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de Sousa IM, Fayh APT, Gonzalez MC, Silva FM. Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values. Nutr Clin Pract 2024; 39:611-618. [PMID: 38443160 DOI: 10.1002/ncp.11138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). METHODS Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). RESULTS Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). CONCLUSION Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.
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Affiliation(s)
- Iasmin M de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Coelho MPP, de Castro PASV, de Vries TP, Colosimo EA, Bezerra JMT, Rocha GA, Silva LD. Sarcopenia in chronic viral hepatitis: From concept to clinical relevance. World J Hepatol 2023; 15:649-665. [PMID: 37305369 PMCID: PMC10251280 DOI: 10.4254/wjh.v15.i5.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.
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Affiliation(s)
- Marta Paula Pereira Coelho
- Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Pedro Alves Soares Vaz de Castro
- Medical Undergraduate Student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Thaís Pontello de Vries
- Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Enrico Antônio Colosimo
- Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Juliana Maria Trindade Bezerra
- Department of Biological Sciences, Universidade Estadual do Maranhão, Açailândia 65715-000, Maranhão, Brazil
- Post-Graduate Programme of Animal Science, Universidade Estadual do Maranhão, São Luiz do Maranhão 65.055-310, Maranhão, Brazil
| | - Gifone Aguiar Rocha
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Luciana Diniz Silva
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
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Borges K, Artacho R, Jodar-Graus R, Molina-Montes E, Ruiz-López MD. Calf Circumference, a Valuable Tool to Predict Sarcopenia in Older People Hospitalized with Hip Fracture. Nutrients 2022; 14:4255. [PMID: 36296937 PMCID: PMC9608637 DOI: 10.3390/nu14204255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 ± 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68−0.91], p < 0.05) and CC (OR = 0.64 [0.51−0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations.
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Affiliation(s)
- Keith Borges
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Reyes Artacho
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
| | - Rosa Jodar-Graus
- Hospital of Neurotraumatology and Rehabilitation, 18013 Granada, Spain
| | - Esther Molina-Montes
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain
- CIBER Epidemiología y Salud Pública, CIBERESP, 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - María Dolores Ruiz-López
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, 18071 Granada, Spain
- Biomedical Research Center, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, 18071 Granada, Spain
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Wei J, Jiao J, Chen CL, Tao WY, Ying YJ, Zhang WW, Wu XJ, Zhang XM. The association between low calf circumference and mortality: a systematic review and meta-analysis. Eur Geriatr Med 2022; 13:597-609. [PMID: 35006574 DOI: 10.1007/s41999-021-00603-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association. METHODS The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data. RESULTS Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97-2.97, I2 = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93-3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76-3.54), and communities (pooled HR = 2.22, 95% CI 1.60-3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06-3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59-2.81). CONCLUSION Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.
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Affiliation(s)
- Jian Wei
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, China
| | - Chun-Lan Chen
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Wu-Yuan Tao
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Yuan-Jiang Ying
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Wen-Wu Zhang
- Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People's Hospital of Baoan Shenzhen, Shenzhen, China.
| | - Xin-Juan Wu
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, China.
| | - Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, China.
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Li X, Lang X, Peng S, Ding L, Li S, Li Y, Yin L, Liu X. Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches. J Nutr Health Aging 2022; 26:826-838. [PMID: 36156674 DOI: 10.1007/s12603-022-1838-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC. METHODS We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses. RESULTS Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool. CONCLUSIONS Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.
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Affiliation(s)
- X Li
- Lu Yin, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 102300, China. E-mail: ; Xiaomei Liu, Department of Emergency, Zhongshan Hospital of Xiamen University, Xiamen, China. Tel:
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Saeki C, Tsubota A. Influencing Factors and Molecular Pathogenesis of Sarcopenia and Osteosarcopenia in Chronic Liver Disease. Life (Basel) 2021; 11:life11090899. [PMID: 34575048 PMCID: PMC8468289 DOI: 10.3390/life11090899] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023] Open
Abstract
The liver plays a pivotal role in nutrient/energy metabolism and storage, anabolic hormone regulation, ammonia detoxification, and cytokine production. Impaired liver function can cause malnutrition, hyperammonemia, and chronic inflammation, leading to an imbalance between muscle protein synthesis and proteolysis. Patients with chronic liver disease (CLD) have a high prevalence of sarcopenia, characterized by progressive loss of muscle mass and function, affecting health-related quality of life and prognosis. Recent reports have revealed that osteosarcopenia, defined as the concomitant occurrence of sarcopenia and osteoporosis, is also highly prevalent in patients with CLD. Since the differentiation and growth of muscles and bones are closely interrelated through mechanical and biochemical communication, sarcopenia and osteoporosis often progress concurrently and affect each other. Osteosarcopenia further exacerbates unfavorable health outcomes, such as vertebral fracture and frailty. Therefore, a comprehensive assessment of sarcopenia, osteoporosis, and osteosarcopenia, and an understanding of the pathogenic mechanisms involving the liver, bones, and muscles, are important for prevention and treatment. This review summarizes the molecular mechanisms of sarcopenia and osteosarcopenia elucidated to data in hopes of promoting advances in treating these musculoskeletal disorders in patients with CLD.
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Affiliation(s)
- Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan;
| | - Akihito Tsubota
- Core Research Facilities, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
- Correspondence: ; Tel.: +81-3-3433-1111
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