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Lee DY, Oh JS, Kim JW, Kim JS, Oh M, Kim YI, Ko DH, Bae SJ, Kim HK, Ryu JS. Comparative analysis of body composition using torso CT from PET/CT with bioelectrical impedance and muscle strength in healthy adults. Sci Rep 2024; 14:21597. [PMID: 39285204 PMCID: PMC11405889 DOI: 10.1038/s41598-024-71878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
The role of torso computed tomography (CT) in evaluating body composition has been unexplored. This study assessed the potential of low-dose torso CT from positron emission tomography (PET)/CT for analyzing body composition and its relation to muscle strength. We retrospectively recruited 384 healthy Korean adults (231 men, 153 women) who underwent torso 18F-FDG PET/CT, bioelectrical impedance analysis (BIA), and muscle strength tests (handgrip strength [HGS] and knee extension strength [KES]). CT images were segmented into three compartments: torso volumetric, abdominal volumetric, and abdominal areal. Muscle amounts from each compartment were indexed to height (m2). BIA and HGS served as reference standards, with correlation coefficients (r) calculated. Torso muscle volumetric index (TorsoMVI) had the strongest correlations with BIA-derived values (r = 0.80 for men; r = 0.73 for women), surpassing those from the abdominal compartments. TorsoMVI was also correlated significantly with HGS (r = 0.39, p < 0.01) and differentiated between normal and possible sarcopenia in men (n = 225, 5960 ± 785 cm3/m2 vs. n = 6, 5210 ± 487 cm3/m2, p = 0.02). In women, KES correlated more strongly with muscle parameters than HGS. Despite gender-specific variations, torso CT-derived parameters show promise for evaluating body composition and sarcopenia.
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Affiliation(s)
- Dong Yun Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeong Won Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Duk Han Ko
- Department of Health Screening & Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Sung-Jin Bae
- Department of Health Screening & Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Health Screening & Promotion Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Kim HS, Cho YK, Kim MJ, Kim EH, Lee MJ, Lee WJ, Kim HK, Jung CH. Association between atherogenic dyslipidemia and muscle quality defined by myosteatosis. Front Endocrinol (Lausanne) 2024; 15:1327522. [PMID: 39170735 PMCID: PMC11335673 DOI: 10.3389/fendo.2024.1327522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background Myosteatosis, ectopic fat accumulation in skeletal muscle, is a crucial component of sarcopenia, linked to various cardiometabolic diseases. This study aimed to analyze the association between dyslipidemia and myosteatosis using abdominal computed tomography (CT) in a large population. Methods This study included 11,823 patients not taking lipid-lowering medications with abdominal CT taken between 2012 and 2013. Total abdominal muscle area (TAMA), measured at the L3 level, was segmented into skeletal muscle area (SMA) and intramuscular adipose tissue. SMA was further classified into normal attenuation muscle area (NAMA: good quality muscle) and low attenuation muscle area (poor quality muscle). NAMA divided by TAMA (NAMA/TAMA) represents good quality muscle. Atherosclerotic dyslipidemia was defined as high-density lipoprotein cholesterol (HDL-C) less than 40 mg/dL in men and 50 mg/dL in women, low-density lipoprotein cholesterol (LDL-C) greater than 160 mg/dL, triglycerides (TG) greater than 150 mg/dL, small dense LDL-C (sdLDL-C) greater than 50.0 mg/dL, or apolipoprotein B/A1 (apoB/A1) greater than 0.08. Results The adjusted odds ratios (ORs) of dyslipidemia according to the HDL-C and sdLDL definitions were greater in both sexes in the lower quartiles (Q1~3) of NAMA/TAMA compared with Q4. As per other definitions, the ORs were significantly increased in only women for LDL-C and only men for TG and ApoB/A1. In men, all lipid parameters were significantly associated with NAMA/TAMA, while TG and ApoB/A1 did not show significant association in women. Conclusion Myosteatosis measured in abdominal CT was significantly associated with a higher risk of dyslipidemia. Myosteatosis may be an important risk factor for dyslipidemia and ensuing cardiometabolic diseases.
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Affiliation(s)
- Hwi Seung Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Yun Kyung Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Myung Jin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Hee Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jung Lee
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
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Henin G, Loumaye A, Deldicque L, Leclercq IA, Lanthier N. Unlocking liver health: Can tackling myosteatosis spark remission in metabolic dysfunction-associated steatotic liver disease? Liver Int 2024; 44:1781-1796. [PMID: 38623714 DOI: 10.1111/liv.15938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
Myosteatosis is highly prevalent in metabolic dysfunction-associated steatotic liver disease (MASLD) and could reciprocally impact liver function. Decreasing muscle fat could be indirectly hepatoprotective in MASLD. We conducted a review to identify interventions reducing myosteatosis and their impact on liver function. Non-pharmacological interventions included diet (caloric restriction or lipid enrichment), bariatric surgery and physical activity. Caloric restriction in humans achieving a mean weight loss of 3% only reduces muscle fat. Lipid-enriched diet increases liver fat in human with no impact on muscle fat, except sphingomyelin-enriched diet which reduces both lipid contents exclusively in pre-clinical studies. Bariatric surgery, hybrid training (resistance exercise and electric stimulation) or whole-body vibration in human decrease both liver and muscle fat. Physical activity impacts both phenotypes by reducing local and systemic inflammation, enhancing insulin sensitivity and modulating the expression of key mediators of the muscle-liver-adipose tissue axis. The combination of diet and physical activity acts synergistically in liver, muscle and white adipose tissue, and further decrease muscle and liver fat. Several pharmacological interventions (patchouli alcohol, KBP-089, 2,4-dinitrophenol methyl ether, adipoRon and atglistatin) and food supplementation (vitamin D or resveratrol) improve liver and muscle phenotypes in pre-clinical studies by increasing fatty acid oxidation and anti-inflammatory properties. These interventions are effective in reducing myosteatosis in MASLD while addressing the liver disease itself. This review supports that disturbances in inter-organ crosstalk are key pathophysiological mechanisms involved in MASLD and myosteatosis pathogenesis. Focusing on the skeletal muscle might offer new therapeutic strategies to treat MASLD by modulating the interactions between liver and muscles.
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Affiliation(s)
- Guillaume Henin
- Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Laboratory of Hepatogastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Audrey Loumaye
- Service d'Endocrinologie, Diabétologie et Nutrition, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | | | - Isabelle A Leclercq
- Laboratory of Hepatogastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nicolas Lanthier
- Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Laboratory of Hepatogastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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Kong SH, Cho W, Park SB, Choo J, Kim JH, Kim SW, Shin CS. A Computed Tomography-Based Fracture Prediction Model With Images of Vertebral Bones and Muscles by Employing Deep Learning: Development and Validation Study. J Med Internet Res 2024; 26:e48535. [PMID: 38995678 PMCID: PMC11282387 DOI: 10.2196/48535] [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: 04/27/2023] [Revised: 01/27/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND With the progressive increase in aging populations, the use of opportunistic computed tomography (CT) scanning is increasing, which could be a valuable method for acquiring information on both muscles and bones of aging populations. OBJECTIVE The aim of this study was to develop and externally validate opportunistic CT-based fracture prediction models by using images of vertebral bones and paravertebral muscles. METHODS The models were developed based on a retrospective longitudinal cohort study of 1214 patients with abdominal CT images between 2010 and 2019. The models were externally validated in 495 patients. The primary outcome of this study was defined as the predictive accuracy for identifying vertebral fracture events within a 5-year follow-up. The image models were developed using an attention convolutional neural network-recurrent neural network model from images of the vertebral bone and paravertebral muscles. RESULTS The mean ages of the patients in the development and validation sets were 73 years and 68 years, and 69.1% (839/1214) and 78.8% (390/495) of them were females, respectively. The areas under the receiver operator curve (AUROCs) for predicting vertebral fractures were superior in images of the vertebral bone and paravertebral muscles than those in the bone-only images in the external validation cohort (0.827, 95% CI 0.821-0.833 vs 0.815, 95% CI 0.806-0.824, respectively; P<.001). The AUROCs of these image models were higher than those of the fracture risk assessment models (0.810 for major osteoporotic risk, 0.780 for hip fracture risk). For the clinical model using age, sex, BMI, use of steroids, smoking, possible secondary osteoporosis, type 2 diabetes mellitus, HIV, hepatitis C, and renal failure, the AUROC value in the external validation cohort was 0.749 (95% CI 0.736-0.762), which was lower than that of the image model using vertebral bones and muscles (P<.001). CONCLUSIONS The model using the images of the vertebral bone and paravertebral muscle showed better performance than that using the images of the bone-only or clinical variables. Opportunistic CT screening may contribute to identifying patients with a high fracture risk in the future.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Wonwoo Cho
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Jaegul Choo
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hatzantonis C, Satkunam L, Rabey KN, Hocking JC, Agur AMR. Fatty infiltration of gastrocnemius-soleus muscle complex: Considerations for myosteatosis rehabilitation. J Anat 2024; 245:50-57. [PMID: 38361481 PMCID: PMC11161819 DOI: 10.1111/joa.14025] [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: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
Although previous studies have reported fatty infiltration of the gastrocnemius-soleus complex, little is known about the volumetric distribution and patterns of fatty infiltration. The purpose of this anatomical study was to document and quantify the frequency, distribution, and pattern of fatty infiltration of the gastrocnemius-soleus complex. One hundred formalin-embalmed specimens (mean age 78.1 ± 12.3 years; 48F/52M) were serially dissected to document the frequency, distribution, and pattern of fatty infiltration in the medial and lateral heads of gastrocnemius and soleus muscles. Fatty infiltration was found in 23% of specimens, 13 unilaterally (8F/5M) and 10 (5M/5F) bilaterally. The fatty infiltration process was observed to begin medially from the medial aspect of the medial head of gastrocnemius and medial margin of soleus and then progressed laterally throughout the medial head of gastrocnemius and the marginal, anterior, and posterior soleus. The lateral head of gastrocnemius remained primarily muscular in all specimens. Microscopically, the pattern of infiltration was demonstrated as intramuscular with intact aponeuroses, and septa. The remaining endo-, peri-, and epimysium preserved the overall contour of the gastrocnemius-soleus complex, even in cases of significant fatty replacement. Since the external contour of the calf is preserved, the presence of fatty infiltration may be underdiagnosed in the clinic without imaging. Myosteatosis is associated with gait and balance challenges in the elderly, which can impact quality of life and result in increased risk of falling. The findings of the study have implications in the rehabilitation management of elderly patients with sarcopenia and myosteatosis.
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Affiliation(s)
| | - Lalith Satkunam
- Division of Physical Medicine and Rehabilitation, Department of MedicineGlenrose Rehabilitation Hospital, University of AlbertaEdmontonAlbertaCanada
| | - Karyne N. Rabey
- Division of Anatomy, Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Jennifer C. Hocking
- Division of Anatomy, Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Anne M. R. Agur
- Division of Anatomy, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
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Zhuang CL, Wu HF, Jiang HJ, Zhang FM, Shi HP, Yu Z, Shen X, Chen XL, Wang SL. Muscle attenuation, not skeletal muscle index, is an independent prognostic factor for survival in gastric cancer patients with overweight and obesity. Nutrition 2024; 122:112391. [PMID: 38460446 DOI: 10.1016/j.nut.2024.112391] [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: 08/06/2023] [Revised: 12/19/2023] [Accepted: 02/04/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Skeletal muscle index (SMI) is insufficient for evaluating muscle in obesity, and muscle attenuation (MA) may be a preferred indicator. This study aimed to investigate whether MA has greater prognostic value than SMI in gastric cancer patients with overweight and obesity. METHODS Clinical parameters of 1312 patients with gastric cancer who underwent radical gastrectomy were prospectively collected between 2013 and 2019. MA and SMI were analyzed by computed tomography scan. Overweight/obesity was defined as body mass index (BMI) ≥24 kg/m2. The hazard ratio (HR) for death was calculated using Cox regression analysis. RESULTS Among all patients, 405 were identified as overweight and obese, and 907 were identified as normal and underweight. MA was inversely associated with BMI and visceral fat area. Among the 405 patients with overweight and obesity, 212 patients (52%) were diagnosed with low MA. In the overweight/obese group, MA was an independent predictor for overall survival (HR, 1.610; P = 0.021) in multivariate Cox regression analyses, whereas SMI did not remain in the model. In the normal/underweight group, both low MA (HR, 1.283; P = 0.039) and low SMI (HR, 1.369; P = 0.008) were independent factors of overall survival. Additionally, 318 patients were identified as having visceral obesity in the overweight/obese group, and low MA was also an independent prognostic factor for survival in these patients (HR, 1.765; P = 0.013). CONCLUSION MA had a higher prognostic value than SMI in overweight and obese patients with gastric cancer after radical gastrectomy.
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Affiliation(s)
- Cheng-Le Zhuang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Fan Wu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Jie Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Feng-Min Zhang
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Su-Lin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
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Heitman K, Alexander MS, Faul C. Skeletal Muscle Injury in Chronic Kidney Disease-From Histologic Changes to Molecular Mechanisms and to Novel Therapies. Int J Mol Sci 2024; 25:5117. [PMID: 38791164 PMCID: PMC11121428 DOI: 10.3390/ijms25105117] [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: 04/09/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic kidney disease (CKD) is associated with significant reductions in lean body mass and in the mass of various tissues, including skeletal muscle, which causes fatigue and contributes to high mortality rates. In CKD, the cellular protein turnover is imbalanced, with protein degradation outweighing protein synthesis, leading to a loss of protein and cell mass, which impairs tissue function. As CKD itself, skeletal muscle wasting, or sarcopenia, can have various origins and causes, and both CKD and sarcopenia share common risk factors, such as diabetes, obesity, and age. While these pathologies together with reduced physical performance and malnutrition contribute to muscle loss, they cannot explain all features of CKD-associated sarcopenia. Metabolic acidosis, systemic inflammation, insulin resistance and the accumulation of uremic toxins have been identified as additional factors that occur in CKD and that can contribute to sarcopenia. Here, we discuss the elevation of systemic phosphate levels, also called hyperphosphatemia, and the imbalance in the endocrine regulators of phosphate metabolism as another CKD-associated pathology that can directly and indirectly harm skeletal muscle tissue. To identify causes, affected cell types, and the mechanisms of sarcopenia and thereby novel targets for therapeutic interventions, it is important to first characterize the precise pathologic changes on molecular, cellular, and histologic levels, and to do so in CKD patients as well as in animal models of CKD, which we describe here in detail. We also discuss the currently known pathomechanisms and therapeutic approaches of CKD-associated sarcopenia, as well as the effects of hyperphosphatemia and the novel drug targets it could provide to protect skeletal muscle in CKD.
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Affiliation(s)
- Kylie Heitman
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Matthew S. Alexander
- Division of Neurology, Department of Pediatrics, The University of Alabama at Birmingham and Children’s of Alabama, Birmingham, AL 35294, USA
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Civitan International Research Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Center for Neurodegeneration and Experimental Therapeutics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Christian Faul
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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Chen J, Li Y, Li C, Song T. Myosteatosis is associated with poor survival after kidney transplantation: a large retrospective cohort validation. Abdom Radiol (NY) 2024; 49:1210-1222. [PMID: 38326665 DOI: 10.1007/s00261-023-04180-w] [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: 11/12/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE We aim to establish diagnostic thresholds of sarcopenia and myosteatosis based on CT measurements, and to validate their prognostic value in a large cohort of kidney transplant recipients. METHODS Local healthy population with abdominal CT between 2010 and 2022, and patients underwent kidney transplantation between 2015 and 2019 at our center were retrospectively included. The skeletal muscle index and muscle attenuation of abdominal muscles were calculated based on CT image at the middle of the third lumbar vertebra. Primary endpoints included all-cause mortality and death censored allograft survival. RESULTS Age- and sex-specific thresholds for sarcopenia and myosteatosis were established based on 1598 healthy local population. The final patient cohort consisted of 992 kidney transplant recipients (median age 34 years, interquartile range 28-44 years; 694 males), including 33 (3.3%) with sarcopenia and 95 (9.5%) with myosteatosis. Multivariate analysis revealed myosteatosis (adjusted hazard ratio = 3.08, p = 0.022) was an independent baseline risk factor of mortality after adjusting for age, the history of cancer, and the history of cardiovascular event. Multivariate analysis found preemptive transplantation (adjusted hazard ratio = 0.36, p = 0.037) was an independent protective factor of allograft loss. No difference was found in the prognosis between kidney transplant recipients with and without sarcopenia. CONCLUSION Myosteatosis was an independent risk factor of mortality after kidney transplantation, but sarcopenia was not. Neither sarcopenia nor myosteatosis was associated with graft loss.
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Affiliation(s)
- Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yue Li
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Chengjie Li
- Department of Radiology, Chongqing Southeast Hospital, No. 98, Tongjiang Avenue, Nan'an District, Chongqing, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
- Transplant Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Felipe TL, Grili PPDF, Vidigal CV, Albergaria BH, da Cruz GF, Marques-Rocha JL, Guandalini VR. Skeletal muscle mass obtained by anthropometric equation and presence of sarcopenia in postmenopausal women. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo9. [PMID: 38765537 PMCID: PMC11075426 DOI: 10.61622/rbgo/2024ao09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/11/2023] [Indexed: 05/22/2024] Open
Abstract
Objective To analyze the amount of muscle and the presence of sarcopenia in postmenopausal women using different methods, verifying the agreement between them as to skeletal muscle mass (SMM). Methods This cross-sectional observational study was conducted with postmenopausal women aged ≥ 50 years. SMM was obtained from a predictive equation, Bioelectrical Impedance (BIA), and Dual Energy X-Ray Absorptiometry (DXA). The skeletal muscle mass index (SMI) and the appendicular skeletal muscle mass index (ASMI) were calculated. The cut-off point of SMI was determined for the population itself. The agreement between the SMI obtained using the different methods was verified. Sarcopenia was diagnosed according to the criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The significance level adopted for all tests was 5.0%. Results A total of 112 women were evaluated, with an average age of 66.1 ± 5.65 years. Among them, 51.8% were sufficiently active and 43.8% were overweight and obese. The SMI cut-offs were 6.46 kg/m2 for the predictive equation and 7.66 kg/m2 for BIA, with high sensitivity and specificity. There was an excellent agreement in the identification of SMM by the predictive equation (0.89 [0.824-0.917], p < 0.001) and BIA (0.92 [0.883-0.945], p < 0.001), in reference to DXA. The prevalence of sarcopenia was 0.9%, 1.8%, and 2.7% according to BIA, DXA, and the predictive equation, respectively. Conclusion The predictive equation showed the expected agreement in estimating skeletal muscle mass in postmenopausal women, offering a viable and accurate alternative.
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Affiliation(s)
- Thaís Loureiro Felipe
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | | | - Camila Vilarinho Vidigal
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Ben-Hur Albergaria
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Geise Ferreira da Cruz
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - José Luiz Marques-Rocha
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Valdete Regina Guandalini
- Universidade Federal do Espírito SantoVitóriaESBrazilUniversidade Federal do Espírito Santo, Vitória, ES, Brazil.
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Liu FP, Guo MJ, Yang Q, Li YY, Wang YG, Zhang M. Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes. World J Diabetes 2024; 15:429-439. [PMID: 38591084 PMCID: PMC10999038 DOI: 10.4239/wjd.v15.i3.429] [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: 11/02/2023] [Revised: 12/19/2023] [Accepted: 02/20/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Myosteatosis, rather than low muscle mass, is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus (T2DM). Myosteatosis may lead to a series of metabolic dysfunctions, such as insulin resistance, systematic inflammation, and oxidative stress, and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis. AIM To investigate the association between myosteatosis and coronary artery calcification (CAC) in patients with T2DM. METHODS Patients with T2DM, who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography (CT) scans, were included. The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level. The CAC score was determined from thoracic CT images using the Agatston scoring method. Myosteatosis was diagnosed according to Martin's criteria. Severe CAC (SCAC) was defined when the CAC score exceeded 300. Logistic regression and decision tree analyses were performed. RESULTS A total of 652 patients with T2DM were enrolled. Among them, 167 (25.6%) patients had SCAC. Logistic regression analysis demonstrated that myosteatosis, age, duration of diabetes, cigarette smoking, and alcohol consumption were independent risk factors of SCAC. Myosteatosis was significantly associated with an increased risk of SCAC (OR = 2.381, P = 0.003). The association between myosteatosis and SCAC was significant in the younger patients (OR = 2.672, 95%CI: 1.477-4.834, P = 0.002), but not the older patients (OR = 1.456, 95%CI: 0.863-2.455, P = 0.188), and was more prominent in the population with lower risks of atherosclerosis. The decision tree analyses prioritized older age as the primary variable for SCAC. In older patients, cigarette smoking was the main contributing factor for SCAC, while in younger patients, it was myosteatosis. CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM, especially in the population with younger ages and fewer traditional risk factors.
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Affiliation(s)
- Fu-Peng Liu
- The Affiliated Hospital of Medical College Qingdao University, Qingdao University, Qingdao 266071, Shandong Province, China
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Mu-Jie Guo
- Department of Medical Imaging, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Qing Yang
- Department of Clinical Nutrition, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Ying Li
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
| | - Yan-Gang Wang
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Mei Zhang
- Department of Endocrinology, The Affiliated Hospital of Jining Medical University, Jining 272029, Shandong Province, China
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11
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Kim Y, Kim YG, Park JW, Kim BW, Shin Y, Kong SH, Kim JH, Lee YK, Kim SW, Shin CS. A CT-based Deep Learning Model for Predicting Subsequent Fracture Risk in Patients with Hip Fracture. Radiology 2024; 310:e230614. [PMID: 38289213 DOI: 10.1148/radiol.230614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Patients have the highest risk of subsequent fractures in the first few years after an initial fracture, yet models to predict short-term subsequent risk have not been developed. Purpose To develop and validate a deep learning prediction model for subsequent fracture risk using digitally reconstructed radiographs from hip CT in patients with recent hip fractures. Materials and Methods This retrospective study included adult patients who underwent three-dimensional hip CT due to a fracture from January 2004 to December 2020. Two-dimensional frontal, lateral, and axial digitally reconstructed radiographs were generated and assembled to construct an ensemble model. DenseNet modules were used to calculate risk probability based on extracted image features and fracture-free probability plots were output. Model performance was assessed using the C index and area under the receiver operating characteristic curve (AUC) and compared with other models using the paired t test. Results The training and validation set included 1012 patients (mean age, 74.5 years ± 13.3 [SD]; 706 female, 113 subsequent fracture) and the test set included 468 patients (mean age, 75.9 years ± 14.0; 335 female, 22 subsequent fractures). In the test set, the ensemble model had a higher C index (0.73) for predicting subsequent fractures than that of other image-based models (C index range, 0.59-0.70 for five of six models; P value range, < .001 to < .05). The ensemble model achieved AUCs of 0.74, 0.74, and 0.73 at the 2-, 3-, and 5-year follow-ups, respectively; higher than that of most other image-based models at 2 years (AUC range, 0.57-0.71 for five of six models; P value range, < .001 to < .05) and 3 years (AUC range, 0.55-0.72 for four of six models; P value range, < .001 to < .05). Moreover, the AUCs achieved by the ensemble model were higher than that of a clinical model that included known risk factors (2-, 3-, and 5-year AUCs of 0.58, 0.64, and 0.70, respectively; P < .001 for all). Conclusion In patients with recent hip fractures, the ensemble deep learning model using digital reconstructed radiographs from hip CT showed good performance for predicting subsequent fractures in the short term. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Li and Jaremko in this issue.
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Affiliation(s)
- Yisak Kim
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Young-Gon Kim
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Jung-Wee Park
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Byung Woo Kim
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Youmin Shin
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Sung Hye Kong
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Jung Hee Kim
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Young-Kyun Lee
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Sang Wan Kim
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
| | - Chan Soo Shin
- From the Interdisciplinary Program in Bioengineering (Y.K., Y.S.) and Integrated Major in Innovative Medical Science (Y.K.), Seoul National University Graduate School, Seoul, Republic of Korea; Department of Radiology (Y.K.), Transdisciplinary Department of Medicine & Advanced Technology (Y.G.K., B.W.K., Y.S.), and Department of Internal Medicine (J.H.K., C.S.S.), Seoul National University Hospital, Seoul, Republic of Korea; Departments of Orthopaedic Surgery (J.W.P., Y.K.L.) and Internal Medicine (S.H.K.), Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang gu, Seongnam, Republic of Korea; Departments of Medicine (Y.G.K.) and Internal Medicine (S.H.K., J.H.K., S.W.K., C.S.S.), Seoul National University College of Medicine, Seoul, Republic of Korea; and Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Republic of Korea (S.W.K.)
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12
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Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [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: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
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Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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Zhang W, Tang J, Tang H, Xie L, Wang J, Wu J, Yang M. Different computed tomography parameters for defining myosteatosis in patients with advanced non-small cell lung cancer. Clin Nutr 2023; 42:2414-2421. [PMID: 37871482 DOI: 10.1016/j.clnu.2023.10.006] [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: 07/21/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND & AIMS Myosteatosis, excess muscle fat infiltration, is a novel prognostic factor in cancer patients. To define myosteatosis, skeletal muscle radiodensity (SMD) is most commonly used, while intramuscular adipose tissue (IMAT) is newly introduced. We aimed to compare SMD-defined and IMAT-defined myosteatosis for predicting overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC) and to explore whether patients with both low SMD and high IMAT had a shorter OS than patients with low SMD or high IMAT alone. METHODS We consecutively and prospectively recruited adult patients with stage IIIB or IV NSCLC at a teaching hospital. The mean SMD of all skeletal muscle areas and the area of IMAT on the unenhanced chest computed tomography (CT) images at the 12th thoracic vertebral level were segmented using Mimics version 21.0. Myosteatosis was defined by either low SMD (SMD-defined myosteatosis) or high IMAT (IMAT-defined myosteatosis). The optimal cutoffs for low SMD and high IMAT were also determined using the maximally selected rank statistics method. We calculated hazard ratios (HRs) and the corresponding confidence intervals (CIs) to evaluate the associations of OS with low SMD, high IMAT, and a combination of them. RESULTS We included 565 patients (345 men and 220 women; mean age 58.5 ± 9.0 years). Lower IMAT exhibited a tendency toward a favorable prognosis in men (p = 0.0015) and women (p < 0.0001); whereas higher SMD tended to have a favorable prognosis in men (p = 0.0006) and women (p < 0.0001). At baseline, 423 (74.9 %) participants had high IMAT, 432 (76.5 %) participants had low SMD and 370 (65.5 %) participants had both high IMAT and low SMD. Compared to those without either high IMAT or low SMD, the participants with either high IMAT or low SMD had a shorter OS, while the participants with both High IMAT and Low SMD had the shortest OS (log-rank p < 0.0001). After adjustment for the same confounders, high IMAT (HR, 1.44; 95 % CI, 1.10-1.87) and low SMD (HR, 1.92; 95 % CI, 1.36-2.43) were separately associated with poor prognosis. Moreover, the combination of high IMAT and low SMD indicated a higher risk of poor prognosis (HR, 2.43; 95 % CI, 1.62-3.66). CONCLUSIONS Both SMD-defined and IMAT-defined myosteatosis are highly prevalent in patients with advanced NSCLC and may serve as independent prognostic factors for OS. The diagnosis of myosteatosis might consider a combination of low SMD and high IMAT because this would help identify patients at a higher risk of mortality.
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Affiliation(s)
- Wenyi Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Huiyu Tang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingling Xie
- West China School of Nursing, West China Hospital, Sichuan University/ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Wang
- West China School of Nursing, West China Hospital, Sichuan University/ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
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14
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Kim MJ, Cho YK, Jung HN, Kim EH, Lee MJ, Jung CH, Park JY, Kim HK, Lee WJ. Association Between Insulin Resistance and Myosteatosis Measured by Abdominal Computed Tomography. J Clin Endocrinol Metab 2023; 108:3100-3110. [PMID: 37401630 DOI: 10.1210/clinem/dgad382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
CONTEXT Ectopic fat deposition in skeletal muscle, termed myosteatosis, is a key factor in developing insulin resistance. OBJECTIVE This work aimed to evaluate the association between insulin resistance and myosteatosis in a large Asian population. METHODS A total of 18 251 participants who had abdominal computed tomography were included in this cross-sectional study. Patients were categorized into 4 groups according to quartiles of Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The total abdominal muscle area (TAMA) at the L3 vertebral level was segmented into normal-attenuation muscle area (NAMA), low-attenuation muscle area (LAMA), and intermuscular adipose tissue (IMAT). The absolute values of TAMA, NAMA, LAMA, and IMAT and the ratios of NAMA/BMI, LAMA/BMI, and NAMA/TAMA were used as myosteatosis indices. RESULTS The absolute values of TAMA, NAMA, LAMA, and IMAT appeared to increase with higher HOMA-IR levels, and LAMA/BMI showed a similar upward trend. Meanwhile, the NAMA/BMI and NAMA/TAMA index showed downward trends. As HOMA-IR levels increased, the odds ratios (ORs) of the highest quartile of NAMA/BMI and NAMA/TAMA index decreased and that of LAMA/BMI increased. Compared with the lowest HOMA-IR group, the adjusted ORs (95% CI) in the highest HOMA-IR group for the lowest NAMA/TAMA quartile were 0.414 (0.364-0.471) in men and 0.464 (0.384-0.562) in women. HOMA-IR showed a negative correlation with NAMA/BMI (r = -0.233 for men and r = -0.265 for women), and NAMA/TAMA index (r = -0.211 for men and r = -0.214 for women), and a positive correlation with LAMA/BMI (r = 0.160 for men and r = 0.119 for women); P was less than .001 for all. CONCLUSION In this study, a higher HOMA-IR level was significantly associated with a high risk of myosteatosis.
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Affiliation(s)
- Myung Jin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Yun Kyung Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Han Na Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Eun Hee Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Min Jung Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Hong-Kyu Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul 05505, Republic of Korea
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Bikbavova GR, Livzan MA, Tikhonravova DV. All you need to know about sarcopenia: a short guide for an internal medicine physician in questions and answers. BULLETIN OF SIBERIAN MEDICINE 2023; 22:88-97. [DOI: 10.20538/1682-0363-2023-3-88-97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Sarcopenia is associated with social, economic, and individual burdens, including loss of independence, poor quality of life, and disability. In a short period of time, ideas about sarcopenia transformed from geriatric syndrome to disease. Initially, sarcopenia was considered in the context of gradual age-related deterioration in the functioning of all physiological systems. Over the years, it became clear that it can develop a second time, as a consequence of various diseases and pathological conditions.To date, there have been no generally accepted diagnostic criteria for sarcopenia. There are several tests and tools available for screening sarcopenia, the choice of which depends on physical capabilities of the patient, capabilities of the medical institution, and the purpose for which it is detected (research or clinical practice).From the point of view of human health, sarcopenia increases the risk of falls and fractures; impairs the ability to perform daily activities; is associated with the progression of major diseases and cognitive impairments; leads to movement disorders; contributes to a decrease in the quality of life, loss of independence or a need for long-term care. The presence of sarcopenia increases both the risk of hospitalization and hospitalization costs.The aim of the literature review is to provide an analysis of up-to-date information on the causes, pathogenesis, screening, diagnosis, treatment, and consequences of sarcopenia, myosteatosis, and sarcopenic obesity. The search for literature containing information on relevant studies was conducted in PubMed and Google Scholar by the following keywords: sarcopenia, dynapenia, myosteatosis, sarcopenic obesity, nutritional status, malnutrition.
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16
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Kim HK, Bae SJ, Lee MJ, Kim EH, Park H, Kim HS, Cho YK, Jung CH, Lee WJ, Choe J. Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity. Clin Mol Hepatol 2023; 29:987-1001. [PMID: 37403320 PMCID: PMC10577332 DOI: 10.3350/cmh.2023.0035] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND/AIMS To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis. METHODS This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio, sarcopenia by body mass index-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography. RESULTS Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19-1.67, P<0.001; women: OR=1.59, 95% CI 1.40-1.90, P<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02-1.50, P=0,028; women: OR=1.23, 95% CI 1.04-1.46, P=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43-4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44-4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53-6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51-6.31 [adjusted for myosteatosis]; all P<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors. CONCLUSION In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.
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Affiliation(s)
- Hong-Kyu Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Sung-Jin Bae
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Min Jung Lee
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Eun Hee Kim
- Subdivision of Endocrinology and Metabolism, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Hana Park
- Subdivision of Gastroenterology and Hepatology, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Hwi Seung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Yun Kyung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Woo Je Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Korea
| | - Jaewon Choe
- Subdivision of Gastroenterology and Hepatology, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
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Rosano C, Newman A, Santanasto A, Zhu X, Goodpaster B, Miljkovic I. Increase in skeletal muscular adiposity and cognitive decline in a biracial cohort of older men and women. J Am Geriatr Soc 2023; 71:2759-2768. [PMID: 37282843 PMCID: PMC10524226 DOI: 10.1111/jgs.18419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/03/2023] [Accepted: 04/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Obesity and loss of muscle mass are emerging as risk factors for dementia, but the role of adiposity infiltrating skeletal muscles is less clear. Skeletal muscle adiposity increases with older age and especially among Black women, a segment of the US population who is also at higher risk for dementia. METHODS In 1634 adults (69-79 years, 48% women, 35% Black), we obtained thigh intermuscular adipose tissue (IMAT) via computerized tomography at Years 1 and 6, and mini-mental state exam (3MS) at Years 1, 3, 5, 8 and 10. Linear mixed effects models tested the hypothesis that increased IMAT (Year 1-6) would be associated with 3MS decline (Year 5-10). Models were adjusted for traditional dementia risk factors at Year 1 (3MS, education, APOe4 allele, diabetes, hypertension, and physical activity), with interactions between IMAT change by race or sex. To assess the influence of other muscle and adiposity characteristics, models accounted for change in muscle strength, muscle area, body weight, abdominal subcutaneous and visceral adiposity, and total body fat mass (all measured in Years 1 and 6). Models were also adjusted for cytokines related to adiposity: leptin, adiponectin, and interleukin-6. RESULTS Thigh IMAT increased by 4.85 cm2 (Year 1-6) and 3MS declined by 3.20 points (Year 6-10). The association of IMAT increase with 3MS decline was statistically significant: an IMAT increase of 4.85 cm2 corresponded to a 3MS decline of an additional 3.60 points (p < 0.0001), indicating a clinically important change. Interactions by race and sex were not significant. CONCLUSIONS Clinicians should be aware that regional adiposity accumulating in the skeletal muscle may be an important, novel risk factor for cognitive decline in Black and White participants independent of changes to muscle strength, body composition and traditional dementia risk factors.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh
| | - Anne Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh
| | - Adam Santanasto
- Department of Epidemiology, School of Public Health, University of Pittsburgh
| | - Xiaonan Zhu
- Department of Epidemiology, School of Public Health, University of Pittsburgh
| | | | - Iva Miljkovic
- Department of Epidemiology, School of Public Health, University of Pittsburgh
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Ahn SS, Park YB, Lee SW. Association between computed tomography-assessed sarcopenia and mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Int J Rheum Dis 2023; 26:1704-1713. [PMID: 37350277 DOI: 10.1111/1756-185x.14795] [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: 12/14/2022] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
AIM Sarcopenia is frequently observed in patients with autoimmune rheumatic diseases; however, its relationship with patient outcomes has not been well understood. This study evaluated the influence of sarcopenia, especially muscle quality, on outcomes of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS Records of patients with AAV at the Severance Hospital with computed tomography (CT) images taken at initial disease diagnosis were retrospectively reviewed. For measures of sarcopenia, normal attenuation muscle area (NAMA), low attenuation muscle area (LAMA), intramuscular adipose tissue (IMAT), and total abdominal muscle area (TAMA) in the axial muscles of the middle third lumbar vertebra level were calculated. Correlations between NAMA, LAMA, IMAT, and baseline patient characteristics, as well as the association between the NAMA/TAMA ratio and clinical outcomes were assessed. RESULTS A total of 136 patients with CT images at AAV diagnosis were identified. Correlation analyses revealed that age, female sex, total cholesterol, and alanine aminotransferase were significantly associated with NAMA. LAMA was associated with age, body mass index (BMI), five-factor score (FFS), and C-reactive protein, and a relationship between IMAT and age and BMI was observed. During the follow up of 31.2 months, 23 (16.9%) patients died, and Cox-proportional hazard analysis demonstrated that a NAMA/TAMA ≤0.46 (odds ratio [OR] 10.247, p < .001), female sex (OR 0.206, p = .006), dyslipidemia (OR 3.143, p = .027), creatinine (OR 1.342, p = .012), and FFS (OR 1.775, p = .046), were independently associated with patient mortality. CONCLUSION A higher rate of mortality was observed in patients with AAV with NAMA/TAMA ≤0.46, indicating that careful monitoring is required in these patients.
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Affiliation(s)
- Sung Soo Ahn
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
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Sabatino A, Avesani CM, Regolisti G, Adinolfi M, Benigno G, Delsante M, Fiaccadori E, Gandolfini I. Sarcopenic obesity and its relation with muscle quality and mortality in patients on chronic hemodialysis. Clin Nutr 2023; 42:1359-1368. [PMID: 37418843 DOI: 10.1016/j.clnu.2023.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND & AIMS Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity and mortality in the general population. Myosteatosis, i.e., muscle fat infiltration, has major effects on muscle strength and physical performance, but is poorly investigated in the nephrology setting. In the present study we aimed to assess the association between sarcopenic obesity, as diagnosed by abdominal CT, and mortality. Moreover, the relationship between myosteatosis, sarcopenic obesity and mortality was also investigated. METHODS This is a retrospective study in which ESKD patients on HD submitted to unenhanced abdominal CT for clinical reasons at least 6 months after dialysis initiation were evaluated for sarcopenic obesity and myosteatosis, defined as intermuscular fat area and low attenuation muscle area. Sarcopenic obesity was diagnosed in cases of low abdominal skeletal muscle area and high total fat area. Receiver-operating characteristics (ROC) analysis with Youden index was used to determine the cut-off for high total fat area. Intermuscular fat area and low attenuation muscle area were evaluated by applying the Hounsfield unit of interest (-190; -30, and -29; +29 respectively). Cox regression analysis was used to evaluate the association between predictors and mortality risk. RESULTS We enrolled 212 patients, aged 68.8 (±14.7) years, 65.5% (139/212) male. Median follow-up was 19.7 (interquartile range [IQR] 2.7-35) months. Sarcopenic obesity was diagnosed in 19.8% of patients and was associated with increased mortality (HR: 3.29 (1.72; 6.27), P < 0.001), and with the presence of myosteatosis. Both intermuscular fat area and low attenuation muscle area were associated with increased mortality in adjusted analyses. CONCLUSIONS Patients with sarcopenic obesity have increased myosteatosis. Sarcopenic obesity and myosteatosis are associated with increased mortality in patients on HD.
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Affiliation(s)
- Alice Sabatino
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Regolisti
- UO Clinica e Immunologia Medica, Parma University Hospital, Parma, Italy
| | - Marianna Adinolfi
- Dipartimento di Scienze degli Alimenti e del Farmaco, Parma University, Parma, Italy
| | - Giuseppe Benigno
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Delsante
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ilaria Gandolfini
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
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20
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Damigou E, Kouvari M, Panagiotakos D. The role of skeletal muscle mass on cardiovascular disease risk: an emerging role on modulating lipid profile. Curr Opin Cardiol 2023; 38:352-357. [PMID: 36928171 DOI: 10.1097/hco.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to present updated evidence on the role of skeletal muscle mass on cardiometabolic health. RECENT FINDINGS Increased lean, and especially skeletal, muscle mass has been associated with better cardiometabolic health in various epidemiological studies, even in younger age groups. In addition, the link between skeletal muscle mass and adult lipid profile is of interest. A preliminary analysis using the data from the ATTICA prospective cohort study (2002-2022) supports this association. SUMMARY Skeletal muscle mass has many metabolic functions (i.e., glucose, insulin and protein metabolism, mitochondrial function, arterial stiffness, inflammation, oxidative stress, brain function, hormone status). Given its associations with the lipid profile and overall cardiometabolic risk, skeletal muscle mass stands among the emerging risk factors for cardiovascular diseases. In addition to only using body mass index or fat distribution, more studies should evaluate lean mass and its prognostic and predictive ability regarding chronic diseases.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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21
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Kang M, Kim SH, Jo M, Jung HE, Bae J, Kim HJ. Evaluation of Paraspinal Muscle Degeneration on Pain Relief after Percutaneous Epidural Adhesiolysis in Patients with Degenerative Lumbar Spinal Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1118. [PMID: 37374322 DOI: 10.3390/medicina59061118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The analgesic effectiveness of epidural adhesiolysis may be influenced by morphological changes in the paraspinal muscles, particularly in elderly patients. The objective of this study was to assess whether the cross-sectional area or fatty infiltration of the paraspinal muscles impacts the treatment outcomes of epidural adhesiolysis. Materials and Methods: The analysis included a total of 183 patients with degenerative lumbar disease who underwent epidural adhesiolysis. Good analgesia was defined as a reduction in pain score of ≥30% at the 6-month follow up. We measured the cross-sectional area and fatty infiltration rate of the paraspinal muscles and divided the study population into age groups (≥65 years and <65 years). Variables were compared between the good and poor analgesia groups. Results: The results revealed that elderly patients experienced poorer analgesic outcomes as the rate of fatty infiltration in the paraspinal muscles increased (p = 0.029), predominantly in female patients. However, there was no correlation between the cross-sectional area and the analgesic outcome in patients younger than or older than 65 years (p = 0.397 and p = 0.349, respectively). Multivariable logistic regression analysis indicated that baseline pain scores < 7 (Odds Ratio (OR) = 4.039, 95% Confidence Interval (CI) = 1.594-10.233, p = 0.003), spondylolisthesis (OR = 4.074, 95% CI = 1.144-14.511, p = 0.030), and ≥ 50% fatty infiltration of the paraspinal muscles (OR = 6.576, 95% CI = 1.300-33.268, p = 0.023) were significantly associated with poor outcomes after adhesiolysis in elderly patients. Conclusions: Fatty degeneration of paraspinal muscles is correlated with inferior analgesic outcomes following epidural adhesiolysis in elderly patients, but not in young and middle-aged patients. The cross-sectional area of the paraspinal muscles is not associated with pain relief after the procedure.
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Affiliation(s)
- Misun Kang
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyun Eom Jung
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jungbin Bae
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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22
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Cho YK, Jung HN, Kim EH, Lee MJ, Park JY, Lee WJ, Kim HK, Jung CH. Association between sarcopenic obesity and poor muscle quality based on muscle quality map and abdominal computed tomography. Obesity (Silver Spring) 2023; 31:1547-1557. [PMID: 37133436 DOI: 10.1002/oby.23733] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study evaluated whether sarcopenic obesity is closely associated with muscle quality using abdominal computed tomography. METHODS This cross-sectional study included 13,612 participants who underwent abdominal computed tomography. The cross-sectional area of the skeletal muscle was measured at the L3 level (total abdominal muscle area [TAMA]) and segmented into normal attenuation muscle area (NAMA, +30 to +150 Hounsfield units), low attenuation muscle area (-29 to +29 Hounsfield units), and intramuscular adipose tissue (-190 to -30 Hounsfield units). The NAMA/TAMA index was calculated by dividing NAMA by TAMA and multiplying by 100, and the lowest quartile of NAMA/TAMA index was defined as myosteatosis (<73.56 in men and <66.97 in women). Sarcopenia was defined using BMI-adjusted appendicular skeletal muscle mass. RESULTS The prevalence of myosteatosis was found to be significantly higher in participants with sarcopenic obesity (17.9% vs. 54.2%, p < 0.001) than the control group without sarcopenia or obesity. Compared with the control group, the odds ratio (95% CI) for having myosteatosis was 3.70 (2.87-4.76) for participants with sarcopenic obesity after adjusting for age, sex, smoking, drinking, exercise, hypertension, diabetes, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. CONCLUSIONS Sarcopenic obesity is significantly associated with myosteatosis, which is representative of poor muscle quality.
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Affiliation(s)
- Yun Kyung Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Han Na Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Hee Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jung Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
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23
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Westenberg LB, Zorgdrager M, Swaab TDA, van Londen M, Bakker SJL, Leuvenink HGD, Viddeleer AR, Pol RA. Reference values for low muscle mass and myosteatosis using tomographic muscle measurements in living kidney donors. Sci Rep 2023; 13:5835. [PMID: 37037940 PMCID: PMC10086018 DOI: 10.1038/s41598-023-33041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
Low muscle mass and myosteatosis are associated with poor clinical outcomes. Computed tomography (CT) imaging is an objective method for muscle mass and quality assessment; however consensus on cut-off values is lacking. This study assessed age-, sex-, and body mass index (BMI)-specific reference values of skeletal muscle parameters and correlated muscle mass with 24-h urinary creatinine excretion (24-h UCE). In total, 960 healthy subjects were included in this study. Muscle mass and quality were determined using axial CT slices at the vertebral level L3. The muscle area was indexed for height (skeletal muscle index [SMI]). The mean age was 53 ± 11 years, and 50% were male. The SMI reference values for low muscle mass in males were 38.8 cm2/m2 (20-29 years), 39.2 (30-39 years), 39.9 (40-49 years), 39.0 (50-59 years), 37.0 (60-69 years), and 36.8 (70-79 years). For females, these reference values were 37.5 cm2/m2 (20-29 years), 35.5 (30-39 years), 32.8 (40-49 years), 33.2 (50-59 years), 31.2 (60-69 years), and 31.5 (70-79 years). 24-h UCE and SMI were significantly correlated (r = 0.54, p < 0.001) without bias between the two methods of assessing muscle mass. This study provides age-, sex-, and BMI-specific reference values for skeletal muscle parameters that will support clinical decision making.
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Affiliation(s)
- Lisa B Westenberg
- Division of Transplant Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Marcel Zorgdrager
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim D A Swaab
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Division of Transplant Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Alain R Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Centre Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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24
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Avesani CM, de Abreu AM, Ribeiro HS, Brismar TB, Stenvinkel P, Sabatino A, Lindholm B. Muscle fat infiltration in chronic kidney disease: a marker related to muscle quality, muscle strength and sarcopenia. J Nephrol 2023; 36:895-910. [PMID: 36719556 PMCID: PMC10090035 DOI: 10.1007/s40620-022-01553-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/03/2022] [Indexed: 02/01/2023]
Abstract
Muscle fat infiltration (MFI) also known as myosteatosis refers to any deposit of lipids found in the skeletal muscle. MFI is preferably assessed by image-based methods like computed tomography (CT), magnetic resonance image (MRI) and ultrasound, normally from muscle groups located in the legs, arms and in the trunk. MFI is understood as a marker of muscle quality, where a muscle with higher fat deposition has lower contraction power and capacity to produce force per unit of muscle mass. This concept supports the hypothesis that a decrease in muscle strength is not always explained by a decrease in muscle mass, but also by other factors, including lipid deposition in the muscle. In the general population, MFI is associated with older age, physical inactivity and with insulin resistance and inflammation. In chronic kidney disease (CKD), MFI has been associated with a decrease in muscle strength and impaired muscle quality as well as with metabolic abnormalities, cardiovascular disease and increased mortality. Interventions aimed at reducing MFI in CKD are incipient, but it seems that guided exercise can ameliorate muscle quality in patients on hemodialysis. The aim of this narrative review about MFI in CKD is to draw attention to a still not often addressed complication in CKD. We conclude that more studies are warranted to investigate mechanisms and factors promoting MFI in CKD. Thus, clinical trials aimed at understanding the type, frequency and intensity of exercise that can diminish MFI and improve the clinical condition of the patients are needed.
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Affiliation(s)
- Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, M99, Karolinska Hospital University Hospital Huddinge, 14186, Stockholm, Sweden.
| | - Aline Miroski de Abreu
- Post-Graduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Heitor S Ribeiro
- Faculty of Health Sciences, University of Brasilia, Brasília, Brazil
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Maia, Maia, Portugal
| | - Torkel B Brismar
- Unit of Radiology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, M99, Karolinska Hospital University Hospital Huddinge, 14186, Stockholm, Sweden
| | - Alice Sabatino
- Department of Nephrology, Parma University Hospital, Parma, Italy
| | - Bengt Lindholm
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, M99, Karolinska Hospital University Hospital Huddinge, 14186, Stockholm, Sweden
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Zhang S, Huang Y, Li J, Wang X, Wang X, Zhang M, Zhang Y, Du M, Lin J, Li C. Increased visceral fat area to skeletal muscle mass ratio is positively associated with the risk of cardiometabolic diseases in a Chinese natural population: A cross-sectional study. Diabetes Metab Res Rev 2023; 39:e3597. [PMID: 36426681 PMCID: PMC10078378 DOI: 10.1002/dmrr.3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/26/2022]
Abstract
AIMS Visceral adiposity and skeletal muscle loss may be positively correlated with cardiometabolic outcomes. This study aimed to explore the associations between the visceral fat area to skeletal muscle mass ratio (VSR) and the risk of cardiometabolic diseases in a Chinese natural population. MATERIALS AND METHODS A total of 5158 participants were included in this study. Body composition, anthropometrical, and biochemical measurements were performed. Body composition was assessed via the direct segmental multi-frequency bioelectrical impedance analysis method. The associations between VSR and metabolic associated fatty liver disease (MAFLD), hyperglycemia, hypertension, dyslipidemia, and hyperuricemia were analysed. RESULTS With the increase of VSR by one quartile, the odds ratio (OR) increased significantly for all five cardiometabolic diseases in both genders (ptrend < 0.001). With regard to the highest versus the lowest quartile of VSR, the ORs for cardiometabolic diseases were significantly higher in women than in men. Restricted cubic splines showed that there were significant non-linear relationships between VSR and the risk of MAFLD, dyslipidemia, hyperglycemia, and hypertension in both genders (p for non-linearity <0.05). The risk was relatively flat until VSR reached 3.078 cm2 /kg in men and 4.750 cm2 /kg in women and started to increase rapidly afterwards. In men, however, the risk slowed down after the VSR value reached around 4 cm2 /kg. CONCLUSIONS VSR was positively associated with cardiometabolic diseases regardless of gender. As VSR increased, the risk of cardiometabolic diseases was significantly higher in women than in men. TRIAL REGISTRATION www.chictr.org.cn (Registration number: ChiCTR2100044305).
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Affiliation(s)
- Shi Zhang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Yaping Huang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Jing Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Xincheng Wang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Xiaohe Wang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Minying Zhang
- School of Medicine, Nankai University, Tianjin, China
| | - Yanju Zhang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Meiyang Du
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Jingna Lin
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Chunjun Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
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Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings. Eur J Appl Physiol 2023; 123:945-964. [PMID: 36683091 PMCID: PMC10119074 DOI: 10.1007/s00421-022-05114-y] [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: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
Given their importance in predicting clinical outcomes, cardiorespiratory fitness (CRF) and muscle status can be considered new vital signs. However, they are not routinely evaluated in healthcare settings. Here, we present a comprehensive review of the epidemiological, mechanistic, and practical bases of the evaluation of CRF and muscle status in adults in primary healthcare settings. We highlight the importance of CRF and muscle status as predictors of morbidity and mortality, focusing on their association with cardiovascular and metabolic outcomes. Notably, adults in the best quartile of CRF and muscle status have as low as one-fourth the risk of developing some of the most common chronic metabolic and cardiovascular diseases than those in the poorest quartile. The physiological mechanisms that underlie these epidemiological associations are addressed. These mechanisms include the fact that both CRF and muscle status reflect an integrative response to the body function. Indeed, muscle plays an active role in the development of many diseases by regulating the body's metabolic rate and releasing myokines, which modulate metabolic and cardiovascular functions. We also go over the most relevant techniques for assessing peak oxygen uptake as a surrogate of CRF and muscle strength, mass, and quality as surrogates of muscle status in adults. Finally, a clinical case of a middle-aged adult is discussed to integrate and summarize the practical aspects of the information presented throughout. Their clinical importance, the ease with which we can assess CRF and muscle status using affordable techniques, and the availability of reference values, justify their routine evaluation in adults across primary healthcare settings.
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Association between hypertension and myosteatosis evaluated by abdominal computed tomography. Hypertens Res 2023; 46:845-855. [PMID: 36635524 DOI: 10.1038/s41440-022-01157-y] [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: 08/17/2022] [Revised: 11/24/2022] [Accepted: 12/04/2022] [Indexed: 01/14/2023]
Abstract
Few studies have examined the relationship between myosteatosis and hypertension, and no studies have enrolled an Asian population. Existing studies also found discordant results, possibly due to the use of conventional myosteatosis indices that are not sufficiently reliable and representative. Therefore, we investigated the association between myosteatosis and hypertension in Asian individuals using novel, objective computed tomography (CT) markers. The total abdominal muscle area (TAMA) was determined from abdominal CT scans taken at the L3 level. Based on the mean CT attenuation, the TAMA was divided into intramuscular adipose tissue and skeletal muscle area (SMA), which was further segmented into normal attenuation muscle area (NAMA) and low attenuation muscle area (LAMA). Among SMA/body mass index (BMI), NAMA/BMI, LAMA/BMI, and the NAMA/TAMA index, NAMA/BMI was chosen through receiver operating characteristic curves as the best predictive marker for hypertension. The hypertension risk for each quartile of NAMA/BMI was calculated by logistic regression analysis. Among the 19,766 participants, 40.3% of men and 23.8% of women had hypertension. People with hypertension showed unhealthier myosteatosis profiles than normotensive controls. Similarly, a lower NAMA/BMI was significantly associated with a greater hypertension risk. The lowest quartile group of NAMA/BMI exhibited 2.3- and 2.6-fold higher risks of hypertension than the highest quartile in men and women, respectively. In conclusion, advanced myosteatosis assessed by abdominal CT was significantly correlated with a higher risk of hypertension. Improving myosteatosis may be a new approach for preventing cardiovascular diseases, including hypertension. Advanced myosteatosis measured by abdominal CT taken at the L3 level was significantly correlated with a higher risk of hypertension even after adjusting for health behaviors, intake of lipid-lowering drugs, plasma lipid levels, and other ectopic fat distribution.
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Guo W, Zhao X, Cheng D, Liang X, Miao M, Li X, Lu J, Xu N, Hu S, Zhang Q. Muscle Fat Content Is Associated with Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Chinese Adults. J Nutr Health Aging 2023; 27:960-965. [PMID: 37997716 DOI: 10.1007/s12603-023-2015-9] [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: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Several studies have linked myosteatosis with nonalcoholic fatty liver disease (NAFLD) in individuals with obesity. The clinical significance of myosteatosis in individuals with NAFLD in the general population has not been well investigated. Here, we wanted to explore and compare the associations of NAFLD and liver fibrosis with muscle fat content and skeletal muscle mass (SMM) in a relatively large general population in China. METHODS We retrospectively included all participants who underwent abdominal CT scans in our health promotion center between April 2021 and October 2021. Muscle fat content was assessed by abdomen quantitative computed tomography (QCT) scans, and SMM was evaluated by bioelectrical impedance. NAFLD was assessed by ultrasonography. The NAFLD fibrosis score (NFS) and Fibrosis-4 Index (FIB-4) score were calculated to assess liver fibrosis. RESULTS Compared with participants without NAFLD, patients with NAFLD showed significantly increased intermuscular adipose tissue (IMAT%) (7.40±3.37% vs. 6.76±2.66%, P <0.01). According to a multiple logistic regression model, IMAT% (OR=1.091, 95% CI 1.030-1.155, P=0.003) was only independently correlated with NAFLD in obese participants. Mediation analysis showed that BMI mediated the association between IMAT% and NAFLD. In participants with NAFLD, increased IMAT% was independently associated with an increased intermediate to high risk of advanced fibrosis assessed by the NFS or FIB-4 score after adjusting for multiple potential confounders. However, SMM was only independently correlated with an intermediate to high risk for advanced fibrosis evaluated by the NFS and not by the FIB-4 score. CONCLUSION Increased muscle fat content is positively correlated with NAFLD and intermediate to high risk for advanced fibrosis in the general Chinese population.
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Affiliation(s)
- W Guo
- Qun Zhang, M.D., Department of Health Promotion Center, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, China, 210029. E-mail: , ORCID: 0000-0003-2208-7998; Shuang Hu, M.D., Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China, 210008, E-mail:
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Lonardo A, Mantovani A, Petta S, Carraro A, Byrne CD, Targher G. Metabolic mechanisms for and treatment of NAFLD or NASH occurring after liver transplantation. Nat Rev Endocrinol 2022; 18:638-650. [PMID: 35840803 DOI: 10.1038/s41574-022-00711-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/08/2022]
Abstract
The rising tide of non-alcoholic fatty liver disease (NAFLD) associated with the obesity epidemic is a major health concern worldwide. NAFLD - specifically its more advanced form, non-alcoholic steatohepatitis (NASH)-related cirrhosis - is now the fastest growing indication for liver transplantation in the USA and Europe. Although the short-term and mid-term overall survival rates of patients who receive a liver transplant for NASH-related cirrhosis are essentially similar to those of patients who receive a transplant for other liver indications, recipients with NASH-related cirrhosis have an increased risk of waiting-list mortality and of developing recurrent liver disease and cardiometabolic complications in the longer term after liver transplantation. This Review provides a brief overview of the epidemiology of NAFLD and NASH and the occurrence of NAFLD or NASH in patients after liver transplantation for NASH and other liver indications. It also discusses the putative metabolic mechanisms underlying the emergence of NAFLD or NASH after liver transplantation as well as optimal therapeutic approaches for recipients of liver transplants, including the management of cardiometabolic comorbidities, tailored immunosuppression, lifestyle changes and pharmacotherapy for NAFLD.
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Affiliation(s)
- Amedeo Lonardo
- Metabolic Syndrome Unit, University of Modena, Modena, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Petta
- Section of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy
| | - Amedeo Carraro
- Liver Transplant Unit, University of Verona, Verona, Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
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Jung HN, Cho YK, Kim HS, Kim EH, Lee MJ, Park JY, Lee WJ, Kim HK, Jung CH. Association of serum gamma-glutamyl transferase with myosteatosis assessed by muscle quality mapping using abdominal computed tomography. Clin Imaging 2022; 93:4-11. [DOI: 10.1016/j.clinimag.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/18/2022] [Accepted: 10/12/2022] [Indexed: 11/03/2022]
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Murawiak M, Krzymińska-Siemaszko R, Kaluźniak-Szymanowska A, Lewandowicz M, Tobis S, Wieczorowska-Tobis K, Deskur-Śmielecka E. Sarcopenia, Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over. Nutrients 2022; 14:2889. [PMID: 35889850 PMCID: PMC9317847 DOI: 10.3390/nu14142889] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Poor nutritional status (PNS) is a modifiable factor determining abnormalities in body composition-sarcopenia, obesity, and sarcopenic obesity (SO). We aimed to assess the prevalence of these conditions and their association with PNS in 211 community-dwelling older adults. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recommendations. Obesity was diagnosed with the Percent Body Fat (>42% in women and >30% in men). Subjects fulfilling the criteria for obesity and concomitantly with reduced lower and/or upper limbs muscle strength and muscle mass (ALM/BMI < 0.512 in women and <0.789 in men) were classified as SO phenotype. Participants without obesity and sarcopenia were categorized as ‘normal’ phenotype. Nutritional status was estimated with the Mini Nutritional Assessment, and a score of <24 indicated PNS. In total, 49.8% participants had abnormal body composition (60.7% men and 42.5% women; p = 0.001). Sarcopenia, obesity, and SO were diagnosed in 10%, 32.7%, and 7.1% of subjects. PNS was found in 31.3% of the study sample. Its prevalence differed between phenotypes: 81% in sarcopenia, 60% in SO, 14.5% in obesity, and 28.3% in the ‘normal’ phenotype group (p = 0.000). Based on the results, abnormal body composition is prevalent in elderly subjects. Sarcopenia and SO are often associated with PNS.
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Affiliation(s)
- Marika Murawiak
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Roma Krzymińska-Siemaszko
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Aleksandra Kaluźniak-Szymanowska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Marta Lewandowicz
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland;
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
| | - Ewa Deskur-Śmielecka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (M.M.); (A.K.-S.); (M.L.); (K.W.-T.); (E.D.-Ś.)
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Kim HJ, Rho M, Yoon KB, Jo M, Lee DW, Kim SH. Influence of cross-sectional area and fat infiltration of paraspinal muscles on analgesic efficacy of epidural steroid injection in elderly patients. Pain Pract 2022; 22:621-630. [PMID: 35735193 DOI: 10.1111/papr.13141] [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: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND An assessment of paraspinal muscle degeneration based on magnetic resonance imaging has been used to investigate both sarcopenia and myosteatosis. The morphologic changes in cross-sectional area and fat infiltration of the paraspinal muscles can affect pain outcomes after epidural steroid injection. METHODS Patients ≥65 years of age who underwent fluoroscopy-guided lumbar epidural steroid injections were enrolled. Good analgesia was defined as ≥50% reduction in pain score at 4 weeks after injection. Cross-sectional area and grade of fat infiltration of the paraspinal muscles on magnetic resonance images at the level of L3-L4 disc were measured. Patient demographics, pain-related factors, clinical factors, and paraspinal muscle measurements were compared between good and poor analgesia groups. The factors associated with pain outcomes after injection were identified using multivariate analysis. RESULTS A total of 245 patients consisting of 149 and 96 patients in the good and poor analgesia groups, respectively, fully satisfied the study criteria for analysis. Patients of older age, opioid use, and high-grade foraminal stenosis were frequently observed in the poor analgesia group. The grade of fat infiltration of the paraspinal muscles was significantly higher in the poor analgesia group (Grade 2, 20.8% vs. 42.7%, p < 0.001), and this result was predominantly observed in female patients. However, there was no difference in the muscle cross-sectional area between the two groups (18.29 ± 3.16 vs. 18.59 ± 3.03 cm2 /m2 , p = 0.460). The percentage of patients with good analgesia decreased as the grade of fat infiltration increased (Grade 0 = 75.0%, Grade 1 = 65.8%, Grade 2 = 43.0%, p < 0.001). Multivariate logistic regression analysis revealed that preinjection opioid use [adjusted odds ratio (aOR) = 1.926, 95% confidence interval (CI) = 1.084-3.422, p = 0.025], moderate to severe foraminal stenosis (aOR = 2.859, 95% CI = 1.371-5.965, p = 0.005), and high-grade fat infiltration of the paraspinal muscles (aOR = 4.258, 95% CI = 1.805-10.043, p = 0.001) were significantly associated with poor analgesia after injection. CONCLUSION High fat infiltration of the paraspinal muscles at the mid-lumbar region appeared to be an independent factor associated with poor analgesia after epidural steroid injection in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care. However, the cross-sectional area of the paraspinal muscles was not associated with pain relief after injection.
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Affiliation(s)
- Hee Jung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Miribi Rho
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Bong Yoon
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minju Jo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Koo BK. Assessment of Muscle Quantity, Quality and Function. J Obes Metab Syndr 2022; 31:9-16. [PMID: 35318289 PMCID: PMC8987447 DOI: 10.7570/jomes22025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia is a syndrome characterized by loss of skeletal muscle mass and strength that can increase the risk of physical disability, chronic conditions such as diabetes mellitus and cardiovascular diseases, and long-term mortality. Sarcopenia adversely affects not only the elderly population, but also young adults. This review provides updated definitions of sarcopenia and recommendations for the assessment of muscle quantity and quality.
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Affiliation(s)
- Bo Kyung Koo
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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