Effects of multi-domain lifestyle interventions on sarcopenia measures and blood biomarkers: secondary analysis of a randomized controlled trial of community-dwelling pre-frail and frail older adults

Sarcopenia and the biological determinants of aging: A narrative review from a geroscience perspective

BACKGROUND

The physiopathology of sarcopenia shares common biological cascades with the aging process, as does any other age-related condition. However, our understanding of the interconnected pathways between diagnosed sarcopenia and aging remains limited, lacking sufficient scientific evidence.

METHODS

This narrative review aims to gather and describe the current evidence on the relationship between biological aging determinants, commonly referred to as the hallmarks of aging, and diagnosed sarcopenia in humans.

RESULTS

Among the twelve hallmarks of aging studied, there appears to be a substantial association between sarcopenia and mitochondrial dysfunction, epigenetic alterations, deregulated nutrient sensing, and altered intercellular communication. Although limited, preliminary evidence suggests a promising association between sarcopenia and genomic instability or stem cell exhaustion.

DISCUSSION

Overall, an imbalance in energy regulation, characterized by impaired mitochondrial energy production and alterations in circulatory markers, is commonly associated with sarcopenia and may reflect the interplay between aging physiology and sarcopenia biology.

Developing a Nomogram-Based Prediction Model for Malnutrition Risk in Preoperative Elderly Patients with Hip Fracture

Objective

To evaluate the risk factors contributing to preoperative malnutrition in elderly patients with hip fractures.

Methods

The study retrospectively analysed clinical data from 182 elderly patients aged 60 years or older with hip fractures. Nutritional status was assessed according to the Global Leadership Initiative on Malnutrition diagnostic criteria, and risk factors associated with malnutrition were identified through univariate and logistic regression analyses. Based on the findings, a nomogram was developed, and a calibration curve model was constructed. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve. Finally, the model was validated using an independent cohort of 78 patients.

Results

Data analysis revealed that among the 182 elderly patients with hip fractures, 76 were men and 106 were women, with a mean age of 75.77 ± 8.66 years. The fractures included 135 femoral neck fractures and 47 intertrochanteric fractures. Malnutrition was identified in 39.01% (71/182) of the patients. Independent risk factors for malnutrition included age, body mass index, the number of comorbidities, haemoglobin level and serum albumin level. A nomogram model incorporating these indicators was developed, demonstrating robust predictive performance, with an area under the ROC curve of 0.886 (95% confidence interval: 0.809-0.962).

Conclusion

It is anticipated that the proposed model will serve as a valuable tool for the timely and accurate clinical identification of malnutrition risk in elderly patients with hip fractures.

Machine Learning for Movement Pattern Changes during Kinect-Based Mixed Reality Exercise Programs in Women with Possible Sarcopenia: Pilot Study

BACKGROUND

Sarcopenia is a muscle-wasting condition that affects older individuals. It can lead to changes in movement patterns, which can increase the risk of falls and other injuries.

METHODS

Older women participants aged ≥65 years who could walk independently were recruited and classified into two groups based on knee extension strength (KES). Participants with low KES scores were assigned to the possible sarcopenia group (PSG; n=7) and an 8-week exercise intervention was implemented. Healthy seniors with high KES scores were classified as the reference group (RG; n=4), and a 3-week exercise intervention was conducted. Kinematic movement data were recorded during the intervention period. All participants' exercise repetitions were used in the data analysis (number of data points=1,128).

RESULTS

The PSG showed significantly larger movement patterns in knee rotation during wide squats compared to the RG, attributed to weakened lower limb strength. The voting classifier, trained on the movement patterns from wide squats, determined that significant differences in overall movement patterns between the two groups persisted until the end of the exercise intervention. However, after the exercise intervention, significant improvements in lower limb strength in the PSG resulted in reduced knee rotation range of motion and max, thereby stabilizing movements and eliminating significant differences with the RG.

CONCLUSION

This study suggests that exercise interventions can modify the movement patterns in older individuals with possible sarcopenia. These findings provide fundamental data for developing an exercise management system that remotely tracks and monitors the movement patterns of older adults during exercise activities.

The effect of dose, frequency, and timing of protein supplementation on muscle mass in older adults: A systematic review and meta-analysis

Protein supplementation has shown to improve muscle mass in older adults. However, its effect may be influenced by supplementation dose, frequency and timing. This systematic review aimed to assess the effect of dose, frequency and timing of protein supplementation on muscle mass in older adults. Five databases were systematically searched from inception to 14 March 2023, for randomised controlled trials investigating the effect of protein supplementation on muscle mass in adults aged ≥65 years. Random effects meta-analyses were performed, stratified by population. Subgroups were created for dose (≥30 g, <30 g/day), frequency (once, twice, three times/day) and timing of supplementation (at breakfast, breakfast and lunch, breakfast and dinner, all meals, between meals). Heterogeneity within and between subgroups was assessed using I2 and Cochran Q statistics respectively. Thirty-eight articles were included describing community-dwelling (28 articles, n=3204, 74.6±3.4 years, 62.8 % female), hospitalised (8 articles, n=590, 77.0±3.7 years, 50.3 % female) and institutionalised populations (2 articles, n=156, 85.7±1.2 years, 71.2 % female). Protein supplementation showed a positive effect on muscle mass in community-dwelling older adults (standardised mean difference 0.116; 95 % confidence interval 0.032-0.200 kg, p=0.007, I2=15.3 %) but the effect did not differ between subgroups of dose, frequency and timing (Q=0.056, 0.569 and 3.084 respectively, p>0.05). Data including hospitalised and institutionalised populations were limited. Protein supplementation improves muscle mass in community-dwelling older adults, but its dose, frequency or timing does not significantly influence the effect.

The prevalence patterns and risk factor profiles of poor muscle health and its associated components in multiethnic older Asians: The PIONEER study

BACKGROUND

We aim to determine the multiethnic patterns of the prevalence and associated factors of poor muscle health and its associated components in older Chinese, Malays, and Indian Asian adults.

METHODS

We included 2199 participants (mean age ± SD: 72.9 ± 8.3 years; 54.3% female) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017-2022) cohort study. Poor muscle health was defined as the presence of either low muscle mass (DEXA), or low muscle strength (handgrip strength), or low physical performance (gait speed). Its components include poor muscle function (low muscle strength and/or low physical performance without low muscle mass), pre-sarcopenia (low muscle mass only), and any sarcopenia (low muscle mass with low muscle strength and/or low physical performance). Sociodemographic, clinical, and lifestyle factors were assessed using biochemistry, clinical tests, and validated questionnaires. Regression models were utilized to evaluate the independent risk factors of poor muscle health and its components.

RESULTS

The national census-adjusted prevalence of poor muscle health (88%) was similar across the three ethnic groups. However, Chinese individuals had higher prevalence of pre-sarcopenia and any sarcopenia, and a lower prevalence of poor muscle function compared with Indians or Malays. We observed ethnic differences in modifiable risk factors (low physical activity, diabetes, osteoporosis, and obesity) of poor muscle health and its components. Although obesity was protective of pre-sarcopenia (RRR = 0.19, 95% CI: 0.11, 0.36) and any sarcopenia (RRR = 0.29, 95% CI: 0.18, 0.47) in the overall population and across ethnic groups, it was associated with 1.7 times (95% CI: 1.07, 2.67) the likelihood of poor muscle function in the entire population.

CONCLUSIONS

Almost 90% of community dwelling Singaporean aged ≥60 years have poor muscle health across the three ethnic groups with ethnic disparities in modifiable risk factors, highlighting an urgent need for community-wide targeted interventions to promote muscle health.

Effectiveness of resistance training in modulating inflammatory biomarkers among Asian patients with sarcopenia: a systematic review and meta-analysis of randomized controlled trials

Objective

Given the high incidence of sarcopenia among Asians, it is imperative to identify appropriate intervention methods. The International Clinical Practice Guidelines for Sarcopenia, developed by the International Conference on Sarcopenia and Frailty Research (ICFSR) task force, recommends resistance training (RT) as a primary treatment for managing sarcopenia. Inflammatory biomarkers serve as indicators of sarcopenia. However, there is currently insufficient conclusive evidence regarding the effectiveness of RT in modulating inflammatory biomarker levels among Asian participants with sarcopenia.

Data sources

Four databases were utilized for this study until October 9, 2023. This study focused on randomized controlled trials (RCTs) that examined the effects of RT on interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-10 (IL-10) about sarcopenia. This study has been registered in the PROSPERO database (CRD42024501855).

Results

The meta-analysis included six studies from Asians involving 278 participants. The results showed a significant decrease in RT for IL-6 (weighted mean difference (WMD) = -0.73, 95% confidence interval (CI) = -1.02 to -0.44; n=5). However, no significant differences were found for TNF-α (WMD = -1.00, 95% CI = -2.47 to 0.46; n=5), CRP (WMD = -0.45, 95% CI = -1.14 to 0.23; n=3), and IL-10 (WMD = 0.13, 95% CI = -3.99 to 4.25; n=2). Subgroup analysis revealed that factors including gender selection, intervention methods, frequency, period, and duration could have a particular effect on the part of inflammatory biomarkers.

Conclusion

RT has been shown to reduce part of the level of inflammatory markers, specifically IL-6, in Asian sarcopenia participants. However, other inflammatory factors, such as TNF-α, CRP, and IL-10, did not show significant changes. Further research should confirm the impact of RT on these indicators and explore the potential effects of various factors on different inflammatory markers, such as diet, body composition, and medications.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=501855, identifier CRD42024501855.

Functional mobility and physical fitness are improved through a multicomponent training program in institutionalized older adults

Physical exercise has demonstrated its effectiveness in the management of the deleterious process of aging. However, it is less studied in institutionalized elderly people. This investigation aims to clarify the benefits of a multicomponent training program in institutionalized older adults. A randomized controlled trial was conducted with institutionalized older adults (≥ 70 years old). Intervention group (IG; N = 18) were submitted to a multicomponent training program based on muscle power training and interval endurance exercise, 2 times/week for 12 weeks. Control group (CG; N = 16) continued their usual mobility exercises. Independence was estimated with the Barthel index, and physical fitness and functional mobility were evaluated by the Short Physical Performance Battery (SPPB), the Timed Up and Go (TUG) test, the 6-min Walking Test (6'WT), the 10-Meter Walking Test (10MWT), hand grip strength dynamometry, and lower limb muscle strength and power. The IG improved, compared with the CG, in TUG scores in -7.43 s (95% IC: 3.28, 11.59; p < 0.001); in 10MWT scores in -5.19 s (95% IC: 1.41, 8.97; p = 0.004) and -4.43 s (95% IC: 1.14, 7.73; p = 0.002), 6'WT scores in + 54.54 m (95% IC: 30.24, 78.84; p < 0.001); and SPPB in + 2.74 points (95% IC: 2.10, 3.37; p < 0.001). Maximum muscle power and maximum strength did not show statistically significant differences. The multicomponent training program based on muscle power and interval endurance exercise was shown to be safe, well tolerated and effective for the improvement of functional mobility and physical fitness, but not for independence in institutionalized older adults.

The Impact of Behavioral Lifestyle Intervention on Inflammatory Cytokines in Older Adults Living With Type 2 Diabetes: A Feasibility Study

OBJECTIVE

This study investigates the effects of a behavioral lifestyle intervention on inflammatory cytokines and frailty in older adults (≥ 65 years) with type 2 diabetes (T2D).

METHOD

We conducted a single-arm, 6-month intervention supplemented with diet and activity self-monitoring technology. We assessed frailty using Fried criteria and quantified inflammatory cytokines (interleukin [IL]-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating-factor [GM-CSF], interferon [IFN-γ], tumor necrosis factor [TNF-α]) using a multiplex assay. We used paired t-tests with significance at P < .05. We calculated the Spearman correlation and evaluated the relationship between frailty, BMI, and inflammatory cytokines.

RESULTS

Eighteen participants completed the study (mean ± SD: 71.5 ± 5.3 years; BMI: 34 ± 6 kg/m2). At baseline, we had 4 frail, 13 pre-frail, and 1 non-frail participant. At 6 months, we observed the therapeutic effects of the intervention on frailty score, BMI, IL-2, IFN-y, and GM-CSF.

DISCUSSION

The study highlights the importance of behavioral lifestyle intervention in improving inflammatory cytokines and frailty in older adults.

Circulating inflammatory biomarker responses in intervention trials in frail and sarcopenic older adults: A systematic review and meta-analysis

Consistent with the inflammaging concept, cross-sectional associations have been established between inflammatory biomarkers, frailty and sarcopenia. Less certain is the value of inflammatory markers in monitoring potential anti-inflammatory effects of therapeutic interventions targeted at frailty and sarcopenia. The aims of this systematic review and meta-analysis are to determine if there is a measurable change in inflammatory or immune biomarkers in interventions that improve frailty or sarcopenia and 2. To determine if there are specific inflammatory biomarkers with greater sensitivity to change. In total, 3051 articles were scanned with 16, primarily exercise and nutrition interventions, included in the systematic review and 11 in the meta-analysis. At least one of C reactive protein (CRP), interleukin-6 (IL-6) or tumour necrosis factor alpha (TNF-α) was reduced in 10 of the 16 review studies but only 3/13 studies reported reductions in multiple markers. CRP, IL-6 and TNF-α were individually sensitive to change in 5/11, 3/12 and 5/12 studies respectively. In meta-analyses, there was a positive effect favouring intervention conditions for CRP (SMD = -0.28, p = 0.05) and IL-6 (SMD = -0.28, p = 0.05) but not TNF- α (SMD = -0.12, p = 0.48). There were specific issues with the quality of these studies which were not designed with an inflammatory marker as the primary outcome. In conclusion, interventions that improve frailty and sarcopenia can also reduce CRP, IL-6 and TNF-α but the literature lacks consistency. We are unable to conclude any one marker as being superior to others.

Biochemical Markers of Musculoskeletal Health and Aging to be Assessed in Clinical Trials of Drugs Aiming at the Treatment of Sarcopenia: Consensus Paper from an Expert Group Meeting Organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the Centre Académique de Recherche et d'Expérimentation en Santé (CARES SPRL), Under the Auspices of the World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Conditions and Aging

In clinical trials, biochemical markers provide useful information on the drug's mode of action, therapeutic response and side effect monitoring and can act as surrogate endpoints. In pharmacological intervention development for sarcopenia management, there is an urgent need to identify biomarkers to measure in clinical trials and that could be used in the future in clinical practice. The objective of the current consensus paper is to provide a clear list of biochemical markers of musculoskeletal health and aging that can be recommended to be measured in Phase II and Phase III clinical trials evaluating new chemical entities for sarcopenia treatment. A working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) proposed classifying biochemical markers into 2 series: biochemical markers evaluating musculoskeletal status and biochemical markers evaluating causal factors. For series 1, the group agreed on 4 biochemical markers that should be assessed in Phase II or Phase III trials (i.e., Myostatin-Follistatin, Brain Derived Neurotrophic Factor, N-terminal Type III Procollagen and Serum Creatinine to Serum Cystatin C Ratio - or the Sarcopenia Index). For series 2, the group agreed on 6 biochemical markers that should be assessed in Phase II trials (i.e., the hormones insulin-like growth factor-1 (IGF-I), dehydroepiandrosterone sulphate, and cortisol, and the inflammatory markers C-reactive protein (CRP), interleukin-6 and tumor necrosis factor-α), and 2 in Phase III trials (i.e., IGF-I and CRP). The group also proposed optional biochemical markers that may provide insights into the mode of action of pharmacological therapies. Further research and development of new methods for biochemical marker assays may lead to the evolution of these recommendations.

Impact of Vitamin D Level on Sarcopenia in Elderly People: A Critical Review

Vitamin D insufficiency is a widespread health issue globally, particularly among the elderly. Vitamin D controls and affects the metabolism and functionality of several human systems, including muscle tissue. The action of vitamin D on muscles has been extensively studied, with evidence indicating that this vitamin can increase the osteogenic differentiation of muscle fibers, hence preserving and enhancing muscular strength and athletic performance. Low hormone levels are more common in older people as a result of poor food intake and decreased skin ultraviolet irradiation. As a result, elderly persons who are deficient in vitamin D may be at risk of developing sarcopenia, a geriatric condition defined by gradual loss of skeletal muscle mass and strength that is frequently accompanied by adverse events such as falls, incapacity hospitalization, and mortality. As a result, these activities are seen to be crucial in illuminating the underlying functional condition of the aged, and functional mobility is employed as a technique for assessing fall risk and frailty. Several randomized controlled studies have been done to explore the efficacy of oral treatment in elderly people to prevent or cure sarcopenia; however, the results are still debatable. We describe the biochemical, clinical, and epidemiological data supporting the idea of a causal relationship between vitamin D insufficiency and a higher likelihood of sarcopenia in elderly adults in this narrative review. The muscular system, the biggest organ in the body, contributing to around 40% of body composition, is vital in exercising and glycogen depletion. Sarcopenia, a steady deterioration in muscle mass and strength, and function in the aged can result in prolonged circumstances, wheelchair confinement, and a reduction in quality of life. Diagnosis and control of muscle wasting are vital for improving health and quality of life in industrialized nations with aging populations. Vitamin D, a fat-soluble vitamin, has gained popularity in recent years because of its relevance in sarcopenia. The role of vitamin D deficiency and fortification on muscle wasting will be the focus of this review.

Markers for the Prediction of Probably Sarcopenia in Middle-Aged Individuals

Sarcopenia is a condition that is characterized by a progressive loss of muscle mass, strength, and function, resulting in reduced quality of life. The aim of the study was to analyze the significance of pro-inflammatory markers in the prognostic diagnosis of sarcopenia. The participants were divided into two groups: the main group of 146 people and the control-75 people. The complex of examinations included neuropsychological testing (Hospital Anxiety and Depression Scale (HADS), quality-of-life questionnaire for patients with sarcopenia (SarQoL), and short health assessment form (MOS SF-36)), a 6 m walking speed test, manual dynamometry, bioimpedancemetry, and metabolic markers (nitrates, fibroblast growth factor 21, and malondialdehyde). When analyzing metabolic markers in the main group, a twofold increase in nitrates in the main group was recorded in a subsequent analysis adjusted for multiple variables, there was a negative association between the nitrate levels for weak grip strength and appendicular muscle mass. An additional analysis revealed that the complaint of pain in the lower extremities was more frequent in patients of the main group, as well as constipation and the pathology of thyroid gland, and they were more frequently diagnosed with arterial hypertension. At the same time, patients from the main group more frequently took vitamin D. When conducting body composition, the main group recorded a higher weight visceral fat content, as well as a decrease in appendicular and skeletal muscle mass; these changes were accompanied by a decrease in protein and minerals. Among the markers that differed significantly were nitrates, and it was this that was associated with decreased muscle strength and appendicular mass, which may indicate both a possible mechanism and a possible predictive marker. The results of this study can be used to develop a screening method for diagnosing sarcopenia at the outpatient stage.

Combined Ketogenic Diet and Walking Exercise Interventions in Community Older Frailty and Skeletal Muscle Sarcopenia

The ketogenic diet and walking exercise training interventions are two key public health lifestyle factors. The potential of combined lifestyle factors interventions focused on getting to compliance in diet and exercise. A balanced ketogenic diet and regular exercise interventions is key modifiable factor to the prevention and management of community older frailty and skeletal muscle sarcopenia. Influence health across the lifespan and reduction of the risk of premature death through several biochemistry mechanisms. Community older group’s lifestyle factors interventions contribute identity in their natural living environment. While the older health benefits of walking exercise training interventions strategies are commonly to study, combining ketogenic diet and walking exercise interventions can induce greater benefits in community older groups.

Association between Alcohol Consumption and the Risk of Sarcopenia: A Systematic Review and Meta-Analysis

Sarcopenia is a common disease defined as the loss of skeletal muscle mass, strength, and physical performance. Alcohol consumption is an uncertain risk factor for sarcopenia. Previous observational epidemiological studies have reported inconsistent results regarding the association between alcohol consumption and sarcopenia risk. This study aimed to investigate the association between alcohol consumption and sarcopenia. A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, and the Cochrane Library through April 2022 using keywords related to alcohol consumption and sarcopenia. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using a random effects model meta-analysis. The risk of bias of the studies was assessed using the Newcastle−Ottawa scale. Nineteen observational studies that reported 3826 sarcopenia patients among 422,870 participants were included in the qualitative analysis. Alcohol consumption was not significantly associated with sarcopenia risk (OR, 1.00; 95% CI, 0.83 to 1.20; I2 = 60.6%). Alcohol consumption resulted in a non-significant decrease in the risk of sarcopenia in men (OR, 0.70; 95% CI, 0.46 to 1.07; I2 = 0.0%) and in women (OR, 1.20; 95% CI, 0.63 to 2.30; I2 = 75.8%). The subgroup analyses by age and alcohol consumption were significantly associated with an increased the risk of sarcopenia in <65 years (OR, 2.62; 95% CI, 1.22 to 5.62; I2 = 100%). This meta-analysis of observational studies indicated that alcohol consumption was not significantly associated with sarcopenia risk. However, there are factors influencing the association between alcohol consumption and sarcopenia, such as smoking and dietary patterns. Additional study of these confounding factors is needed for the systematic analysis of the association of alcohol consumption with sarcopenia in future studies.

Efficacy of Exercise on Muscle Function and Physical Performance in Older Adults with Sarcopenia: An Updated Systematic Review and Meta-Analysis

This study aimed to analyze the efficacy of exercise interventions on muscle strength, muscle mass, and physical performance in older adults with sarcopenia. Randomized controlled studies assessing exercise effects on sarcopenia were searched in Web of Science, PubMed, Cochrane Library, ProQuest, EBSCOhost, Scopus, EMBASE, and VIP and CNKI up to 31 March 2022. Data were expressed as weighted/standardized mean difference (MD/SMD) with 95% confidence intervals (CI). I² index was employed for heterogeneity. The initial search identified 5379 studies, and 23 studies involving 1252 participants met the inclusion criteria for further analysis. Results revealed that exercise interventions can significantly improve grip strength (MD = 2.38, 95%CI = 1.33–3.43), knee extension strength (SMD = 0.50, 95%CI = 0.36–0.64), muscle mass of lower extremities (MD = 0.28, 95%CI = 0.01–0.56), walking speed (SMD = 0.88, 95%CI = 0.49–1.27), and functional mobility (MD = −1.77, 95%CI = −2.11–−1.42) among older adults with sarcopenia. No significant exercise effects were found on fat-free muscle mass, appendicular muscle mass, skeletal muscle mass, and muscle mass of the upper extremities. The results of subgroup analysis indicated that both resistance training and multicomponent exercise could significantly increase the muscle strength, while aerobic exercise did not. The findings suggest that exercise intervention can effectively improve muscle function and physical performance in older adults with sarcopenia, but has limited effects on the muscle mass of the upper extremities. In addition, it is highly recommended to apply group-based and supervised resistance training and multicomponent exercise in the prevention and treatment of sarcopenia among the older population.