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Terlemez R, Caliskaner Ozturk B, Kurtoglu SS, Palamar D, Atahan E, Akgun K. Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study. Eur J Phys Rehabil Med 2024; 60:523-529. [PMID: 38551519 PMCID: PMC11255879 DOI: 10.23736/s1973-9087.24.08232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/05/2024] [Accepted: 03/13/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis. AIM To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness. DESIGN Observational, case-control study. SETTING Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study. METHODS The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS). RESULTS The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008). CONCLUSIONS Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up. CLINICAL REHABILITATION IMPACT The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.
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Affiliation(s)
- Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye -
| | - Buket Caliskaner Ozturk
- Department of Pulmonary Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Sevgi S Kurtoglu
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ersan Atahan
- Department of Pulmonary Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
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Prell T, Grimm A, Axer H. Uncovering sarcopenia and frailty in older adults by using muscle ultrasound-A narrative review. Front Med (Lausanne) 2024; 11:1333205. [PMID: 38828232 PMCID: PMC11140070 DOI: 10.3389/fmed.2024.1333205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Muscle ultrasound is a valuable non-invasive and cost-effective method in assessing muscle mass and structure, both of which are significant indicators for the development of sarcopenia and frailty in elderly individuals. Sarcopenia refers to the loss of muscle mass and strength that occurs with age, whereas frailty is a complex geriatric syndrome characterized by reduced physical function and an increased susceptibility to negative health outcomes. Both conditions are prevalent in older adults and are associated with higher risks of falls, disability, and mortality. By measuring muscle size and structure and several other ultrasound parameters, including muscle thickness, cross-sectional area, echogenicity (brightness in the ultrasound image), pennation angle, and fascicle length ultrasound can assist in identifying sarcopenia and frailty in older adults. In addition, ultrasound can be used to evaluate muscle function such as muscle contraction and stiffness, which may also be affected in sarcopenia and frailty. Therefore, muscle ultrasound could lead to better identification and tracking of sarcopenia and frailty. Such advancements could result in the implementation of earlier interventions to prevent or treat these conditions, resulting in an overall improvement in the health and quality of life of the elderly population. This narrative review describes the benefits and challenges when using ultra-sound for the evaluation of frailty and sarcopenia.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
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Güner G, Özçakar L, Baytar Y, Onur MR, Demir M, Aktaş BY, Aktepe OH, Güven DC, Taban H, Yıldırım HÇ, Akın S, Aksoy S, Kara M, Dizdar Ö. Sonographic Measurements of Rectus Femoris Muscle Thickness Strongly Predict Neutropenia in Cancer Patients Receiving Chemotherapy. Cancers (Basel) 2024; 16:1061. [PMID: 38473418 DOI: 10.3390/cancers16051061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
The objective of this study was to explore the possible association between low skeletal muscle mass (SMM)-assessed by computed tomography (CT) and ultrasound (US)-and hematologic toxicity in cancer patients. A prospective cohort study was conducted in cancer patients who received anthracycline-based chemotherapy between 2018 and 2020 and who had baseline abdominal CT including L3 level for measuring SMM. Regional muscle measurements were carried out using US. A total of 65 patients (14 males, 51 females) were included. ROC (receiver operating characteristic) analysis identified threshold values of 18.0 mm [AUC (area under the curve) = 0.765] for females and 20.0 mm (AUC = 0.813) for males, predicting severe neutropenia. Using these cut-offs, females with low rectus femoris (RF) thickness (<18.0 mm) had a significantly higher incidence of grade ≥3 neutropenia (50.0% vs. 10.8%, p = 0.005), and males with low RF values (<20.0 mm) had a higher incidence (80.0% vs. 22.2%, p = 0.063). A regression analysis, irrespective of age, gender, and body mass index, revealed that only low RF muscle thickness increased the risk of grade 3-4 neutropenia by 9.210 times (95% CI = 2.401-35.326, p = 0.001). Utilizing US to measure RF muscle thickness aids in identifying cancer patients at an elevated risk of developing neutropenia. Needless to say, US can serve as a convenient and easily accessible tool for assessing low SMM, providing repeat point-of-care evaluations in clinical practice.
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Affiliation(s)
- Gürkan Güner
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
- Department of Medical Oncology, Medical Point Hospital, Izmir Economy University Faculty of Medicine, Izmir 35575, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yusuf Baytar
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Metin Demir
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Burak Yasin Aktaş
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Deniz Can Güven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hakan Taban
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Hasan Çağrı Yıldırım
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Serkan Akın
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ömer Dizdar
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey
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Uzuner B, Ketenci S, Durmus D, Atay HM. The frequency of sarcopenia in haemophilia patients: Effects on musculoskeletal health and functional performance. Haemophilia 2024; 30:505-512. [PMID: 38353986 DOI: 10.1111/hae.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION In patients with haemophilia A, chronic arthropathy develops over time as a result of recurrent joint bleeds, which leads to restricted mobility and disability in the affected joints. There are limited studies in the literature evaluating sarcopenia in patients with haemophilia. The present study aims to determine the prevalence of sarcopenia in severe haemophilia-A patients and to evaluate musculoskeletal health and functional performance. METHODS Thirty haemophilia-A patients and 26 adult male volunteers were enrolled in the study. For detection of sarcopenia, the appendicular skeletal muscle mass (ASM) obtained by bioelectrical impedance analysis (BIA) was divided by height squared (m2 ) to obtain the appendicular skeletal muscle mass index (ASMI) value. The thighs of both lower extremities were measured using the Modified Sonographic Tight Adjustment Ratio (STAR) method, which was obtained by adding the bilateral rectus femoris and vastus intermedius muscle thicknesses measured by ultrasound. Hand and quadriceps muscle strength (MS) were measured with a dynamometer. Physical performance was determined using the walking speed (WS), timed up-and-go test (TUGT), 5-repetition sit-to-stand test (5RSTS), and 6-min walk test (6MWT). Haemophilia Joint Health Score (HJHS) and Haemophilia Early Arthropathy Detection-Ultrasonography (HEAD-US) were also used to assess the musculoskeletal system. RESULTS According to the modified STAR values calculated based on body mass index, sarcopenia was present in 15 (50%) of 30 patients. However, based on the ASMI-BIA values, sarcopenia was present in only two (6.6%) patients. A weak correlation was found between ASMI and HJHS, HEAD-US, WS, TUGT, and hand MS (left), while a moderate correlation was found with knee MS (right), knee MS (left), and 5RSTS. A strong correlation was found between the modified STAR score and HEAD-US, HJHS, knee MS (left), 5RSTS, TUGT, and WS, while a moderate correlation was found with hand MS (left), hand MS (right), and knee MS (right). CONCLUSION This study showed muscle loss, joint mobility restrictions, and decreased functional capacity in haemophilia patients and demonstrated the presence of sarcopenia in these patients. The STAR measurement method showed stronger relationships with MS and functional performance values than ASMI measurements in terms of evaluating sarcopenia.
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Affiliation(s)
- Bora Uzuner
- Department of Physical Medicine and Rehabilitation and Department of Algology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Sertaç Ketenci
- Department of Physical Medicine and Rehabilitation and Department of Rheumatology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Dilek Durmus
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Hilmi Memis Atay
- Department of Internal medicine, Hematology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Kara M, Kaymak B, Ata AM, Özkal Ö, Kara Ö, Baki A, Şengül Ayçiçek G, Topuz S, Karahan S, Soylu AR, Çakır B, Halil M, Özçakar L. STAR-Sonographic Thigh Adjustment Ratio: A Golden Formula for the Diagnosis of Sarcopenia. Am J Phys Med Rehabil 2020; 99:902-908. [PMID: 32941253 DOI: 10.1097/phm.0000000000001439] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to explore an individualized sonographic muscle thickness ratio and its cutoff values in the diagnosis of sarcopenia. DESIGN A total of 326 community-dwelling adults were included in this cross-sectional study. Total skeletal muscle mass was evaluated by bioelectrical impedance analysis, and nine-site muscle thickness measurements using ultrasound. Isometric handgrip and knee extension strengths were assessed. Physical performance was evaluated by usual Gait Speed, Chair Stand Test, and Timed Up and Go Test. RESULTS Because the anterior thigh muscle thickness was the most significantly decreasing measurement with aging and the most significantly related value with body mass and height; sonographic thigh adjustment ratio was calculated by dividing it with body mass index. Using the two standard deviation values of our healthy young adults, sonographic thigh adjustment ratio cutoff values were found as 1.4 and 1.0 for male and female subjects, respectively. Sonographic thigh adjustment ratio values were negatively correlated with Chair Stand Test and Timed Up and Go Test in both sexes (all P < 0.05) and positively correlated with gait speed in female subjects and knee extension strength in male subjects (both P < 0.05). CONCLUSIONS Our results imply that regional (rather than total) muscle mass measurements should be taken into consideration for the diagnosis of sarcopenia.
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Affiliation(s)
- Murat Kara
- From the Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, BK, AB, LÖ) Department of Physical and Rehabilitation Medicine, Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey (AMA); Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey (ÖÖ, ST); Geriatrics Unit, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey (ÖK); Department of Geriatrics, Hacettepe University Medical School, Ankara, Turkey (GŞA, MH); Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey (SK); Department of Biophysics, Hacettepe University Medical School, Ankara, Turkey (ARS); and Department of Public Health, Hacettepe University Medical School, Ankara, Turkey (BÇ)
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Miljkovic I, Kuipers AL, Cvejkus RK, Carr JJ, Terry JG, Thyagarajan B, Wheeler VW, Nair S, Zmuda JM. Hepatic and Skeletal Muscle Adiposity Are Associated with Diabetes Independent of Visceral Adiposity in Nonobese African-Caribbean Men. Metab Syndr Relat Disord 2020; 18:275-283. [PMID: 32392448 DOI: 10.1089/met.2019.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Adipose tissue (AT) around and within non-AT organs (i.e., ectopic adiposity) is emerging as a strong risk factor for type 2 diabetes (T2D). Not known is whether major ectopic adiposity depots, such as hepatic, skeletal muscle, and pericardial adiposity (PAT), are associated with T2D independent of visceral adiposity (VAT). More data are particularly needed among high-risk nonobese minority populations, as the race/ethnic gap in T2D risk is greatest among nonobese. Methods: Thus, we measured several ectopic adiposity depots by computed tomography in 718 (mean age = 64 years) African-Caribbean men on the Island of Tobago overall, and stratified by obesity (obese N = 187 and nonobese N = 532). Results: In age, lifestyle risk factors, health status, lipid-lowering medication intake, body mass index and all other adiposity-adjusted regression analyses, and hepatic and skeletal muscle adiposity were associated with T2D among nonobese men only (all P < 0.05), despite no association between VAT and PAT and T2D. Conclusions: Our results support the "ectopic fat syndrome" theory in the pathogenesis of T2D among nonobese African-Caribbean men. Longitudinal studies are needed to clarify the independent role of ectopic adiposity in T2D, and to identify possible biological mechanisms underlying this relationship, particularly in high-risk African ancestry and other nonwhite populations.
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Affiliation(s)
- Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Allison L Kuipers
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan K Cvejkus
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James G Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Victor W Wheeler
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad & Tobago, West Indies
| | - Sangeeta Nair
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph M Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chang KV, Wu WT, Huang KC, Jan WH, Han DS. Limb muscle quality and quantity in elderly adults with dynapenia but not sarcopenia: An ultrasound imaging study. Exp Gerontol 2018; 108:54-61. [PMID: 29604401 DOI: 10.1016/j.exger.2018.03.019] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dynapenia is prevalent in people with reduced skeletal muscle mass, i.e. sarcopenia, but a certain population develops muscle strength loss despite having normal skeletal muscle volume. To date, studies investigating muscle quality and quantity in groups with dynapenia but not sarcopenia are limited. METHODS Echogenicity and thickness of the biceps brachii, triceps brachii, rectus femoris, and medial gastrocnemius muscles were measured using high-resolution ultrasonography in 140 community-dwelling elderly adults. Participants with decreased handgrip strength but normal muscular volume were diagnosed as having dynapenia without sarcopenia. A multivariate regression model was used to analyze the association between dynapenia and ultrasound indicators of the sampled muscle expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 140 participants were recruited for the study, 12.6% (n = 18) of whom had dynapenia. The dynapenia group had a higher mean age, higher proportion of women, slower fast gait speed, reduced handgrip strength, and decreased thicknesses of the biceps brachii, rectus femoris, and medial gastrocnemius muscles. On multivariate logistic regression analysis, dynapenia was associated with older age (OR, 1.18; 95% CI, 1.05 to 1.33), higher body mass index (OR, 1.28; 95% CI, 1.05 to 1.64), and decreased thicknesses of the rectus femoris (OR, 0.01; 95% CI, <0.01 to 0.24) and medial gastrocnemius muscles (OR, 0.03; 95% CI, <0.01 to 0.61). CONCLUSION Dynapenia without sarcopenia is associated with decreased thicknesses of the rectus femoris and medial gastrocnemius muscles, an association that remains significant after adjustment for demographics, body composition, and physical performance. Ultrasound measurements of lower-limb muscle thickness can be considered an auxiliary criterion for evaluating dynapenia.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan
| | - Kuo-Chin Huang
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei Han Jan
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Community and Geriatric Medicine Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan.
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Age-related muscle loss of the anterior and posterior thigh assessed by means of MRI/CT and ultrasound. ACTA ACUST UNITED AC 2014. [DOI: 10.17338/trainology.3.2_47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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