Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis

SARC-CalF using calf circumference adjusted for BMI predicts 6-mo readmission and mortality in hospitalized patients: a secondary analysis of a cohort study

BACKGROUND

Sarcopenia is a prevalent condition associated with worse clinical outcomes in hospitalized patients. The SARC-CalF is an accurate instrument for its screening; however, it includes the calf circumference (CC) measure as a criterion, which is influenced by adiposity. An adjustment for CC based on body mass index (BMI) has been proposed, but the literature lacks studies evaluating the SARC-CalF using adjusted CC.

OBJECTIVES

This study aimed to evaluate the prognostic value of the SARC-CalF with BMI-adjusted CC and compare it between adult and older hospitalized patients.

METHODS

This is a secondary analysis of a cohort with prospective data collection, including individuals aged ≥18 y who were lucid and able to communicate. SARC-CalF was applied using BMI-adjusted CC, obtained by subtracting 3, 7, and 12 cm from CC values when BMI was 25 to 29.99, 30 to 39.99, and ≥40 kg/m2, respectively. Outcomes of interest included prolonged hospital stay, in-hospital death, hospital readmission, and mortality 6 mo after discharge. Logistic and Cox regression analyses, adjusted for Charlson Comorbidity Index and sex, were performed.

RESULTS

We analyzed data from 554 patients (mean age 55.2 ± 14.9 y, 52.9% male). Suggestive signs of sarcopenia by SARC-CalF with BMI-adjusted CC were identified in 40.4% of patients (38.6% of adults and 42.7% of older patients, P = 0.380). Suggestive signs of sarcopenia were associated with hospital readmission in adults (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.1, 2.9), and 6-mo death in both adult (OR: 4.0; 95% CI: 1.3, 12.1) and older patients (OR: 2.8; 95% CI: 1.2, 6.6). It was not independently associated with in-hospital outcomes.

CONCLUSIONS

SARC-CalF with BMI-adjusted CC identifies a high frequency of patients with suggestive signs of sarcopenia, regardless of age, and it is independently associated with worse outcomes 6 mo after discharge.

Physical activity and exercise health benefits: cancer prevention, interception, and survival

Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.

Perindopril erbumine-entrapped ultradeformable liposomes alleviate sarcopenia via effective skin delivery in muscle atrophy mouse model

Sarcopenia is a pertinent challenge in the super-aged societies causing reduced functional performance, poor quality of life and increased morbidity. In this study, the potential of perindopril erbumine-loaded ultradeformable liposomes (PE-UDLs) against sarcopenia was investigated. PE-UDLs were prepared by thin-film hydration and extrusion method using egg yolk L-α-phosphatidylcholine (EPC) as a lipid bilayer former and Tween 80 or sodium deoxycholate as an edge activator. Owing to the smallest particle size (75.0 nm) and the highest deformability (54.2) and entrapment efficiency (35.7 %), PE-UDLs with EPC to Tween 80 ratio of 8:2 was selected as the optimized formulation. The optimized PE-UDLs showed substantially higher cumulative amount of drug permeated and permeation rate across the rat skin compared to PE solution (485.7 vs. 50.1 µg and 13.4 vs. 2.3 µg/cm2/h, respectively). Topically applied PE-UDLs successfully ameliorated the effects of lipopolysaccharide (LPS)-induced sarcopenia in mice by improving body weight changes, grip strength and muscle weight. Furthermore, PE-UDLs reduced the shrinkage of muscle fibers as demonstrated by higher cross-sectional area than PE solution. PE-UDLs also increased the expression of myosin heavy chain (MHC) protein and reduced the expression of muscle atrophy F-box (Atrogin-1) and muscle ring-finger protein-1 (MuRF1), thereby improving muscles atrophy. In conclusion, these results demonstrate the therapeutic potential of PE-UDLs against sarcopenia.

Associations between housing quality and sarcopenia among older adults: evidence from China and India

OBJECTIVES

Housing is an important social determinant of health. However, limited studies have focused on the relationship between housing quality and sarcopenia, especially in low- and middle-income countries. This study aims to examine the association between housing quality and sarcopenia in older adults in China and India.

METHODS

The study was based on the China Health and Retirement Longitudinal Study and Longitudinal Aging Study in India. Housing quality was evaluated by five indicators, including housing materials, water sources, sanitation facilities, main fuel for cooking, and availability of electricity. Housing quality is divided into three types: good (0-1 poor housing indicators), medium (2-3 poor housing indicators), and poor (4-5 poor housing indicators). Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus. The logistic regression model was performed to examine the association between housing quality and sarcopenia.

RESULTS

The medium (OR = 1.69, 95%CI = 1.49-1.90) and poor housing quality (OR = 2.19, 95%CI = 1.89-2.54) were associated with sarcopenia in CHARLS. Similar results were also observed in the LASI with significantly higher prevalence of sarcopenia in medium (OR = 1.22, 95%CI = 1.11-1.33), and poor housing quality (OR = 1.60, 95%CI = 1.43-1.79). Moreover, we observed a linear relationship between housing quality and the prevalence of sarcopenia both in CHARLS and LASI (all P for trend <0.001).

CONCLUSIONS

Poorer housing quality was associated with a higher prevalence of sarcopenia in older adults in China and India. Housing quality improvement plans such as access to tap water, promotion of clean energy may have a positive effect on reducing the prevalence of sarcopenia.

Association Between SARC-F and Clinical Outcomes in Older Adults With Cardiovascular Diseases Admitted to the Emergency Room: A Longitudinal Study

INTRODUCTION

Sarcopenia can be more significant and severe in the presence of cardiovascular diseases. In hospitalized older adults with acute cardiac disease, assessing strength parameters, muscle mass, and physical performance is difficult largely because of bed rest restrictions. In this context, simple questionnaire to rapidly diagnose sarcopenia (SARC-F) emerges as a feasible screening tool to identify sarcopenia in an emergency room setting.

OBJECTIVES

Assess the association between SARC-F, length of stay, mechanical ventilation, and in-hospital mortality in older adults with cardiovascular diseases admitted to the ER.

METHODOLOGY

An observational longitudinal study with 160 Brazilian older adults with cardiovascular diseases admitted to the hospital following an ER visit. The risk of sarcopenia was assessed by the SARC-F tool (independent variable). Length of stay, use of mechanical ventilation, and in-hospital mortality were the dependent variables, collected via an electronic medical chart. Data were analyzed by simple and multiple linear and logistic regression.

RESULTS

SARC-F explained 62% of length of stay, adjusted for the confounding variables age, male sex, and use of continuous medication, mechanical ventilation, and corticosteroids. Risk of sarcopenia was also associated with mechanical ventilation during hospitalization (odds ratio = 1.398; 95% CI, 1.018-1.919). SARC-F was not related to mortality.

CONCLUSION

Older adults with cardiovascular diseases hospitalized at greater risk of sarcopenia were more likely to need invasive mechanical ventilation and more prone to prolonged hospital stays.

Influence of sarcopenia as determined by bioelectrical impedance analysis in acute pancreatitis

Sarcopenia can be defined as the loss of muscle mass and strength. It is a poor prognostic factor for many diseases. Our study aims to assess the prevalence of sarcopenia in patients with acute pancreatitis using bioelectrical impedance analysis (BIA) and hand dynamometry while also investigating its impact on acute pancreatitis. Sixty patients admitted with a diagnosis of acute pancreatitis were included in this prospective study. Following their admissions, prognostic markers were calculated, muscle strengths were measured using a hand dynamometer, and body compositions were determined using a BIA device. Accordingly, acute pancreatitis patients were divided into 2 groups: sarcopenic and nonsarcopenic. The demographic characteristics, anthropometric measurements, Ranson score, Glasgow-Imrie score, Balthazar score, APACHE-II score, disease severity according to the Atlanta classification, length of hospital stay, and laboratory findings of the 2 groups were compared. Sarcopenia was identified in 11 cases among those with acute pancreatitis included in the study. In the sarcopenic group, the mean age, Glasgow-Imrie score and number of cases with severe acute pancreatitis according to the Atlanta classification were significantly higher; body mass index, upper arm circumference, skeletal muscle mass index, and grip strength were significantly lower (P < .05). This study is the first to evaluate sarcopenia in acute pancreatitis cases using BIA and hand dynamometry. Sarcopenia may play a significant role in predicting the prognosis of acute pancreatitis.

The influence of the multifactorial falls prevention programme on mortality

AIMS

Multifactorial falls prevention programmes (MFFPs) can prevent falls and fall-related injuries. We aimed to study MFFP patients' mortality compared with their sex-, age- and residence-matched population-based controls.

METHODS

This study is a Finnish single-centre retrospective register-based controlled cohort study of a total of 527 home-dwelling MFFP patients and their 3:1 age-, sex- and residence-matched population-based controls (n = 1581), who had not attended the MFFP.

RESULTS

During the follow-up, the cumulative mortality of all patients was 40.4, and of controls 39.1 %. Hazard ratio was 0.82 (95% confidence interval 0.68 to 0.99), p= 0.041. Case patients had a 2.7 times greater risk to die due to accidents, but they had a lower risk to die due to dementia, compared with the control group. The 72-years-old or older participants had a lower mortality rate than the controls during follow-up.

CONCLUSIONS

The MFFP seems to relate to a lower all-cause mortality when comparing MFFP patients with their age-, sex- and residence-matched controls. However, the MFFP did not seem to relate to a lower injury-related mortality. The relationship between the MFFP and lower all-cause mortality seemed to be strongest in the patients aged 72 years or older. Due to the study setting and population-based control group, it is difficult to draw solid conclusions and further studies are needed. A randomized controlled trial comparing the MFFP with standard care would give better insight on the effectiveness of a MFFP on mortality.

Prediction of Fragility Fractures and Mortality in a Cohort of Geriatric Patients

BACKGROUND

Risk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death.

METHODS

We assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow-ups until the occurrence of further fractures or death. Dual-energy X-ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia.

RESULTS

The mean age was 81 years (70-95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872-0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973-0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192-5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052-1.151; p < 0.001), in men (HR 6.464, CI 3.141-13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009-1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976-0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900-0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018-0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836-0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971-0.997; p = 0.015).

CONCLUSIONS

In a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters.

Differences in muscle composition and functionality: Exploring CT anatomical points and SARC-F components

PURPOSE

Our study aimed to 1) investigate the differences of muscle parameters in relation to each SARC-F component/question; and 2) explore the relationship between SARC-F score with these muscle parameters using various landmarks derived from computed tomography (CT) scans of patients with cancer.

METHODS

This study is a cross-sectional analysis of a cohort comprised of consecutive patients with cancer, displaying CT scans. SARC-F questionnaire was utilized as a proxy for muscle functionality, with a score ≥4 indicating a poor status. Muscle assessment via CT measurements was performed using single cross-sectional images at the level of the third lumbar vertebrae (L3) in the abdominal region, the thigh region, and the total gluteal region at the level of the second sacral vertebrae. Skeletal muscle (SM) cross-sectional area, SM index (normalized to height2), and SM radiodensity (SMD) were evaluated for all anatomical landmarks.

RESULTS

A total of 128 patients were included in this analysis (53.1% females, 61.7% older adults). Patients with SARC-F scores ≥4 demonstrated significantly lower values of SMD across all landmarks assessed. Those reporting difficulties related to strength (P = 0.039), requiring assistance in walking (P = 0.033), and climbing stairs (P = 0.012) exhibited significantly lower SMD values at the L3 landmark. At gluteus and thigh levels, only patients experiencing difficulty climbing stairs (P = 0.012) showed significantly lower values of SMD. Only SMD at gluteus level was independently associated with SARC-F score (βadjusted -0.09, 95% CI -0.16 to -0.02).

CONCLUSIONS

Our findings suggest that individuals with poor muscle composition may experience a higher risk of sarcopenia/poor muscle functionality.

Correlation between Phase Angle and the Number of Medications in Older Inpatients: A Cross-Sectional Study

BACKGROUND

Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≥65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality.

METHODS

This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission.

RESULTS

In this study of 517 hospitalized older adults (median age 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (β=-0.104, p=0.041) and polypharmacy (β=-0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (β=-0.119, p=0.026) and polypharmacy (β=-0.098, p=0.063). Analyses were adjusted for age, body mass index, sarcopenia, C-reactive protein, and hemoglobin levels.

CONCLUSION

The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.

The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients

BACKGROUND

This study explored if computerized tomography-derived body composition parameters (CT-BCPs) are related to malnutrition in severely injured patients admitted to the Intensive Care Unit (ICU).

METHODS

This prospective cohort study included severely injured (Injury Severity Score ≥ 16) patients, admitted to the ICU of three level-1 trauma centers between 2018 and 2022. Abdominal CT scans were retrospectively analyzed to assess the CT-BCPs: muscle density (MD), skeletal muscle index (SMI), and visceral adipose tissue (VAT). The Subjective Global Assessment was used to diagnose malnutrition at ICU admission and on day 5 of admission, and the modified Nutrition Risk in Critically ill at admission was used to assess the nutritional risk.

RESULTS

Seven (11%) of the 65 analyzed patients had malnutrition at ICU admission, increasing to 23 patients (35%) on day 5. Thirteen (20%) patients had high nutritional risk. CT-BCPs were not related to malnutrition at ICU admission and on day 5. Patients with high nutritional risk at admission had lower MD (median (IQR) 32.1 HU (25.8-43.3) vs. 46.9 HU (37.7-53.3); p < 0.01) and higher VAT (median 166.5 cm2 (80.6-342.6) vs. 92.0 cm2 (40.6-148.2); p = 0.01) than patients with low nutritional risk.

CONCLUSION

CT-BCPs do not seem related to malnutrition, but low MD and high VAT may be associated with high nutritional risk. These findings may prove beneficial for clinical practice, as they suggest that CT-derived parameters may provide valuable information on nutritional risk in severely injured patients, in addition to conventional nutritional assessment and screening tools.

LEVEL OF EVIDENCE

Level III, Prognostic/Epidemiological.

Clinical Impact of Sarcopenia Screening on Long-Term Mortality in Patients Undergoing Coronary Bypass Grafting

BACKGROUND

Sarcopenia is an aging-related condition characterized by loss of skeletal muscle mass and is an indicator of subclinical atherosclerosis. The relationship between reduced muscle mass and long-term clinical outcomes in patients with advanced coronary artery disease who have undergone coronary artery bypass grafting (CABG) is not fully understood. This study is sought to evaluate the prognostic implications of sarcopenia screening in patients undergoing CABG.

METHODS

A total of 2810 patients who underwent CABG were analysed and classified according to presence of reduced muscle mass. The skeletal muscle index (SMI) was calculated as L3 muscle area (cm2)/height (m)2 on computed tomography. Reduced SMI was defined as SMI ≤ 45 cm2/m2 in male and ≤ 38 cm2/m2 in female. The primary outcome was all-cause mortality, and survival analysis was performed using the Kaplan-Meier method and compared with the log-rank test.

RESULTS

The median follow-up was 8.7 years, and 924 patients (32.9%) had reduced SMI. Patients with reduced SMI were older (67.7 ± 8.8 vs. 62.2 ± 9.8 years; p < 0.001) and less frequently male (69.8% vs. 81.1%; p < 0.001). SMI was significantly associated with risk of death on a restricted cubic spline curve (HR = 1.04 per-1 decrease; 95% CI 1.03-1.05; p < 0.001). Patients with reduced SMI had a higher incidence of long-term mortality than those with preserved SMI (survival rate 41.4% vs. 62.8%; HRadj = 1.18, 95% CI 1.03-1.36, p = 0.020). Subgroup analysis showed that the prognostic implication of reduced SMI on long-term survival was more evident in male (HRadj = 2.01, 95% CI 1.72-2.35) than female (HRadj = 1.28, 95% CI 0.98-1.68) (interaction p = 0.006).

CONCLUSIONS

Reduced muscle mass, defined by SMI on computed tomography, was associated with long-term mortality after CABG. These results provide contemporary data to allow the evaluation of physical frailty in patients with advanced coronary artery disease before surgery.

TRIAL REGISTRATION

Long-Term Outcomes and Prognostic Factors in Patients Undergoing CABG or PCI: NCT03870815.

Can simple measures from clinical practice serve as a proxy for sarcopenic obesity and identify mortality risk?

BACKGROUND

Sarcopenic obesity is a condition where loss of muscle mass occurs alongside fat gain, and it is considered a risk factor for mortality. However, the use of various definitions for this condition has led to conflicting results.

AIM

To investigate whether the coexistence of low muscle mass and abdominal obesity, defined using two simple measures employed in clinical practice, is a risk factor for mortality in individuals aged 50 or older.

METHODS

A longitudinal study with a 14-year follow-up was conducted involving 5,440 participants of the English Longitudinal Study of Ageing. Abdominal obesity and low muscle mass were respectively defined based on high waist circumference and low skeletal muscle mass index (SMMI) determined by an equation. The sample was divided into four groups: non-low muscle mass/non-abdominal obesity (NLMM/NAO), non-low muscle mass/abdominal obesity (NLMM/AO), low muscle mass/non-abdominal obesity (LMM/NAO), and low muscle mass/abdominal obesity (LMM/AO). Cox regression models were used to estimate the mortality risk as a function of muscle mass and abdominal obesity status.

RESULTS

LMM/AO increased the risk of death by 83% (HR:1.83; 95%CI: 1.35-2.66) compared to those in the NLMM/NAO group. AO alone was not associated with a greater risk of mortality (HR:1.09; 95%CI: 0.93-1.27), whereas LMM alone increased the risk by 40% (HR:1.40; 95%CI:1.18-1.66).

CONCLUSIONS

Identifying LMM/AO in individuals aged 50 or older can be crucial for predicting the risk of mortality. Simple and easily applicable measures can serve as a proxy for sarcopenic obesity and aid in implementing the necessary interventions.

Association between the systemic inflammatory response index and mortality in patients with sarcopenia

BACKGROUND

Sarcopenia is closely linked to inflammation; however, the association between the systemic inflammatory response index (SIRI) and mortality in patients with sarcopenia remains unclear. This study aims to explore the relationship between SIRI and mortality in sarcopenia patients.

METHODS

We analyzed data from ten cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, selecting 3,141 sarcopenia patients. Mortality data were obtained from the National Death Index up to December 31, 2019. Participants were divided into three groups based on the ranking of their SIRI values. The association between SIRI and mortality was assessed using Cox proportional hazards models, with smooth curve fitting employed to test the correlation. Sensitivity analyses, subgroup analyses, and interaction tests were conducted to validate the stability of the findings.

RESULTS

A total of 101,316 individuals were included in this study. During a median follow-up of 10.4 years (minimum follow-up time of approximately 0.08 years, maximum follow-up time of 20.75 years), 667 participants died. Kaplan-Meier (KM) analysis indicated a higher risk of mortality in the SIRI Q3 group. Cox regression analysis showed a significant association between the SIRI Q3 group and all-cause mortality [HR 1.24 (95% CI: 1.05, 1.47)] and cardiovascular disease mortality [HR 1.46 (95% CI: 1.04, 2.04)]. Subgroup analysis revealed that SIRI was significantly associated with all-cause mortality across various demographic characteristics (e.g., gender, diabetes, hypertension, cardiovascular disease). Sensitivity analysis, excluding participants with cardiovascular disease, those who died within two years of follow-up, and those under 50 years old, indicated higher hazard ratios (HRs) for all-cause and cardiovascular mortality in the SIRI Q3 group.

CONCLUSION

This study demonstrates a significant association between SIRI and an increased risk of mortality in sarcopenia patients aged 20 years and older.

Association Between Sarcopenia and Acupressure Testing in Older Adults Requiring Long-Term Care

Background and Objectives: This study analyzed the relationship between pressure pain test outcomes and sarcopenia in elderly patients and explored possible clinical applications. Materials and Methods: The participants included 143 older adults requiring long-term care who could be diagnosed with sarcopenia. Along with sarcopenia diagnosis, the participants underwent acupressure testing symmetrically at nine sites (occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteus, greater trochanter, and knee), totaling 18 sites. The analyses included comparisons of sarcopenia status and total tender points between the groups and a multivariable analysis. The association between sarcopenia and the number of tender points were examined based on correlations between the number of tender points and grip strength, walking speed, and skeletal muscle mass index (SMI). Intergroup comparisons and multivariable analysis of tender points with and without sarcopenia were performed to investigate specific tender points associated with sarcopenia. Results: An independent association was observed between sarcopenia and the number of tender points (p = 0.001). Furthermore, the number of tender points was correlated with grip strength (ρ = -0.536, p < 0.001), walking speed (ρ = -0.200, p = 0.028), and SMI (ρ = -0.394, p < 0.001). The supraspinatus (p = 0.029, 95% confidence interval: 1.221-35.573) and lower cervical (p = 0.039, 95% confidence interval: 1.050-7.245) regions were identified as specific tender points. Conclusions: In older adult patients requiring long-term care, sarcopenia is associated with an increased number of tender points throughout the body, with the supraspinatus and lower cervical regions potentially being specific tender points. Acupressure testing for tenderness may be a useful assessment parameter in sarcopenia patients.

Assessment of muscle strength in elderly as a screening method for sarcopenia in primary care: a scoping review

OBJECTIVES

To identify and map the available evidence for whether a test of handgrip strength (HGS) and/or the chair stand test (CST) have been used as screening tools for the detection of sarcopenia in elderly individuals within primary care settings.

DESIGN

This study was designed as a scoping review, in accordance with the methodological framework for scoping reviews, developed by Arksey and O'Malley, and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

DATA SOURCES

A literature search was conducted to identify relevant articles listed in PubMed and Scopus databases up to 16 October 2023.

ELIGIBILITY CRITERIA

Studies including individuals aged ≥60 years who had undergone assessments of HGS and/or the CST in primary care settings were included.

DATA EXTRACTION AND SYNTHESIS

Following the article selection process, based on predetermined criteria for inclusion and exclusion, the selected articles were analysed regarding population demographics, the setting in which the research was conducted, the study design, used diagnostic tools and reported results.

RESULTS

The search yielded 282 unique articles, of which 7 were included in the final analysis. All seven included articles had a cross-sectional study design, whereof one also had a longitudinal 3-year follow-up. The number of participants ranged from 75 to 719. Three of the articles used the diagnostic criteria presented by European Working Group on Sarcopenia in Older People (EWGSOP), two used the criteria by Asian Working Group for Sarcopenia 2019, one used the EWGSOP2 criteria and one applied both the EWGSOP and EWGSOP2 criteria to their data. All the articles used HGS to assess muscle strength. CST was not used for this purpose in any of the articles, although it was used to estimate physical performance or as part of the short physical performance battery. The prevalence of sarcopenia in the included articles was 12.0%-20.7%, while the prevalence of possible sarcopenia was 69.9%-73.3% and that of probable sarcopenia was 25.5%-94%.

CONCLUSION

None of the included articles aimed to study a test of HGS and/or the CST as screening tools for the detection of sarcopenia. However, four of the articles diagnosed possible or probable sarcopenia by using a test of HGS and/or the CST among elderly patients in a primary care setting. There is a need for more research to elucidate whether a test of HGS and/or the CST might be used for screening of sarcopenia in primary care.

Association of variabilities in body mass index and metabolic parameters with post-kidney transplantation renal outcomes

Metabolic syndrome is a significant risk factor for poor graft outcomes in kidney transplant (KT) patients. However, the effects of variability in metabolic parameters on graft outcomes in KT patients have not been completely elucidated. A total of 852 KT patients were included from the Korean Organ Transplantation Registry. The study exposure was variability in body mass index (BMI) or other metabolic parameters measured at 6 months, 1 year, and 2 years after KT. Patients were classified into tertiles according to the degree of variability. The primary outcome was a composite of adverse kidney outcomes, such as death-censored graft loss or ≥ 30% decline in estimated glomerular filtration rate. The adverse kidney outcomes occurred in 73 (8.6%) participants. The high-BMI variability group had a higher risk for adverse kidney outcomes compared to the low-variability group. High variabilities in triglyceride, fasting blood glucose, and systolic blood pressure were also associated with adverse kidney outcomes. Furthermore, high variability in metabolic syndrome-related composite indices, such as the triglyceride and glucose index and metabolic variability scores, showed a higher risk for adverse kidney outcomes. In conclusion, high variability in metabolic parameters could be associated with an increased risk of adverse kidney outcome in KT patients.

Impact of fat to muscle ratio with risk of disability on community-dwelling Japanese older adults: A 5-year longitudinal study

PURPOSE

Sarcopenic obesity is a combination of sarcopenia and obesity, which is associated with the onset of disability. Fat to muscle ratio (FMR) is a screening measure that assesses the ratio of muscle mass to fat mass. However, the relationship between the FMR and disability has not been investigated.

METHODS

This study included 11,427 community-dwelling older adults aged ≥65 years enrolled in NCGG-SGS (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes), a national cohort study in Japan. FMR was measured by the bioelectrical impedance analysis and calculated by dividing fat mass by muscle mass. Cox proportional hazard regression analysis adjusted for covariates was used to investigate the association between FMR and the risk of developing new care needs at 5 years. FMR was divided by about quintile, with quintile 5 as the high.

RESULTS

The high FMR group had the highest incidence of disability at 20.8 % for women and 20.1 % for men. In women, the association between FMR and disability was significantly different for the FMR (hazard risk [HR]: 1.43, 95 % confidence interval [CI]: 1.16-1.75). There was no association between FMR and disability in men (HR: 0.98, 95 %CI: 0.76-1.25). Lagged analyses accounting for reverse causality did not change the relationship.

CONCLUSIONS

FMR is associated with increased risk of disability in women community-dwelling older adults but not among men. Because the rate of decreased muscle strength is faster in men than in women, early decreased muscle strength may affect men's risk of disability more than muscle mass or fat mass.

MicroRNAs as commonly expressed biomarkers for sarcopenia and frailty: A systematic review

BACKGROUND

Coexistent sarcopenia and frailty is more strongly associated with adverse health outcomes than each condition alone. As the importance of coexistent sarcopenia and frailty increases, exploring their underlying mechanisms is warranted. Recently, noncoding ribonucleic acids (RNAs) have been suggested as potential biomarkers of sarcopenia and frailty. This systematic review aimed to summarize noncoding RNAs commonly expressed in sarcopenia and frailty, and to search the predicted target genes and biological pathways of them.

METHODS

We systematically searched the literatures on PubMed, Embase, Cochrane Library, Web of Science, and Scopus for literature published till November 15, 2023. A total of 7,202 literatures were initially retrieved. After de-duplication, 34 studies (26 sarcopenia-related and 8 frailty-related) were full-text reviewed, and 15 studies (11 sarcopenia-related and 4 frailty-related) were finally included.

RESULTS

miR-29a-3p, miR-29b-3p, and miR-328 were identified as commonly expressed in same direction in sarcopenia and frailty. These microRNAs (miRNAs), identified in the literature search using PubMed, modulate transforming growth factor-β signaling via extracellular matrix components and calcineurin/nuclear factor of activated T cells 3 signaling via sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a, which are involved in regulating skeletal muscle fibrosis and the growth of slow-twitch muscle fibers, respectively. miR-155-5p, miR-486, and miR-23a-3p were also commonly expressed in two conditions, although in different or conflicting directions.

CONCLUSION

In this systematic review, we highlight the potential of shared miRNAs that exhibit consistent expression patterns as biomarkers for the early diagnosis and progression assessment of both sarcopenia and frailty.

Long-chain n-3 polyunsaturated fatty acid supplementation and neuromuscular function in older adults

PURPOSE OF REVIEW

This review aims to explore the latest research investigating the effects of marine-derived long-chain n -3 polyunsaturated fatty acid (LC n -3 PUFA) supplementation on neuromuscular function in older adults.

RECENT FINDINGS

Ageing results in a decline in skeletal muscle strength and mass. There is growing evidence that LC n -3 PUFA supplementation increases muscle strength and mass in healthy older adults, yet the mechanisms underlying these effects remain elusive. Recent studies investigating LC n -3 PUFA supplementation have demonstrated effects on neuromuscular function such as increases in the compound muscle action potential (M-wave) amplitude and surface electromyography alongside increases in muscular strength. Therefore, evidence suggests that LC n -3 PUFA may elicit a beneficial effect at the neuromuscular junction and possess neuroprotective properties in older adults.

SUMMARY

LC n -3 PUFA supplementation may increase or maintain neuromuscular function throughout the ageing process. Further research is warranted to investigate the long-term effects LC n -3 PUFA supplementation on neuromuscular outcomes such as single motor unit properties and cortical/supraspinal networks, utilizing state-of-the-art techniques in neuromuscular physiology.

Association between possible sarcopenia, all-cause mortality, and adverse health outcomes in community-dwelling older adults in China

The relationship between possible sarcopenia and mortality remains ambiguous within Asian populations. To clarify this, we investigated the association in older adults residing in Chinese communities. Utilizing data from the China Health and Retirement Longitudinal Study, this population-based cohort study included individuals aged ≥ 60 years, followed from 2011 to 2012 through 2020. Possible sarcopenia was defined in accordance with the Asian Working Group on Sarcopenia 2019 criteria, and Cox proportional hazards regression was used to analyze its impact on mortality, while exploratory analyses were conducted to investigate the associations of possible sarcopenia with chronic diseases, functional independence, and hospitalization frequency. The study encompassed 5,160 participants (median age: 66 years), nearly half of whom (48.8%) were identified with possible sarcopenia. Over a 9-year follow-up period, there were 1216 recorded deaths. Analysis indicated that individuals with possible sarcopenia faced a significantly elevated mortality risk compared to their counterparts (HR: 1.79, 95% CI: 1.58-2.03; P < 0.001). Further, subgroup analyses confirmed a strong association between possible sarcopenia and all-cause mortality across various subgroups, including those related to sex, obesity status, and living environment. Additionally, exploratory analyses revealed that possible sarcopenia was significantly associated with an increased likelihood of heart disease (OR = 1.18, 95% CI: 1.03-1.34, P = 0.014) and stroke (OR = 1.41, 95% CI: 1.19-1.68, P < 0.001), as well as reduced functional independence (β = -0.17, 95% CI: -0.24--0.10, P < 0.001). Possible sarcopenia was also associated with a higher frequency of hospitalizations at baseline (Exp(β) = 1.50, 95% CI: 1.25-1.81, P < 0.001), although this association was no longer significant during the follow-up period. In conclusion, in Chinese community-dwelling older adults, possible sarcopenia was associated with an increased risk of all-cause mortality, several chronic diseases, and functional dependence. Thus, alleviating or preventing possible sarcopenia may improve health outcomes and extend the lifespan of these individuals.

Prognostic Value of Sarcopenia in Elderly Patients with Metastatic Non-Small-Cell Lung Cancer Undergoing Radiotherapy

Background: Sarcopenia, a syndrome characterized by age-related loss of muscle mass and function, lacks universally accepted diagnostic criteria, particularly for its role as a prognostic factor in elderly patients with non-small-cell lung cancer (NSCLC). This study aimed to evaluate the prognostic significance of sarcopenia, assessed by psoas muscle size on baseline CT scans, in patients over 70 years of age with metastatic NSCLC. Methods: We retrospectively analyzed 85 elderly patients undergoing palliative radiation therapy between August 2022 and July 2024. Using morphometric analysis of psoas size, we investigated its correlation with overall survival (OS) and progression-free survival (PFS). Results: Our results showed that decreased psoas size was significantly associated with shorter OS and PFS, with median OS of 10 months and PFS of 4 months in sarcopenic patients compared to longer survival times in non-sarcopenic patients. Median survival of non-sarcopenic vs. sarcopenic patients was 21 ± 7 months (muscle area > median) versus 5 ± 2.3 months (muscle area < median). Multivariate analysis confirmed that psoas size, along with ECOG performance status and treatment of primary NSCLC, was a significant predictor of survival. Discussion: These findings suggest that psoas muscle size is a valuable prognostic marker for elderly NSCLC patients, potentially guiding treatment decisions and patient management. Further research is needed to validate these results and refine prognostic models for this population.

Mediating effects of physical activities and cognitive function on the relationship between dietary diversity and all-cause mortality in community-dwelling older adults

Background

Although dietary diversity (DD) has been confirmed to be associated with multiple health outcomes and longevity in older people, the related mechanisms have not been elucidated. In this study, we explored the mediating roles of physical activities and cognitive function in the relationship between DD and all-cause mortality.

Methods

We recruited 34 068 community-dwelling older adults aged ≥60 years from the Chinese Longitudinal Healthy Longevity Study and followed them up until 2018. Dietary diversity score (DDS) was assessed by the intake frequency of nine food sources. We evaluated physical activities and cognitive function using the Katz index and Mini-Mental State Examination. We explored the mediating roles of physical activities and cognitive function between DDS and all-cause mortality using mediated analyses in Cox proportional risk regression models.

Results

A total of 25 362 deaths were recorded during 148 188.03 person-years of follow-up. Participants with physical disability and cognitive impairment had lower DDS than the normal group (P < 0.001). After controlling for all covariates, DDS, physical activities, and cognitive functioning were negatively associated with all-cause mortality. Physical activities and cognitive function mediated 18.29% (95% confidence interval (CI) = 12.90-23.10) and 27.84% (95% CI = 17.52-37.56) of the total effect of DDS on mortality, respectively.

Conclusions

Physical activities and cognitive function mediated the association between DDS and all-cause mortality. Maintaining DD may benefit early death prevention by reducing physical disability and cognitive impairment in community-dwelling older people.

Appendicular skeletal muscle mass is associated with metabolic dysfunction-associated steatotic liver disease severity in young men: a cross-sectional and longitudinal study

BACKGROUND AND AIM

Although appendicular skeletal muscle mass (ASM) has been linked to the severity of hepatic steatosis, investigations of its correlation among younger age groups are lacking. We aimed to elucidate the role of ASM in determining the severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in younger patients.

METHODS

Retrospective data were collected from patients younger than 35 years who visited the Armed Forces Goyang Hospital between June 2022 and February 2024. Steatosis presence was determined by a controlled attenuation parameter score ≥ 250 dB/m, and significant fibrosis was identified with liver stiffness measurement > 8.0 kPa. ASM was measured using multifrequency bioelectrical impedance analysis (InBody 620).

RESULTS

Of 910 participants, 630 were diagnosed with MASLD. Patients with MASLD had lower ASM/fat mass (ASM/F) (1.02 vs. 1.91; p < 0.001), ASM/body mass index (BMI) (0.91 vs. 1.04/m2; p < 0.001), and ASM/body weight (ASM/W) (29.5% vs. 33.8%; p < 0.001) than non-MASLD patients. Additionally, ASM/F, ASM/BMI, and ASM/W significantly decreased with worsening steatosis severity and were notably lower in patients with significant fibrosis. Among 107 patients with MASLD who underwent two examinations with a median interval of 6.0 months, those with increased ASM/F showed a higher proportion of steatosis regression and a lower proportion of steatosis worsening than those with decreased ASM/F (steatosis regression, 43.1% vs. 22.9%; worsening, 11.1% vs. 28.6%; p = 0.031). All three ASM indices were significant factors in steatosis regression during the study period.

CONCLUSIONS

ASM is associated with the severity of steatosis and significant fibrosis in MASLD in young adults < 35 years.

Pre-Transplant Dual-Energy X-ray Absorptiometry (DXA)-Derived Body Composition Measures as Predictors of Treatment Outcomes and Early Post-Transplant Complications in Patients with Multiple Myeloma (MM) Treated with Autologous Hematopoietic Stem Cell Transplantation (AutoHSCT)

Background/Objectives: Changes in muscle mass and bone density are common in multiple myeloma (MM) patients. Dual-energy X-ray absorptiometry (DXA) offers precise, non-invasive insights into a patient's physical condition before autologous stem cell transplantation (autoHSCT). This study examines how pre-transplant body composition impacts treatment outcomes and early complications in MM patients undergoing autoHSCT. Methods: This study is a single-center, retrospective analysis of patients with MM who were treated with first or second autoHSCT and underwent DXA pre-transplant between 11 August 2019 and 12 June 2024. Results: We conducted a study of pre-transplant body composition in 127 patients with MM. Among them, 108 (85%) qualified for first autoHSCT, while 19 (15%) qualified for a second. The median age of the patients was 64 years (range 50-73). In the Cox proportional hazards regression conducted in the group of women, Total Body %Fat was a statistically significant predictor for progression-free survival (PFS) (HR = 0.07, 95% CI = 0.01,0.6, p = 0.0157). In the Mann-Whitney U test conducted on males, Lean Mass/Height2 and Appen. Lean Height2 were statistically significant predictors of early infections after autoHSCT (Z = 1.98, p = 0.0473 and Z = 2.32, p = 0.0204, respectively). In males, Fat Mass/Height2 was a significant predictor of non-infectious toxicity related to treatment (Z = -1.98, p = 0.0476). Conclusions: In women, higher levels of adipose tissue initially appear to exert a protective effect; however, this benefit diminishes over time, with greater fat mass eventually correlating with an increased risk of disease progression. In men, muscle mass has been identified as a significant predictor of early infection risk post-autoHSCT. Furthermore, our findings indicate that an increased amount of adipose tissue in men is statistically associated with a higher risk of non-infectious treatment-related toxicity. These conclusions highlight the critical need for further investigation into the role of body composition.

Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure

The gradual deterioration of physiological systems with ageing makes it difficult to maintain skeletal muscle mass (sarcopenia), at least partly due to the presence of 'anabolic resistance', resulting in muscle loss. Sarcopenia can be transiently but markedly accelerated through periods of muscle disuse-induced (i.e., unloading) atrophy due to reduced physical activity, sickness, immobilisation or hospitalisation. Periods of disuse are detrimental to older adults' overall quality of life and substantially increase their risk of falls, physical and social dependence, and early mortality. Disuse events induce skeletal muscle atrophy through various mechanisms, including anabolic resistance, inflammation, disturbed proteostasis and mitochondrial dysfunction, all of which tip the scales in favour of a negative net protein balance and subsequent muscle loss. Concerningly, recovery from disuse atrophy is more difficult for older adults than their younger counterparts. Resistance training (RT) is a potent anabolic stimulus that can robustly stimulate muscle protein synthesis and mitigate muscle losses in older adults when implemented before, during and following unloading. RT may take the form of traditional weightlifting-focused RT, bodyweight training and lower- and higher-load RT. When combined with sufficient dietary protein, RT can accelerate older adults' recovery from a disuse event, mitigate frailty and improve mobility; however, few older adults regularly participate in RT. A feasible and practical approach to improving the accessibility and acceptability of RT is through the use of resistance bands. Moving forward, RT must be prescribed to older adults to mitigate the negative consequences of disuse atrophy.

Effect of low muscle mass on total mortality related to metabolic disease in chronic kidney disease patients

Low muscle mass is a risk factor for mortality in patients with chronic kidney disease (CKD). However, it is not clear to what extent low muscle mass contributes to this risk, either independently or in combination with metabolic abnormalities and frailty. This study used data from the National Health and Nutrition Examination Survey 1999-2006 and 2011-2018. Low muscle mass was defined as Appendicular Skeletal Mass Index < 7 kg/m2 in men or < 5.5 kg/m2 in women. The follow-up duration was from the first anthropometric and clinical measurements to death or the last follow-up. This study enrolled 2072 patients with CKD. Low muscle mass was associated with a lower risk of metabolic abnormalities, but was associated with an elevated mortality risk. Conversely, central obesity was associated with a higher likelihood of metabolic abnormalities and frailty, yet showed no significant association with mortality risk. Subsequently conducted mediation analysis indicated that the effect of low muscle mass on mortality was direct, not mediated by frailty and metabolic abnormalities. In spite of the inverse relationship between low muscle mass and metabolic abnormalities, low muscle mass are directly associated with an increased risk of all-cause mortality. Low muscle mass may directly contribute to mortality in patients with CKD, independent of metabolic abnormalities and frailty in these patients.

The Performance and Associated Risks of the Criteria for Sarcopenic Obesity Proposed by the European Association for the Study of Obesity in a Geriatric Population

BACKGROUND

There is no gold standard definition of sarcopenic obesity (SO). Our objective is to evaluate the benefit of using the new definition proposed by the European Association for the Study of Obesity (EASO) in older people.

METHODS

Data from the Toledo Study of Healthy Aging, a study based on a cohort of community-dwelling older adults, were used. SO was defined according to the EASO and by a composite of the Foundation for the National Institute of Health (FNIH) for the diagnosis of sarcopenia and the WHO's criteria for obesity (Body Mass Index, BMI ≥ 30 kg/m2; waist circumference, >88 cm for women and >102 cm for men). Frailty [Frailty Phenotype (FFP) and Frailty Trait Scale-5 (FTS5)] and disability (Katz Index) statuses were assessed at baseline and at the follow-up (median 2.99 years). Mortality at a 5-year follow-up was also assessed. The Logistic and Cox regression models were used to assess the associations.

RESULTS

Of the 1559 subjects (age 74.79 ± 5.76 years; 45.54% men), 30.15% (EASO/ESPEN) vs. 16.36% (FNIH) met the SO criteria (Kappa = 0.42). SO was associated with the prevalence of frailty by both the EASO's [OR(95%CI): FFP: 1.70 (1.33-2.16); FTS-5 binary: 2.29 (1.60-3.27); β(95%CI): FTS-5 continuous 3.63 (3.00-4.27)] and FNIH+WHO's criteria [OR (95%CI): 2.20 (1.61, 3.00)]. The FNIH + WHO's criteria were cross-sectionally associated with disability [OR: 1.52 (1.07, 2.16); p-value 0.018], while the EASO's criteria were not. The EASO's criteria did not show any association at the follow-up, while the FNIH + WHO's criteria were associated with incident frailty.

CONCLUSIONS

The EASO's new criteria for sarcopenic obesity demonstrate moderate agreement with the traditional definition and are cross-sectionally associated with adverse events, but they do not effectively predict the outcomes generally associated with sarcopenic obesity in older adults. Therefore, the performance of the EASO's criteria in older people raises the need for refinement before recommending it for generalized use in this population.

Accuracy of four sarcopenia screening methods in patients with chronic stroke in Thailand: a cross-sectional study

AIMS

The aim of this study was to evaluate the accuracy of screening tools for sarcopenia and to determine whether the same or different cutoff points should be applied in patients with chronic stroke.

MATERIALS AND METHODS

Sixty-eight participants with residual hemiparetic deficit for over 6 months were enrolled. We evaluated the accuracy of calf circumference, SARC-F questionnaire, SARC-CalF, and Ishii's score chart using the Asia Working Group for Sarcopenia (AWGS) 2019 revised criteria as the gold standard.

RESULTS

Sarcopenia was identified in 22 participants (32.4%) based on the AWGS criteria. Overall, SARC-F showed the lowest diagnostic accuracy. The Area Under the receiver operating characteristic Curves (AUC) of calf circumference, SARC-F, SARC-CalF, and Ishii's score chart were 0.77 (95% confidence interval [CI], 0.66-0.88), 0.58 (95% CI, 0.42-0.74), 0.75 (95% CI, 0.62-0.87), and 0.78 (95% CI, 0.65-0.90), respectively. The mean AUC of SARC-F was inferior to SARC-CalF (0.58 vs. 0.75, p = 0.035).

CONCLUSIONS

The accuracy and diagnostic properties of calf circumference, SARC-CalF, and Ishii's score chart were comparable (mean AUC of 0.77, 0.75, and 0.78, respectively). SARC-F showed the lowest accuracy (mean AUC = 0.58). The recommended screening tools are calf circumference, SARC-CalF, and Ishii's score chart. It is not recommended to rely solely on SARC-F for screening sarcopenia after stroke. We proposed potential new cutoff points for each screening instrument, including SARC-F, SARC-CalF, calf circumference in women, and Ishii's score chart for both men and women.

Improving Undernutrition with Microalgae

Undernutrition is an important global health problem, especially in children and older adults. Both reversal of maternal and child undernutrition and heathy ageing have become United Nations-supported global initiatives, leading to increased attention to nutritional interventions targeting undernutrition. One feasible option is microalgae, the precursor of all terrestrial plants. Most commercially farmed microalgae are photosynthetic single-celled organisms producing organic carbon compounds and oxygen. This review will discuss commercial opportunities to grow microalgae. Microalgae produce lipids (including omega-3 fatty acids), proteins, carbohydrates, pigments and micronutrients and so can provide a suitable and underutilised alternative for addressing undernutrition. The health benefits of nutrients derived from microalgae have been identified, and thus they are suitable candidates for addressing nutritional issues globally. This review will discuss the potential benefits of microalgae-derived nutrients and opportunities for microalgae to be converted into food products. The advantages of microalgae cultivation include that it does not need arable land or pesticides. Additionally, most species of microalgae are still unexplored, presenting options for further development. Further, the usefulness of microalgae for other purposes such as bioremediation and biofuels will increase the knowledge of these microorganisms, allowing the development of more efficient production of these microalgae as nutritional interventions.

Sarcopenia

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.

Vitamin D and Sarcopenia in the Senior People: A Review of Mechanisms and Comprehensive Prevention and Treatment Strategies

This article reviews the mechanisms and prevention strategies associated with vitamin D and sarcopenia in older adults. As a geriatric syndrome, sarcopenia is defined by a notable decline in skeletal muscle mass and strength, which increases the risk of adverse health outcomes such as falls and fractures. Vitamin D, an essential fat-soluble vitamin, is pivotal in skeletal muscle health. It affects muscle function through various mechanisms, including regulating calcium and phosphorus metabolism, promoting muscle protein synthesis, and modulation of muscle cell proliferation and differentiation. A deficiency in vitamin D has been identified as a significant risk factor for the development of sarcopenia in older adults. Many studies have demonstrated that low serum vitamin D levels are significantly associated with an increased risk of sarcopenia. While there is inconsistency in the findings, most studies support the importance of vitamin D in maintaining skeletal muscle health. Vitamin D influences the onset and progression of sarcopenia through various pathways, including the promotion of muscle protein synthesis, the regulation of mitochondrial function, and the modulation of immune and inflammatory responses. Regarding the prevention and treatment of sarcopenia, a combination of nutritional, exercise, and pharmacological interventions is recommended. Further research should be conducted to elucidate the molecular mechanism of vitamin D in sarcopenia, to study genes related to sarcopenia, to perform large-scale clinical trials, to investigate special populations, and to examine the combined application of vitamin D with other nutrients or drugs. A comprehensive investigation of the interconnection between vitamin D and sarcopenia will furnish a novel scientific foundation and productive strategies for preventing and treating sarcopenia. This, in turn, will enhance the senior people's quality of life and health.

Temporalis muscle thickness as a predictor of functional outcome after reperfusion therapies for acute ischemic stroke: a retrospective, cohort study

BACKGROUND

Sarcopenia, defined as the loss of skeletal muscle mass, has been associated with a worse functional outcome after stroke. Measurement of temporal muscle thickness (TMT) has been introduced as an easily obtainable surrogate marker to identify patients with sarcopenia. Our study aims to investigate the correlation between pre-stroke sarcopenia, measured by TMT assessment, and functional outcome in patients treated with revascularization procedures for acute ischemic stroke.

METHODS

We included consecutive adult patients who underwent thrombolysis, endovascular thrombectomy or both for acute ischemic stroke at our Centre from January 2020 to June 2022. Besides collecting baseline clinical and neuroradiological features, TMT was measured on brain computed tomography scans according to a standardized protocol. Modified Rankin Scale (mRS) scores at 3 months represented the main endpoint of functional outcome.

RESULTS

A total of 261 patients were available for the analysis. In univariate models, patients with excellent outcomes (mRS = 0-1) were younger, had higher TMT values and lower pre-event disability and stroke severity. In multivariate models higher TMT values resulted independently associated with reduced mortality (Odds Ratio 0.708, 95% Confidence Interval 0.538-0.930, p = 0.013). Age, diabetes, brain bleeding events and stroke severity were found to be predictors of mortality, too.

CONCLUSIONS

Our retrospective analysis shows that in patients who underwent revascularization treatments for ischemic stroke TMT is as an independent predictor of survival easily obtainable from the baseline CT scan. Further investigation is required to confirm the role of sarcopenia assessment and TMT measurement in the prognostication toolkit of this disease.

Digital Biomarker for Muscle Function Assessment Using Surface Electromyography With Electrical Stimulation and a Non-Invasive Wearable Device

Sarcopenia is a comprehensive degenerative disease with the progressive loss of skeletal muscle mass with age, accompanied by the loss of muscle strength and muscle dysfunction. Individuals with unmanaged sarcopenia may experience adverse outcomes. Periodically monitoring muscle function to detect muscle degeneration caused by sarcopenia and treating degenerated muscles is essential. We proposed a digital biomarker measurement technique using surface electromyography (sEMG) with electrical stimulation and wearable device to conveniently monitor muscle function at home. When motor neurons and muscle fibers are electrically stimulated, stimulated muscle contraction signals (SMCSs) can be obtained using an sEMG sensor. As motor neuron activation is important for muscle contraction and strength, their action potentials for electrical stimulation represent the muscle function. Thus, the SMCSs are closely related to muscle function, presumptively. Using the SMCSs data, a feature vector concatenating spectrogram-based features and deep learning features extracted from a convolutional neural network model using continuous wavelet transform images was used as the input to train a regression model for measuring the digital biomarker. To verify muscle function measurement technique, we recruited 98 healthy participants aged 20-60 years including 48 [49%] men who volunteered for this study. The Pearson correlation coefficient between the label and model estimates was 0.89, suggesting that the proposed model can robustly estimate the label using SMCSs, with mean error and standard deviation of -0.06 and 0.68, respectively. In conclusion, measuring muscle function using the proposed system that involves SMCSs is feasible.

Comparing Sarcopenia Definitions and Muscle Power Reduction: Associations with Health Outcomes in Spanish Community-Dwelling Older Adults

Objectives: To analyze the associations between the different operational definitions of sarcopenia published in the last decade and reduced muscle power with a set of adverse health-related outcomes, such as comorbidities, depression, polypharmacy, self-perceived health, educational attainment, socioeconomic status, falls, and hospitalizations in Spanish community-dwelling older adults. Methods: A total of 686 community-dwelling older adults (median age: 72; women: 59.2%; physically active: 84%) were included in this cross-sectional analysis (ClinicalTrials.gov: NCT05148351). Sarcopenia was assessed using the FNIH, EWGSOP2, AWGS, and SDOC algorithms. Reduced muscle power was defined as the lowest sex-specific tertile and measured during the rising phase of the sit-to-stand test using a validated mobile application. Unadjusted and adjusted logistic regressions by potential confounders were performed to identify the association between sarcopenia and reduced muscle power with health-related outcomes. Results: Sarcopenia prevalence was 3.4%, 3.8%, 12.4%, and 21.3% according to the SDOC, FNIH, EWGSOP2, and AWGS, respectively. Among these definitions, moderate and large associations with health-related outcomes were observed for EWGSOP2 and SDOC, respectively, but few associations were found for FNIH and AWGS criteria. Reduced muscle power was associated more frequently and moderately with health-related outcomes compared to sarcopenia definitions. These associations remained constant after adjusting for confounders. Conclusions: The prevalence and impact of sarcopenia varied depending on the definitions used. Among the sarcopenia definitions, the SDOC exhibited the strongest associations, while reduced muscle power was the variable most frequently associated with health-related outcomes compared to any of the four sarcopenia definitions in well-functioning and physically active community-dwelling older adults.

Decoding the decline: unveiling drivers of sarcopenia

There remains a critical need to define molecular pathways underlying sarcopenia to identify putative therapeutic targets. Research in the mechanisms of aging and sarcopenia relies heavily on preclinical rodent models. In this issue of the JCI, Kerr et al. implemented a clinically-relevant sarcopenia classification system of aged C57BL/6J mice, capturing sarcopenia prevalence across both sexes. The authors performed detailed physiological, molecular, and energetic analyses and demonstrated that mitochondrial biogenesis, oxidative capacity, and AMPK-autophagy signaling decreased as sarcopenia progressed in male mice. Sarcopenia was less prevalent in female mice with fewer alterations compared with the male-affected processes. The findings highlight factors beyond age as necessary for classifying the sarcopenic phenotype in rodent models, reveal sexual dimorphism across the trajectory of age-related declines in muscle mass and function in a commonly used rodent model, and provide insight into sex-dependent molecular alterations associated with sarcopenia progression.

Diagnostic and prognostic value of calf circumference for sarcopenia in community-dwelling older adults

BACKGROUND

An age-dependent normative values of calf circumference (CC) has been recently proposed as an accessible proxy for muscle mass. However, its usefulness to estimate sarcopenia has not been assessed. The objectives of the present study were to determine if the substitution of the classical way to assess muscle mass by these values have enough diagnostic accuracy and prognostic value among older adults living in the community.

METHODS

Data from the Toledo Study of Healthy Ageing (TSHA) were used. CC was measured using an anthropometric tape. We used two age-groups CC cut-off points: the TSHA CC median and the one proposed in the Longevity Check-up 7+ (Lookup 7+) project. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and FNIH criteria standardized for our population (sFNIH). Frailty (according to the Frailty Phenotype and the Frailty Trait Scale-5) and disability (Katz index) were assessed at baseline and follow-up. Mortality and first hospitalization were also recorded. Logistic (incident frailty and worsening disability) and Cox (mortality and hospitalization) regressions were performed. Diagnostic accuracy was assessed through Kappa index, AUCs, positive and negative predictive values. Predictive ability was assessed through AUCs and integrated AUCs (IAUCs).

RESULTS

1531 participants (74.8 ± 5.8 years; 45.6% men) were included in the analysis. Prevalence rates of sarcopenia were 22.7% (sFNIH), 15.0% (FNIH), and 13.9% (EWGSOP2). Using TSHA-based cut-points of CC, the prevalence of sarcopenia was 16.8% (sFNIH), 11.0% (FNIH), and 11.5% (EWGSOP2). According to LC7+-based CC cut-off points, sarcopenia prevalence was 17.6% (sFNIH), 11.9% (FNIH), and 12.4% (EWGSOP2). CC cut-off points showed low-to-moderate agreement (Kappa Index values between 0.49 and 0.69) with appendicular lean mass for the evaluation of sarcopenia. Sarcopenia identified by Lookup 7+ and TSHA CC cut-off points was associated with the adverse events examined, with similar AUCs and IAUCs than original sarcopenia definitions, and were lost after adjustment by baseline frailty, except when the original EWGSOP2 definition was used.

CONCLUSIONS

Using normalized values of CC as a criteria of muscle mass shows moderate agreement with classical criteria for diagnosing sarcopenia and offer similar predictive value in community-dwelling older adults.

Diabetes mellitus: association of cystatin C- versus creatinine-based estimated glomerular filtration rate with mortality and cardiovascular events

BACKGROUND

To explore the association between the differences between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff), and the risk of mortality and cardiovascular (CV) events in individuals with diabetes.

METHODS

Three prospective cohorts analyzed data from adults with diabetes from the Incident, Development, and Prognosis of Diabetic Kidney Disease (INDEED) study (2016-17 to 2020) in China, the National Health Nutrition Examination Survey (NHANES, 1999-2004 to 2019) in the USA and UK Biobank (UKB, 2006-10 to 2022) in the UK. Baseline eGFRdiff was calculated using both absolute difference between cystatin C- and creatinine-based calculations (eGFRabdiff), and the ratio between them (eGFRrediff). Cox proportional hazards regression models were used to investigate the association between eGFRdiff and outcomes including all-cause mortality and incident CV events.

RESULTS

A total of 8129 individuals from INDEED (aged 60.7 ± 10.0 years), 1634 from NHANES (aged 62.5 ± 14.4 years) and 29 358 from UKB (aged 59.4 ± 7.3 years) were included. At baseline, 43.6%, 32.4% and 42.1% of participants in INDEED, NHANES and UKB, respectively, had an eGFRabdiff value ≥15 mL/min/1.73 m2. During a median follow-up of 3.8 years for INDEED, 15.2 years for NHANES and 13.5 years for UKB, a total of 430, 936 and 6143 deaths and a total of 481, 183 and 5583 CV events occurred, respectively. Each 1-standard deviation higher baseline eGFRabdiff was independently associated with a lower risk of all-cause mortality and CV events, with hazard ratios of 0.77 and 0.82 in INDEED, 0.70 and 0.68 in NHANES, and 0.66 and 0.78 in UKB. Similar results were observed for eGFRrediff.

CONCLUSIONS

eGFRdiff represents a marker of adverse events for diabetes among general population. Monitoring both eGFRcys and eGFRcr yields additional prognostic information and has clinical utility in identifying high-risk individuals for mortality and CV events.

Exercise training for patients with heart failure and preserved ejection fraction. A narrative review

Heart failure with preserved ejection fraction (HFpEF) remains a significant global health challenge, accounting for up to 50% of all heart failure cases and predominantly affecting the elderly and women. Despite advancements in therapeutic strategies, HFpEF's complexity poses substantial challenges in management, particularly due to its high comorbidity burden, including renal failure, atrial fibrillation, and obesity, among others. These comorbidities not only complicate the pathophysiology of HFpEF but also exacerbate its symptoms, necessitating a personalized approach to treatment focused on comorbidity management and symptom alleviation. In heart failure with reduced ejection fraction, exercise training (ET) was effective in improving exercise tolerance, quality of life, and reducing hospitalizations. However, the efficacy of ET in HFpEF patients remains less understood, with limited studies showing mixed results. Exercise intolerance is a key symptom in HFpEF patients, and it has a multifactorial origin since both central and peripheral oxygen mechanisms of transport and utilization are often compromised. Recent evidence underscores the potential of supervised ET in enhancing exercise tolerance and quality of life among HFpEF patients; however, the literature remains sparse and predominantly consists of small-scale studies. This review highlights the critical role of exercise intolerance in HFpEF and synthesizes current knowledge on the benefits of ET. It also calls for a deeper understanding and further research into exercise-based interventions and their underlying mechanisms, emphasizing the need for larger, well-designed studies to evaluate the effectiveness of ET in improving outcomes for HFpEF patients.

Association between SARC-F scores and risk of adverse outcomes in older patients with cardiovascular disease: a prospective study at a tertiary hospital in the south of Vietnam

Introduction

Older patients typically face elevated mortality rates and greater medical resource utilization during hospitalizations compared to their younger counterparts. Sarcopenia, serving as a prognostic indicator, is related to disability, diminished quality of life, and increased mortality. The SARC-F questionnaire, known for its cost-effectiveness, offers a valuable means of assessing sarcopenia. This study aims to explore the association between SARC-F scores and risk of adverse outcomes in elderly patients with cardiovascular disease at a Ho Chi Minh City hospital.

Method

Participants aged 60 and above, admitted to the Department of Cardiology - Interventional and Cardiovascular Emergency of Thong Nhat Hospital in Ho Chi Minh City from November 2021 to June 2022, were recruited for the prospective, single-center study. The prognostic outcomes included all-cause death and the initial occurrence of emergency re-hospitalization within 6 months' post-discharge. The Kaplan-Meier analysis compared the overall survival rates between different SARC-F score groups.

Results

The study enrolled 285 patients with a median age of 74 (67, 81). During a 6-month follow-up period, there were 14 cases of mortality. A SARC-F score of 4 or higher was significantly associated with an increased risk of all-cause mortality, with HR of 2.02 (95% CI: 1.39-2.92, p < 0.001), and higher incidence of re-hospitalization events with RR of 1.66 (95% CI: 1.06 to 2.59, p = 0.026). Kaplan-Meier survival analysis indicated a notably higher mortality rate in the patients with high SARC-F scores (p < 0.001).

Conclusion

In elderly patients with cardiovascular disease, the SARC-F questionnaire could serve as a simple and cost-effective method for detecting mortality and the risk of re-hospitalization.

Urban-rural differences in the prevalence and associated factors of sarcopenia: A systematic review and meta-analysis

BACKGROUND

Loss of muscle mass, muscle strength, and/or physical performance due to aging is known as sarcopenia. Regardless of how serious this illness is, no single diagnostic criteria have been established. Much research conducted recently has demonstrated differences between built environment characteristics (i.e., urban and rural) and the occurrence of sarcopenia; however, variations in sarcopenia prevalence in urban-rural areas around the world have been reported by fewer studies. This work sought to determine how sarcopenia prevalence varied between urban and rural areas and to explore the associated influencing factors.

METHODS

Using the pertinent MESH phrases and free words, PubMed, Web of Science, Embase, and China national knowledge infrastructure databases were scanned for core sarcopenia literature up to February 26, 2023. Observational studies involving urban-rural patients with sarcopenia published in Chinese and English, and assessing muscle mass via computed tomography, bioelectrical impedance, or dual-energy X-ray absorption techniques were considered as inclusion criteria. The meta-analysis involved analysis of the urban-rural prevalence in subgroups by diagnostic criteria, tools for assessing muscle mass and study type, as well as the factors related to urban-rural differences in the occurrence of sarcopenia. STATA version 11.0 was used to perform the statistical analysis.

RESULTS

Sixty-six articles involving 433,091 participants were included for analysis: of which 27 were analyzed for both prevalence and related factors whereas 39 were for only prevalence. The meta-analysis revealed the prevalence of sarcopenia to be 0.18 (95 % CI 0.14-0.22), with significant heterogeneity (P < 0.001; I2 = 99.9 %). Moreover, the prevalence of sarcopenia in urban group [0.16 (I2 = 99.9 %, 95 % CI 0.1-0.22)] was lower than in rural group [0.2 (I2 = 99.6 %, 95 % CI 0.16-0.25)] and urban-rural group [0.21 (I2 = 97.5 %, 95 % CI 0.16-0.25)]. Besides, the factors significantly associated with sarcopenia in urban-rural areas were age, gender, BMI, malnutrition, physical activity, and polypharmacy. There was significant heterogeneity between these factors and the association of sarcopenia.

CONCLUSIONS

Sarcopenia is associated with aspects of the built environment, and studies have revealed that sarcopenia is more common in rural than in urban populations with influencing factors including age, gender, BMI, poor nutrition, insufficient physical activity, and polypharmacy. The lack of uniform diagnostic criteria makes a robust and comprehensive assessment difficult. Therefore, the formation of certain universal and standardized diagnostic criteria will help future research on sarcopenia.

Trends and projections in fall death in the Netherlands from 1990 to 2045

BACKGROUND

Increasing life expectancy in high-income countries has been linked to a rise in fall mortality. In the Netherlands, mortality rates from falls have increased gradually from the 1950s, with some indication of stabilisation in the 1990s. For population health and clinical practice, it is important to foresee the future fall mortality trajectories.

METHODS

A graphical approach was used to explore trends in mortality by age, calendar period and cohorts born in the periods of 1915-1945. Population data and the numbers of people with accidental fall fatality as underlying cause of death from 1990 to 2021 were derived from Statistics Netherlands. Age-standardised mortality rates of unintentional falls per 100 000 population were calculated by year and sex. A log-linear model was used to examine the separate effects of age, period and cohort on the trend in mortality and to produce estimates of future numbers of fall deaths until 2045.

RESULTS

While the total population increased by 17% between 1990 and 2021, absolute numbers of fall-related deaths rose by 230% (from 1584 to 5234), which was 251% (an increase of 576 deaths in 1990 to 2021 deaths in 2020) for men and 219% (from 1008 to 3213) for women. Age-standardised figures were higher for women than men and increased more over time. In 2020, 79% of those with death due to falls were over the age of 80, and 35% were 90 years or older. From 2020 to 2045, the observed and projected numbers of fall deaths were 2021 and 7073 for men (250% increase) and 3213 and 12 575 for women (291% increase).

CONCLUSION

Mortality due to falls has increased in the past decades and will continue to rise sharply, mainly caused by growing numbers of older adults, especially those in their 80s and 90s. Contributing risk factors are well known, implementation of preventive measures is a much needed next step. An effective approach to managing elderly people after falls is warranted to reduce crowding in the emergency care and reduce unnecessary long hospital stays.

Prediabetes and diabetes were attributed to the prevalence and severity of sarcopenia in middle-aged and elderly adults

BACKGROUND

Sarcopenia and diabetes are both prevalent health problems worldwide. However, little is known about the relationship between prediabetes and the prevalence and severity of sarcopenia. Therefore, the current study aimed to explore the association between glucose status and the components of sarcopenia, including low muscle mass (LMM), low muscle strength (LMS) and low gait speed (LGS) in US adults.

METHODS

Data from the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) were analyzed. A total of 4002 participants aged ≥ 50 years with available information on glucose status (NGR: 1939 cases; prediabetes: 1172 cases; diabetes: 891 cases) and sarcopenia were included in this study. Sarcopenia was defined according to the Foundation for National Institute of Health criteria. Muscle mass, muscle strength and gait speed were used to evaluate sarcopenia and its severity. Weighed multivariable logistic regression were used to explore the association between glucose status and the components of sarcopenia. The hypothetical population attributable fraction (PAF) for the glucose status was also calculated.

RESULTS

The mean age of the cohort was 63.01 ± 9.89 years, with 49.4% being male. Multiple logistic regression analysis suggested that diabetes was an independent risk factor for sarcopenia (OR = 5.470, 95% CI 1.551-19.296) and showed a marginal association with severe sarcopenia (OR = 10.693, 95% CI 0.955-119.73) compared to NGR in men, but not in women. Additionally, prediabetes was independently associated with severe sarcopenia (OR = 3.647, 95% CI 1.532-8.697), LMS (OR = 1.472, 95% CI 1.018-2.127) and LGS (OR = 1.673, 95% CI 1.054-2.655) in the entire cohort. When stratifying by gender, we further observed that prediabetes was significantly associated with LMS in men (OR = 1.897, 95% CI 1.019-3.543) and related to LMM (OR = 3.174, 95% CI 1.287-7.829) and LGS (OR = 2.075, 95% CI 1.155-3.727) in women. HbA1c was positively associated with the prevalence of sarcopenia in men (OR = 1.993, 95% CI 1.511-2.629). PAF showed that diabetes accounted for 16.3% of observed sarcopenia cases. Maintaining NGR in the entire population could have prevented 38.5% of sarcopenia cases and 50.9% of severe sarcopenia cases.

CONCLUSIONS

Prediabetes and diabetes were independently associated with the prevalence and severity of sarcopenia in US population. Slowing down the progression of hyperglycemia could have prevented a significant proportion of sarcopenia cases.

Review: myogenic and muscle toxicity targets of environmental methylmercury exposure

A number of environmental toxicants are noted for their activity that leads to declined motor function. However, the role of muscle as a proximal toxicity target organ for environmental agents has received considerably less attention than the toxicity targets in the nervous system. Nonetheless, the effects of conventional neurotoxicants on processes of myogenesis and muscle maintenance are beginning to resolve a concerted role of muscle as a susceptible toxicity target. A large body of evidence from epidemiological, animal, and in vitro studies has established that methylmercury (MeHg) is a potent developmental toxicant, with the nervous system being a preferred target. Despite its well-recognized status as a neurotoxicant, there is accumulating evidence that MeHg also targets muscle and neuromuscular development as well as contributes to the etiology of motor defects with prenatal MeHg exposure. Here, we summarize evidence for targets of MeHg in the morphogenesis and maintenance of skeletal muscle that reveal effects on MeHg distribution, myogenesis, myotube formation, myotendinous junction formation, neuromuscular junction formation, and satellite cell-mediated muscle repair. We briefly recapitulate the molecular and cellular mechanisms of skeletal muscle development and highlight the pragmatic role of alternative model organisms, Drosophila and zebrafish, in delineating the molecular underpinnings of muscle development and MeHg-mediated myotoxicity. Finally, we discuss how toxicity targets in muscle development may inform the developmental origins of health and disease theory to explain the etiology of environmentally induced adult motor deficits and accelerated decline in muscle fitness with aging.

Predictive value of adductor pollicis muscle thickness for ultrasound-based sarcopenia in older adults

BACKGROUND

The adductor pollicis muscle thickness (APMT) is least affected by subcutaneous adipose tissue and can be measured externally. The aim of this study is to identify the predictive value of APMT for the diagnosis of ultrasonography-based sarcopenia.

METHODS

A total of 245 outpatients who were aged ≥65 years (49 with sarcopenia and 196 without sarcopenia) were included in this cross-sectional study. Patients with knee or hip replacement, advanced dementia, cerebrovascular disease, neurodegenerative disease, or decompensated heart failure and those using drugs that affect muscle functions, such as steroids, were excluded. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. The diagnosis of sarcopenia was based on a low Sonographic Thigh Adjustment Ratio (STAR) index (anterior thigh muscle thickness by ultrasonography/body mass index [BMI] ratio, cutoff points are <1.4 for men and <1.0 for women) and low handgrip strength. The predictive ability of APMT for ultrasound-based sarcopenia diagnosis was examined.

RESULTS

There was no significant difference in terms of arm and calf circumference and BMI between the sarcopenic and nonsarcopenic groups. APMT, handgrip strength, anterior thigh muscle thickness, and gait speed were significantly lower in the patients with sarcopenia. The best cutoff points of APMT for sarcopenia were ≤16.5 for women and ≤21.5 for men with areas under the curve of 0.70 and 0.66, respectively, and negative predictive values of 91.2 and 94.3, respectively (P < 0.001).

CONCLUSION

APMT can be a useful anthropometric marker for ultrasound-based sarcopenia diagnosis.

Serum branched-chain amino acid levels are associated with fracture risk in Japanese women

AIM

Branched-chain amino acids (BCAAs) have been shown to exert beneficial effects on muscle and bone metabolism; however, no studies to date have investigated whether BCAAs have beneficial effects on bone fractures. Herein, we aim to prospectively investigate the relationship between serum BCAA concentrations and the occurrence of vertebral fractures (VFs) in Japanese women.

METHODS

During the observation period (7.5 ± 6.1 years), 188 of 983 participants experienced VF. Kaplan-Meier analyses were conducted to examine time-dependent variations in the vertebral compression fracture occurrence rate. Patients were stratified into quartiles based on serum BCAA concentration for this analysis.

RESULTS

The analysis results indicated that the group with the lowest BCAA level developed VFs significantly earlier and with a higher frequency than the other groups (P < 0.001). A Cox proportional hazards model showed that BCAA concentration was a significant risk factor for incident fracture, even after adjusting for possible confounding factors. A series of multiple regression analyses were performed to identify factors related to serum BCAA concentration, with the results identifying levels of glycated hemoglobin (P < 0.001), adiponectin (P < 0.001), and NOx (P = 0.011) as significant factors associated with serum BCAA.

CONCLUSIONS

Overall, the present study revealed that a lower serum BCAA level was an independent risk factor for incident VF in postmenopausal women. Geriatr Gerontol Int 2024; 24: 603-608.

Sarcopenia and mild kidney dysfunction and risk of all-cause and cause-specific mortality in older adults

BACKGROUND

Sarcopenia has been identified as a risk factor for increased mortality in individuals with CKD. However, when considering individuals with mild kidney dysfunction prior to CKD, the impact of sarcopenia on adverse outcomes, particularly mortality, remains uncertain.

METHODS

This study included 323 801 participants from the UK Biobank. Mild kidney dysfunction was defined as estimated glomerular filtration rate between 60 and 89.9 mL/min/1.73 m2, and sarcopenia was defined according to the criteria of the 2019 European Working Group of Sarcopenia in Older People. Cox proportional hazard models with inverse probability weighting and competing risk models were used for analysis.

RESULTS

During a median follow-up of 11.8 years, 20 146 participants died from all causes. Compared with participants with normal kidney function and without sarcopenia, those with mild kidney dysfunction or sarcopenia had significantly increased risks of all-cause mortality [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.12-1.19; HR 1.29, 95% CI 1.20-1.37]; those with both mild kidney dysfunction and sarcopenia had an even higher risk of all-cause mortality (HR 1.61, 95% CI 1.52-1.71), with a significant overall additive interaction (relative risk due to interaction 0.17, 95% CI 0.05-0.29). Further subgroup analyses revealed that the associations of probable sarcopenia with all-cause and cause-specific mortality (non-accidental cause, non-communicable diseases and cancer) were stronger among participants with mild kidney dysfunction than those with normal kidney function.

CONCLUSIONS

The study indicates that sarcopenia and mild kidney dysfunction synergistically increase the risk of all-cause and cause-specific mortality. Early recognition and improvement of mild kidney function or sarcopenia in older people may reduce mortality risk but would require more prospective confirmation.

Prognostic Features of Sarcopenia in Older Hospitalized Patients: A 6-Month Follow-Up Study

Background: Sarcopenia is associated with adverse health outcomes. Understanding the association between sarcopenia, multidimensional frailty, and prognosis is essential for improving patient care. The aim of this study was to assess the prevalence and prognostic signature of sarcopenia in an acute hospital setting co-led by internists and geriatricians. Methods: Sarcopenia was assessed by applying the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, including the SARC-F score, handgrip strength, bioelectrical impedance analysis (BIA), and Timed Up and Go (TUG) test, to 97 older multimorbid inpatients (76.5 ± 6.8 years, 55% women). The patients underwent a Comprehensive Geriatric Assessment (CGA) including an evaluation of Geriatric Syndromes (GSs) and Resources (GR) and prognosis calculation using the CGA-based Multidimensional Prognostic Index (MPI), European Quality of life-5 Dimensions (EQ-5D-5L) scale, Rosenberg Self-Esteem Scale (RSES), and Geriatric Depression Scale (GDS). Information on survival and rehospitalizations was collected 1, 3, and 6 months after discharge. Results: Sarcopenia was present in 63% (95% CI: 54-72%) of patients and categorized as probable (31%), confirmed (13%), and severe sarcopenia (18%). Sarcopenic patients showed significantly higher median MPI-values (p < 0.001), more GSs (p = 0.033), fewer GR (p = 0.003), lower EQ-5D-5L scores (p < 0.001), and lower RSES scores (p = 0.025) than non-sarcopenic patients. Six months after discharge, being sarcopenic at baseline was predictive of falls (p = 0.027) and quality of life (p = 0.043), independent of age, gender, and MPI. Conclusions: Sarcopenia is highly prevalent in older hospitalized multimorbid patients and is associated with poorer prognosis, mood, and quality of life up to 6 months after discharge, independent of age, sex, and MPI as surrogate markers of biological age.