to electrical current and a non-invasive tool to monitor neuromuscular performance. The relationship between PhA and components of athletic performance is not fully understood. The purpose of this study was to determine if maximal running speed, critical speed (CS), and/or D prime (D') derived from a 3-minute all-out-test (3MAOT) correlates to PhA, reactance (Xc), or resistance (R). Sixty-one (male n=35, female n=26) healthy young adults (23.4±3.9 years) completed bioelectrical impedance analysis (Inbody770) and a 3MAOT. The correlations between PhA, Xc, and R and 3MAOT results were evaluated using correlations. Simple and multiple linear-regressions were used to test if results from the 3MAOT (maximum running speed, CS, D') could predict PhA. Linear regression analysis indicated that maximum running speed and CS alone explained 32% and 9% of the variance in PhA, respectively (R2=0.32, p<0.05; R2=0.09, p<0.05). Multiple linear regression indicated that maximum running speed, CS, and D' explained 35% of the variance in PhA (R2=0.35; p<0.05). Only maximum running speed remained a significant predictor of PhA after controlling for age (β=0.45; p<0.05), but not after controlling for both age and sex (β=0.14; p>0.05). Since maximum running speed was a stronger predictor of PhA compared to CS (proxy for endurance performance), practitioners should use discernment when using PhA as a readiness tool to monitor endurance performance.
Collapse
Affiliation(s)
- Trevor Short
- Human Performance Laboratory, Department of Kinesiology & Rehabilitation Science, University of Hawai'i-Mānoa, Honolulu, HI, USA
| | - Paulette M Yamada
- Human Performance Laboratory, Department of Kinesiology & Rehabilitation Science, University of Hawai'i-Mānoa, Honolulu, HI, USA
| |
Collapse
|
4
|
Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
Collapse
Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| |
Collapse
|
5
|
García Almeida JM, Bellido D, De Luis D, Guzmán Rolo G, Olveira G. Protocol for a prospective cohort study on the feasibility of application of nutritional ultrasound in the diagnosis and follow-up of patients with nutritional risk at hospital discharge: study on body composition and function (DRECO). BMJ Open 2023; 13:e074945. [PMID: 38070895 PMCID: PMC10729227 DOI: 10.1136/bmjopen-2023-074945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Nutritional ultrasound (US) is an emerging technique in clinical nutrition for the morphological and structural study of muscle mass. Currently, all definitions of malnutrition include the measurement of muscle mass; however, there is no single way to assess it. It is necessary to develop new techniques to identify muscle involvement in malnutrition that are valid, standardised, reliable, accurate and profitable. OBJECTIVE To value the new muscle US techniques aimed to measure muscle and functional status, to make a more accurate diagnosis and a better prediction of complications and morbidity and mortality in patients at nutritional risk. PRIMARY OUTCOME to assess the feasibility of US or muscle US techniques in both nutritional diagnosis and follow-up in a nutritional intervention programme. METHODS AND ANALYSIS Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) is a prospective, multicentre (25 Spanish hospitals), uncontrolled clinical study in standard clinical practice to value the usefulness of nutritional US (muscle US) in the nutritional diagnosis and follow-up, over 3-6 months, after standard nutritional clinical practice intervention and physical activity, to control their disease-related malnutrition. 1000 patients are expected to be included in. DISCUSSION This study will standardise nutritional US measures. It will validate and define specific cut-off values for nutritional US and correlate it with already well-known nutritional tools such as Subjective Global Assessment or Global Leadership Initiative on Malnutrition criteria. Thus, muscle US will become not only a tool to diagnose malnutrition, but it will also be integrated in the daily practice to evaluate nutritional interventions. ETHICS AND DISSEMINATION All DRECO study materials have been approved by each of the IRB/IEC of all the sites enrolled (either approval of the own IRB/IEC or validating the approval of the IRB/IEC of another hospital). The study has been registered with ClinicalTrials.gov, on 27 June 2022. The results from this study will be presented at scientific conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05433831.
Collapse
Affiliation(s)
| | - Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, A Coruña, Spain
| | - Daniel De Luis
- Department of Endocrinology and Nutrition, Valladolid University Hospital, Valladolid, Spain
| | | | - Gabriel Olveira
- Endocrinology and Nutrition Service, Regional University Hospital of Málaga. Málaga Biomedical Research Institute - BIONAND Platform, Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, Málaga, Spain
- CIBER of Diabetes and Associated Metabolic Diseases, Carlos III Health Institute, Málaga, Spain
| |
Collapse
|
6
|
López-Gómez JJ, García-Beneitez D, Jiménez-Sahagún R, Izaola-Jauregui O, Primo-Martín D, Ramos-Bachiller B, Gómez-Hoyos E, Delgado-García E, Pérez-López P, De Luis-Román DA. Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition. Nutrients 2023; 15:3923. [PMID: 37764706 PMCID: PMC10534706 DOI: 10.3390/nu15183923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.
Collapse
Affiliation(s)
- Juan José López-Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | | | - Rebeca Jiménez-Sahagún
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - David Primo-Martín
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Beatriz Ramos-Bachiller
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Emilia Gómez-Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Esther Delgado-García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Paloma Pérez-López
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Daniel A. De Luis-Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (R.J.-S.); (O.I.-J.); (D.P.-M.); (B.R.-B.); (E.G.-H.); (E.D.-G.); (P.P.-L.); (D.A.D.L.-R.)
- Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47003 Valladolid, Spain
| |
Collapse
|
7
|
Bellido D, García-García C, Talluri A, Lukaski HC, García-Almeida JM. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord 2023; 24:563-583. [PMID: 37043140 PMCID: PMC10090740 DOI: 10.1007/s11154-023-09803-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
Bioelectrical impedance analysis (BIA) is the most widely used technique in body composition analysis. When we focus the use of phase sensitive BIA on its raw parameters Resistance (R), Reactance (Xc) and Phase Angle (PhA), we eliminate the bias of using predictive equations based on reference models. In particular PhA, have demonstrated their prognostic utility in multiple aspects of health and disease. In recent years, as a strong association between prognostic and diagnostic factors has been observed, scientific interest in the utility of PhA has increased. In the different fields of knowledge in biomedical research, there are different ways of assessing the impact of a scientific-technical aspect such as PhA. Single frequency with phase detection bioimpedance analysis (SF-BIA) using a 50 kHz single frequency device and tetrapolar wrist-ankle electrode placement is the most widely used bioimpedance approach for characterization of whole-body composition. However, the incorporation of vector representation of raw bioelectrical parameters and direct mathematical calculations without the need for regression equations for the analysis of body compartments has been one of the most important aspects for the development of research in this area. These results provide new evidence for the validity of phase-sensitive bioelectrical measurements as biomarkers of fluid and nutritional status. To enable the development of clinical research that provides consistent results, it is essential to establish appropriate standardization of PhA measurement techniques. Standardization of test protocols will facilitate the diagnosis and assessment of the risk associated with reduced PhA and the evaluation of changes in response to therapeutic interventions. In this paper, we describe and overview the value of PhA in biomedical research, technical and instrumental aspects of PhA research, analysis of Areas of clinical research (cancer patients, digestive and liver diseases, critical and surgical patients, Respiratory, infectious, and COVID-19, obesity and metabolic diseases, Heart and kidney failure, Malnutrition and sarcopenia), characterisation of the different research outcomes, Morphofunctional assessment in disease-related malnutrition and other metabolic disorders: validation of PhA with reference clinical practice techniques, strengths and limitations. Based on the detailed study of the measurement technique, some of the key issues to be considered in future PhA research. On the other hand, it is important to assess the clinical conditions and the phenotype of the patients, as well as to establish a disease-specific clinical profile. The appropriate selection of the most critical outcomes is another fundamental aspect of research.
Collapse
Affiliation(s)
- Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, 15405, Ferrol, A Coruña, Spain
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, Málaga University, 29010, Málaga, Spain
| | | | - Henry C Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND, 58202, USA
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de La Victoria Hospital, Malaga University, 29010, Malaga, Spain.
- Centro de Investigación Biomédica en Red de La Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010, Malaga, Spain.
- Málaga University, 29010, Málaga, Spain.
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, 29004, Málaga, Spain.
| |
Collapse
|
8
|
Cuttitta G, Ferraro M, Cibella F, Alfano P, Bucchieri S, Patti AM, Muratori R, Pace E, Bruno A. Relationship among Body Composition, Adipocytokines, and Irisin on Exercise Capacity and Quality of Life in COPD: A Pilot Study. Biomolecules 2022; 13:biom13010048. [PMID: 36671433 PMCID: PMC9855916 DOI: 10.3390/biom13010048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
Adipose tissue is an endocrine organ that interferes with the severity of chronic obstructive pulmonary disease (COPD). Although inflammatory markers, body composition, and nutritional status have a significant impact on pulmonary function, the real contribution of adipocytokines and myokines in COPD is still controversial. We aimed to evaluate the role played by the body composition, leptin, adiponectin, haptoglobin, and irisin on the functional exercise capacity, respiratory function, and quality of life (QoL) in COPD. In 25 COPD (20% GOLD-1; 60% GOLD-2; 20% GOLD-3) patients and 26 matched control subjects, we find that leptin, total adiponectin and haptoglobin are significantly increased whereas the 6 min walk test (6MWT) and physical functioning scores are significantly decreased in COPD versus controls. A significant positive relationship is found between leptin and fat mass and between 6MWT and the good health indicators of nutritional status. A significant inverse relationship is found between 6MWT and leptin and fat mass, FEV1 and haptoglobin, and irisin and haptoglobin. Phase angle and leptin level are significant predictors for functional exercise capacity assessed with 6MWT. Taken altogether, the results of this pilot study further support the role played by body composition and adipocytokines on exercise capacity respiratory function and QoL in COPD.
Collapse
Affiliation(s)
- Giuseppina Cuttitta
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Maria Ferraro
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Fabio Cibella
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Pietro Alfano
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Salvatore Bucchieri
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Angelo Maria Patti
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Rosalba Muratori
- Azienda Sanitaria Provinciale di Palermo, Via Giacomo Cusmano, 24, 90141 Palermo, Italy
| | - Elisabetta Pace
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
| | - Andreina Bruno
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), 90146 Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), 90146 Palermo, Italy
- Correspondence:
| |
Collapse
|