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Gungor O, Ulu S, Inci A, Topal K, Kalantar-Zadeh K. The Relationship Between Sarcopenia And Proteinuria, What Do We Know? Curr Aging Sci 2024; 17:93-102. [PMID: 38904152 DOI: 10.2174/0118746098232969231106091204] [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: 12/30/2022] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 06/22/2024]
Abstract
Sarcopenia is one of the most common geriatric syndromes in the elderly. It is defined as a decrease in muscle mass and function, and it can lead to physical disability, falls, poor quality of life, impaired immune system, and death. It is known that, the frequency of sarcopenia increases in the kidney patient population compared to healthy individuals. Although it is known that kidney disease can lead to sarcopenia; our knowledge of whether sarcopenia causes kidney disease is limited. Prior studies have suggested that protein energy wasting may be a risk of de novo CKD. Proteinuria is an important manifestation of kidney disease and there is a relationship between sarcopenia and proteinuria in diabetes, geriatric population, kidney transplant, and nephrotic syndrome. Does proteinuria cause sarcopenia or vice versa? Are they both the results of common mechanisms? This issue is not clearly known. In this review, we examined the relationship between sarcopenia and proteinuria in the light of other studies.
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Affiliation(s)
- Ozkan Gungor
- Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Beşiktaş, İstanbul, Turkey
| | - Sena Ulu
- Faculty of Medicine, Bahçeşehir University, Beşiktaş/İstanbul, Turkey
| | - Ayca Inci
- Department of Nephrology, Antalya Eğitim ve Araştırma Hastanesi, Antalya, Turkey
| | - Kenan Topal
- Department of Family Medicine, Adana Numune Eğitim ve Araştırma Hastanesi, Yüreğir, Adana, Turkey
| | - Kamyar Kalantar-Zadeh
- Department of Nephrology, University of California Irvine School of Medicine, Irvine, CA 92617, United States
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Soares ALDS, Machado-Lima A, Brech GC, Greve JMD, Dos Santos JR, Inojossa TR, Rogero MM, Salles JEN, Santarem-Sobrinho JM, Davis CL, Alonso AC. The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105891. [PMID: 37239618 DOI: 10.3390/ijerph20105891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
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Affiliation(s)
- André Luiz de Seixas Soares
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Adriana Machado-Lima
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Guilherme Carlos Brech
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Júlia Maria D'Andréa Greve
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Joselma Rodrigues Dos Santos
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Thiago Resende Inojossa
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Marcelo Macedo Rogero
- Department of Nutrition, Faculty of Public Health, FMSUP, São Paulo 01151-000, SP, Brazil
| | - João Eduardo Nunes Salles
- Department of Internal Medicine, The Discipline of Endocrinology, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil
| | | | - Catherine L Davis
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Angelica Castilho Alonso
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
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Karakousis ND, Biliou S, Pyrgioti EE, Georgakopoulos PN, Liakopoulos V, Papanas N. Frailty, sarcopenia and diabetic kidney disease: where do we stand? Int Urol Nephrol 2022; 55:1173-1181. [PMID: 36352313 DOI: 10.1007/s11255-022-03392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
The aim of this narrative non-systematic review was to investigate the potential interplay among frailty syndrome, sarcopenia and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients. Data derived from a limited number of studies underline that DKD is a significant risk factor for frailty. On the other hand, frailty syndrome poses a higher risk for end-stage renal disease (ESRD) in subjects with DKD. In addition, frailty seems to affect the cognitive function and social life of DKD individuals, whilst as DKD deteriorates, there is a higher prevalence of sarcopenia which is a fundamental frailty factor. As a result, it is shown that a bidirectional relation is established between these entities, as diabetes mellitus (DM) affects the components of frailty and sarcopenia and vice versa. This vicious cycle is created through multiple pathophysiologic mechanisms, including the anabolic role of insulin, low-grade inflammation, cytokines and endothelial function, prompting further investigation in this area. Specific nutritional and exercise interventions are imperative to be established in order to ameliorate potential adverse outcomes, concerning these entities.
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Affiliation(s)
| | | | | | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Although recent heart failure (HF) guidelines highlight integrative palliative care, including end-of-life (EOL), appropriate discussing EOL issues can be challenging due to possibility of unexpected deterioration throughout HF trajectory. Open communication and discussions with multidisciplinary team are important for setting patient and family expectations and establishing mutually agreed goals of care based firmly on the patient’s ‘human dignity’ and ‘right to self-determination.’ Especially when quality-of-life outweighs expanding quantity-of-life, transition to EOL care should be considered. Advanced care planning including resuscitation, device deactivation, site for last days, and bereavement support should focus on ensuring a good death, and be reviewed regularly. Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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Dhar M, Kapoor N, Suastika K, Khamseh ME, Selim S, Kumar V, Raza SA, Azmat U, Pathania M, Rai Mahadeb YP, Singhal S, Naseri MW, Aryana IGPS, Thapa SD, Jacob J, Somasundaram N, Latheef A, Dhakal GP, Kalra S. South Asian Working Action Group on SARCOpenia (SWAG-SARCO) – A consensus document. Osteoporos Sarcopenia 2022; 8:35-57. [PMID: 35832416 PMCID: PMC9263178 DOI: 10.1016/j.afos.2022.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/20/2021] [Accepted: 04/23/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Minakshi Dhar
- Department of Internal Medicine, AIIMS, Rishikesh, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
- Non Communicable Disease Unit, The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ketut Suastika
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University Denpasar, Bali, Indonesia
| | - Mohammad E. Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Vijay Kumar
- Department of Geriatric Medicine AIIMS New Delhi, India
| | - Syed Abbas Raza
- Department of Medicine, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Umal Azmat
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | | | - Sunny Singhal
- Department of Geriatric Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Mohammad Wali Naseri
- Internal Medicine, Division of Endocrinology Metabolism and Diabetes, Kabul University of Medical Sciences (KUMS), Kabul, Afghanistan
| | - IGP Suka Aryana
- Geriatric Division of Internal Medicine Department, Udayana University, Bali, Indonesia
| | - Subarna Dhoj Thapa
- Department of Endocrinology and Metabolism, Grande International Hospital, Kathmandu, Nepal
| | - Jubbin Jacob
- Department of Endocrinology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, 10, Sri Lanka
| | - Ali Latheef
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Maldives
| | - Guru Prasad Dhakal
- Department of Gastroenterology, Jigme Dorji Wangchuk National Referral Hospital, Thimpu, Bhutan
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
- Corresponding author.
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Gungor O, Ulu S, Hasbal NB, Anker SD, Kalantar‐Zadeh K. Effects of hormonal changes on sarcopenia in chronic kidney disease: where are we now and what can we do? J Cachexia Sarcopenia Muscle 2021; 12:1380-1392. [PMID: 34676694 PMCID: PMC8718043 DOI: 10.1002/jcsm.12839] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023] Open
Abstract
Sarcopenia or muscle wasting is a progressive and generalized skeletal muscle disorder involving the accelerated loss of muscle mass and function, often associated with muscle weakness (dynapenia) and frailty. Whereas primary sarcopenia is related to ageing, secondary sarcopenia happens independent of age in the context of chronic disease states such as chronic kidney disease (CKD). Sarcopenia has become a major focus of research and public policy debate due to its impact on patient's health-related quality of life, health-care expenditure, morbidity, and mortality. The development of sarcopenia in patients with CKD is multifactorial and it may occur independently of weight loss or cachexia including under obese sarcopenia. Hormonal imbalances can facilitate the development of sarcopenia in the general population and is a common finding in CKD. Hormones that may influence the development of sarcopenia are testosterone, growth hormone, insulin, thyroid hormones, and vitamin D. Although the relationship between free testosterone level that is low in uraemic patients and sarcopenia in CKD is not well-defined, functional improvement may be seen. Unlike testosterone, it is known that vitamin D is associated with muscle strength, muscle size, and physical performance in patients with CKD. Outcomes after vitamin D replacement therapy are still controversial. The half-life of growth hormone (GH) is prolonged in patients with CKD. Besides, IGF-1 levels are normal in patients with Stage 4 CKD-a minimal reduction is seen in the end-stage renal disease. Unresponsiveness or resistance of IGF-1 and changes in the GH/IGF-1 axis are the main causes of sarcopenia in CKD. Low serum T3 level is frequent in CKD, but the net effect on sarcopenia is not well-studied. CKD patients develop insulin resistance (IR) from the earliest period even before GFR decline begins. IR reduces glucose utilization as an energy source by hepatic gluconeogenesis, decreasing muscle glucose uptake, impairing intracellular glucose metabolism. This cascade results in muscle protein breakdown. IR and sarcopenia might also be a new pathway for targeting. Ghrelin, oestrogen, cortisol, and dehydroepiandrosterone may be other players in the setting of sarcopenia. In this review, we mainly examine the effects of hormonal changes on the occurrence of sarcopenia in patients with CKD via the available data.
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Affiliation(s)
- Ozkan Gungor
- Division of Nephrology, Department of Internal Medicine, Faculty of MedicineKahramanmaras Sutcu Imam UniversityKahramanmarasTurkey
| | - Sena Ulu
- Department of Internal Medicine and Nephrology, Faculty of MedicineBahcesehir UniversityIstanbulTurkey
| | - Nuri Baris Hasbal
- Clinic of NephrologyBasaksehir Cam and Sakura City HospitalIstanbulTurkey
| | - Stefan D. Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT)German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Kamyar Kalantar‐Zadeh
- Division of Nephrology, Hypertension and Kidney TransplantationUniversity of California Irvine School of MedicineOrangeCAUSA
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7
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Guest PC. New Therapeutic Approaches and Biomarkers for Increased Healthspan. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1286:1-13. [PMID: 33725342 DOI: 10.1007/978-3-030-55035-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Healthcare costs have increased in developing countries over the last few decades, mostly due to the escalation in average life expectancy and the concomitant increase in age-related disorders. To address this issue, widespread research is now being undertaken across the globe with the aim of finding a way of increasing healthy aging. A number of potential interventions have already shown promise, including lifestyle changes and the use of natural products or pharmaceuticals that may delay the onset of diseases associated with the aging process. In parallel, a number of potential biomarkers have already been identified that can be used for assessing risk of developing age-associated disorders and for monitoring response to therapeutic interventions. This review describes the most recent advances towards the goal of achieving healthier aging with fewer disabilities that may lead to enhanced quality of life and reduced healthcare costs around the world.
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Affiliation(s)
- Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil.
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Alturki M, Liberman K, Delaere A, De Dobbeleer L, Knoop V, Mets T, Lieten S, Bravenboer B, Beyer I, Bautmans I. Effect of Antihypertensive and Statin Medication Use on Muscle Performance in Community-Dwelling Older Adults Performing Strength Training. Drugs Aging 2021; 38:253-263. [PMID: 33543410 DOI: 10.1007/s40266-020-00831-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Antihypertensive drugs (AHTD) and statins have been shown to have effects beyond their primarily designed purpose; here we investigate their possible effect on muscle performance and strength in older adults following a physical exercise programme. DESIGN The Senior PRoject INtensive Training (SPRINT) study is a randomised, controlled clinical trial designed to evaluate the effects of physical exercise on the immune system and muscle performance in older adults. PARTICIPANTS In this secondary analysis, we included 179 independent participants (aged 65 years and above). We applied further categorisation based on medication use: AHTD (including, angiotensin-converting enzyme inhibitors [ACEI], angiotensin II receptor blockers [ARB], β-blockers, and other AHTD) and statins. INTERVENTION Participants were allocated randomly to one of the three exercise protocols: intensive strength training 3 times/week (3 × 10 repetitions at 80% of one-repetition maximum), strength endurance training (2 × 30 repetitions at 40% of one-repetition maximum), or control (passive stretching exercise) for 6 weeks. MEASUREMENTS The change in maximal hand grip strength (GS), muscle fatigue resistance (FR), Muscle Strength Index (MSI), the 6-min walk test (6MWT), and Timed Up and Go Test (TUG) were assessed before and after 6 weeks of training. RESULTS After 6 weeks, muscle strength (MSI and TUG) improved significantly in all training groups compared to baseline, independently of AHTD use. Moreover, AHTD had no effect on exercise improvements, with no significant differences between medication groups, except for TUG in ARB users, which exhibited a significantly lower performance. On the other hand, statin users presented a significantly longer FR time, indicating better performance compared to non-users. Finally, medication did not affect the participants' commitment to the training programme. CONCLUSION Our study showed that statins and ARB usage might affect participant's response to strength training. Nevertheless, 6 weeks of training significantly improved muscle strength and performance irrespective of AHTD or statin use.
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Affiliation(s)
- Mohammad Alturki
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Keliane Liberman
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Andreas Delaere
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Liza De Dobbeleer
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Veerle Knoop
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Tony Mets
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Siddhartha Lieten
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bert Bravenboer
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingo Beyer
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ivan Bautmans
- Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
- Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
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Multimodal Intervention to Improve Functional Status in Hypertensive Older Adults: A Pilot Randomized Controlled Trial. J Clin Med 2019; 8:jcm8020196. [PMID: 30736317 PMCID: PMC6406861 DOI: 10.3390/jcm8020196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
This pilot randomized controlled trial (RCT) was designed to provide the preliminary data necessary to conduct a full-scale trial to compare the efficacy of differing first-line antihypertensive medications in improving functional status in older adults, when combined with exercise. The primary objectives were to assess study feasibility, safety, and protocol integrity. Dependent outcomes included gait speed, exercise capacity, body composition, and systemic cardiometabolic biomarkers. Thirty-one physically inactive older adults (70.6 ± 6.1 years) with hypertension and functional limitations were randomly assigned to (1) Perindopril (8 mg/day n = 10), (2) Losartan (100 mg/day; n = 13), or (3) Hydrochlorothiazide (HCTZ: 25 mg/day; n = 8). Participants were also assigned to a 24-week multimodal exercise intervention, separated into an aerobic and concurrent (aerobic + resistance) phase to evaluate potential mode effects. Retention was 84% (26/31), and compliance was >90% and >79% with medication and exercise, respectively. A total of 29 adverse events (Perindopril = 5; Losartan = 12; HCTZ = 11) and one unrelated serious adverse event were observed throughout the trial. Overall, this pilot RCT provided critical data and identified several challenges to ultimately designing and implementing a fully powered trial.
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Kwak MK, Lee SE, Cho YY, Suh S, Kim BJ, Song KH, Koh JM, Kim JH, Lee SH. The Differential Effect of Excess Aldosterone on Skeletal Muscle Mass by Sex. Front Endocrinol (Lausanne) 2019; 10:195. [PMID: 30984113 PMCID: PMC6450066 DOI: 10.3389/fendo.2019.00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/07/2019] [Indexed: 01/04/2023] Open
Abstract
The effects of excess aldosterone on skeletal muscle in individuals with primary aldosteronism (PA) are unknown. To examine the effects of aldosterone on skeletal muscle mass in patients with PA, by sex, 309 consecutive patients were enrolled. Skeletal muscle and fat mass of 62 patients with PA were compared with those of 247 controls with non-functioning adrenal incidentaloma (NFAI). Body composition parameters were measured using bioelectrical impedance analysis, and plasma aldosterone concentration (PAC) was measured using radioimmunoassay. The PAC in all women, but not in men, showed an inverse association with both appendicular skeletal muscle mass (ASM) (β = -0.197, P = 0.016) and height-adjusted ASM (HA-ASM) (β = -0.207, P = 0.009). HA-ASM in women (but not in men) with PA was 5.0% lower than that in women with NFAI (P = 0.036). Furthermore, women with PA had a lower HA-ASM than 1:1 age- and sex-matched controls with NFAI by 5.7% (P = 0.049) and tended to have a lower HA-ASM than 1:3 age-, sex-, and menopausal status-matched controls without adrenal incidentaloma (AI) by 7.3% (P = 0.053). The odds ratio (OR), per quartile increase in PAC, of low HA-ASM in women was 1.18 [95% confidence interval (CI), 1.01-1.39; P = 0.035]. The odds of HA-ASM in subjects with PA were 10.63-fold (95% CI: 0.83-135.50) higher, with marginal significance (P = 0.069) than in those with NFAI. Skeletal muscle mass in women with PA was lower than that in women with NFAI; suggesting that excess aldosterone has adverse effects on skeletal muscle metabolism.
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Affiliation(s)
- Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dontan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Seung-Eun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Jae Hyeon Kim
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Seung Hun Lee
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Impact of drugs with anti-inflammatory effects on skeletal muscle and inflammation: A systematic literature review. Exp Gerontol 2018; 114:33-49. [PMID: 30367977 DOI: 10.1016/j.exger.2018.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/01/2018] [Accepted: 10/17/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ageing-related low-grade inflammation is suggested to aggravate sarcopenia and frailty. This systematic review investigates the influence that drugs with anti-inflammatory effects (AIDs) have on inflammation and skeletal muscle. METHODS PubMed and Web of Science were systematically screened for articles reporting the effects of AIDs on inflammation on one hand and on muscle mass and/or performance on the other. RESULTS Twenty-eight articles were included. These articles were heterogeneous in terms of the subjects studied, intervention components, setting, and outcome measures. Articles on older humans with acute inflammation showed evidence that celecoxib and piroxicam could reduce inflammation and improve performance and that ibuprofen improves exercise-induced muscle hypertrophy and gains in strength. In younger humans, only the effects of AIDs combined with exercise were investigated; no significant benefits of non-selective COX-inhibitors were reported, but improved strength gains with etanercept and reduced muscle soreness with celecoxib were noted. Indomethacin increased acute exercise-induced inflammation and reduced satellite cell differentiation in exercising muscle. Most articles did not systematically report occurrences of side effects. CONCLUSIONS Although AIDs showed significant reduction in inflammation-induced muscle weakness in older hospitalised patients with acute inflammation, robust evidence is still lacking. When combined with exercise, AIDs presented a protective effect against age-related loss of muscle mass, thus enhancing muscle mass and performance. The mechanism regulating muscle strength and its mass seems to differ between individuals of old and young age. However, the effects seem drug-specific and dose-dependent and appear to be influenced by subjects' trainability and the clinical context. In addition, the balance between benefits and harm remains unclear.
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12
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Haberl J, Zollner G, Fickert P, Stadlbauer V. To salt or not to salt?-That is the question in cirrhosis. Liver Int 2018; 38:1148-1159. [PMID: 29608812 DOI: 10.1111/liv.13750] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/23/2018] [Indexed: 12/26/2022]
Abstract
Ascites is the most common complication of patients with cirrhosis, resulting from portal hypertension and vasodilatation. It is associated with an increased risk for the development of hyponatraemia and renal failure and has a high mortality rate of 20% per year. The development of ascites represents a baleful sign in the course of disease in cirrhosis. To prevent complications of cirrhosis and improve quality of life, an effective management of ascites is pivotal. Combined salt restriction and diuretic therapy is recommended as first-line therapy in numerous clinical practice guidelines. In contrast, there has been a debate on whether a strict salt-restricted diet for cirrhosis patients should be used at all since salt restriction may increase the risk for malnutrition which in turn may negatively impact on quality of life and survival. This review aims to summarize the current pros and cons regarding salt restriction in patients with cirrhosis and proposes the importance of achieving a sodium balance throughout different stages of cirrhosis.
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Affiliation(s)
- Julia Haberl
- Clinical Medical Nutrition Therapy, University Hospital Graz, Graz, Austria
| | - Gernot Zollner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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13
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Prediction of sarcopenia using a combination of multiple serum biomarkers. Sci Rep 2018; 8:8574. [PMID: 29872072 PMCID: PMC5988732 DOI: 10.1038/s41598-018-26617-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/15/2018] [Indexed: 01/01/2023] Open
Abstract
Sarcopenia is a gradual loss of skeletal muscle mass and function with aging. Given that sarcopenia has been recognized as a disease entity, effective molecular biomarkers for early diagnosis are required. We recruited 46 normal subjects and 50 patients with moderate sarcopenia aged 60 years and older. Sarcopenia was clinically identified on the basis of the appendicular skeletal muscle index by applying cutoff values derived from the Asian Working Group for Sarcopenia. The serum levels of 21 potential biomarkers were analyzed and statistically examined. Interleukin 6, secreted protein acidic and rich in cysteine, macrophage migration inhibitory factor, and insulin-like growth factor 1 levels differed significantly between the normal and sarcopenia groups. However, in each case, the area under the receiver operating characteristics curve (AUC) was <0.7. Subsequent combination of the measurements of these biomarkers into a single risk score based on logistic regression coefficients enhanced the accuracy of diagnosis, yielding an AUC value of 0.763. The best cutoff value of 1.529 had 70.0% sensitivity and 78.3% specificity (95% CI = 2.80–21.69, p < 0.0001). Combined use of the selected biomarkers provides higher diagnostic accuracy than individual biomarkers, and may be effectively utilized for early diagnosis and prognosis of sarcopenia.
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14
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Chung HS, Hwang SY, Choi JH, Lee HJ, Yoo HJ, Seo JA, Kim SG, Kim NH, Choi DS, Baik SH, Choi KM. Effects of Low Muscle Mass on Albuminuria and Chronic Kidney Disease in Patients With Type 2 Diabetes: The Korean Sarcopenic Obesity Study (KSOS). J Gerontol A Biol Sci Med Sci 2018; 73:386-392. [PMID: 28407041 PMCID: PMC5861907 DOI: 10.1093/gerona/glx055] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/16/2017] [Indexed: 12/22/2022] Open
Abstract
Background Previous studies have shown that chronic kidney disease (CKD) is associated with accelerated loss of skeletal muscle in patients on dialysis. However, the relationships of sarcopenia with albuminuria and early-stage CKD in patients with type 2 diabetes have not been examined. Methods We analyzed diabetic subgroup data from 409 patients with type 2 diabetes from the Korean Sarcopenic Obesity Study (KSOS). Sarcopenia was defined as a skeletal muscle mass index (SMI; SMI [%] = total skeletal muscle mass [kg]/weight [kg] × 100) less than 2 SD below the sex-specific mean for a younger reference group. The estimated glomerular filtration rates and urinary albumin-to-creatinine ratios were used to assess renal function and albuminuria. Results The prevalence of sarcopenia was significantly increased in the albuminuria group compared with the normo-albuminuria group (26.7% vs 12.6%, p = .001), as well as in CKD 3 group compared with the CKD 1-2 group (46.7% vs 15.1%, p = .005). After adjusting for age, SMI was negatively correlated with urinary albumin-to-creatinine ratios and positively correlated with aspartate aminotransferase, alanine aminotransferase, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. Multiple logistic regression analysis revealed that the odds ratio for albuminuria association was 3.02 (95% CI 1.37-6.67) in the lowest tertile of SMI compared with the highest tertile after adjusting for various confounding factors. Conclusions Sarcopenia is more prevalent in individuals with albuminuria than in those without albuminuria. Furthermore, increased albuminuria is independently associated with low muscle mass in patients with type 2 diabetes.
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Affiliation(s)
- Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University, Seoul
| | - Ju Hee Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Hyun Jung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Ji-A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Dong Seop Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul
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15
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Bea JW, Wassertheil-Smoller S, Wertheim BC, Klimentidis Y, Chen Z, Zaslavsky O, Manini TM, Womack CR, Kroenke CH, LaCroix AZ, Thomson CA. Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women. J Aging Res 2018; 2018:8491092. [PMID: 29670769 PMCID: PMC5836326 DOI: 10.1155/2018/8491092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 12/25/2022] Open
Abstract
Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health Initiative participants that received dual energy X-ray absorptiometry scans to estimate body composition (n=10,635) at baseline and at years 3 and 6 of follow-up. Of those, 2642 were treated for hypertension at baseline. Multivariate linear regression models, adjusted for relevant demographics, behaviors, and medications, assessed ACE-I/ARB use/nonuse and LBM associations at baseline, as well as change in LBM over 3 and 6 years. Although BMI did not differ by ACE-I/ARB use, LBM (%) was significantly higher in ACE-I/ARB users versus nonusers at baseline (52.2% versus 51.3%, resp., p=0.001). There was no association between ACE-I/ARB usage and change in LBM over time. Reasons for higher LBM with ACE-I/ARB use cross sectionally, but not longitundinally, are unclear and may reflect a threshold effect of these medications on LBM that is attenuated over time. Nevertheless, ACE-I/ARB use does not appear to negatively impact LBM in the long term.
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Affiliation(s)
- Jennifer W. Bea
- University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ 85724-0524, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Belfer Building, Room 1308B, Bronx, NY 10461, USA
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ 85724-0524, USA
| | - Yann Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245211, Drachman Hall A238, Tucson, AZ 85724, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245211, Drachman Hall A238, Tucson, AZ 85724, USA
| | - Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health Systems, University of Washington, P.O Box 357266, 1959 NE Pacific Ave., Seattle, WA 98195-7266, USA
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, P.O. Box 100107, Gainesville, FL 32610, USA
| | - Catherine R. Womack
- Department of Medicine, University of Tennessee, 956 Court Avenue, Memphis, TN 38163, USA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Drive No. 0725, San Diego, La Jolla, CA 92093, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245209, Drachman Hall A260, Tucson, AZ 85724, USA
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Han E, Lee YH, Lee BW, Kang ES, Cha BS. Pre-sarcopenia is associated with renal hyperfiltration independent of obesity or insulin resistance: Nationwide Surveys (KNHANES 2008-2011). Medicine (Baltimore) 2017; 96:e7165. [PMID: 28658107 PMCID: PMC5500029 DOI: 10.1097/md.0000000000007165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Renal hyperfiltration is closely linked to cardiometabolic disorders, and it may increase the mortality risk of the general population. Despite the well-established association between cardiometabolic diseases and sarcopenia, the relationship between renal hyperfiltration and sarcopenia has not yet been assessed.This population-based, cross-sectional study used a nationally representative sample of 13,800 adults from the 2008 to 2011 Korea National Health and Nutrition Examination Survey. Renal hyperfiltration was defined as the age- and sex-specific glomerular filtration rate above the 90th percentile in subjects with normal kidney function (>60 mL/min/1.73 m). Appendicular skeletal muscle (ASM), measured by dual-energy x-ray absorptiometry, was used to assess pre-sarcopenia, which the international consensus defines as both ASM per se and ASM that was adjusted for the body mass index and the height.A total of 1402 (10.2%) participants were classified as having renal hyperfiltration. The prevalence of pre-sarcopenia ranged from 11.6% to 33.0%, by definition. Individuals with pre-sarcopenia had higher risks of renal hyperfiltration compared to those without pre-sarcopenia (10.9% vs 17.4%, P < .001; odds ratio [OR] = 1.71, 95% confidential interval [CI] = 1.48-1.99, P < .001). Multiple logistic regression analyses also demonstrated this independent association between pre-sarcopenia and renal hyperfiltration, following adjustment for confounding factors such as insulin resistance and obesity (OR = 1.84, 95% CI = 1.57-2.15, P < .001).In the general population of healthy individuals, pre-sarcopenia might be associated with renal hyperfiltration independent of obesity or insulin resistance.
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Affiliation(s)
- Eugene Han
- Department of Internal Medicine
- Graduate School
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-ho Lee
- Department of Internal Medicine
- Graduate School
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul
| | - Byung-Wan Lee
- Department of Internal Medicine
- Graduate School
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul
| | - Eun Seok Kang
- Department of Internal Medicine
- Graduate School
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul
| | - Bong-Soo Cha
- Department of Internal Medicine
- Graduate School
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul
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17
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Yoon HE, Nam Y, Kang E, Hwang HS, Shin SJ, Hong YS, Kang KY. Gender-Specific Associations between Low Skeletal Muscle Mass and Albuminuria in the Middle-Aged and Elderly Population. Int J Med Sci 2017; 14:1054-1064. [PMID: 29104458 PMCID: PMC5666535 DOI: 10.7150/ijms.20286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022] Open
Abstract
Objective This study assessed gender-specific associations between low muscle mass (LMM) and albuminuria. Methods Data from the Korea National Health and Nutrition Examination Survey 2011 were employed. The study consisted of 1,087 subjects (≥50 years old). Skeletal muscle index (SMI) was defined as the weight-adjusted appendicular skeletal muscle mass. Mild LMM and severe LMM were defined as SMI that were 1-2 and >2 standard deviations below the sex-specific mean appendicular skeletal muscle mass of young adults, respectively. Increased albuminuria was defined as albumin-to-creatinine ratio ≥30mg/g Results Men with mild and severe LMM were significantly more likely to have increased albuminuria (15.2% and 45.45%, respectively) than men with normal SMI (9.86%, P<0.0001), but not women. Severe LMM associated independently with increased albuminuria in men (OR=7.661, 95% CI=2.72-21.579) but not women. Severe LMM was an independent predictor of increased albuminuria in hypertensive males (OR=11.449, 95% CI=3.037-43.156), non-diabetic males (OR=8.782, 95% CI=3.046-25.322), and males without metabolic syndrome (MetS) (OR=8.183, 95% CI=1.539-43.156). This was not observed in males without hypertension, males with diabetes or MetS, and all female subgroups. Conclusion Severe LMM associated with increased albuminuria in men, especially those with hypertension and without diabetes or MetS.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Yunju Nam
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Eunjin Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Yeon Sik Hong
- Department of Internal Medicine, Incheon St. Mary's Hospital.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Incheon St. Mary's Hospital.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
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Angiotensin-Converting Enzyme Inhibitors and Parameters of Sarcopenia: Relation to Muscle Mass, Strength and Function: Data from the Berlin Aging Study-II (BASE-II). Drugs Aging 2016; 33:829-837. [DOI: 10.1007/s40266-016-0396-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Kim TN, Lee EJ, Hong JW, Kim JM, Won JC, Kim MK, Noh JH, Ko KS, Rhee BD, Kim DJ. Relationship Between Sarcopenia and Albuminuria: The 2011 Korea National Health and Nutrition Examination Survey. Medicine (Baltimore) 2016; 95:e2500. [PMID: 26817888 PMCID: PMC4998262 DOI: 10.1097/md.0000000000002500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Studies have shown that albuminuria, obesity, and sarcopenia may share pathophysiological processes related to cardiovascular disease risk. Their direct relationships, however, have not been examined. This study investigated the association between albuminuria and sarcopenia in a representative fraction of the Korean population.Of the 10,589 people who participated in the 2011 Korea National Health and Nutrition Examination Survey, 2158 participants aged over 19 years had been tested for albumin-to-creatinine ratio and for body composition data using dual-energy x-ray absorptiometry. Albuminuria was defined as an albumin-to-creatinine ratio ≥30 mg/g. Sarcopenia was defined as a skeletal muscle index (SMI) (SMI (%) = total appendicular skeletal muscle mass [kg]/weight [kg] × 100) of less than 1 standard deviation (SD) (grade 1) or 2 SD (grade 2) below the sex-specific mean for a younger reference group.The prevalence of albuminuria was higher in those with grade 2 sarcopenia than in those with a normal SMI or grade 1 sarcopenia (33.3% versus 8.4% and 8.9%; P < 0.001). Conversely, grade 2 sarcopenia was also more prevalent in participants with albuminuria than in those with the upper tertile of normoalbuminuria. In addition, multiple logistic regression analysis showed the odds ratio for albuminuria risk in the grade 2 sarcopenia group was 2.93 (95% confidence interval [CI], 1.46-5.88), compared with normal SMI after adjusting for potential confounding factors, including the presence of obesity, diabetes, and hypertension. Moreover, individuals with albuminuria had an odds ratio of 3.39 (95% [confidence interval], 1.38-8.37) for grade 2 sarcopenia compared with those in the lowest tertile of normoalbuminuria.This is the first study to demonstrate that individuals with sarcopenia exhibited increased risk of albuminuria and vice versa.
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Affiliation(s)
- Tae Nyun Kim
- From the Department of Internal Medicine, Cardiovascular and Metabolic Disease Center (TNK); Department of Internal Medicine, Haeundae Paik Hospital, Busan (EJL, MKK); Department of Internal Medicine, Ilsan-Paik Hospital, Koyang (JWH, JHN, D-JK); and Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, College of Medicine, Sanggye Paik Hospital, Inje University, Seoul, South Korea (JMK, JCW, KSK, BDR)
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Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, Clark DJ, Cohen RA, Corbett DB, Cruz-Almeida Y, Dotson V, Ebner N, Efron PA, Fillingim RB, Foster TC, Gundermann DM, Joseph AM, Karabetian C, Leeuwenburgh C, Manini TM, Marsiske M, Mankowski RT, Mutchie HL, Perri MG, Ranka S, Rashidi P, Sandesara B, Scarpace PJ, Sibille KT, Solberg LM, Someya S, Uphold C, Wohlgemuth S, Wu SS, Pahor M. Successful aging: Advancing the science of physical independence in older adults. Ageing Res Rev 2015; 24:304-27. [PMID: 26462882 DOI: 10.1016/j.arr.2015.09.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 02/08/2023]
Abstract
The concept of 'successful aging' has long intrigued the scientific community. Despite this long-standing interest, a consensus definition has proven to be a difficult task, due to the inherent challenge involved in defining such a complex, multi-dimensional phenomenon. The lack of a clear set of defining characteristics for the construct of successful aging has made comparison of findings across studies difficult and has limited advances in aging research. A consensus on markers of successful aging is furthest developed is the domain of physical functioning. For example, walking speed appears to be an excellent surrogate marker of overall health and predicts the maintenance of physical independence, a cornerstone of successful aging. The purpose of the present article is to provide an overview and discussion of specific health conditions, behavioral factors, and biological mechanisms that mark declining mobility and physical function and promising interventions to counter these effects. With life expectancy continuing to increase in the United States and developed countries throughout the world, there is an increasing public health focus on the maintenance of physical independence among all older adults.
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Buford TW, Anton SD, Bavry AA, Carter CS, Daniels MJ, Pahor M. Multi-modal intervention to reduce cardiovascular risk among hypertensive older adults: Design of a randomized clinical trial. Contemp Clin Trials 2015; 43:237-42. [PMID: 26115878 DOI: 10.1016/j.cct.2015.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/16/2015] [Accepted: 06/20/2015] [Indexed: 01/13/2023]
Abstract
Persons aged over 65 years account for over 75% of healthcare expenditures and deaths attributable to cardiovascular disease (CVD). Accordingly, reducing CVD risk among older adults is an important public health priority. Functional status, determined by measures of physical performance, is an important predictor of cardiovascular outcomes in older adults and declines more rapidly in seniors with hypertension. To date, physical exercise is the primary strategy for attenuating declines in functional status. Yet despite the general benefits of training, exercise alone appears to be insufficient for preventing this decline. Thus, alternative or adjuvant strategies are needed to preserve functional status among seniors with hypertension. Prior data suggest that angiotensin converting enzyme inhibitors (ACEi) may be efficacious in enhancing exercise-derived improvements in functional status yet this hypothesis has not been tested in a randomized controlled trial. The objective of this randomized, double-masked pilot trial is to gather preliminary efficacy and safety data necessary for conducting a full-scale trial to test this hypothesis. Sedentary men and women ≥ 65 years of age with functional limitations and hypertension are being recruited into this 24 week intervention study. Participants are randomly assigned to one of three conditions: (1) ACEi plus exercise training, (2) thiazide diuretic plus exercise training, or (3) AT1 receptor antagonist plus exercise training. The primary outcome is change in walking speed and secondary outcomes consist of other indices of CV risk including exercise capacity, body composition, as well as circulating indices of metabolism, inflammation and oxidative stress.
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Affiliation(s)
- Thomas W Buford
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States; Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, Gainesville, FL, United States.
| | - Stephen D Anton
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Anthony A Bavry
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States; North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Christy S Carter
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Michael J Daniels
- Department of Statistics & Data Sciences and Department of Integrative Biology, College of Natural Sciences, University of Texas, Austin, TX, United States
| | - Marco Pahor
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
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Optimizing the benefits of exercise on physical function in older adults. PM R 2013; 6:528-43. [PMID: 24361365 DOI: 10.1016/j.pmrj.2013.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 01/10/2023]
Abstract
As the number of older adults continues to rise worldwide, the prevention of physical disability among seniors is an increasingly important public health priority. Physical exercise is among the best known methods of preventing disability, but accumulating evidence indicates that considerable variability exists in the responsiveness of older adults to standard training regimens. Accordingly, a need exists to develop tailored interventions to optimize the beneficial effects of exercise on the physical function of older adults at risk for becoming disabled. The present review summarizes the available literature related to the use of adjuvant or alternative strategies intended to enhance the efficacy of exercise in improving the physical function of older adults. Within this work, we also discuss potential future research directions in this area.
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von Haehling S, Steinbeck L, Doehner W, Springer J, Anker SD. Muscle wasting in heart failure: An overview. Int J Biochem Cell Biol 2013; 45:2257-65. [DOI: 10.1016/j.biocel.2013.04.025] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/28/2013] [Indexed: 01/10/2023]
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Abstract
Sarcopenia remains largely undiagnosed and undertreated because of the lack of a universally accepted definition, effective ways to measure it, and identification of the outcomes that should guide treatment efficacy. An ever-growing number of clinicians and researchers along with funding and regulatory agencies have gradually recognized that sarcopenia is a human condition that requires both prevention and treatment. In this article, we review sarcopenia and its common and less known pharmacological treatments, attempt to define sarcopenia in its broader context, and present some new ideas for potential future treatment for this devastating condition.
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Affiliation(s)
- Marco Brotto
- Muscle Biology Research Group-MUBIG, University of Missouri-Kansas City, School of Nursing, Kansas City, MO 64108, USA.
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Kang HJ, Kim CH, Park DS, Choi SY, Lee DH, Nam HS, Hur JG, Woo JH. The Impacts of ACE Activity according to ACE I/D Polymorphisms on Muscular Functions of People Aged 65. Ann Rehabil Med 2012; 36:433-46. [PMID: 22977768 PMCID: PMC3438409 DOI: 10.5535/arm.2012.36.4.433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/02/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate associations between angiotensin-converting enzyme (ACE) polymorphisms and muscle fatigability in 65-year-old Koreans. METHOD The study participants were 49 Koreans aged 65 years. ACE insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction and serum ACE activity, by spectrophotometry. Body mass index (BMI), body fat mass (BFM), and lean body mass (LBM) were determined. To evaluate muscle fatigability, dynamic Electromyography was used to measure maximum voluntary isometric contractions (MVICs) of ankle plantar flexor muscles. Patients were seated with their hips flexed at 90°, knees fully extended, and ankles at 0°. Continuous submaximal VICs (40% MVIC) were then performed, and contraction duration and EMG frequency changes during the initial 2 min were measured. A self-reported physical activity questionnaire was used to evaluate effects of ACE activity levels on muscle fatigability. RESULTS Among the 49 volunteers, 15 showed II genotype; 22, ID genotype; and 12, DD genotype. Serum ACE activity levels were significantly higher in DD genotype subjects than in II genotype subjects (p<0.05). Furthermore, the duration of submaximal isometric contractions was longer in II and ID genotype subjects than in DD genotype subjects (p<0.05). Dynamic EMG showed significantly lower mean frequency changes in II genotype subjects than in DD genotype subjects (p<0.05). However, LBM, BFM, and BMI were independent of ACE genotypes. CONCLUSION ACE II genotype subjects showed significantly higher resistant to muscle fatigue than that by DD genotype subjects. However, body composition and BMI showed no correlations with ACE I/D polymorphisms.
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Affiliation(s)
- Hyeon-Jung Kang
- Department of Rehabilitation Medicine, Hallym University College of Medicine, Seoul 134-701, Korea
| | - Chul-Hyun Kim
- Department of Physiology and Biophysics, Antiaging Research Center, School of Medicine, Eulji University, Daejeon 301-832, Korea
| | - Dong-Sik Park
- Department of Rehabilitation Medicine, Hallym University College of Medicine, Seoul 134-701, Korea
| | - Seung-Yeon Choi
- Department of Rehabilitation Medicine, Hallym University College of Medicine, Seoul 134-701, Korea
| | - Dong-Hoon Lee
- Department of Rehabilitation Medicine, Hallym University College of Medicine, Seoul 134-701, Korea
| | - Hee-Seung Nam
- Department of Rehabilitation Medicine, Hallym University College of Medicine, Seoul 134-701, Korea
| | - Jin-Gang Hur
- Department of Physical Therapy, Hallym College, Chuncheon 200-711, Korea
| | - Ji-Hea Woo
- Department of Physical Therapy, Hallym College, Chuncheon 200-711, Korea
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Ghrelin improves body weight loss and skeletal muscle catabolism associated with angiotensin II-induced cachexia in mice. ACTA ACUST UNITED AC 2012; 178:21-8. [PMID: 22750276 DOI: 10.1016/j.regpep.2012.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 06/20/2012] [Indexed: 12/20/2022]
Abstract
Ghrelin is a gastric peptide that regulates energy homeostasis. Angiotensin II (Ang II) is known to induce body weight loss and skeletal muscle catabolism through the ubiquitin-proteasome pathway. In this study, we investigated the effects of ghrelin on body weight and muscle catabolism in mice treated with Ang II. The continuous subcutaneous administration of Ang II to mice for 6 days resulted in cardiac hypertrophy and significant decreases in body weight gain, food intake, food efficiency, lean mass, and fat mass. In the gastrocnemius muscles of Ang II-treated mice, the levels of insulin-like growth factor 1 (IGF-1) were decreased, and the levels of mRNA expression of catabolic factors were increased. Although the repeated subcutaneous injections of ghrelin (1.0mg/kg, twice daily for 5 days) did not affect cardiac hypertrophy, they resulted in significant body weight gains and improved food efficiencies and tended to increase both lean and fat mass in Ang II-treated mice. Ghrelin also ameliorated the decreased IGF-1 levels and the increased mRNA expression levels of catabolic factors in the skeletal muscle. IGF-1 mRNA levels in the skeletal muscle significantly decreased 24h after Ang II infusion, and this was reversed by two subcutaneous injections of ghrelin. In C2C12-derived myocytes, the dexamethasone-induced mRNA expression of atrogin-1 was decreased by IGF-1 but not by ghrelin. In conclusion, we demonstrated that ghrelin improved body weight loss and skeletal muscle catabolism in mice treated with Ang II, possibly through the early restoration of IGF-1 mRNA in the skeletal muscle and the amelioration of nutritional status.
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Gray SL, Boudreau RM, Newman AB, Studenski SA, Shorr RI, Bauer DC, Simonsick EM, Hanlon JT. Angiotensin-converting enzyme inhibitor and statin use and incident mobility limitation in community-dwelling older adults: the Health, Aging and Body Composition study. J Am Geriatr Soc 2011; 59:2226-32. [PMID: 22092102 PMCID: PMC3389784 DOI: 10.1111/j.1532-5415.2011.03721.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate whether the use of angiotensin-converting enzyme (ACE) inhibitors and statins is associated with a lower risk of incident mobility limitation in older community dwelling adults. DESIGN Longitudinal cohort study. SETTING Health, Aging and Body Composition (Health ABC) study. PARTICIPANTS Three thousand fifty-five participants who were well functioning at baseline (no mobility limitations). MEASUREMENTS Summated standardized daily doses (low, medium, high) and duration of ACE inhibitor and statin use were computed. Mobility limitation (two consecutive self-reports of having any difficulty walking one-quarter of a mile or climbing 10 steps without resting) was assessed every 6 months after baseline. Multivariable Cox proportional hazards analyses were conducted, adjusting for demographics, health status, and health behaviors. RESULTS At baseline, 15.2% used ACE inhibitors and 12.9% used statins; use of both was greater than 25% by Year 6. Over 6.5 years of follow-up, 49.8% had developed mobility limitation. In separate multivariable models, neither ACE inhibitor (multivariate hazard ratio (HR) = 0.95, 95% confidence interval (CI) = 0.82-1.09) nor statin use (multivariate HR = 1.02, 95% CI = 0.87-1.17) was associated with lower risk of mobility limitation. Similar findings were seen in analyses examining dose-response and duration-response relationships and a sensitivity analysis restricted to those with hypertension. CONCLUSION ACE inhibitors and statins widely prescribed to treat hypertension and hypercholesterolemia, respectively, do not lower risk of mobility limitation, an important indicator of quality of life.
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Affiliation(s)
- Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, Washington 98195, USA.
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Burton LA, McMurdo MET, Struthers AD. Mineralocorticoid antagonism: a novel way to treat sarcopenia and physical impairment in older people? Clin Endocrinol (Oxf) 2011; 75:725-9. [PMID: 21699555 DOI: 10.1111/j.1365-2265.2011.04148.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dysregulation of the renin-angiotensin-aldosterone system has been associated with a number of age-related pathologies including hypertension, heart failure and chronic kidney disease. More recently, it has been suggested that alterations within the RAAS may contribute to the development of sarcopenia and subsequent decline in physical function. There is growing interest in developing interventions to prevent age-associated decline in muscle function. We postulate that inhibition of the RAAS with the mineralocorticoid antagonist spironolactone may have a role in countering the effects of physical impairment in older people by improving skeletal muscle function. Spironolactone may prevent skeletal myocyte apoptosis, improve vascular endothelial function and enhance muscle contractility by increasing muscle magnesium and sodium-potassium pumps. This article will review the literature underpinning the hypothesis that spironolactone may have a role in maintaining muscle function in older people.
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Affiliation(s)
- Louise A Burton
- Section of Ageing and Health, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
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Cruz-Jentoft AJ, Triana FC, Gómez-Cabrera MC, López-Soto A, Masanés F, Martín PM, Rexach JAS, Hidalgo DR, Salvà A, Viña J, Formiga F. [The emergent role of sarcopenia: Preliminary Report of the Observatory of Sarcopenia of the Spanish Society of Geriatrics and Gerontology]. Rev Esp Geriatr Gerontol 2011; 46:100-110. [PMID: 21216498 DOI: 10.1016/j.regg.2010.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 11/25/2010] [Indexed: 05/30/2023]
Abstract
Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology. The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.
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Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010; 66:383-8. [DOI: 10.1016/j.maturitas.2010.03.020] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 03/23/2010] [Accepted: 03/23/2010] [Indexed: 12/23/2022]
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Cesari M, Pedone C, Incalzi RA, Pahor M. ACE-inhibition and physical function: results from the Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. J Am Med Dir Assoc 2009; 11:26-32. [PMID: 20129212 DOI: 10.1016/j.jamda.2009.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/21/2009] [Accepted: 09/23/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Aim of the present study was to evaluate whether an ACE inhibitor intervention is able to significantly improve physical performance and muscle strength in a sample of older persons. DESIGN Double-blind, cross-over, randomized, placebo-controlled trial. SETTING The Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. PARTICIPANTS Participants were 257 subjects aged 55 years and older with high cardiovascular risk profile. INTERVENTION Six months of fosinopril use versus placebo. MEASUREMENTS The Short Physical Performance Battery score (rescaled to obtain a continuous variable ranging from 0 to 3 points), and the hand grip strength were measured at the baseline visit, and after 6 and 12 months of follow-up. Paired t test analyses were performed to compare results of physical function measures after ACE inhibition and placebo interventions. RESULTS Mean age of the sample population was 65.97 (standard deviation 7.41) years old. No statistically significant difference was found at the Short Physical Performance Battery (P=.23) and hand grip strength (P=.57) results after ACE inhibition (2.113, standard deviation [SD] 0.284; and 37.044 kg, SD 12.993 kg, respectively) compared to placebo (2.096, SD 0.298; and 36.898 kg, SD 13.178 kg, respectively). No significant effects from ACE inhibition were also found when the 3 subtests composing the Short Physical Performance Battery (ie, 4-meter walking speed, balance, and chair stand tests) were separately analyzed. Consistent negative results were obtained after analyses were restricted to participants showing the highest compliance to treatment and/or receiving the maximum fosinopril dosage. CONCLUSION No significant modifications in physical performance and muscle strength were reported after 6 months of fosinopril use in older persons with high cardiovascular risk profile. Given these negative findings, it is possible that the beneficial effects of ACE inhibitors on physical function might be attributable to the activation of a virtuous cycle determined by an improved cardiovascular system. Further specifically designed studies are needed to confirm our findings, and expand them to different populations and ACE inhibitors. If our findings will be confirmed, the extracardiovascular properties of ACE inhibitors in older persons might be substantially resized.
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Affiliation(s)
- Matteo Cesari
- Centro per la Salute dell'Anziano-Area di Geriatria, Università Campus Bio-Medico, Via Alvaro del Portillo 5, Rome, Italy.
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Palliative care in congestive heart failure. J Am Coll Cardiol 2009; 54:386-96. [PMID: 19628112 DOI: 10.1016/j.jacc.2009.02.078] [Citation(s) in RCA: 279] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 12/23/2022]
Abstract
Symptoms and compromised quality of life prevail throughout the course of heart failure (HF) and thus should be specifically addressed with palliative measures. Palliative care for HF should be integrated into comprehensive HF care, just as evidence-based HF care should be included in end-of-life care for HF patients. The neurohormonal and catabolic derangements in HF are at the base of HF symptoms. A complex set of abnormalities can be addressed with a variety of interventions, including evidence-based HF care, specific exercise, opioids, treatment of sleep-disordered breathing, and interventions to address patient and family perceptions of control over their illness. Both potential sudden cardiac death and generally shortened length of life by HF should be acknowledged and planned for. Strategies to negotiate communication about prognosis with HF patients and their families can be integrated into care. Additional evidence is needed to direct care at the end of life, including use of HF medications, and to define management of multiple sources of distress for HF patients and their families.
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Bautmans I, Van Puyvelde K, Mets T. Sarcopenia and functional decline: pathophysiology, prevention and therapy. Acta Clin Belg 2009; 64:303-16. [PMID: 19810417 DOI: 10.1179/acb.2009.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Twenty years ago, the term 'sarcopenia' has been introduced to describe the ageing related loss of skeletal muscle mass. Since then, sarcopenia has been intensively studied and prevalence values have been reported in fifteen papers covering several continents and races. However, consistency regarding the outcome measures and corresponding cut-off values defining sarcopenia is lacking. Most approaches are based on estimations of muscle mass and proposed cut-off values might be too strict, thus reducing their use in daily practice. From a clinical viewpoint, the assessment of muscle performance (grip strength and endurance) can be proposed as a screening tool showing sufficient sensitivity. The pathophysiology of sarcopenia is multifactorial, and important changes at the tissue level have been identified. Close relationships with inflammatory processes have been demonstrated and there is strong evidence for the involvement of a chronic low-grade inflammatory activity. Sarcopenia is aggravated by a complex interaction of several factors among which aging, disuse, immobilization, disease and malnutrition. A comprehensive geriatric assessment should allow the clinician to estimate the relative contribution of these factors and to elaborate appropriate management. From all interventions studied, intensive resistance training seems the most efficient to counter sarcopenia, even in the very old geriatric patients. Significant ameliorations (up to >50% strength gain) can be expected after six weeks of training at a rhythm of 2-3 sessions per week. From a preventive viewpoint, all elderly patients should be advised to start such an exercise program and continue it as long as possible. To date, most pharmacological interventions to counter sarcopenia include drugs with anabolic effects. Unfortunately, their effect is questionable and no clear guidelines exist for the prescription of these products in the context of sarcopenia.
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Affiliation(s)
- Ivan Bautmans
- Gerontology department and Frailty in Ageing research group, Vrije Universiteit Brussel, Laarbeeklaan 103, 8-1090 Brussels, Belgium
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Vandenburgh H, Shansky J, Benesch-Lee F, Skelly K, Spinazzola JM, Saponjian Y, Tseng BS. Automated drug screening with contractile muscle tissue engineered from dystrophic myoblasts. FASEB J 2009; 23:3325-34. [PMID: 19487307 DOI: 10.1096/fj.09-134411] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Identification of factors that improve muscle function in boys with Duchenne muscular dystrophy (DMD) could lead to an improved quality of life. To establish a functional in vitro assay for muscle strength, mdx murine myoblasts, the genetic homologue of DMD, were tissue engineered in 96-microwell plates into 3-dimensional muscle constructs with parallel arrays of striated muscle fibers. When electrically stimulated, they generated tetanic forces measured with an automated motion tracking system. Thirty-one compounds of interest as potential treatments for patients with DMD were tested at 3 to 6 concentrations. Eleven of the compounds (insulin-like growth factor-1, creatine, beta-hydroxy-beta-methylbutyrate, trichostatin A, lisinopril, and 6 from the glucocorticoid family) significantly increased tetanic force relative to placebo-treated controls. The glucocorticoids methylprednisolone, deflazacort, and prednisone increased tetanic forces at low doses (EC(50) of 6, 19, and 56 nM, respectively), indicating a direct muscle mechanism by which they may be benefitting DMD patients. The tetanic force assay also identified beneficial compound interactions (arginine plus deflazacort and prednisone plus creatine) as well as deleterious interactions (prednisone plus creatine inhibited by pentoxifylline) of combinatorial therapies taken by some DMD patients. Since mdx muscle in vivo and DMD patients respond in a similar manner to many of these compounds, the in vitro assay will be a useful tool for the rapid identification of new potential treatments for muscle weakness in DMD and other muscle disorders.
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Affiliation(s)
- Herman Vandenburgh
- Department of Pathology, Brown Medical School-Miriam Hospital, Providence, Rhode Island, USA.
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Gray SL, LaCroix AZ, Aragaki AK, McDermott M, Cochrane BB, Kooperberg CL, Murray AM, Rodriguez B, Black H, Woods NF. Angiotensin-converting enzyme inhibitor use and incident frailty in women aged 65 and older: prospective findings from the Women's Health Initiative Observational Study. J Am Geriatr Soc 2009; 57:297-303. [PMID: 19207145 DOI: 10.1111/j.1532-5415.2008.02121.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine the associations between current use, duration, and potency of angiotensin-converting enzyme (ACE) inhibitors and incident frailty in women aged 65 and older who were not frail at baseline. DESIGN Data were from the Women's Health Initiative Observational Study (WHI-OS), a prospective study conducted at 40 U.S. clinical centers. PARTICIPANTS Women aged 65 to 79 at baseline who were not frail (N=27,378). MEASUREMENTS Current ACE inhibitor use was ascertained through direct inspection of medicine containers at baseline. Components of frailty were self-reported low physical function or impaired walking, exhaustion, low physical activity, and unintended weight. Frailty was ascertained through self-reported and physical measurements data at baseline and 3-year clinic contacts. RESULTS By the 3-year follow-up, 3,950 (14.4%) women had developed frailty. Current ACE inhibitor use had no association with incident frailty (multivariate adjusted odds ratio=0.96, 95% confidence interval=0.82-1.13). Duration and potency of ACE inhibitor use were also not significantly associated with incident frailty. A similar pattern of results was observed when incident cardiovascular disease events were studied as a separate outcome or when the sample was restricted to subjects with hypertension. CONCLUSION Overall, incidence of frailty was similar in current ACE inhibitor users and nonusers.
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Morley JE, Anker SD, Evans WJ. Cachexia and aging: an update based on the Fourth International Cachexia Meeting. J Nutr Health Aging 2009; 13:47-55. [PMID: 19151908 DOI: 10.1007/s12603-009-0009-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This manuscript highlights the new developments in the pathophysiology of anorexia, cachexia and sarcopenia, based on presentations given at the Fourth International Cachexia Meeting. It stresses the importance of these conditions in older persons.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine and GRECC, VA Medical Center, St Louis, MO 63104, USA.
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Witham MD, Sumukadas D, McMurdo MET. ACE inhibitors for sarcopenia--as good as exercise training? Age Ageing 2008; 37:363-5. [PMID: 18515289 DOI: 10.1093/ageing/afn124] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cranney A. Is there a new role for angiotensin-converting-enzyme inhibitors in elderly patients? CMAJ 2007; 177:891-2. [PMID: 17923657 DOI: 10.1503/cmaj.071062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ann Cranney
- Ottawa Health Research Institute, Ottawa, Ont.
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