Implications of ICD-10 for Sarcopenia Clinical Practice and Clinical Trials: Report by the International Conference on Frailty and Sarcopenia Research Task Force

Evaluating sarcopenia prevalence and SARC-F effectiveness in elderly Spanish women with RA: a comparative study of EWGSOP criteria

Introduction

The European Working Group on Sarcopenia in Older People (EWGSOP) has put forward two key proposals for diagnosing sarcopenia: the EWGSOP1 in 2010 and the EWGSOP2 in 2019. These proposals are currently the most widely used guidelines for diagnosing sarcopenia. However, data on the prevalence of sarcopenia in patients with rheumatoid arthritis (RA) based on EWGSOP criteria are limited. This study aimed to: (a) establish the prevalence of sarcopenia in an elderly Spanish cohort of women with RA using both EWGSOP1 and EWGSOP2 criteria; and (b) evaluate the effectiveness of the SARC-F questionnaire in detecting sarcopenia.

Methods

In this observational, cross-sectional study, 67 women aged over 65 years who met the ACR 2010 criteria for RA were consecutively recruited from a tertiary university hospital. Assessments included: (a) demographic and anthropometric data; (b) RA-related variables (disease history, analytical evaluation, activity, disability, quality of life); and (c) sarcopenia-related variables (muscle strength, gait speed, skeletal muscle mass, and SARC-F questionnaire). The prevalence of sarcopenia was determined using both EWGSOP1 and EWGSOP2 criteria. Furthermore, the effectiveness of the SARC-F questionnaire for detecting sarcopenia were calculated.

Results

The prevalence of sarcopenia was 43% according to the EWGSOP1 criteria and 16% according to the EWGSOP2 criteria. Patients diagnosed with sarcopenia based on the latter criteria also met the EWGSOP1's criteria for sarcopenia. Agreement between the two sets of EWGSOP criteria was poor. The SARC-F questionnaire demonstrated an inherently high sensitivity (100%) as well as good specificity (75%) and diagnostic accuracy (79%) in detecting sarcopenia according to EWGSOP2 criteria.

Conclusions

The prevalence rate of sarcopenia among elderly Spanish women with RA varies significantly depending on whether EWGSOP1 or EWGSOP2 criteria are applied. The SARC-F questionnaire is effective for predicting sarcopenia when used in conjunction with the EWGSOP2 criteria, which is currently the most accepted standard in clinical practice.

Endurance exercise preserves physical function in adult and older male C57BL/6 mice: high intensity interval training (HIIT) versus voluntary wheel running (VWR)

Exercise has been shown to improve physical function, mitigate aspects of chronic disease and to potentially alter the trajectory of age-related onset of frailty and sarcopenia. Reliable and valid preclinical models are necessary to elucidate the underlying mechanisms at the intersection of age, exercise, and functional decline. The purpose of this study was to compare, head to head, the effects of two common pre-clinical models of endurance exercise: high intensity interval training (HIIT) and voluntary wheel running (VWR). The hypothesis was that a prescribed and regimented exercise program, HIIT, would prove to be a superior training method to unregulated voluntary exercise, VWR. To investigate this hypothesis, we evaluated adult (n = 24, designated 10 m, aged 6 months at the beginning of the study, 10 months at its completion) and older adult (n = 18, designated 26 m, aging from 22 months to 26 months over the course of the study) C57BL/6 male mice. These mice were randomly assigned (with selection criteria) to a 13-week program of voluntary wheel running (VWR), high intensity interval training (HIIT), or sedentary control (SED). The functional aptitude of each mouse was determined pre- and post-training using our composite CFAB (comprehensive functional assessment battery) scoring system consisting of voluntary wheel running (volitional exercise and activity rate), treadmill (endurance), rotarod (overall motor function), grip meter (forelimb strength), and inverted cling (whole body strength/endurance). To measure sarcopenia, we tracked body mass, body composition (with EchoMRI), plantar flexor torque (in 10 m), and measured muscle wet mass post-training. Overall, adult CFAB scores decreased while body mass and percent body fat increased as they matured; however, exercise significantly mitigated the changes (p < 0.05) compared to SED. Older adults demonstrated preservation of function (CFAB) and reduced body fat (p < 0.05) compared to SED. To conclude, both types of exercise maintained physical function equally in older mice.

Causal associations of sarcopenia-related traits with cardiometabolic disease and Alzheimer's disease and the mediating role of insulin resistance: A Mendelian randomization study

The causal influence of sarcopenia on cardiometabolic disease and Alzheimer's disease and whether and to what extent insulin resistance plays a mediating role therein were unclear. We performed two-step, two-sample Mendelian randomization applying genetic instruments of sarcopenia-related traits based on GWASs from the UK Biobank (up to 461,026 European participants) to examine their causal associations with six cardiometabolic diseases and Alzheimer's disease extracted from large-scale European descent GWASs with adjustment for body fat percentage and physical activity, and to assess proportions of the causal effects mediated by insulin resistance. Genetic instruments of insulin resistance were derived from the GWASs by Meta-Analyses of Glucose and Insulin-related traits Consortium and Global Lipids Genetics Consortium. Each 1-SD lower grip strength, appendicular lean mass (ALM) and whole-body lean mass (WBLM), as well as lower walking pace, were causally associated with higher risks of diabetes (odds ratio [OR] range: 1.20 [95% confidence interval: 1.10-1.32] for ALM to 2.30 [1.14-4.68] for walking pace), nonalcoholic fatty liver disease ([NAFLD], 1.33 [1.08-1.64] for ALM to 2.30 [1.02-5.18] for grip strength), hypertension (1.12 [1.05-1.20] for ALM to 4.43 [2.68-7.33] for walking pace), coronary heart disease ([CHD], 1.20 [1.13-1.27] for ALM to 2.73 [1.84-4.05] for walking pace), myocardial infarction ([MI], 1.18 [1.11-1.25] for ALM to 2.47 [1.63-3.73] for walking pace), small vessel stroke (1.25 [1.15-1.37] for ALM to 1.29 [1.10-1.52] for WBLM), and Alzheimer's disease (1.10 [1.05-1.15] for ALM to 1.28 [1.19-1.38] for WBLM). These causal associations were largely independent of body fat percentage and physical activity. Insulin resistance mediated 16%-34% of the effect of grip strength and 7%-28% of the effect of ALM on diabetes, NAFLD, hypertension, CHD, and MI. The direct effect of WBLM on diabetes diminished toward null with adjustment for insulin resistance. We found no evidence that insulin resistance was on the causal pathways from walking pace to the studied disease outcomes. Causal findings from the inverse-variance weighted method were validated by sensitivity analyses. These findings support improving sarcopenia-related traits as precautions against major cardiometabolic diseases and Alzheimer's disease, with particular emphasis on insulin resistance as a target in the intervention of sarcopenia-related cardiometabolic risk.

Physical and functional evaluations in oncological patients elective to medium and large operations

PURPOSE

To evaluate the risk of sarcopenia on the length of hospital stay and deaths in preoperative cancer patients as well its relation to physical and functional capacity.

METHODS

Preoperative patients admitted to the Cancer Hospital of Mato Grosso comprised the sample. Sociodemographic data, lifestyle data, and a questionnaire for sarcopenia screening were collected. Subsequently, total body mass, height, muscle strength, muscle mass, and physical performance were evaluated. The primary, secondary and tertiary outcomes were sarcopenia, length of stay and death, respectively. The data were tabulated and analyzed using the statistical software SPSS (25.0). The significance level was 5%.

RESULTS

We observed 12 (7.4%) patients with low muscle strength, 20 (12.3%) patients with low muscle mass, 11 (6.8%) patients with low physical performance, and 18 (11.1%) patients with scores for possible sarcopenia. When the risk of sarcopenia was observed, 44 (27.2%) patients had at least one risk related to muscle disorder. When analyzing the prevalence and association of sarcopenia with sociodemographic variables, we observed that education level was associated with sarcopenia (p = 0.031). In addition, there was an association between preoperative sarcopenia and postoperative death (p = 0.006). Finally, there were important correlations between muscle strength and physical performance (p < 0.05), between muscle strength and the sarcopenia questionnaire (p < 0.001), and between physical performance and the sarcopenia questionnaire (p < 0.05).

CONCLUSION

The results suggest the need for counseling and the need to evaluate patients for risk of sarcopenia, since early intervention, such as dietary supplementation and physical exercise, may favor a better postoperative prognosis, possibly corresponding to shorter hospital stays and longer survival and quality of life for patients, especially those who will undergo surgical procedures.

An elusive consensus definition of sarcopenia impedes research and clinical treatment: A narrative review

The definition of sarcopenia, the age-related loss of muscle mass, has evolved since the term's inception and yet there is no consensus. Many of the identified definitions of sarcopenia centre their criteria around the loss of muscle mass, loss of function, and weakness. Common variables to various definitions of sarcopenia are appendicular lean soft tissue mass (often called muscle mass), grip strength, and gait speed. However, a lack of consensus remains among operational definitions and diagnostics for this newly recognized disease and may be attributed to the absence of appropriate tools that accurately measure the outcomes of interest, such as skeletal muscle instead of lean mass. In this narrative review, we describe the evolution of the consensus groups' definition of sarcopenia, address the need for more accurate measures of muscle mass and function, and effective, low-cost treatments (i.e., resistance training and diet) for this disease. Consensus on what constitutes sarcopenia is critical to propel research in the field and, importantly, provide what prognostic value a sarcopenia diagnosis provides and how such a patient would be treated.

Comparing Prevalence of Sarcopenia Using Twelve Sarcopenia Definitions in a Large Multinational European Population of Community-Dwelling Older Adults

OBJECTIVES

Multinational prevalence data on sarcopenia among generally healthy older adults is limited. The aim of the study was to assess prevalence of sarcopenia in the DO-HEALTH European trial based on twelve current sarcopenia definitions.

SETTING AND PARTICIPANTS

This is an analysis of the DO-HEALTH study including 1495 of 2157 community-dwelling participants age 70+ years from Germany, France, Portugal, and Switzerland with complete measurements of the sarcopenia toolbox including muscle mass by DXA, grip strength, and gait speed.

MEASUREMENTS

The twelve sarcopenia definitions applied were Asian Working Group on Sarcopenia (AWGS1), AWGS2, Baumgartner, Delmonico, European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, EWGSOP2-lower extremities, Foundation for the National Institutes of Health (FNIH1), FNIH2, International Working Group on Sarcopenia in Older People (IWGS), Morley, and Sarcopenia Definitions and Outcomes Consortium (SDOC).

RESULTS

Mean age was 74.9 years (SD 4.4); 63.3% were women. Sarcopenia prevalence ranged between 0.7% using the EWGSOP2 or AWGS2 definition, up to 16.8% using the Delmonico definition. Overall, most sarcopenia definitions, including Delmonico (16.8%), Baumgartner (12.8%), FNIH1(10.5%), IWGS (3.6%), EWGSOP1 (3.4%), SDOC (2.0%), Morley (1.3%), and AWGS1 (1.1%) tended to be higher than the prevalence based on EWGSOP2 (0.7%). In contrast, the definitions AWGS2 (0.7%), EWGSOP2-LE (1.1%), FNIH2 (1.0%) - all based on muscle mass and muscle strength - showed similar lower prevalence as EWGSOP2 (0.7%). Moreover, most sarcopenia definitions did not overlap on identifying sarcopenia on an individual participant-level.

CONCLUSION

In this multinational European trial of community-dwelling older adults we found major discordances of sarcopenia prevalence both on a population- and on a participant- level between various sarcopenia definitions. Our findings suggest that the concept of sarcopenia may need to be rethought to reliably and validly identify people with impaired muscle health.

Sarcopenia and Ageing

Musculoskeletal ageing is a major health challenge as muscles and bones constitute around 55-60% of body weight. Ageing muscles will result in sarcopenia that is characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes. In recent years, a few consensus panels provide new definitions for sarcopenia. It was officially recognized as a disease in 2016 with an ICD-10-CM disease code, M62.84, in the International Classification of Diseases (ICD). With the new definitions, there are many studies emerging to investigate the pathogenesis of sarcopenia, exploring new interventions to treat sarcopenia and evaluating the efficacy of combination treatments for sarcopenia. The scope of this chapter is to summarize and appraise the evidence in terms of (1) clinical signs, symptoms, screening, and diagnosis, (2) pathogenesis of sarcopenia with emphasis on mitochondrial dysfunction, intramuscular fat infiltration and neuromuscular junction deterioration, and (3) current treatments with regard to physical exercises and nutritional supplement.

Trends in Nutrition Research for Sarcopenia: A Bibliometric Analysis

Sarcopenia is age-related, pathophysiological muscle atrophy. Research regarding nutrition treatment of sarcopenia has developed rapidly, particularly as populations age. We evaluated the development of trends in this field using a bibliometric analysis. Articles up to July 2022 were searched in the Scopus database. Bibliographic information from the selected publications, such as countries, citations, world maps, institutions, authors, journals, and keywords, were converted and analyzed automatically using the “bibliometrix” package in R environment (version 4.2.0). We identified 368 Scopus articles from 1998–2021. According to citation analyses, 27 documents received more than 100 citations. Bibliometric analysis based on the literature included in this study revealed that South Korea (61 publications), United States (50), Japan (35), China (30), and Italy (20) contributed the most publications. Tehran University of Medical Science (19 records, 2.55% of articles) contributed the most publications. The most productive author was Landi, with eight articles (2.17% of articles). The publications were located in 196 journals, with Nutrients having the most publications (30, 8.15% of articles). The curves representing keywords “sarcopenia” and “aged” were the most apparent. Our analysis suggested that global nutrition and sarcopenia-related research increased rapidly from 2001 to 2021, demonstrating that this was a promising area of future research that could benefit from continued advances. Future research may focus on the effects of age and sex as well as intervention effectiveness, particularly exercise and nutrition supplementation.

Modulation of Neuroendocrine and Immunological Biomarkers Following Rehabilitation in Sarcopenic Patients

This study aimed to investigate if rehabilitation could down-regulated sarcopenia-associated inflammation by modulating the crosstalk between the neuroendocrine and immune systems, with the aim of ameliorating quality of life of sarcopenic subjects. A total of 60 sarcopenic patients (49 females and 11 males; median age 74.5, interquartile range 71–79), undergoing a personalized rehabilitation program, have been recruited and subjected to: (1) functional and physical evaluation (Short Physical Performance Battery (SPPB), Barthel Index and Tinetti Test); (2) pro-inflammatory IL-1β, TNF-α, IL-6, IL-18, and anti-inflammatory IL-10 cytokines plasmatic level measures; and (3) norepinephrine, epinephrine, dopamine, and serotonin neurotransmitter level evaluation at time of enrollment (T0) and once rehabilitation was concluded (1 month, T1). Rehabilitation combined a balance and strength training program with two daily sessions that were fine-tuned and personalized according to the ability of the patient. The results showed a significant increase at T1 in the plasmatic levels of IL-10 (p = 0.018) and of norepinephrine (p = 0.016)), whereas the concentration of IL-18 was significantly reduced (p = 0.012). Notably, changes in norepinephrine were positively correlated with clinical improvements (Tinetti and Barthel scores, p ≤ 0.0001; SPPB scores, p = 0.0002). These results show that efficient rehabilitation induces a reduction of inflammation, suggesting that this effect could be mediated by a modulation of the neuro-immune axis that results in an increase of norepinephrine.

Sarcopenic Obesity: An Emerging Public Health Problem

Population aging and the obesity epidemic are important global public health problems that pose an unprecedented threat to the physical and mental health of the elderly and health systems worldwide. Sarcopenic obesity (SO) is a new category of obesity and a high-risk geriatric syndrome in the elderly. SO is associated with many adverse health consequences such as frailty, falls, disability, and increased morbidity and mortality. The core mechanism of SO is the vicious circle between myocytes and adipocytes. In order to implement effective prevention and treatment strategies and reduce adverse clinical outcomes, it is essential to further our understanding of SO in the elderly. Herein, we reviewed the definition, diagnosis, epidemiology, pathogenesis, and treatment of SO in older adults.

Sarcopenia, a major clinical problem in old age, potential causes, clinical consequences and therapeutic possibilities

Sarcopenia or degeneration of skeletal muscle tissue with aging, is responsible for functional de-cline and loss of independence in older adults. The purpose of this article is to review the current definitions of sarcopenia, its potential causes, clinical consequences and the potential for prop-hylactic and curative intervention. Sarcopenia is recognized as a major clinical problem for the elderly, and the research in this area is growing exponentially. One of the most important recent developments has been convergence in the operational definition of sarcopenia that combines muscle mass, strength and muscle function. In 2010, the European Working Group on Sarcopenia in Oder People (EWGSOP) published a definition of sarcopenia aimed at promoting progress in the identification and care of the elderly. In early 2018 (EWGSOP2) he met again to update the original definition to reflect the scientific and clinical evidence that has been built over the past decade. The cause of sarcopenia is considered to be multifactorial: hormonal changes, neurologi-cal decline, sedentary / immobilization for a long period, chronic diseases, obesity, all these fac-tors contribute to the onset of sarcopenia. Prophylactic or curative interventions are essentially aimed at nutrition and exercise. Although pharmaceutical agents are developed that target seve-ral biological pathways, proper nutrition and specific physical exercises remain the gold stan-dard for therapy. Through this review, we want to draw attention to the need to implement complex analyzes of the elderly patient, regardless of the acute problem with which he presents himself at the consultation. These analyses should contain tests, measurements, questionnaires that identify in time a possible musculoskeletal degeneration. The results did not show any sig-nificant difference between the perception of sarcopenia, the way of approaching it and the prophylactic or therapeutic treatment. We focused on this pathology because sarcopenia is rela-tively newly observed, defined, it is not fully investigated and a clinical skill has not been for-med for the evaluation of the elderly patient. Keywords: Skeletal muscle, elderly, sarcopenia, degeneration, exercises

Defining Normal Ranges of Skeletal Muscle Area and Skeletal Muscle Index in Children on CT Using an Automated Deep Learning Pipeline: Implications for Sarcopenia Diagnosis

Background: Skeletal muscle area (SMA), representing skeletal muscle cross-sectional area at the L3 vertebral level, and skeletal muscle index (SMI), representing height-normalized SMA, can serve as markers of sarcopenia. Normal SMA and SMI values have been reported primarily in adults. Objective: To use an automated deep-learning (DL) pipeline for muscle segmentation on abdominal CT to define normative age- and sex-based values for pediatric muscle cross-sectional area, as a guide for diagnosis of sarcopenia in children. Methods: This retrospective study reviewed records of patients who underwent abdominal CT at Cincinnati Children's Hospital Medical Center from January 1, 2009 to January 3, 2019. Patients were excluded on the basis of age outside of the eligible range (2.00-18.99 years), body mass index (BMI) outside of 5% to 95% age-based percentiles using CDC and WHO growth charts), known medical condition, medication use, support devices, surgery, or missing axial images at L3 level. A previously validated automated DL pipeline (https://github.com/cchmc-dll/pediatric_sarcopenia_pipeline.git) was used to identify an axial slice at L3 and segment skeletal muscle, to generate SMA and SMI. Pearson correlation coefficients were computed. Quantile regression analysis was used to plot SMA and SMI as functions of age and sex and to determine age- and sex-based percentile values. Results: Of 8817 patients who underwent abdominal CT during the study period, 2168 (mean age, 11.5±45 years; 1125 females, 1043 males) met inclusion criteria. Mean BMI-for-age percentile based on CDC and WHO growth charts was 64.8±25.3% for females and 61.4±25.8% for males. SMA showed strong correlation with weight, height, age, and BMI for males (0.79-0.94) and females (0.75-0.90); SMI showed weak-to-moderate correlation with weight, height, age and BMI for males (0.25-0.57) and females (0.00-0.43). Normal SMA and SMI ranges for age and sex were expressed as curves and as a lookup table, identifying 54 males and 59 females with muscle measurements below the 5-percentile regression curve. Conclusion: By using an automated DL pipeline in a large sample of carefully selected children, normal ranges for SMA and SMI were calculated as functions of age and sex. Clinical Impact: The normative values should aid the diagnosis of sarcopenia in children.

Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Mitochondrial Quality Control in Sarcopenia: Updated Overview of Mechanisms and Interventions

Sarcopenia is a common geriatric disorder characterized by decreased muscle strength, low muscle mass and poor physical performance. This aging-related skeletal muscle deterioration leads to adverse outcomes and severely impairs the quality of life of patients. The accumulation of dysfunctional mitochondria with aging is an important factor in the occurrence and progression of sarcopenia. Mitochondrial quality control (MQC) fundamentally ensures the normal mitochondrial functions and is comprised of four main parts: proteostasis, biogenesis, dynamics and autophagy. Therefore, any pathophysiologic factors compromising the quality control of homeostasis in the skeletal muscle may lead to sarcopenia. However, the specific theoretical aspects of these processes have not been fully elucidated. Current therapeutic interventions using nutritional and pharmaceutical treatments show a modest therapeutic efficacy; however, only physical exercise is recommended as the first-line therapy for sarcopenia, which can ameliorate skeletal muscle deficiency by maintaining the homeostatic MQC. In this review, we summarized the known mechanisms that contribute to the pathogenesis of sarcopenia by impairing normal mitochondrial functions and described potential interventions that mitigate sarcopenia through improving MQC.

Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions

Introduction

Sarcopenia is defined by a loss of muscle mass and function associated with mortality, decreased physical performance, falls, and disability. Since chronic inflammation and decreased physical activity are risk factors for developing sarcopenia, it is critical to assess the role of sarcopenia in immune-mediated rheumatic diseases (IMRDs). Moreover, nutritional interventions are emerging as key modifiable and affordable options to improve physical performance in sarcopenia.

Objective

The aim of this review is to critically summarize current information on the evidence linking nutritional interventions and sarcopenia in IMRDs.

Methods

The search and selection of articles was performed in Medline, Dimensions.ai, Google Scholar, Cochrane Library, Epistemonikos, and Trip Database. The results were clustered into three areas: sarcopenia and IMRDs, sarcopenia and biological disease-modifying antirheumatic drugs (bDMARDs), and nutritional interventions for sarcopenia.

Findings

Several cross-sectional studies have shown a higher prevalence of sarcopenia in IMRDs, such as rheumatoid arthritis. Although not fully established, evidence linking sarcopenia and other IMRDs (ankylosing spondylitis and systemic sclerosis) has been also described. For secondary sarcopenia prevention and treatment, bDMARDs’ administration proved efficacy in patients with rheumatoid arthritis. Furthermore, there is growing evidence linking nutrition to the prevention and treatment of sarcopenia. Evidence linking unfavourable results in nutritional risk assessment, insufficient intake of protein, vitamin D, antioxidant nutrients, and long-chain polyunsaturated fatty acids and sarcopenia have been reported.

Conclusion

Given that sarcopenia and IMRDs have strong links, further research is needed to improve patient care.

A Comprehensive Analysis of the Association of Psoas and Masseter Muscles with Traumatic Brain Injury Using Computed Tomography Anthropometry

Objective

Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI).

Methods

Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm²/m²). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS).

Results

A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm², p=0.028) and PMI (5.9 vs. 5.1 cm²/m², p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535–0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study.

Conclusion

Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.

Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients

Purpose

To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients.

Methods

In this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12^th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05).

Results

One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×10¹²L⁻¹), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×10⁹L⁻¹), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each).

Conclusions

Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.

The Effects of Lifestyle and Diet on Gut Microbiota Composition, Inflammation and Muscle Performance in Our Aging Society

Living longer is associated with an increased risk of chronic diseases, including impairments of the musculoskeletal and immune system as well as metabolic disorders and certain cancers, each of which can negatively affect the relationship between host and microbiota up to the occurrence of dysbiosis. On the other hand, lifestyle factors, including regular physical exercise and a healthy diet, can affect skeletal muscle and immune aging positively at all ages. Accordingly, health benefits could partly depend on the effect of such interventions that influence the biodiversity and functionality of intestinal microbiota. In the present review, we first discuss the physiological effects of aging on the gut microbiota, immune system, and skeletal muscle. Secondly, we describe human epidemiological evidence about the associations between physical activity and fitness and the gut microbiota composition in older adults. The third part highlights the relevance and restorative mechanisms of immune protection through physical activity and specific exercise interventions during aging. Fourth, we present important research findings on the effects of exercise and protein as well as other nutrients on skeletal muscle performance in older adults. Finally, we provide nutritional recommendations to prevent malnutrition and support healthy active aging with a focus on gut microbiota. Key nutrition-related concerns include the need for adequate energy and protein intake for preventing low muscle mass and a higher demand for specific nutrients (e.g., dietary fiber, polyphenols and polyunsaturated fatty acids) that can modify the composition, diversity, and metabolic capacity of the gut microbiota, and may thus provide a practical means of enhancing gut and systemic immune function.

Sarcopenia

Objective: To assess the prevalence of sarcopenia and associated factors among older women from the local community and older women living in Long-Term Care (LTC) institutions.Methods: A cross-sectional study conducted with 423 older women aged 60 or more, from the local community and older women aged 60 or more, living in LTC institutions. Sarcopenia was defined, according to the consensus of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), including three criteria: low muscle strength (LMS) (<16kg); low muscle mass (LMM) (≤6.75kg/m2) assessed by a skeletal muscle mass index, and low physical performance (LPP) (≤0,8m/s) assessed by gait speed test. Older women who only showed LMS were considered to have pre-sarcopenia, those with LMS associated with LMM were diagnosed with sarcopenia and those who met all three criteria, were diagnosed with severe sarcopenia.Results: Among the community-dwelling older women, the prevalence of sarcopenia was 2.0% (from 60 to 69), 8.6% (from 70 to 79) and 12.9% (80 or more) and among the ones living in LTC Institutions, 3.3% (from 60 to 69), 14.8% (from 70 to 79) and 34.2% (80 or more). After multivariate logistic regression, age and low body mass index (BMI) were associated with sarcopenia in both groups.Conclusion: The prevalence of sarcopenia is higher among LTC older women. However, this is not an independent factor. In addition, regardless of residence, low BMI and advanced age are predictive for sarcopenia.

A cross-sectional study about the relationship between physical activity and sarcopenia in Taiwanese older adults

To the best of our knowledge, none of Taiwanese studies on the relationship between physical activity (PA) and sarcopenia by the latest 2019 Asian Working Group for Sarcopenia (AWGS) cutoff points of sarcopenia has been published. We used the Taiwan version of international physical activity questionnaire-short version and the 2019 AWGS diagnostic criteria of sarcopenia to examine the relationship between PA and sarcopenia in older adults. Volunteers in this cross-sectional study were recruited from those attending senior health checkup program held at a regional hospital in Taipei City from May 2019 to Sep 2019. Muscle strength was assessed by grip strength, physical performance was assessed by usual gait speed on a 6-m course, and muscle mass was measured by bioelectrical impedance analysis. Multiple logistic regression was used to analyze the relationship between PA and sarcopenia. Odds ratios and corresponding 95% confidence intervals were calculated. 565 participants were recruited and data from 500 participants were used. The study participants had a mean age of 73.87 years old, with 47% men and 53% women. 138 (27.6%) participants were classified as having sarcopenia, among which 48 (45.3%) in low PA participants and 90 (22.8%) in moderate to high PA participants. Compared with those with low PA, moderate to high PA protected against the risk of sarcopenia with the odds ratio (OR) 0.46 (95% CI 0.27–0.79, p-value = 0.005). A significant protective effect of PA on sarcopenia was found among the older adults after adjusting for sex, institutionalization, age, BMI, albumin, hemoglobin, HDL-C levels, history of cardiovascular disease, education level and alcohol drinking.

Sarcopenia and Vitamin D Deficiency in Patients with Crohn's Disease: Pathological Conditions That Should Be Linked Together

Sarcopenia is a prevalent condition in patients with Crohn’s disease (CD), representing an independent predictor factor for the development of major postoperative complications. Thus, a proper assessment of the muscle strength, by using different validated tools, should be deemed an important step of the clinical management of these patients. Patients with CD are frequently malnourished, presenting a high prevalence of different macro- and micro-nutrient deficiencies, including that of vitamin D. The available published studies indicate that vitamin D is involved in the regulation of proliferation, differentiation, and regeneration of muscle cells. The relationship between vitamin D deficiency and sarcopenia has been extensively studied in other populations, with interesting evidence in regards to a potential role of vitamin D supplementation as a means to prevent and treat sarcopenia. The aim of this review was to find studies that linked together these pathological conditions.

A comparison of sarcopenia prevalence between former Tokyo 1964 Olympic athletes and general community-dwelling older adults

BACKGROUND

This study aimed to determine how increased muscle mass and athletic performance in adolescence contribute to the prevention of sarcopenia in old age, accounting for the type of sport and the continuation of exercise habits. We compared the prevalence of sarcopenia, its components (low appendicular skeletal muscle mass, low muscle strength, and low physical function), and musculoskeletal pain using data from two cohorts: former athletes who competed in the 1964 Tokyo Olympics and general community-dwelling older adults living in Kashiwa City, Chiba Prefecture.

METHODS

We analysed the data from 101 former Olympic athletes (mean age ± SD: 75.0 ± 4.4 years; 26% female) and 1529 general community-dwelling older adults (74.1 ± 5.5 years; 49% women). We assessed sarcopenia (defined by the Asian Working Group for Sarcopenia revised in 2019) and musculoskeletal pain and considered potential confounding factors such as demographic characteristics, for example, sex and exercise habits.

RESULTS

The prevalence of sarcopenia was significantly lower in former Olympic athletes than general older adults (odds ratios [OR], 0.49; 95% confidence interval [CI], 0.20-0.94), especially with regard to superior appendicular skeletal muscle mass and muscle strength. This effect was more pronounced in individuals who continued their exercise and in athletes whose sporting discipline was classified as having a high exercise intensity. Conversely, low physical function (OR, 2.60; 95% CI, 1.16-6.07) and musculoskeletal pain (OR, 2.22; 95% CI, 1.24-3.97) were more prevalent in former Olympic athletes and in athletes who competed in sports with physical contact.

CONCLUSIONS

We observed a lower prevalence of sarcopenia and superior appendicular skeletal muscle mass and strength in the former Olympic athletes, especially among those that continued their exercise habits and those in sports with high exercise intensity. Conversely, low physical function and higher musculoskeletal pain scores were more prevalent in former Olympic athletes, especially among athletes who competed in sports with physical contact. Our results warrant further promotion of exercise in adolescence and beyond as well as providing safety education, which is required to prevent the development of sarcopenia and musculoskeletal pain in old age.

Sterol metabolism and protein metabolism are differentially correlated with sarcopenia in Asian Chinese men and women

OBJECTIVES

Our aim was to investigate the prevalence and predictive variables of sarcopenia.

METHODS

We recruited participants from the Peking Union Medical College Hospital Multicenter Prospective Longitudinal Sarcopenia Study (PPLSS). Muscle mass was quantified using bioimpedance, and muscle function was quantified using grip strength and gait speed. Logistic regression revealed the relationships between sarcopenia and nutritional, lifestyle, disease, psychosocial and physical variables.

RESULTS

The prevalence of sarcopenia and sarcopenic obesity was 9.2%-16.2% and 0.26%-9.1%, respectively. Old age, single status, undernourishment, higher income, smoking, low physical activity, poor appetite and low protein diets were significantly associated with sarcopenia. Multiple logistic regression analysis showed that age was a risk factor for all stages of sarcopenia, and participants above 80 years were greater than fivefold more susceptible to sarcopenia, while lower physical activity was an independent risk factor. The optimal cut-off value for age was 71 years, which departs from the commonly accepted cut-off of 60 years. Female participants were greater than twofold less susceptible to sarcopenia than male participants. The sterol derivative 25-hydroxyvitamin D was associated with fourfold lower odds of sarcopenia in male participants. Several protein intake variables were also correlated with sarcopenia. Based on these parameters, we defined a highly predictive index for sarcopenia.

CONCLUSIONS

Our findings support a predictive index of sarcopenia, which agglomerates the complex influences that sterol metabolism and nutrition exert on male vs female participants.

Estimation of sarcopenia prevalence in individuals at different ages from Zheijang province in China

In this study, we analyzed sarcopenia prevalence and the cut-off points for skeletal muscle mass index (SMI), gait speed, and handgrip strength in young (18-39 years), middle-aged (40-59 years), and elderly (>60 years) individuals (n=1685) from Zhejiang Province in China. The prevalence of sarcopenia among individuals above 65 years was 2.21%, 4.87%, 5.31%, 14.16%, and 16.37% according to five diagnostic criteria (AWGS2019, AWGS2014, EWGSOP1, EWGSOP2, and local standard). The mean SMI (Kg/m²) was 7.961±0.7966, 7.801±0.7276, and 7.544±0.7493, respectively, in young, middle-aged, and elderly males. The mean SMI in young, middle-aged, and elderly females was 6.1570±0.5658, 6.604±0.5658, and 6.248±0.7483, respectively. SMI correlated negatively with age (r=-0.2344, P<0.001), but was not associated with age in females (r=0.0573, P=0.1463). The cut-off point of SMI for sarcopenia was ≤6.3678 kg/m² in males and ≤5.0254 kg/m² in females. These findings shows that the prevalence of sarcopenia increased gradually with age and varied significantly based on the diagnostic criteria used for this analysis. The mean SMI of young women was lower than in middle-aged women, making them an unsuitable reference population for determining cut-off values for sarcopenia diagnosis.

Malnutrition and Sarcopenia in Community-Dwelling Adults in Singapore: Yishun Health Study

OBJECTIVES

To determine the overlapping prevalence of malnutrition and sarcopenia and the association between parameters of malnutrition with muscle mass and strength in a community-dwelling Singaporean adult population.

DESIGN

This was a cross-sectional study.

SETTING

Large north-eastern residential town of Yishun in Singapore.

PARTICIPANTS

Random sampling of community-dwelling Singaporeans aged 21-90 years old (n=541).

MEASUREMENTS

Anthropometry, body composition and handgrip strength (muscle strength) were measured. Sarcopenia was identified using dual-energy x-ray absorptiometry scan (muscle mass). Nutritional status was measured using Mini Nutritional Assessment (MNA-SF). Other questionnaires collected included physical activity and cognition. Associations between nutritional status with sarcopenia as well as with muscle mass and strength were analysed using multinomial logistics and linear regressions.

RESULTS

The overall population-adjusted prevalence of those at nutritional risk and malnourished were 18.5% and 0.1% respectively. More than a third of participants (35%) who were at nutritional risk were sarcopenic. Malnourished participants were all sarcopenic (100%, N=2) whereas those who were sarcopenic, 27.0% (N=37) were at nutritional risk/malnourished. Being at nutritional risk/malnourished was significantly associated with 2 to 3 times increased odds of sarcopenia in multivariate analyses adjusting for age, gender, physical activity level and cognition, and fat mass index. Favourable MNA parameter scores on food intake and BMI were positively associated with greater muscle mass and handgrip strength (p<0.05).

CONCLUSION

Given the overlapping clinical presentation of malnutrition and sarcopenia, community screening protocols should include combination screening of nutritional status and sarcopenia with appropriate interventions to mitigate risk of adverse health outcomes.

Update on the ESCEO recommendation for the conduct of clinical trials for drugs aiming at the treatment of sarcopenia in older adults

BACKGROUND

In 2016, an expert working group was convened under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and formulated consensus recommendations for the conduct of clinical trials for drugs to prevent or treat sarcopenia.

AIMS

The objective of the current paper is to provide a 2020 update of the previous recommendations in accordance with the evidence that has become available since our original recommendations.

METHODS

This paper is based on literature reviews performed by members of the ESCEO working group and followed up with face to face meetings organized for the whole group to make amendments and discuss further recommendations.

RESULTS

The randomized placebo-controlled double-blind parallel-arm drug clinical trials should be the design of choice for both phase II and III trials. Treatment and follow-up should run at least 6 months for phase II and 12 months for phase III trials. Overall physical activity, nutrition, co-prescriptions and comorbidity should be recorded. Participants in these trials should be at least 70-years-old and present with a combination of low muscle strength and low physical performance. Severely malnourished individuals, as well as bedridden patients, patients with extremely limited mobility or individuals with physical limitations clearly attributable to the direct effect of a specific disease, should be excluded. Multiple outcomes are proposed for phase II trials, including, as example, physical performance, muscle strength and mass, muscle metabolism and muscle-bone interaction. For phase III trials, we recommend a co-primary endpoint of a measure of functional performance and a Patient Reported Outcome Measure.

CONCLUSION

The working group has formulated consensus recommendations on specific aspects of trial design, and in doing so hopes to contribute to an improvement of the methodological robustness and comparability of clinical trials. Standardization of designs and outcomes would advance the field by allowing better comparison across studies, including performing individual patient-data meta-analyses, and different pro-myogenic therapies.

Vascular dysfunction as a potential culprit of sarcopenia

Aging-related changes to biological structures such as cardiovascular and musculoskeletal systems contribute to the development of comorbid conditions including cardiovascular disease and frailty, and ultimately lead to premature death. Although, frail older adults often demonstrate both cardiovascular and musculoskeletal comorbidities, the etiology of sarcopenia, and especially the contribution of cardiovascular aging is unclear. Aging-related vascular calcification is prevalent in older adults and is a known risk factor for cardiovascular disease and death. The effect vascular calcification has on function during aging is not well understood. Emerging findings suggest vascular calcification can impact skeletal muscle perfusion, negatively affecting nutrient and oxygen delivery to skeletal muscle, ultimately accelerating muscle loss and functional decline. The present review summarizes existing evidence on the biological mechanisms linking vascular calcification with sarcopenia during aging.

Sarcopenia, Diet, Physical Activity and Obesity in European Middle-Aged and Older Adults: The LifeAge Study

The revised European consensus defined sarcopenia as a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality. The aim of this study was to determine the prevalence of sarcopenia and analyse the influence of diet, physical activity (PA) and obesity index as risk factors of each criteria of sarcopenia. A total of 629 European middle-aged and older adults were enrolled in this cross-sectional study. Anthropometrics were assessed. Self-reported PA and adherence to the Mediterranean diet were evaluated with the Global Physical Activity Questionnaire (GPAQ) and Prevention with Mediterranean Diet questionnaire (PREDIMED), respectively. The functional assessment included handgrip strength, lower body muscle strength, gait speed and agility/dynamic balance. Of the participants, 4.84% to 7.33% showed probable sarcopenia. Sarcopenia was confirmed in 1.16% to 2.93% of participants. Severe sarcopenia was shown by 0.86% to 1.49% of participants. Male; age group ≤65 years; lower body mass index (BMI); high levels of vigorous PA; and the consumption of more than one portion per day of red meat, hamburgers, sausages or cold cuts and/or preferential consumption of rabbit, chicken or turkey instead of beef, pork, hamburgers or sausages (OR = 0.126-0.454; all p < 0.013) resulted as protective factors, and more time of sedentary time (OR = 1.608-2.368; p = 0.032-0.041) resulted as a risk factor for some criteria of sarcopenia. In conclusion, age, diet, PA, and obesity can affect the risk of having low muscle strength, low muscle mass or low functional performance, factors connected with sarcopenia.

Differences in sarcopenia prevalence between upper-body and lower-body based EWGSOP2 muscle strength criteria: the Tromsø study 2015-2016

Background

The European Working Group on Sarcopenia in Older People (EWGSOP2) recommends grip strength and chair stand tests to be used as primary defining measures. It is unclear how either test affects prevalence estimates.

Methods

This cross-sectional study involved 3498 community-dwelling participants (40–84 years) from the 7th Tromsø Study survey (2015–2016). We used grip strength, five-repetition chair stands, four-meter Walk Speed Test, Timed-Up-and-Go (TUG) and Dual-Energy X-ray Absorptiometry measurements. Data were analyzed using multiple linear regression models and ROC-curves.

Results

Probable and confirmed sarcopenia prevalence was 1.3 and 4.4% based on grip strength and chair stands, respectively. There was very low agreement between grip strength and chair stand cut-offs (κ = 0.07), with only 4.3% of participants defined as having probable sarcopenia overlapping in the two criteria. Participants with grip strength-based sarcopenia had lower mean height, weight, waist circumference, and appendicular lean mass relative to body height (ALM_height²) than non-sarcopenic participants (all p < 0.001), after adjusting for multiple covariates. Conversely, participants with chair stand-based sarcopenia had similar height, higher weight, waist circumference and body fat% compared to non-sarcopenic participants (all p < 0.05). Area-under-curves (AUCs) for TUG-time were significantly larger when using chair stand instead of grip strength cut-offs (0.86, 95% CI 0.84–0.89 vs. 0.75, 95% CI 0.69–0.83).

Conclusions

Using chair stands instead of grip strength more than doubled probable sarcopenia prevalence across all ages. The two measures defined individuals of contradictory anthropometrics, body composition, and dissimilar physical function to have probable sarcopenia. Researchers should further evaluate the consequences of using different strength measures in the EWGSOP2 definition to classify sarcopenia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01860-w.

Association of dietary approaches to stop hypertension eating style and risk of sarcopenia

The association between habitual intake of the “dietary approaches to stop hypertension” (DASH) eating plan and sarcopenia has received limited attention. The present study aimed to investigate the association between adherence to DASH dietary pattern and sarcopenia and its components including muscle mass, muscle strength, and muscle performance among community-dwelling older adults population. This population-based cross-sectional study was performed in 2011 among 300 older people (150 men and 150 women) aged ≥ 55 years, who were selected using cluster random sampling method. Dietary intake of study participants were examined by the use of a Block-format 117-item food frequency questionnaire (FFQ). The DASH score was constructed based on eight main foods and nutrients emphasized or minimized in the DASH diet. All components of sarcopenia was measured using standard protocols and sarcopenia was defined based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. Mean age and BMI of study participants were 66.7 ± 7.7 years and 27.3 ± 4.2 kg/m², respectively. Totally, 31 individuals meet the criteria of EWGSOP2-sarcopenia. We found no significant association between adherence to the DASH diet and EWGSOP2-sarcopenia either before (OR 1.08; 95% CI 0.45–2.54) or after adjustment for potential confounders (OR 1.04; 95% CI 0.39–2.75). The same findings were obtained in the gender-stratified analyses (men: OR 2.29; 95% CI 0.39–13.29 and women: 0.75; 95% CI 0.23–2.45). In conclusion, we found that adherence to the DASH-style diet was not significantly associated with odds of sarcopenia. Future prospective studies are required to confirm these findings.

Inflammatory indexes are not associated with sarcopenia in Chinese community-dwelling older people: a cross-sectional study

Background

Inflammatory indexes (platelet-to-lymphocyte ratio [PLR], neutrophil-to-lymphocyte ratio [NLR], and lymphocyte-to-monocyte ratio [LMR]) are recently supposed to be the biomarkers of sarcopenia. We aimed to validate the association between these inflammatory indexes and sarcopenia in Chinese community-dwelling older people.

Methods

We consecutively recruited community-dwelling older adults aged 60 years or older. The neutrophil, lymphocyte, monocyte, and platelet counts, and C-reactive protein (CRP) were tested using standard methods. Sarcopenia was defined according to different criteria: the Asian Working Group for Sarcopenia (AWGS), the updated version of AWGS (AWGS 2019), the European Working Group on Sarcopenia in Older People (EWGSOP), the updated version of EWGSOP (EWGSOP2), the International Working Group on Sarcopenia (IWGS), and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). Multiple logistic regression analysis was performed.

Results

We included 384 participants. A total of 61 participants (15.9%) were diagnosed with sarcopenia according to the AWGS criteria. There was no significant difference in PLR, NLR, LMR, and CRP between the sarcopenia group and the non-sarcopenia group regardless of the diagnostic criteria. No significant association between PLR, NLR, LMR, and AWGS-defined sarcopenia was found (PLR per 1- standard deviation [SD]: adjusted odds ratio [OR] 1.09, 95% confidence interval [CI] 0.82 to 1.45; NLR per 1-SD: adjusted OR 0.96, 95% CI 0.71 to 1.30; LMR per 1-SD: adjusted OR 1.01, 95% CI 0.74 to 1.38). Similar results were found when sarcopenia was defined by different criteria and when PLR, NLR, LMR were treated as categorical variables.

Conclusions

Our study did not support the utility of the inflammatory indexes (NLR, PLR, and LMR) as the biomarkers of sarcopenia in Chinese community-dwelling older people. However, considering the inflammatory indexes can be simply calculated from a routine blood test, further studies in different populations remain warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01857-5.

Bimagrumab vs Optimized Standard of Care for Treatment of Sarcopenia in Community-Dwelling Older Adults: A Randomized Clinical Trial

IMPORTANCE

The potential benefit of novel skeletal muscle anabolic agents to improve physical function in people with sarcopenia and other muscle wasting diseases is unknown.

OBJECTIVE

To confirm the safety and efficacy of bimagrumab plus the new standard of care on skeletal muscle mass, strength, and physical function compared with standard of care alone in community-dwelling older adults with sarcopenia.

DESIGN, SETTING, AND PARTICIPANTS

This double-blind, placebo-controlled, randomized clinical trial was conducted at 38 sites in 13 countries among community-dwelling men and women aged 70 years and older meeting gait speed and skeletal muscle criteria for sarcopenia. The study was conducted from December 2014 to June 2018, and analyses were conducted from August to November 2018.

INTERVENTIONS

Bimagrumab 700 mg or placebo monthly for 6 months with adequate diet and home-based exercise.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in Short Physical Performance Battery (SPPB) score after 24 weeks of treatment. Secondary outcomes included 6-minute walk distance, usual gait speed, handgrip strength, lean body mass, fat body mass, and standard safety parameters.

RESULTS

A total of 180 participants were recruited, with 113 randomized to bimagrumab and 67 randomized to placebo. Among these, 159 participants (88.3%; mean [SD] age, 79.1 [5.3] years; 109 [60.6%] women) completed the study. The mean SPPB score increased by a mean of 1.34 (95% CI, 0.90 to 1.77) with bimagrumab vs 1.03 (95% CI, 0.53 to 1.52) with placebo (P = .13); 6-minute walk distance increased by a mean of 24.60 (95% CI, 7.65 to 41.56) m with bimagrumab vs 14.30 (95% CI, -4.64 to 33.23) m with placebo (P = .16); and gait speed increased by a mean of 0.14 (95% CI, 0.09 to 0.18) m/s with bimagrumab vs 0.11 (95% CI, 0.05 to 0.16) m/s with placebo (P = .16). Bimagrumab was safe and well-tolerated and increased lean body mass by 7% (95% CI, 6% to 8%) vs 1% (95% CI, 0% to 2%) with placebo, resulting in difference of 6% (95% CI, 4% to 7%) (P < .001).

CONCLUSIONS AND RELEVANCE

This randomized clinical trial found no significant difference between participants treated with bimagrumab vs placebo among older adults with sarcopenia who had 6 months of adequate nutrition and light exercise, with physical function improving in both groups. Bimagrumab treatment was safe, well-tolerated, increased lean body mass, and decreased fat body mass. The effects of sarcopenia, an increasing cause of disability in older adults, can be reduced with proper diet and exercise.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02333331; EudraCT number: 2014-003482-25.

Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia

Sarcopenia is a clinical condition mainly affecting the elderly that can be associated in a long run with severe consequences like malnutrition and frailty. Considering the progressive ageing of the world population and the socio-economic impact of this disease, much effort is devoted and has to be further focused on an early and accurate diagnostic assessment of muscle loss. Currently, several radiological techniques can be applied for evaluating sarcopenia. If dual-energy X-ray absorptiometry (DXA) is still considered the main tool and it is even recommended as reference by the most current guidelines of the European working group on sarcopenia in older people (EWGSOP), the role of ultrasound (US), computed tomography (CT), peripheral quantitative CT (pQCT), and magnetic resonance imaging (MRI) should not be overlooked. Indeed, such techniques can provide robust qualitative and quantitative information. In particular, regarding MRI, the use of sequences like diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS) and mapping that could provide further insights into the physiopathological features of sarcopenia, should be fostered. In an era pointing to the quantification and automatic evaluation of diseases, we call for future research extending the application of organ tailored protocols, taking advantage of the most recent technical developments.

The Predictive Value of Sarcopenia and Falls for 2-Year Major Osteoporotic Fractures in Community-Dwelling Older Adults

To evaluate the associations of sarcopenia and previous falls with 2-year major osteoporotic fractures (MOFs) in community-dwelling older adults. Four thousand Chinese men and women ≥ 65 years recruited from Hong Kong communities were prospectively followed up. Measures of muscle mass, grip strength, gait speed and falls in the previous year were recorded at baseline, the 2nd year and the 4th year visit for each subject. The associations of fall history, sarcopenia and its components with 2-year MOFs were evaluated using generalized linear mixed models. Poor grip strength and poor gait speed were significantly associated with a higher 2-year MOFs risk, with an adjusted OR (95% CI) per one SD decrease of 1.48 (1.17, 1.87) and 1.17 (1.00, 1.36), respectively. Falls in the previous year was a significant predictor for 2-year MOFs risk, with an adjusted OR (95% CI) per one added fall of 1.85 (1.40, 2.44) in men and 1.26 (1.01, 1.58) in women. The adjusted OR (95% CI) of height adjusted appendicular lean muscle mass (ALM/height²) per one SD decrease and sarcopenia for 2-year MOFs risk were 1.34 (0.87, 2.06) and 1.72 (0.92, 3.21) in men, and were 0.73 (0.57, 0.93) and 0.76 (0.39, 1.47) in women, respectively (P for interaction by gender = 0.012 and 0.017, respectively). Poor sarcopenia-related physical performance and falls in the previous year were significant predictors for 2-year MOFs in community-dwelling older adults. The predictive value of ALM by DXA for near-term fracture risk is limited and different across genders.

Sarcopenia, frailty and cachexia patients detected in a multisystem electronic health record database

BACKGROUND

Sarcopenia, cachexia and frailty have overlapping features and clinical consequences, but often go unrecognized. The objective was to detect patients described by clinicians as having sarcopenia, cachexia or frailty within electronic health records (EHR) and compare clinical variables between cases and matched controls.

METHODS

We conducted a case-control study using retrospective data from the Indiana Network for Patient Care multi-health system database from 2016 to 2017. The computable phenotype combined ICD codes for sarcopenia, cachexia and frailty, with clinical note text terms for sarcopenia, cachexia and frailty detected using natural language processing. Cases with these codes or text terms were matched to controls without these codes or text terms matched on birth year, sex and race. Two physicians reviewed EHR for all cases and a subset of controls. Comorbidity codes, laboratory values, and other coded clinical variables were compared between groups using Wilcoxon matched-pair sign-rank test for continuous variables and conditional logistic regression for binary variables.

RESULTS

Cohorts of 9594 cases and 9594 matched controls were generated. Cases were 59% female, 69% white, and a median (1st, 3rd quartiles) age 74.9 (62.2, 84.8) years. Most cases were detected by text terms without ICD codes n = 8285 (86.4%). All cases detected by ICD codes (total n = 1309) also had supportive text terms. Overall 1496 (15.6%) had concurrent terms or codes for two or more of the three conditions (sarcopenia, cachexia or frailty). Of text term occurrence, 97% were used positively for sarcopenia, 90% for cachexia, and 95% for frailty. The remaining occurrences were negative uses of the terms or applied to someone other than the patient. Cases had lower body mass index, albumin and prealbumin, and significantly higher odds ratios for diabetes, hypertension, cardiovascular and peripheral vascular diseases, chronic kidney disease, liver disease, malignancy, osteoporosis and fractures (all p < 0.05). Cases were more likely to be prescribed appetite stimulants and caloric supplements.

CONCLUSIONS

Patients detected with a computable phenotype for sarcopenia, cachexia and frailty differed from controls in several important clinical variables. Potential uses include detection among clinical cohorts for targeting recruitment for research and interventions.

Role of Age-Related Mitochondrial Dysfunction in Sarcopenia

Skeletal muscle aging is associated with a significant loss of skeletal muscle strength and power (i.e., dynapenia), muscle mass and quality of life, a phenomenon known as sarcopenia. This condition affects nearly one-third of the older population and is one of the main factors leading to negative health outcomes in geriatric patients. Notwithstanding the exact mechanisms responsible for sarcopenia are not fully understood, mitochondria have emerged as one of the central regulators of sarcopenia. In fact, there is a wide consensus on the assumption that the loss of mitochondrial integrity in myocytes is the main factor leading to muscle degeneration. Mitochondria are also key players in senescence. It has been largely proven that the modulation of mitochondrial functions can induce the death of senescent cells and that removal of senescent cells improves musculoskeletal health, quality, and function. In this review, the crosstalk among mitochondria, cellular senescence, and sarcopenia will be discussed with the aim to elucidate the role that the musculoskeletal cellular senescence may play in the onset of sarcopenia through the mediation of mitochondria.

Effect of testing procedures on gait speed measurement: A systematic review

BACKGROUND

Although gait speed is a widely used measure in older people, testing methods are highly variable. We conducted a systematic review to investigate the influence of testing procedures on resulting gait speed.

METHODS

We followed the PRISMA checklist for this systematic review. Two independent reviewers screened Pubmed and Embase for publications on pairwise comparisons of testing procedures of usual gait speed. Descriptives were abstracted from the included publications using a predefined extraction tool by two independent reviewers. We defined the cut-off for the minimal clinically imporant diffence in gait speed as 0.1 m/sec.

RESULTS

Of a total of 2109 records identified for screening, 29 reports on 53 pairwise comparisons were analyzed. The median (range) difference in gait speed for dynamic versus static start was 0.06 (-0.02 to 0.35) m/sec (14 reports); for longer versus shorter test distance 0.04 (-0.05 to 0.23) m/sec (14 reports); for automatic versus manual timing 0.00 (-0.05 to 0.07) m/sec (12 reports), for hard versus soft surfaces -0.11 (-0.18 to 0.08) m/sec (six reports), and electronic walkways versus usual walk test 0.04 (-0.08 to 0.14) m/sec (seven reports), respectively. No report compared the effect of finishing procedures.

CONCLUSIONS

The type of starting procedure, the length of the test distance, and the surface of the walkway may have a clinically relevant impact on measured gait speed. Manual timing resulted in statistically significant differences of measured gait speed as compared to automatic timing, but was below the level of clinical importance. These results emphasize that it is key to use a strictly standardized method for obtaining a reliable and valid measurement of gait speed.

Polish Translation and Validation of the SARC-F Tool for the Assessment of Sarcopenia

INTRODUCTION

Completion of the SARC-F questionnaire constitutes the obligatory first step in the diagnostic process of sarcopenia, according to the revised European consensus on the definition and diagnosis of sarcopenia published by the European Working Group on Sarcopenia in Older People2 (EWGSOP2). SARC-F has been recognized as the most up-to-date and coherent screening tool for sarcopenia. The aim of the study was to translate and to validate the Polish version of the SARC-F questionnaire.

MATERIALS AND METHODS

The validation process was performed in two stages: 1) translation and intercultural adaptation and 2) clinical validation. The inclusion criteria were as follows: age ≥65 years, unimpaired mobility, and no cognitive impairment. The EWGSOP2 criteria were used to diagnose sarcopenia. Hand grip strength measurement, physical fitness test, and body weight composition analysis were conducted. Sensitivity, specificity, accuracy-likelihood ratios, and SARC-F predictive values were calculated using the EWGSOP2 criteria.

RESULTS

Sixty-seven people participated in the study of whom 21% were diagnosed with sarcopenia (SARC-F score: ≥4). The reliability of the questionnaire based on the Cronbach's alpha coefficient was 0.784. Sensitivity, specificity, and negative predictive values were 92.9%, 98.1%, and 98.1%, respectively.

CONCLUSION

The process of validating the SARC-F questionnaire against Polish conditions demonstrated its applicability as a simple and reliable tool for diagnosing sarcopenia in daily clinical practice with older adults.

Quantification of skeletal muscle mass: sarcopenia as a marker of overall health in children and adults

Sarcopenia is defined as the loss of muscle mass or function and has been associated with increased morbidity and mortality in a variety of diseased populations. Sarcopenia results from a higher rate of muscle protein degradation compared to protein synthesis and is an important marker of metabolic status related to nutrition and physical activity. The diagnosis of sarcopenia is accomplished by clinical assessment demonstrating decreased muscle function and radiographic confirmation of decreased muscle mass, via dual X-ray absorptiometry, bioelectric impedance or cross-sectional imaging with CT or MRI. However, normative data for skeletal muscle mass are lacking, especially for children and young adults. Additionally, studies of skeletal muscle mass by cross-sectional imaging in children are scarce. Here, we review the concept of sarcopenia with an emphasis on its relevance in the pediatric population.

Determinants of Adherence in Time-Restricted Feeding in Older Adults: Lessons from a Pilot Study

Time-restricted feeding (TRF) is a type of intermittent fasting in which no calories are commonly consumed for approximately 12-18 hours on a daily basis. The health benefits of this eating pattern have been shown in overweight adults, with improvements in cardiometabolic risk factors as well as the preservation of lean mass during weight loss. Although TRF has been well studied in younger and middle-aged adults, few studies have evaluated the effects of TRF in older adults. Thus, the goal of this study was to evaluate older-adult perspectives regarding the real-world advantages, disadvantages, and challenges to adopting a TRF eating pattern among participants aged 65 and over. A four-week single-arm pre- and post-test design was used for this clinical pilot trial TRF intervention study. Participants were instructed to fast for approximately 16 h per day with the daily target range between 14 and 18 h. Participants were provided with the TRF protocol at a baseline visit, along with a pictorial guide that depicted food items and beverages that were allowed and not allowed during fasting windows to reinforce that calorie-containing items were to be avoided. The trial interventionist called each participant weekly to promote adherence, review the protocol, monitor for adverse events, and provide support and guidance for any challenges faced during the intervention. Participants were instructed to complete daily eating time logs by recording the times at which they first consumed calories and when they stopped consuming calories. At the end of the intervention, participants completed an exit interview and a study-specific Diet Satisfaction Survey (Table 1) to assess their satisfaction, feasibility, and overall experience with the study intervention. Of the 10 participants who commenced the study (mean age = 77.1 y; 6 women, 4 men), nine completed the entire protocol. Seven of the ten participants reported easy adjustment to a 16-hour fast and rated the difference from normal eating patterns as minimal. Eight participants reported no decrease in energy during fasting periods, with greater self-reported activity levels in yardwork and light exercise. Adverse events were rare, and included transient headaches, which dissipated with increased water intake, and dizziness in one participant, which subsided with a small snack. The findings of the current trial suggest that TRF is an eating approach that is well tolerated by most older adults. Six participants, however, did not fully understand the requirements of the fasting regimen, despite being provided with specific instructions and a pictorial guide at a baseline visit. This suggests that more instruction and/or participant contact is needed in the early stages of a TRF intervention to promote adherence.

Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients

To investigate the association of the sarcopenia index (SI, serum creatinine value/cystatin C value × 100) with 3-year mortality and readmission among older inpatients, we reanalyzed a prospective study in the geriatric ward of a teaching hospital in western China. Older inpatients aged ≥ 60 years with normal kidney function were included. Survival status and readmission information were assessed annually during the 3-year follow-up. We applied Cox regression models to calculate the hazard ratio (HR) and 95% confidence intervals (CIs) of sarcopenia for predicting mortality and readmission. We included 248 participants (mean age: 81.2 ± 6.6 years). During the follow-up, 57 participants (23.9%) died, whereas 179 participants (75.2%) were readmitted at least one time. The SI was positively correlated with body mass index (BMI) (r = 0.214, p = 0.001), calf circumference (CC) (r = 0.253, p < 0.001), handgrip strength (r = 0.244, p < 0.001), and gait speed (r = 0.221, p < 0.001). A higher SI was independently associated with a lower risk of 3-year all-cause mortality after adjusting for potential confounders (HR per 1-SD = 0.80, 95% CI: 0.63–0.97). The SI was not significantly associated with readmission (HR per 1-SD = 0.97, 95% CI: 0.77–1.25). In conclusion, the SI is associated with 3-year all-cause mortality but not readmission in a study population of hospitalized older patients.

Metabolic and Nutritional Characteristics in Middle-Aged and Elderly Sarcopenia Patients with Type 2 Diabetes

Sarcopenia is considered to be a new complication of type 2 diabetes (T2DM) leading to increased risk of adverse outcome. We performed a survey to evaluate glucose metabolism and nutritional status in sarcopenia patients with T2DM. Diabetic participants aged ≥50 years were grouped into a probable sarcopenia group with low muscle strength (n = 405) and a nonsarcopenia group with normal muscle strength (n = 720) according to the revised recommendations from EWGSOP2 (2018). Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, longer diabetes duration, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate and lower bone mineral content, lower fatless upper arm circumference, lower appendicular skeletal muscle mass index (ASMI), and muscle quality in both genders. Multivariable logistic regression analysis showed increased age, male, low BMI, and increased HbA1c, combined with diabetic nephropathy and decreased serum albumin levels, were risk factors associated with low muscle strength in diabetes patients. In conclusion, diabetic patients with sarcopenia had worse glucose metabolism and nutritional status, decreased renal function and reduced muscle quality ,and muscle mass with a greater likelihood of osteoporosis, who need an overall health management to improve outcomes. This clinical trial registration is registered with the Chinese Clinical Trial Registry, ChiCTR-EOC-15006901.

ROMANIAN TRANSLATION AND VALIDATION OF THE SARC-F QUESTIONNAIRE

Context

Several studies have addressed the impact of sarcopenia on various health outcomes. As the most critical issue is the early identification of individuals, a short screening tool may help clinicians to simply test for sarcopenia and start early management of the disease. Recently, a simple questionnaire, Sarc-F was provided that may adequately realize this aim.

Subjects and Methods

To validate the questionnaire we translated the original Sarc-F according to the recommended methodology. A total of 80 people, aged 65+ were evaluated for sarcopenia. Muscle mass, strength, and physical performance were measured. Volunteers completed the Sarc-F as well as other two questionnaires. Discriminative power, reliability, construct validity analyses, specificity, sensitivity, negative and positive predictive value evaluations were made.

Results

A good discriminative power and internal consistency were found. With the functional sarcopenia diagnostic criteria the test demonstrates a high specificity (84%). The positive and negative predictive values were: 78% and 77%. Using the more conservative diagnostic criteria the negative predictive value was: 85.4%, sufficient to rule out those not at risk of having sarcopenia and eliminate the need for further investigations.

Conclusions

A valid Romanian Sarc-F questionnaire is now available to simply detect patients at risk/no risk of sarcopenia.

Sarcopenic Obesity: Epidemiologic Evidence, Pathophysiology, and Therapeutic Perspectives

PURPOSE OF REVIEW

This review provides a comprehensive update on the definition, assessment, epidemiology, pathophysiology, clinical implications, and therapeutic approach of sarcopenic obesity (SO) and highlights the challenges, limitations, and knowledge gaps in SO research.

RECENT FINDINGS

The confluence of a rapidly aging population with rising obesity rates has led to the phenotype of SO, defined as the concurrent presence of sarcopenia and obesity. Despite efforts, a standardized definition of SO is still lacking. Its prevalence varies widely between studies, depending on population characteristics and different definitions. The major pathogenetic mechanisms include age-related changes in body composition and hormonal milieu, positive energy balance, pro-inflammatory pathways, and insulin resistance. Lifestyle interventions, including caloric restriction and physical activity, are the cornerstones of SO treatment. SO is a multifaceted syndrome with serious clinical implications. The development and implementation of effective prevention and treatment strategies is a top priority based on its dramatically increasing health impact.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73–6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25–6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86–9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29–11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73-6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25-6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86-9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29-11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

Effects of high-velocity resistance training and creatine supplementation in untrained healthy aging males

The purpose was to investigate the effects of high-velocity resistance training (HVRT) and creatine supplementation in untrained healthy aging males. Participants were randomized to supplement with creatine (0.1 g·kg−1·day−1 of creatine + 0.1 g·kg−1·day−1 of maltodextrin) or placebo (0.2 g·kg−1·day−1 of maltodextrin) during 8 weeks of HVRT. Prior to and following HVRT and supplementation, assessments were made for muscle strength, muscle thickness, peak torque, and physical performance. There was a significant increase over time for all measures of muscle strength (p < 0.001), muscle thickness (p < 0.001), and some measures of peak torque (knee flexion; 1.05 and 3.14 rad/s; p < 0.001) and physical performance (balance board time-to-completion; p = 0.017). There was a group × time interaction for leg press strength (p = 0.044) and total lower-body strength (leg press, knee flexion, knee extension combined; p = 0.039). The creatine group experienced greater gains in leg press and total lower-body strength compared with the placebo group, with no other differences. HVRT increases muscle strength, muscle thickness, and some measures of peak torque and physical performance in untrained healthy aging males. The addition of creatine supplementation to HVRT further augments the gains in leg press and total lower-body strength.

Novelty High-velocity resistance training increases muscle mass and performance. Creatine supplementation increases lower-body muscle strength. High-velocity resistance training and creatine supplementation are safe interventions for aging adults.

Interactions between Sedentary and Physical Activity Patterns, Lean Mass, and Bone Density in Arab Men

The study examined the associations between physical activity and appendicular lean mass (ALM), fat mass, and bone mineral density (BMD) and examined the role of physical activity on these variables. The participants included 497 men (age: 32.2 ± 10.4 years and body mass index: 28.2 ± 5.4 kg/m²). The study was cross-sectional, and measurements included body composition measured on dual-energy X-ray absorptiometry and self-reported physical activity assessed using the International Physical Activity Questionnaire. Physical activity, including light physical activity, was associated with increased ALM (P ≤ 0.05). Fat indicators, including waist circumference, were positively associated with ALM (P ≤ 0.05), but not with BMD. Physical activity, including moderate-to-vigorous physical activity, was not associated with BMD, whereas ALM and handgrip strength were significantly associated with BMD (P ≤ 0.05). Physical activity independent of exercise intensity was directly associated with ALM and indirectly associated with BMD through increased muscle mass and strength.

Sarcopenia: A Time for Action. An SCWD Position Paper

The term sarcopenia was introduced in 1988. The original definition was a "muscle loss" of the appendicular muscle mass in the older people as measured by dual energy x-ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC-F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease-related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age-related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age-related and disease-related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life-long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.