Search

Summary: Background and aims: Oral nutritional supplements (ONS) are prescribed for older adults with malnutrition and sarcopenia to prevent nutritional and functional deterioration. Studies investigating ONS effectiveness commonly provide the same ONS prescription for participants. This scoping review aimed to provide an overview of studies that have personalized ONS prescription in older adults with malnutrition or sarcopenia. Methods: In July 2023, PubMed, CINAHL, SCOPUS and EMBASE were searched for studies wherein older adults with malnutrition, risk of malnutrition or sarcopenia received personalized ONS. Data extracted were synthesized into tables and descriptively summarized. Results: Fifteen studies met the inclusion criteria, all in developed countries: 10 randomized controlled, 3 cross-over, 1 non-randomized and 1 single-arm trials. Fourteen studies included older adults at risk of malnutrition/malnourished. One study included older adults with sarcopenia. Studies included between 34 and 671 participants aged 70–88 years. Dietitians (10 studies) or trained nutritionists (5 studies) personalized the ONS prescription. Personalization included: (i) providing ONS for protein requirements based on weight (11 studies) or (ii) current dietary intake (2 studies), or (iii) offering ONS flavors based on personal preference (2 studies). Outcome measures included nutritional status, change in body weight/composition and quality of life. Definition and methods of assessing adherence varied. Seven studies showed a significant improvement in primary outcomes when personalized ONS were prescribed. Conclusion: 15 studies which personalized ONS for older adults with malnutrition/sarcopenia were identified. Further research on optimizing personalized approaches with standardized outcome measures is warranted.

Summary: Background and Aims: Poor body composition is associated with impaired outcomes in patients with chronic liver disease (CLD), and various assessment tools are used. The aim of this study is to gain insight into the clinical practice of nutritional assessment in patients with CLD. Methods: A semi-structured online survey on nutritional assessment tools for measuring body composition in patients with CLD was conducted among hepatologists and dietitians, mainly from hospitals between April 2023 and May 2023. Results: A total of 45 eligible surveys were included in this study (dieticians N=35, hepatologists N=10). All dieticians had at least one nutritional assessment tool available. Bio-electrical impedance and hand-grip strength were the most available and used. The most important reasons for assessment were diagnosis of nutritional status, evaluation of nutritional intervention and for assessing risk of mortality. A proportion of 49% of the dieticians and 60% of the hepatologists respectively were familiar with the ‘European society of parenteral and enteral nutrition Guideline Clinical Nutrition in Liver disease’. Only 13% of dieticians and 60% of the hepatologists knew the ‘European Association for the Study of the Liver Clinical Practice Guidelines on nutrition in chronic liver disease’ and only eight dieticians and one hepatologist used a protocol for nutritional assessment in patients with CLD. Conclusion: The importance of measuring body composition in patients with CLD for diagnosing and monitoring nutritional status and for assessing risk of mortality is well-known by dieticians and most hepatologists. However, implementation of the current guidelines is substandard and should be improved.

Background: Muscle atrophy or sarcopenia is the loss of muscle mass and strength and leads to an increased risk of disability and death including osteoporotic fractures. Currently, there are no available clinical biologic agents for the treatment of sarcopenia. Since exosomes have become increasingly attractive as a novel therapeutic approach due to their ability to facilitate cell-cell transfer of proteins and RNAs, promoting cell repair and function recovery, we hypothesized that human umbilical cord mesenchymal stem cell-derived exosomes (hucMSC-Exos) might benefit muscle atrophy in age-related and dexamethasone-induced sarcopenia animal models. Methods: HucMSC-Exos were harvested by ultrafast centrifugation and identified by transmission electron microscopy, particle size analysis, and Western blot analysis. The effects of hucMSC-Exos on muscle atrophy were evaluated using age-related and dexamethasone-induced muscle atrophy mice models. Body weight, grip strength, muscle weight, and muscle histology of these mice were assessed. The expression levels of muscle RING finger 1 (MuRF1) and muscle atrophy F-box (atrogin-1) were measured by Western blot. Dexamethasone-induced C2C12 myotube atrophy was used to establish the cell model of muscle atrophy. Myotube diameter was evaluated by immunofluorescence staining. Bioinformatic analysis, RNA sequencing analysis, and Western blot analysis were performed to explore the underlying mechanisms. Results: In vivo experiments, hucMSC-Exos demonstrated a remarkable capacity to improve grip strength, increase muscle mass, and muscle fiber cross-sectional area, while concurrently reducing the expression of MuRF1 and atrogin-1 in age-related and dexamethasone-induced muscle atrophy mice. In vitro experiments, hucMSC-Exos can promote the proliferation of C2C12 cells, and rescue the dexamethasone-induced decline in the viability of C2C12 myotubes. In addition, hucMSC-Exos can increase the diameter of C2C12 myotubes, and reduce dexamethasone-induced upregulation of MuRF1 and atrogin-1. Combined with bioinformatics analysis and RNA sequencing analysis, we further showed that miR-132-3p was one of the essential miRNAs in hucMSC-Exos and played an important role by targeting FoxO3. Conclusion: Our findings suggested that hucMSC-Exos can improve age-related and dexamethasone-induced muscle atrophy in mice models. This study first demonstrated that hucMSC-Exos may ameliorate muscle atrophy via the miR-132-3p/FoxO3 axis. These data may provide novel and valuable insights into the clinical transformation of hucMSC-Exos for the treatment of sarcopenia. The translational potential of this article: HucMSC-Exos are easily available for clinical application, this study further consolidates the evidence for the clinical transformation potential of hucMSC-Exos for sarcopenia and provides its new target pathway.

Summary: Background & Aims: Sarcopenia and myosteatosis are proving to be major factors to predict mortality in intensive care patients. Few studies are currently focusing on evaluating the functional impact after intensive care discharge and none has considered sarcopenia and myosteatosis as prognostic factors.The aim of our study was to determine whether sarcopenia and myosteatosis are reliable prognostic factors for mid-term functional impact in critical patients a few months after intensive care discharge. Methods: We carried out a retrospective monocentric study using computed-tomography scanner performed on intensive care admission and/or three months after discharge to assess sarcopenia and myosteatosis in 43 patients with critical illnesses who underwent a multidisciplinary evaluation on a multidisciplinary consultation's day hospital.We used L3 and/or T4 computed-tomography-scan levels to assess sarcopenia with the skeletal muscle index and myosteatosis with skeletal muscle density. These data were compared with main patient characteristics on intensive care admission and during intensive care stay and with functional assessments at the post intensive care multidisciplinary consultations, based on hand grip strength test, 6-minute walking test, and peak inspiratory pressure. Results: We found a good correlation of both skeletal muscle index and skeletal muscle density for T4 and L3 levels. Skeletal muscle index was correlated with hand grip strength test, and skeletal muscle density with 6-minute walking test, which are both functional tests recommended in the algorithm of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia. Peak inspiratory pressure was correlated with both skeletal muscle index and skeletal muscle density and also with other functional tests. Conclusions: We confirmed the reliability of thoracic computed-tomography-scan to assess sarcopenia and myosteatosis. We found that skeletal muscle index and skeletal muscle density are independent but complementary predictive factors for functional impact at mid-term in intensive care patients. Peak inspiratory pressure could be a useful tool for the assessment and management of sarcopenia.

Summary: Objective: Sarcopenia, characterized by the loss of muscle mass and function, is prevalent in peritoneal dialysis (PD) patients. Early diagnosis is crucial, but universal screening is often hindered by the complexity of diagnostic algorithms and limited clinical resources. Therefore, this study aims to investigate the ability of bioelectrical impedance analysis-derived phase angle (PhA), a convenient and cost-effective technique, in detecting sarcopenia among PD patients. Methods: A single-center cross-sectional study was conducted on 130 multi-ethnic PD patients in Malaysia. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) 2019 diagnostic algorithm. PhA was measured by a multi-frequency bioelectrical impedance analysis device at 50kHz. Multivariable logistic regression was used to determine predictability of PhA on sarcopenia. Receiver operating characteristics analysis was used to evaluate the discriminative performance of PhA in detecting sarcopenia. Optimal gender-specific PhA cut-off values for sarcopenia detection were determined based on desired sensitivity and specificity. Results: Sarcopenia was identified in 25.4% of the PD patients. PhA emerged as an independent predictor of sarcopenia (adjOR= 0.147; 95%CI =0.042–0.516; P =0.003), exhibiting excellent discriminative power in identifying sarcopenia (adjAUCoverall= 0.818±0.041; bootstrapped 95%CI =0.734–0.899, P

Purpose: Frailty and sarcopenia may progressively worsen physical function, and studies have noted the frequent presence of sarcopenia in patients who undergo total hip arthroplasty (THA). This study aimed to examine the prevalence of comorbid frailty and sarcopenia in older patients undergoing THA and to determine the impact of these conditions on lower limb strength and hip function. Methods: Patients aged ≥65 years who had undergone THA at least 1 year previously were divided into five groups according to the presence and severity of frailty and sarcopenia. Lower limb strength [hip abductor (HA) and knee extensor (KE)], balance, and hip function were compared. Results: Sarcopenia and frailty affected lower limb muscle strength and hip function in a staircase-like manner, with mean ​± ​standard deviation values for the five groups as follows: HA muscle strength (in Nm/body weight), robust 0.80 ​± ​0.23, pre-frail ​+ ​non-sarcopenia 0.69 ​± ​0.17, pre-frail ​+ ​sarcopenia 0.58 ​± ​0.20, frail ​+ ​non-sarcopenia 0.54 ​± ​0.16, frail ​+ ​sarcopenia 0.50 ​± ​0.16; KE muscle strength (in kgf/body weight), robust 1.17 ​± ​0.23, pre-frail ​+ ​non-sarcopenia 1.03 ​± ​0.32, pre-frail ​+ ​sarcopenia 0.90 ​± ​0.31, frail ​+ ​non-sarcopenia 0.84 ​± ​0.27, frail ​+ ​sarcopenia 0.74 ​± ​0.21; and Harris Hip Score, robust 96.8 ​± ​4.6, pre-frail ​+ ​non-sarcopenia 94.3 ​± ​7.9, pre-frail ​+ ​sarcopenia 88.6 ​± ​9.6, frail ​+ ​non-sarcopenia 87.5 ​± ​10.3, frail ​+ ​sarcopenia 83.5 ​± ​8.6. Conclusion: Progression of sarcopenia and frailty affects lower limb muscle strength and physical function in a staircase-like fashion, suggesting the need to assess the cumulative effects of the two. Among this population, rather than interventions to improve muscle strength and balance in specific areas, interventions to maintain a comprehensive level of physical fitness and muscle mass (including nutrition and lifestyle changes) may be necessary.

Objectives: Locomotive syndrome (LS) leads to reduced physical function and a high risk of becoming bedridden. Grip strength serves as an indicator of upper limb and overall physical function. Rheumatoid arthritis (RA) patients with reduced grip strength frequently show finger and wrist joint inflammation. The purpose of this study was to verify grip strength as an evaluation tool for physical function and LS in RA patients. Methods: As part of an ongoing multicenter observational study, 591 consecutive RA patients whose background information was available, including data for the 25-question Geriatric Locomotive Function Scale (GLFS-25) and grip strength, were examined. LS was defined as a GLFS-25 score ≥ 16 points. Finger and wrist joint inflammation were defined as tender or swollen joints. Results: Among the 591 patients, 244 (41.3%) patients had LS, and 167 (28.3%) were male. Receiver operating characteristic curve analysis yielded cut-off values of grip strength for LS of 24 kg (specificity 72.2%; sensitivity 62.7%) for males and 17 kg (specificity 65.7%; sensitivity 67.6%) for females. Multivariable logistic regression analysis revealed a significant association of grip strength with LS, even after adjusting for finger and wrist joint inflammation. Conclusions: LS was significantly associated with grip strength, even after adjusting for the presence of finger and wrist joint inflammation. We recommend adopting grip strength measurement as a screening tool for evaluating LS and guiding interventions.

Background: The prevalence of sarcopenia is high among older adults residing in long-term care settings (LTCS). Guidelines to manage sarcopenia cannot be directly implemented among sarcopenic older adults residing in LTCS. Objectives: To examine the effectiveness of a codesigned Reablement Strategies targeting Sarcopenia (ReStart-S) program on muscle parameters, physical performance, blood biomarkers and quality of life among sarcopenic older adults residing in LTCS. Methods: The study is a cluster randomized trial that will take place in LTCS. A total of 78 sarcopenic older adults will be included, selected through convenience sampling, and diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. The LTCS clusters will be randomized into intervention and control groups. The participants in the intervention group will receive the ReStart-S multicomponent exercise intervention twice a week for a total of six weeks, while those in the control group will continue with their usual daily activities. The primary outcome will be grip strength, and the secondary outcomes will include a short physical performance battery, muscle mass, C-terminal agrin fragment, and quality of life as assessed through the sarcopenia and quality of life-Kannada version questionnaire. The outcomes will be measured at week 0, week 6, week 12, and week 18. Conclusion: ReStart-S program if found to be effective could be implemented globally to manage sarcopenia and promote healthy ageing in older adults, enhancing their independence in LTCS.

Backgound: Older lung transplant recipients experience increased rates of adverse clinical outcomes, including infection compared with younger patients, potentially related to impaired cell-mediated immunity, frailty, and sarcopenia. Methods: Patients over age 55 years undergoing evaluation for lung transplantation were evaluated for sarcopenia by cross-sectional area and average attenuation of the pectoralis major muscle on chest computed tomography. Frailty was measured using the Fried Frailty Phenotype. Immune phenotyping was performed using multichannel flow cytometry of peripheral blood mononuclear cells (PBMC) in a total of 26 lung transplant candidates. Results: The median patient age was 65, primarily with restrictive lung disease (76.9%). Hospital readmission was associated with lower frequency of naïve CD4 (p = 0.004) and CD8 T cells (p = 0.026). Senescent CD4 (KLRG1+/CD28−) and CD8 T cells were also associated with readmission (p = 0.014 and p = 0.013, respectively), and senescent CD4 T cells were predictive of total hospital time (p = 0.003). TEMRA CD4 T cells were significantly associated with frailty (p = 0.015) and sarcopenia (p = 0.011). Senescent CD4 and CD8 T cells were significantly associated with sarcopenia (p = 0.009 and p = 0.006, respectively). Conclusions: These findings suggest that impaired cell-mediated immunity may underlie the associations between frailty and sarcopenia and poor clinical outcomes. A multifaceted approach to evaluation of older patients has the potential to improve risk stratification and inform management of immunosuppression.

Background: Poor sleep quality may contribute to sarcopenia, but evidence remains sparse. This retrospective cross-sectional study investigated the association between subjective sleep quality and probable sarcopenia in a cohort of community-dwelling older adults enrolled in the Longevity Check-Up 8+ study. Methods: Participants were asked about their sleep quality over the past month, with four possible options (“very good”, “quite good”, “quite bad”, very bad”). For the analysis, participants were grouped into good or bad sleep quality categories. Probable sarcopenia was operationalized according to handgrip strength values < 27 kg for men and

Summary: Background: A better understanding of body-brain links may provide insights on targets for preventing cognitive decline. The aim was to explore associations of body composition with neuroimaging biomarkers and cognitive function among dementia-free 70-year-olds. Methods: Dual-energy X-ray absorptiometry body composition measures in relation to neuroimaging measures of cortical thickness, hippocampal volume, small vessel disease, predicted brain age, and cognitive performance were explored in a cross-sectional study of 674 dementia-free 70-year-olds from the Swedish Gothenburg H70 Birth Cohort study. Linear or ordinal regression analyses were performed. Findings: Higher quantity of muscle mass was associated with lower predicted brain age (β: −0.31 [95% CI: −0.45, −0.16], p: 0.00013). Those with normal level muscle mass (>7.0 men, >5.5 women kg/height m2) had overall thicker cortex (β: 0.043 [95% CI: 0.023, 0.064], p: 0.00016), thicker cortex in Alzheimer's disease signature regions (β: 0.051 [95% CI: 0.025, 0.076], p: 0.00040), and larger hippocampal volume (β: 111.52 [95% CI: 25.28, 197.75], p: 0.030) compared to those with sarcopenic level muscle mass. Higher accumulation of visceral fat was associated with overall thinner cortex (β: −0.017 [95% CI: −0.028, −0.005], p: 0.024). Faster gait speed and higher handgrip strength were associated with indicators of better brain health. Interpretation: Improving muscle mass fitness and lower visceral fat may be beneficial for brain health. Intervention studies are needed to confirm that targeting body composition can promote healthy brain ageing and reduce the risk of cognitive impairment among older adults. Funding: The Swedish Research Council, Hjärnfonden, and Alzheimerfonden.

Background: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a newly developed lipid parameter that's used to evaluate cardiovascular disease risk. However, its association with sarcopenia risk has not been explored before. Methods: Data on NHHR and sarcopenia were based on the secondary analysis of the years 2011–2018 of National Health and Nutrition Examination Survey (NHANES) dataset. NHHR was nature log-transformed (LnNHHR) to achieve a normal distribution. A multivariate logistic regression and a restricted cubic spline (RCS) model adjusted for associated factors were utilized to evaluate the correlation between NHHR and sarcopenia. Subgroup and sensitivity analyses were conducted to verify the robustness of the findings. Results: The study cohort comprised 7069 participants, of whom 6497 (91.91 %) were sarcopenia-free, and 572 (8.09 %) exhibited sarcopenia. A significant increase in NHHR was observed in the sarcopenia group compared to the non-sarcopenic group (P

Objectives: The utility of the updated Asian Working Group for Sarcopenia (AWGS) criteria in diagnosing sarcopenia in older patients with heart failure (HF) remains unclear. Objective: To analyze the prevalence and prognostic impact of sarcopenia diagnosed by the updated AWGS criteria in older patients with HF. Design: Ambispective cohort study. Setting & subjects: 534 older patients with HF from a university hospital in Japan. Measurements: Sarcopenia was assessed using different versions of the AWGS criteria: AWGS 2014, AWGS 2019H (muscle mass relative to height squared), and AWGS 2019B (muscle mass relative to BMI). The primary endpoint was all-cause mortality at three years post-discharge. Results: Of 534 patients, 42%, 57%, and 44% were diagnosed with sarcopenia according to AWGS 2014, AWGS 2019H, AWGS 2019B, respectively. Among patients without AWGS 2014-defined sarcopenia, 23% were reclassified as having sarcopenia by AWGS 2019H criteria. Forty-four percent of sarcopenic patients diagnosed by AWGS 2019H were re-classified as non-sarcopenic by AWGS 2019B, with lower fat mass and poorer nutritional status. After the multivariate Cox proportional hazard analyses, an association between all-cause death and sarcopenia remained significant for AWGS 2014 (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.01–2.37) and AWGS 2019H (HR, 1.65; 95% CI, 1.05–2.59), but not for AWGS 2019B (HR, 0.99; 95% CI, 0.64–1.51). Conclusion: The updated AWGS 2019H criteria detected more sarcopenic patients with HF while maintaining favorable predictive ability. The use of BMI-adjusted muscle mass reclassified underweight and malnourished patients as non-sarcopenic, limiting its impact on the mortality prediction in older patients with HF.

Objectives: To identify whether the Grip-Strength-Lean-Mass Index (GSLMI) can precisely diagnose sarcopenia and predict prognosis for cancer patients in clinical settings. Design: A nationwide multicenter cohort study. Setting and participants: 8,831 inpatients aged 18 years and older, histologically diagnosed with cancer and receiving anti-cancer therapy. Measurements: The GSLMI is the ratio of hand grip strength (HGS) divided by lean mass (LM), calculated by the formula: GSLMI = HGS (kg) / LM (kg). Kaplan-Meier curves and Cox models were used to estimate the association between the GSLMI and survival. Results: A total of 3,071 (48.40%) male and 3,274 (51.60%) female patients were enrolled in the study. The prevalence of GLIS-defined sarcopenia was 2,646 (41.70%). The optimal sex-specific thresholds with the best diagnostic performance to identify a low GSLMI were determined to be

Background: There has been a growing body of research demonstrating that thigh circumference is closely associated with the development of various chronic disease. However, limited evidence has been obtained regarding the relationship between thigh circumference and sarcopenia. Objective: The aim of this study was to investigate the relationship between thigh circumference and sarcopenia, and explore the potential role of thigh circumference for sarcopenia screening among community-dwelling older adults. Methods: The investigation was carried out in six rural communities located in northwestern China with participants aged ≥60 years old. We collected variables related to sarcopenia, including function, muscle mass, and strength. The thigh circumference was categorized into four groups based on quartiles, with the first quartile (≤46.65 cm); the second quartile (46.66–48.50 cm); the third quartile (48.51–50.55 cm); and the fourth quartile (>50.55 cm). The associations and screening effect were estimated with multivariate logistics regression and ROC curves. Results: Of the 1000 participants aged 70.72 ± 4.68 years. Compared with the first quartile (≤46.65 cm), the odds ratios for the second, third, and fourth quartiles of thigh circumference were 0.465 (95%CI: 0.281–0.770, p = 0.003), 0.199 (95%CI: 0.097–0.407, p

Background: Despite the emerging interest in phase angle (PhA), a non-invasive marker of cell hydration and nutritional status, no previous study has reported the prospective association between PhA and incident sarcopenia. Therefore, the aim of our study was to evaluate the association of baseline PhA in older subjects without sarcopenia with the development of new sarcopenia as outcome. Methods: Six-hundred ninety-six subjects without sarcopenia aged ≥75 years enrolled in an international multicenter observational study were included. Sarcopenia was assessed according to the revised EWGSOP2 criteria at baseline and in follow-up visits at 12 and 24 months. Muscle strength was assessed through the handgrip strength test using a hydraulic grip strength dynamometer, muscle mass was assessed by bioimpedance analysis (BIA) and appendicular skeletal muscle mass (ASMM) was estimated. Physical performance was assessed by Short Physical Performance Battery (SPPB). Results: Participants who developed sarcopenia were older, less educated, had higher prevalence of osteoporosis, and lower baseline cognitive function, SPPB, handgrip strength and ASMM than those without sarcopenia. Baseline PhA was significantly lower in subjects developing sarcopenia. Nevertheless, after adjusting for all potential covariates including baseline components of sarcopenia in multiple logistic regression, neither PhA as continuous variable nor different levels of PhA were any more significant predictors of sarcopenia. Conclusions: As an indicator of cells function, PhA could be a potential useful early marker in identifying older people at risk of developing sarcopenia but its practical applicability remains uncertain with the present data.

ABSTRACT: Background: Prior studies have linked sarcopenia and fat infiltration in paraspinal muscles with lumbar pain, spinal pathology, and adverse postoperative outcomes in lumbar spine surgery. A recent magnetic resonance imaging (MRI)-based method for assessing muscle health, incorporating parameters such as Goutallier Classification (GC) and the Paralumbar Muscle Cross-Sectional Area to Body Mass Index ratio (PL-CSA/BMI), has shown that higher muscle grades correlate with significant improvements in patient-reported outcomes. Despite these advancements, there is limited research on the associations between paralumbar muscle health and factors such as age, BMI, walking tolerability, and spondylolisthesis. Our study aimed to evaluate such associations. Methods: This Institutional Review Board-approved retrospective cohort study included patients aged 18 or older presenting with back pain symptoms who underwent lumbar spine MRI within 12 months of presentation to a single orthopedic surgeon. Patients with incomplete imaging, cancer pathology, or trauma-induced injuries were excluded. MRI-based measurements of Lumbar Indentation Value (LIV), Goutallier Classification (GC), and PL-CSA/BMI were used as outcome measures. Paralumbar muscles on axial T2-weighted lumbar MRIs were outlined using ImageJ to determine the PL-CS and LIV through the L1–L5 disc spaces, with GC classified by the primary author. Quantile regression analysis was used for continuous variables, and negative binomial regression with an estimated ancillary parameter was applied for ordinal variables, with statistical significance set at p 1 block predicted LIV and GC at L2/L3 while predicting CSA/BMI at L4/L5. Increasing age was associated with decreased CSA at L1/L2, L2/L3 and L4/L5 while it was associated with decreased CSA/BMI and increased GC at all lumbar levels. Age was only associated with decreased LIV at L1/L2, L2/L3. Lastly, increasing BMI was associated with increased CSA, LIV, and decreased CSA/BMI at all lumbar levels and associated with increased GC at all lumbar levels except L4/L5. All statistically significant associations had p-values

Objectives: This study aimed to investigate the effects of resistance training (RT) on knee extensor muscle hypertrophy in adults 65 years and older. Methods: A systematic search was carried out in PubMed, Embase, and Scopus to review randomized controlled trials that assessed the effects of supervised RT on 1) muscle size, 2) fiber area, and 3) leg lean mass (LLM). Random-effects meta-analyses of standardized mean difference (SMD) and raw mean difference (RMD) for LLM were calculated. We performed a meta-regression to examine the interference of age, training volume, and duration on the results related to hypertrophy at muscle and fiber levels. Results: Thirty-two studies were included in the review, and 28 were meta-analyzed. The meta-analysis found a significant effect of RT on muscle size (SMD = 0.34; 95 % CI: 0.16–0.52; p

Sarcopenia, characterized by the progressive loss of muscle mass and function, significantly affects patients with chronic obstructive pulmonary disease (COPD) and worsens their morbidity and mortality. The pathogenesis of muscle atrophy in patients with COPD involves complex mechanisms, including protein imbalance and mitochondrial dysfunction, which have been identified in the muscle tissues of patients with COPD. DKK3 (Dickkopf-3) is a secreted glycoprotein involved in the process of myogenesis. However, the role of DKK3 in the regulation of muscle mass is largely unknown. This study investigated the role of DKK3 in COPD-related sarcopenia. DKK3 was found to be overexpressed in cigarette smoking-induced muscle atrophy and in patients with COPD. Importantly, plasma DKK3 levels in COPD patients with sarcopenia were significantly higher than those without sarcopenia, and plasma DKK3 levels could effectively predict sarcopenia in patients with COPD based on two independent cohorts. Mechanistically, DKK3 is secreted by skeletal muscle cells that acts in autocrine and paracrine manners and interacts with the cell surface-activated receptor cytoskeleton-associated protein 4 (CKAP4) to induce mitochondrial dysfunction and myotube atrophy. The inhibition of DKK3 by genetic ablation prevented cigarette smoking‐induced skeletal muscle dysfunction. These results suggest that DKK3 is a potential target for the diagnosis and treatment of sarcopenia in patients with COPD.

Muscle mass and strength gradually decline from middle age, and appropriate physical activity and exercise habits during this period play a key role in preventing sarcopenia. Exercise is the most effective method for improving muscle health, and consuming appropriate dietary supplements along with exercise can boost its effects. Human milk is the most essential source for muscle growth during infancy, and 2′-fucosyllactose (2′-FL) is most abundant oligosaccharide in human milk. Therefore, we hypothesized that 2′-FL would exhibit muscle protective properties in 10-month-old aged male mice subjected to forced swimming exercises. Our findings revealed that 2′-FL administration significantly improved muscle mass, thickness, and strength of calf muscle compared to forced swimming exercise alone. Additionally, 2′-FL enhanced the hypertrophic changes in gastrocnemius and soleus. Furthermore, 2′-FL upregulated gene expression related to muscle protein synthesis (PI3K, AKT1) and muscle growth (A1R, TRPV4), while inhibiting gene expression related to muscle protein degradation (Atrogin-1, MuRF-1) and muscle growth inhibition (Myostatin, SIRT1). 2′-FL also ameliorated exercise-induced oxidative stress, restored antioxidant enzyme activity, and mitigated muscular cell damage. These findings suggest that 2′-FL may serve as a functional dietary supplement combined with exercise for muscle health.

Fortified foods have garnered significant attention as potential therapeutic strategies with less adverse effects and ready accessibility. However, precise formulation is required to optimize their beneficial effects. Our study aimed to unravel the mechanisms of a functional protein beverage, hydroxymethylbutyrate and glucosamine fortified whey protein drink (HG-WPD), as a possible intervention combatting sarcopenia and Alzheimer's disease (AD) by network pharmacology, molecular docking, and experimental assays. This study investigates the molecular pathways through which HG-WPD acts, by combining in silico and in vitro analyses. Our in silico study predicted the important target proteins, including acetylcholinesterase (AChE), matrix metalloproteinase 9 (MMP9), and angiotensin-converting enzyme (ACE), linked to both diseases. The molecular docking analysis showed that hydroxymethylbutyrate and glucosamine exhibited a notable binding affinity to these proteins, therefore suggesting their possible use as multi-target medicinal agents. In vitro studies on C2C12 myotubes showed that HG-WPD reduced dexamethasone-induced cell death highlighting its potential anti-sarcopenic actions. Furthermore, confirming their possible function in reducing cognitive impairment in AD, the antioxidant tests showed great activity of both substances. The results imply that HG-WPD is potentially effective for future therapeutic approaches as a functional food product with dual benefits in combatting sarcopenia and AD.

Background: Sarcopenia is closely associated with cardiovascular disease. We aimed to examine the association of Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health (CVH), with the presence of sarcopenia among US adults. Methods: This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2005–2006 and 2011–2018, and included adults aged 20 years or older. LE8 score was measured according to American Heart Association definitions. Sarcopenia was measured according to the National Institutes of Health definition, the ratio of appendicular skeletal muscle mass (ASM) to body mass index (BMI). Multivariable logistic and restricted cubic spline models were used to assess the associations between LE8 and sarcopenia. Results: Among the 11,078 participants, 1021 (9.22 %) were diagnosed with sarcopenia. After adjusting for potential confounders, higher LE8, health behavior and health factors scores were associated with reduced odds ratios (OR) of sarcopenia (OR for per 10 scores increase in LE8, 0.65; 95 % CI 0.61–0.70; OR for per 10 scores increase in health behaviors score, 0.90; 95 % CI 0.84–0.97; OR for per 10 scores increase in health factors score, 0.67; 95 % CI 0.63–0.71). A non-linear dose-response relationship was observed between LE8 scores, health factors scores, and sarcopenia. The inversed association between LE8 score and sarcopenia was significantly stronger among males and participants with a high school education or above. Conclusions: LE8 was negatively associated with the prevalence of sarcopenia in a nonlinear fashion. Promoting adherence to optimal CVH levels may benefit to reduce the risk of sarcopenia.

Purpose: The impact of dietary counseling on body composition in early breast cancer patients (EBC) treated with aromatase inhibitors (AIs) is uncertain. The aim of this study was to assess the effects of a diet counseling program on weight, BMI, total and regional body composition in patients treated with AIs. Methods: This observational study involved 194 EBC patients, of which 97 attended a 6-month personalized counseling program, based on Mediterranean diet principles (cohort A) and 97 did not (cohort B). Dual-energy X-ray absorptiometry (DXA) scan was used to measure the total and regional fat and lean body mass, before (baseline) and after at least 18 months of AI-therapy. Results: Weight and BMI increased significantly, on the average, in cohort B, but not in cohort A. In the cohorts A and B, fat mass increased by 10 % and 7.7 % respectively, while lean mass decreased by 3.3 % and 2.6 % from before to after AI therapy, without statistically significant differences between them using the Mann-Whitney test. The changes in body composition were greater in premenopausal than in postmenopausal women at cancer diagnosis. The proportion of patients with sarcopenia, obesity and sarcopenic obesity increased from before to after AI therapy, similarly in both cohorts. Conclusions: Patients treated with AIs reported an increase in fat mass and a decrease in lean mass, and consequently an increase in sarcopenia and obesity, regardless of the participation in a dietary counseling program. A combined dietary counseling and physical exercise program may be necessary for preventing these unfavourable changes in these patients.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity and metabolic syndrome. It is mainly caused by insulin resistance. With the increased risk of visceral obesity in South Asians, the prevalence of MASLD is on the rise. The morbidity associated with MASLD and its complications, including hepatocellular carcinoma is projected to increase in this South Asian population. Methods: In this narrative review we explore the diagnosis and management of MASLD in the South Asian population. We summarize the findings from the recent literature on the diagnostic methods and management options for MASLD in this population. Results: Through our search we found no specific guidelines for the diagnosis and management of MASLD in the South Asian population. The existing general guidelines may not be applied to South Asian populations due to the differences in phenotype, genotype, social and cultural aspects. South Asian countries also have limited resources with the non-availability of newer pharmacotherapeutic agents. Conclusion: The goal of this review is to guide obesity physicians and primary care providers to have a stepwise approach to treat patients at risk for MASLD with a main focus on interdisciplinary management most applicable to South Asian patients. More research is needed to formulate guidelines and algorithm that are specific for the South Asian population.

Objectives: The study was conducted to explore associations between markers of mitochondrial quality control (MQC) from vastus lateralis muscle biopsies, serum inflammatory markers, and measures of muscle power assessed by two different tools in a sample of older adults. Design: Secondary analysis of data collected in the PeppeR develOpMental ProjecT (PROMPT) at the University of Florida (Gainesville, FL, USA). Methods: Forty-three older adults (n = 20 women) were included in the study. Muscle volume of the calf and thigh was quantified by three-dimensional magnetic resonance imaging. Lower-limb muscle power was estimated using 5-time sit-to-stand (5STS) muscle power equations and isokinetic test. Protein markers of MQC were measured in muscle samples by Western immoblotting (n = 12–23), while type I and II fiber cross-sectional area (CSA) and their proportion were quantified using immunohistochemistry (n = 12). Cytochrome C oxidase enzyme activity was measured spectrophotometrically. Finally, inflammatory markers were quantified in the serum using a multiplex immunoassay (n = 39). Results: Mean age of participants was 78.1 ± 5.5 years, and the average body mass index was 26.2 ± 4.5 kg/m2. Markers of mitochondrial biogenesis (i.e., PGC-1α), mitochondrial import proteins (i.e., cHsp70 and mtHsp70), and type I fiber CSA were significantly associated with muscle power estimated via both 5STS muscle power equations and isokinetic test (p < 0.05). Specific associations were also found according to the muscle power assessment method. 5STS muscle power measures were negatively correlated with ClvCasp3, P-AMPK, T-AMPK, P-p38, GM-CSF, INF-γ, IL1b, IL6, IL8, and TNF-α, whereas positive associations were found with BAX (p < 0.05). In contrast, isokinetic measures were significantly and positively correlated with RIP140, Hsp60, and type II muscle fiber CSA (p < 0.05). Conclusions: Markers of mitochondrial biogenesis (PGC-1α), mitochondrial import proteins (cHsp70 and mtHsp70), and type I muscle fiber CSA were significantly linked to lower-limb muscle power in older adults. These results suggest that muscle power is influenced by mitochondrial signaling. We also found that the relationship between mitochondrial mediators, inflammatory markers, and muscle power varied according to the assessment tool used.

Background: The interaction between muscle and bone is shown to be clinically important but the underlying mechanisms are largely unknown. The canonical Wnt/β-catenin signaling pathway is reported to be involved in muscle-bone crosstalk, but its detailed function remains unclear. This systematic review aims to investigate and elucidate the role of the Wnt/β-catenin signaling pathways in muscle-bone crosstalk. Methods: We conducted a literature search on the Web of Science, PubMed, EBSCO and Embase with keywords “Wnt*”, “bone*” and “muscle*”. A systematic review was completed according to the guideline of preferred reporting items of systematic reviews and meta-analyses (PRISMA). Data synthesis included species (human, animal or cell type used), treatments involved, outcome measures and key findings with respect to Wnts. Results: Seventeen papers were published from 2007 to 2021 and were extracted from a total of 1529 search results in the databases of Web of Science (468 papers), PubMed (457 papers), EBSCO (371) and Embase (233). 12 Wnt family members were investigated in the papers, including Wnt1, Wnt2, Wnt2b, Wnt3a, Wnt4, Wnt5a, Wnt8a, Wnt8b, Wnt9a, Wnt10a, Wnt10b and Wnt16. Many studies showed that muscles were able to increase or decrease osteogenesis of bone, while bone increased myogenesis of muscle through Wnt/β-catenin signaling pathways. Wnt3a, Wnt4 and Wnt10b were shown to play important roles in the crosstalk between muscle and bone. Conclusions: Wnt3a, Wnt4 and Wnt10b are found to play important mediatory roles in muscle-bone crosstalk. The role of Wnt4 was mostly found to regulate muscle from the bone side. Whilst the role of Wnt10b during muscle ageing was proposed, current evidence is insufficient to clarify the specific role of Wnt/β-catenin signaling in the interplay between sarcopenia and osteoporosis. More future studies are required to investigate the exact regulatory roles of Wnts in muscle-bone crosstalk in musculoskeletal disease models such as sarcopenia and osteoporosis. Translational potential of this article: The systematic review provides an extensive overview to reveal the roles of Wnt/β-catenin signaling pathways in muscle-bone crosstalk. These results provide novel research directions to further understand the underlying mechanism of sarcopenia, osteoporosis, and their crosstalk, finally helping the future development of new therapeutic interventions.

Background/purpose: Sarcopenia and decreased muscle strength (dynapenia) are emerging health issues. However, the study exploring muscle strength changes of both upper and lower limbs at the same time among all age groups is rare. This study aims to investigate the muscle strength and to establish a muscle strength norm of an ostensibly healthy non-diabetic Asian population. Methods: From 2018 June to 2020 March, subjects (aged from 20 to

Summary: Background: The concomitant loss of lean muscle mass and bone mineral density is known as osteosarcopenia. This disorder can result in increased physical impairment in addition to an increased risk of falls and fractures. Although the diagnostic of osteoporosis and sarcopenia has been described, the inflammatory mediators that identify the presence of osteosarcopenia and propose possible inflammatory mechanisms implicated in muscle and bone loss are unknown. The objective of this study was to evaluate a panel of inflammatory biomarkers and investigate its relationship with the presence of osteosarcopenia. Methods: Body composition was assessed using Dual X-ray absorptiometry and handgrip strength using a Jamar dynamometer. Blood samples were collected for evaluation the plasmatic concentrations of adiponectin, brain-derived neurotrophic factor (BDNF), interferon ɣ (IFN), interleukins 2, 4, 5, 6, 8 and 10, leptin, resistin, tumour necrosis factor (TNF) and its soluble receptors (sTNFr) 1 and 2. Results: In seventy-one older women the age was 75 (±7) years, BMI 26.1 (±4.5) kg/m2, handgrip strength 19 (±6) kgf and the muscle mass index was 6.39 (±1.05) kg/m2. The diagnosis of osteosarcopenia was found in 25% of the sample. Analysis of the distribution of biomarkers demonstrate the osteosarcopenia group presented greater concentrations among all markers measured, and significant differences was found in plasmatic concentrations of interleukin 8 (p = 0.02). Subgroup analysis showed that group with osteopenia plus sarcopenia had significantly greater IL-6 (p = 0.03) and IL-8 (p = 0.007) concentrations. Conclusions: In a panel of biomarkers, IL-6 and IL-8 were found to be related with diagnosis of osteosarcopenia in community-dwelling older women. These results may contribute to understand the inflammatory mechanisms and suggest a diagnostic strategy for these patients, also informing new strategies for prevention, monitoring, and treatment of osteosarcopenia.

Summary: Background and aims: Muscle mass is an important component of nutritional status. At intensive care unit (ICU) admission, ultrasound is an important tool to assess the muscle mass, but there are currently no established cut-off values. Therefore, we retrospectively analyzed cut-off values for an ultrasound-based muscle mass assessment at ICU admission. Methods: We retrospectively analyzed data collected in an observational study. These data included a muscle mass assessment of lower limb thickness and cross-sectional area (CSA), upper limb thickness and CSA, and diaphragm thickness at ICU admission. Skeletal muscle mass was calculated from computed tomography (CT) imaging of the third lumbar vertebra for comparison. Cut-off values were estimated from the relationship between the ultrasound-based muscle mass assessment and CT-derived skeletal muscle index at 7.0 kg/m2 in males and 5.4 kg/m2 in females. Results: Lower limb, upper limb, and diaphragm assessments included 89, 52, and 79 patients, respectively. The age was 70 ± 13 years and body mass index was 22.2 ± 4.4 kg/m2. Cut-off values were 22.5 mm (male) and 19.0 mm (female) for femoral thickness and 5.0 cm2 (male) and 4.5 cm2 (female) for rectus femoris CSA. Cut-off values were 26.9mm (male) and 20.6 mm (female) for upper limb thickness and 6.5 cm2 (male) and 4.0 cm2 (female) for biceps brachii CSA. Cut-off values were 1.8 mm (male) and 1.5 mm (female) for diaphragm. Conclusion: We proposed cut-off values for ultrasound-based muscle mass assessment at ICU admission. Further studies are needed to validate these cut-off values.

Objectives: Evaluation of sarcopenia from computed tomography (CT) is often based on measuring skeletal muscle area on a single transverse slice. Automatic segmentation of muscle volume has a lower variance and may be a better proxy for the total muscle volume than single-slice areas. The aim of the study was to determine which abdominal and thoracic anatomical volumes were best at predicting the total muscle volume. Methods: A cloud-based artificial intelligence tool (recomia.org) was used to segment all skeletal muscle of the torso of 994 patients who had performed whole-torso CT 2008–2020 for various clinical indications. Linear regression models for several anatomical volumes and single-slice areas were compared with regard to predicting the total torso muscle volume. Results: The muscle volume from the tip of the coccyx and 25 cm cranially was the best of the abdominal volumes and was significantly better than the L3 slice muscle area (R2 0.935 vs 0.830, P

Sarcopenia, the age-related decline in muscle mass and function, is a significant contributor to increased frailty and mortality in the elderly. Currently, no FDA-approved treatment exists for sarcopenia. Here, we identified norharmane (NR), a β-carboline alkaloid, as a potential therapeutic agent for mitigating muscle aging. We aimed to determine the ability of NR to delay muscle aging in Caenorhabditis elegans (C. elegans), mouse, and muscle cells in mice and humans. NR treatment improved swimming ability and increased the maximum velocity in aged C. elegans. Transcriptomic analysis revealed that NR upregulated detoxification genes in C. elegans, including cytochrome P450, UGT, and GST enzymes. NR-induced benefits were dependent on the SKN-1/Nrf2 stress response pathway. In mammalian models, NR delayed cellular senescence in human skeletal muscle myoblasts and enhanced myogenesis in C2C12 cells and primary aged myoblasts. NR supplementation in aged mice prevented muscle loss, improved muscle function, and reduced markers of cellular senescence. We found that the p38 MAPK pathway mediated NR activation of Nrf2 by disrupting the Nrf2-Keap1 interaction. NR also improved oxygen consumption rates and promoted mitochondrial biogenesis. These findings suggest that NR is a promising candidate for preventing sarcopenia and improving muscle health.

Background: Dietary protein adequacy is crucial for muscle health in aging individuals, posing a particular challenge for vegetarian seniors. This randomized controlled trial (RCT) investigates the impacts of protein-enriched lacto-vegetarian soup supplementation on body composition, physical performance and muscle strength functional assessment as well as cardiometabolic and inflammatory biomarkers in older adults. Methods: We enrolled 100 participants ≥65 years at risk for malnutrition (MNA-SF ≤ 11) and at risk for sarcopenia (SARC-F ≥4 or SARC-CalF ≥11) in this RCT. Participants were randomized assigned to receive a daily protein-enriched lacto-vegetarian soup (24−30 g protein) or usual diet. Primary outcomes of interest including (1) body composition (anthropometric measurements and body composition measured by bioimpedance analysis (BIA)), (2) physical performance (Short Physical Performance Battery, SPPB) and muscle strength (hand grip strength), and (3) functional assessments (including sarcopenia risk scales and nutritional status) as well as secondary outcomes of interests including cardiometabolic and inflammatory biomarkers were assessed at baseline and the 12th week of follow-up. Results: Data of 97 participants (intervention: n = 48, control: n = 49) were analyzed. Despite no significant changes in body composition were observed in the intervention group, compared to the usual diet, those who received protein-enriched lacto-vegetarian soup supplementation had an improved physical performance including an increase in SPPB score (β = 0.83 [95% CI 0.15–1.51], p = 0.02), a decrease in time to complete the 5 times chair rise test (β = −2.25 [−4.04 to −0.44], p = 0.01). Some functional assessments, including improved sarcopenia risk scale (e.g., SARC-F score [β = −0.68, p = 0.04]) and nutritional status (e.g., MNA-SF score [β = 0.44, p = 0.03]) were also observed. Conclusions: Daily supplementation with protein-enriched lacto-vegetarian soups enhanced physical performance and functional assessments (such as sarcopenia risk scale and nutritional status) among older adults at risk of malnutrition and sarcopenia. Further study is needed to explore the long-term benefits of protein-enriched lacto-vegetarian soup supplementation for healthy aging.

Background: Based on the compelling experimental evidence supporting apelin’s beneficial effects on muscle metabolism, our study aimed to evaluate the role of circulating apelin levels as a biomarker for muscle health in humans. Methods: This investigation employed a cross-sectional design, encompassing 237 community-dwelling older adults aged ≥65 years who underwent comprehensive geriatric evaluations in South Korea. Sarcopenia diagnosis was based on Asian-specific criteria, and serum apelin concentrations were determined using enzyme immunoassay techniques. Results: Following adjustment for potential confounding factors, no significant disparities in serum apelin levels were observed between sarcopenic and non-sarcopenic individuals, nor were differences detected based on skeletal muscle mass, strength, or physical performance categories (P = 0.335 to 0.765). Furthermore, circulating apelin concentrations showed no significant correlations with any sarcopenia assessment metrics, including skeletal muscle index, grip strength, gait speed, chair stand test duration, or short physical performance battery score (P = 0.170 to 0.832). Elevations in serum apelin levels were not significantly associated with the risk of sarcopenia or compromised muscle phenotypes (P = 0.452 to 0.896). Additionally, stratification of participants into quartiles based on serum apelin concentrations revealed no significant variations in sarcopenia-related parameters across groups (P = 0.197 to 0.592). Conclusion: These findings suggest that, contrary to previous studies in cellular and animal models where apelin demonstrated a protective impact on muscle homeostasis, such effects may not translate to the human context, and contribute valuable clinical evidence indicating that serum apelin may not serve as a reliable biomarker for sarcopenia.

Introduction and Objectives: With rising prevalence of pre-sarcopenia in metabolic dysfunction-associated steatotic liver disease (MASLD), this study aimed to develop and validate machine learning-based model to identify pre-sarcopenia in MASLD population. Materials and Methods: A total of 571 MASLD subjects were screened from the National Health and Nutrition Examination Survey 2017–2018. This cohort was randomly divided into training set and internal testing set with a ratio of 7:3. Sixty-six MASLD subjects were collected from our institution as external validation set. Four binary classifiers, including Random Forest (RF), support vector machine, and extreme gradient boosting and logistic regression, were fitted to identify pre-sarcopenia. The best-performing model was further validated in external validation set. Model performance was assessed in terms of discrimination and calibration. Shapley Additive explanations were used for model interpretability. Results: The pre-sarcopenia rate was 17.51 % and 15.16 % in NHANES cohort and external validation set, respectively. RF outperformed other models with area under receiver operating characteristic curve (AUROC) of 0.819 (95 %CI: 0.749, 0.889). When six top-ranking features were retained as per variable importance, including weight-adjusted waist, sex, race, creatinine, education and alkaline phosphatase, a final RF model reached an AUROC being 0.824 (0.737, 0.910) and 0.732 (95 %CI: 0.529, 0.936) in internal and external validation sets, respectively. The model robustness was proved in sensitivity analysis. The calibration curve and decision curve analysis confirmed a good calibration capacity and good clinical usage. Conclusions: This study proposed a user-friendly model using explainable machine learning algorithm to predict pre-sarcopenia in MASLD population. A web-based tool was provided to screening pre-sarcopenia in community and hospitalization settings.

Background: Adequate protein intake is important to maintain skeletal muscle mass in older adults and to prevent sarcopenia. Insect-based supplements were recently introduced to the market as an environmentally friendly protein alternative. We examined the effect of daily supplementation of lesser mealworm (Alphitobius diaperinus) protein for 11 consecutive weeks on muscle mass and muscle strength in older adults. Methods: In this randomized controlled trial, 70 physically active older adults (>60 years) were randomly allocated to three groups: (I) lesser mealworm protein, (II) whey protein or (III) iso-caloric placebo. Participants received 11 weeks of supplements two times a day (30 gram/day). Muscle mass, fat mass, leg muscle strength and handgrip strength were measured at baseline and after 11 weeks of supplementation. Results: Of the 70 participants, 59 completed the supplementation period (mealworm n = 16; whey n = 23; iso-caloric placebo n = 20). Overall, skeletal muscle mass increased from 29.0 ± 6.2 kg to 29.3 ± 6.1 kg, with a significantly more profound increase in the lesser mealworm group (+0.67 [0.20–1.14] kg) compared to the whey (+0.03 [-0.20 – 0.28] kg) and placebo group (+0.30 [0.03 – 0.63] kg, Pgroup*time = 0.030). Fat mass and maximum handgrip strength decreased over time, whereas one-repetition maximum (1RM) leg muscle strength did not change pre- versus post-intervention. No group differences, nor interaction effects, were observed for fat mass, leg muscle strength and handgrip strength Conclusion: 11-weeks of lesser mealworm protein supplementation induced an increase in skeletal muscle mass compared to whey protein supplementation and iso-caloric placebo in physically active older adults. No differences among groups were observed for changes in muscle strength.

Objectives: Aging involves significant changes in body composition, marked by declines in muscle mass and bone mineral density alongside an increase in fat mass. Sarcopenia is characterized by low strength and muscle mass, and osteosarcopenia is the coexistence of sarcopenia and osteopenia/osteoporosis. Physiologically, there is a crosstalk between muscle and bone tissues mediated by several pathways. Both, sarcopenia and osteosarcopenia, have been related with adverse outcomes such as functional disability. However, there is a lack of longitudinal studies. Therefore, this study aimed to assess whether sarcopenia and osteosarcopenia phenotypes increased the risk of functional disability in a longitudinal cohort of community-dwelling adults. Design: This study constitutes a secondary longitudinal analysis of data derived from the prospective cohort FraDySMex (Frailty, Dynapenia, and Sarcopenia in Mexican adults). Setting and participants: FraDySMex is conducted in community-dwelling adults aged 50 years or older living in Mexico City. Data from 2014 to 2015 was considered as baseline evaluation, and the 2019 wave was the follow-up evaluation. Individuals with complete baseline and follow-up evaluations were included in the analysis. Measurements: Sarcopenia diagnosis adhered to the FNIH criteria, while osteopenia/osteoporosis classification followed WHO guidelines. Osteosarcopenia was defined as the concurrent presence of sarcopenia and osteopenia/osteoporosis. Functional disability was identified by the Lawton Instrumental Activities of Daily Living (IADL) Scale. Adjusted mixed-effects logistic regression models were estimated to evaluate the effect of body composition phenotype on the risk of functional disability. Results: The final sample included 320 adults with complete longitudinal data. The majority of were women (83.4%) and had 7–12 years of education (48.4%). At the baseline evaluation, 50.9% aged 50–70. The osteosarcopenia phenotype was associated with a higher risk of functional disability (OR: 2.17, p = 0.042) compared with the no osteopenia/sarcopenia group. Conversely, sarcopenia (OR: 1.50, p = 0.448) and osteopenia/osteoporosis (OR: 1.50, p = 0.185) phenotypes were not associated with functional disability. Conclusions: Our study underscores that osteosarcopenia significantly increased the risk of functional disability, particularly in terms of Instrumental Activities of Daily Living (IADL). These results emphasize the importance of screening for sarcopenia, osteopenia/osteoporosis, and osteosarcopenia across various clinical settings. Early detection and intervention hold promise for averting functional disability and mitigating associated adverse outcomes in adults.

Background: Coexistent sarcopenia and frailty is more strongly associated with adverse health outcomes than each condition alone. As the importance of coexistent sarcopenia and frailty increases, exploring their underlying mechanisms is warranted. Recently, noncoding ribonucleic acids (RNAs) have been suggested as potential biomarkers of sarcopenia and frailty. This systematic review aimed to summarize noncoding RNAs commonly expressed in sarcopenia and frailty, and to search the predicted target genes and biological pathways of them. Methods: We systematically searched the literatures on PubMed, Embase, Cochrane Library, Web of Science, and Scopus for literature published till November 15, 2023. A total of 7,202 literatures were initially retrieved. After de-duplication, 34 studies (26 sarcopenia-related and 8 frailty-related) were full-text reviewed, and 15 studies (11 sarcopenia-related and 4 frailty-related) were finally included. Results: miR-29a-3p, miR-29b-3p, and miR-328 were identified as commonly expressed in same direction in sarcopenia and frailty. These microRNAs (miRNAs), identified in the literature search using PubMed, modulate transforming growth factor-β signaling via extracellular matrix components and calcineurin/nuclear factor of activated T cells 3 signaling via sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a, which are involved in regulating skeletal muscle fibrosis and the growth of slow-twitch muscle fibers, respectively. miR-155-5p, miR-486, and miR-23a-3p were also commonly expressed in two conditions, although in different or conflicting directions. Conclusion: In this systematic review, we highlight the potential of shared miRNAs that exhibit consistent expression patterns as biomarkers for the early diagnosis and progression assessment of both sarcopenia and frailty.

Objectives: To investigate the associations of n-3 fatty acid intake with handgrip strength and muscle mass indices in older adults. A secondary aim was to investigate whether these associations differed by physical activity status. Research methods & procedures: A cross-sectional study included 53,170 participants aged 60 years and over from the UK biobank (25,324 men and 27,846 women). The primary outcomes were grip strength index and muscle mass index, the predictor variable was n-3 fatty acid intake and the covariates were age, ethnicity, Townsend deprivation index, physical activity, multimorbidity count, total energy intake, body fat percentage and the month of assessment. Multivariable linear regression analyses were performed across 5 models. Model 1 was unadjusted; model 2 adjusted for age, ethnicity, deprivation index and month of assessment; model 3 adjusted as in model 2 plus total energy intake; model 4 as in model 2 plus multimorbidity count; and model 5 as in model 4 plus body fat percentage. Results: In model 5, higher n-3 fatty acid intake was positively associated with the grip strength index in women. For each additional gram of n-3 fatty acid consumed per day, there was an increase of 0.03 kg/m2 (95% CI: 0.00 to 0.06 kg/m2) in active women and 0.04 kg/m2 (95% CI: 0.00 to 0.07 kg/m2) in inactive women. However, no significant associations were observed in men, whether active (p = 0.405) or inactive (p = 0.323). Additionally, no significant associations were found between n-3 fatty acid intake and muscle mass index in either active (p = 0.858) or inactive (p = 0.250) men, or in active (p = 0.909) or inactive (p = 0.187) women. Conclusion: Although n-3 fatty acid intake was associated with grip strength index in older women, regardless of their activity status, the magnitude of this association was very small and unlikely to be clinically relevant. Additionally, n-3 fatty acid was not associated with muscle mass index.

Background: Elevated circulatory phosphate levels are linked to age-related muscle dysfunction, yet the mechanisms remain unclear. This study investigated the hypothesis that inflammation plays a role in connecting elevated phosphate levels to muscular dysfunction in middle-aged and older individuals and explored potential sex-based differences in these associations. Methods: The study, based on the I-Lan Longitudinal Aging Study Cohort, analyzed individuals' serum phosphate and hsCRP levels. Sex-specific analyses explored links between circulatory phosphate, inflammation, and muscle profiles (mass, handgrip strength, and walking speed). The study also examined potential mediation or synergistic effects of inflammation in the circulatory phosphate-muscle relationship. Results: The study included 2006 participants (mean age: 65.5 ± 6.5 years; 49.8 % men). Women exhibited higher circulatory phosphate levels than men. Linear analyses revealed that higher phosphate levels were significantly associated with weaker handgrip strength but not with reduced muscle mass in both men and women. In women, circulatory phosphate was not associated with inflammation (hsCRP levels), while in men, higher phosphate levels were significantly associated with higher hsCRP levels. In men, a synergistic effect was observed, where the combination of high hsCRP and elevated phosphate levels had a more pronounced impact on reducing handgrip strength than either factor alone. Conclusions: This study highlights a sex-specific association of inflammation in the mechanisms of hyperphosphatemia-related muscle weakness. The findings emphasize the importance of managing both hyperphosphatemia and chronic inflammation to mitigate their collective impact on muscle function, particularly in older men. Addressing these factors is crucial for promoting muscle health in later life.

Introduction and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) formerly known as Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease. Identifying MASLD risk factors could help early intervention and reduce the burden of the disease. Previous studies investigated the association between sarcopenia and NAFLD. Several trials were published after the last meta-analysis with indecisive results. This is an updated meta-analysis which aims to assess the association between sarcopenia, MASLD, and MASLD-related fibrosis. Materials and Methods: Relevant trials published on PubMed, Web of Science, Scopus, and Cochrane Library databases until October 2022 were included. We included studies in which skeletal mass index (SMI) or sarcopenia was compared between patients with and without NAFLD now MASLD. Also, studies comparing fibrosis between MASLD patients with and without sarcopenia were included. Data were pooled as odds ratios (ORs) and 95 % confidence intervals (CIs) using Review Manager Software. Results: A total of 25 studies were included. The incidence of sarcopenia was significantly higher in MASLD than controls (OR, 1.25; 95 % CI, 1.08-1.44; P = 0.003). SMI odds showed no significant difference between MASLD patients and controls (OR, 1.02; 95 % CI, 0.91-1.15; P = 0.7). MASLD patients with sarcopenia had higher odds of fibrosis than MASLD patients without sarcopenia (OR, 1.49; 95 % CI, 1.03-2.14; P = 0.03). Conclusions: Sarcopenia increased MASLD's probability and was associated with a higher probability of liver fibrosis in MASLD patients. However, SMI had no predictive value of MASLD occurrence.

Resumen: Objetivos: Evaluar la prevalencia de inactividad física y el riesgo de sarcopenia en los pacientes de atención primaria y en sus acompañantes. Diseño: Estudio transversal. Se realizó una encuesta anónima a usuarios y acompañantes de atención primaria en consulta y en estand dentro de los centros de atención primaria (CAP) coincidiendo con una actividad de salud comunitaria para el día Mundial de la Actividad Física. Emplazamiento: Cinco CAP de la región sanitaria Metropolitana Sud: en Cornellà de Llobregat (CAP Jaume Soler), en l’Hospitalet de Llobregat (CAP Florida Nord, CAP Florida Sud y CAP Bellvitge) y en Viladecans (CAP Maria Bernades) entre el 27 de marzo y el 6 de abril de 2023. Participantes: La población de atención primaria formada por paciente y sus acompañantes mayores de 18 años. Intervenciones: Los sanitarios administraron cuestionarios a los usuarios y sus acompañantes. Mediciones principales: Se valoró la presencia de inactividad física con el cuestionario BPAAT y el riesgo de sarcopenia con el test SARC-F, además del sexo y el tramo de edad. Se realizó un análisis descriptivo univariante para la descripción de las prevalencias. Resultados: En 998 participantes observamos inactividad física en un 38,9% de los encuestados (33,8% hombres y 42,3% mujeres). Entre los mayores de 50 años (665 participantes), un 15,4% presentó riesgo de sarcopenia (9,58% varones y 19,2% mujeres). Conclusiones: La prevalencia de inactividad física y riesgo de sarcopenia (en mayores de 50 años) en la población estudiada es elevada. Las mujeres presentan mayor inactividad física y mayor riesgo de sarcopenia que los varones. Abstract: Objectives: Assess the prevalence of physical inactivity and risk of sarcopenia in primary care patients and their companions. Design: Cross-sectional study. We carried out an anonymous survey of primary care users (patients and companions) in primary care consultations and stands coinciding with a community health activity for World Physical Activity Day. Site: Five primary care centers (CAPs) of the South Metropolitan health region: in Cornellà de Llobregat (CAP Jaume Soler), in l’Hospitalet de Llobregat (CAP Florida Nord, CAP Florida Sud and CAP Bellvitge) and in Viladecans (CAP Maria Bernades) between 27 March to April 6, 2023 (coinciding with World Physical Activity Day). Participants: Primary care population consists of patients and their companions over 18 years of age. Interventions: The health workers administered questionnaires to users and companions. Main measurements: We evaluated physical inactivity with the BPAAT questionnaire, risk of sarcopenia with SARC-F screening test, sex and age range. We performed an univariate descriptive analysis to report prevalence. Results: Nine hundred ninety-eight participants were surveyed. Physical inactivity was present in 38.9% of the participants. Among those over 50 years (665 participants), 15.4% were at risk of sarcopenia (9.58% men, 19.2% women). Conclusions: The prevalence of physical inactivity and risk of sarcopenia (in individuals over 50 years old) in the studied population is high. Women have greater physical inactivity and a greater risk of sarcopenia than men.

Background: Sarcopenia and frailty often worsen in older adults because of declines in activities of daily living and social connections that are associated with chronic diseases and traumatic injuries such as falls and fractures. Exercise intervention for sarcopenia can take >3 months to improve muscle mass, muscle strength, and walking speed. Thus, a specialized intervention system for shorter periods of time is needed. In this study, we aimed to evaluate the short-term efficacy of an exercise program using the wearable cyborg Hybrid Assistive Limb (HAL) lumbar type in physical function in mobility-limited older adults who do not require transition to long-term care. Methods: This randomized, single-blind, parallel-group study involved 79 community-dwelling older adults with physical frailty or locomotive syndrome assigned to an intervention group (n = 40) with the HAL lumbar type exercise program or a control group (n = 39) without the exercise program. The intervention group underwent trunk training (including trunk and hip flexion, standing and sitting from a single sitting position, and squats) and gait training (treadmill and parallel bars) twice a week for 5 weeks while wearing the HAL lumbar type. The 10-m usual and maximum walking speeds, Timed Up and Go test results, 5-times chair-standing test results, 5-question Geriatric Locomotive Function Scale (GLFS-5) scores, body-fat percentage, and muscle mass were measured before and after the intervention and analyzed using the intention-to-treat method. Results: The intervention (23 % male; mean age, 74.7 ± 4.7 years) and control (21 % male; mean age, 75.1 ± 4.1 years) groups did not differ significantly in baseline characteristics. Seventy-seven participants completed the program; two withdrew for personal reasons. The mean difference (standard error) between the groups for the primary outcome (usual walking speed) was 0.35 (0.04) m/s; the time-by-group interaction was significant (p

Skeletal muscle has been recognized as an endocrine organ which communicates with different systems, including the brain. In conditions involving systemic low-grade chronic inflammation, the skeletal muscle can be negatively impacted, culminating in its quantity (mass) and quality (function) losses, referred to here as muscle wasting. The inflammatory milieu, as well known, also impairs the brain function, however there are some particularities involving skeletal muscle-brain crosstalk, including cognitive function and mental health impairments. Psychoneuroimmunology (PNI) is an important field of neuroendocrine-immune-behavior science and an approach between PNI, and the movement science, or kinesiology, field can enrich future research about the relationship between skeletal muscle wasting and brain health. Thus, in this short review, we present an overview about the interplay between skeletal muscle, inflammatory mediator markers, and brain function with the purpose to strengthen the ties between kinesiology and PNI research to enhance futures discoveries and advances in health sciences.

Organophosphate esters (OPEs) are an emerging group of environmental pollutants linked to numerous health concerns, and their increasing prevalence in the environment is alarming. However, the impact of OPEs exposure on sarcopenia, a condition characterized by muscle loss and weakness, remains unknown. In this study, the connection between urinary metabolites of OPEs and the occurrence of sarcopenia was investigated using data from the National Health and Nutrition Examination Survey (NHANES) covering a period from 2011 to 2018. The analysis found that two specific urinary metabolites, Dibutyl phosphate (DBUP) and Bis (2-chloroethyl) phosphate (BCEP), were positively correlated with an increased risk of sarcopenia. Among these metabolites, DBUP had the highest contribution to sarcopenia development according to weighted quantile sum (WQS) model analysis. Additionally, it was observed that inflammation mediated the relationship between urinary exposure to DBUP/BCEP and the prevalence of sarcopenia. Overall, this research emphasizes the role of OPEs in the progression of sarcopenia, prompting concerns regarding their potential impact on health and advocating for further prospective investigations into their correlation with the risk of developing sarcopenia.

Background & aims: Sarcopenia, a prevalent condition, significantly impacts the prognosis of patients with decompensated cirrhosis (DC). Serum fibroblast growth factor 21 (FGF21) levels are significantly higher in DC patients with sarcopenia. Satellite cells (SCs) play a role in aging- and cancer-induced sarcopenia. Here, we investigated the roles of FGF21 and SCs in DC-related sarcopenia as well as the underlying mechanisms. Methods: We developed two DC mouse models and performed in vivo and in vitro experiments. Klotho beta (KLB) knockout mice in SCs were constructed to investigate the role of KLB downstream of FGF21. In addition, biological samples were collected from patients with DC and control patients to validate the results. Results: Muscle wasting and impaired SC myogenesis were observed in the DC mouse model and patients with DC. Elevated circulating levels of liver-derived FGF21 were observed, which were significantly negatively correlated with skeletal muscle mass/skeletal muscle index. Liver-secreted FGF21 induces SC dysfunction, contributing to sarcopenia. Mechanistically, FGF21 in the DC state exhibits enhanced interactions with KLB on SC surfaces, leading to downstream phosphatase and tensin homolog upregulation. This inhibits the protein kinase B (PI3K/Akt) pathway, hampering SC proliferation and differentiation, and blocking new myotube formation to repair atrophy. Neutralizing circulating FGF21 using neutralizing antibodies, knockdown of hepatic FGF21 by adeno-associated virus, or knockout of KLB in SCs effectively improved or reversed DC-related sarcopenia. Conclusions: Hepatocyte-derived FGF21 mediates liver-muscle crosstalk, which impairs muscle regeneration via the inhibition of the PI3K/Akt pathway, thereby demonstrating a novel therapeutic strategy for DC-related sarcopenia.

Objective: There is limited research on the effectiveness of orthopedic robot-assisted treatment for sarcopenia combined with femoral neck fractures (FNF) in clinical settings. This study aimed to compare the clinical outcomes of orthopedic robot-assisted screw placement with traditional manual screw placement for treating sarcopenia combined with FNF. Methods: The retrospective study included patients with FNF under the age of 65 who were admitted to the Department of Orthopedics at XX Hospital Affiliated to XX University between January 2019 and March 2022 and underwent internal fixation with cannulated screws. Grip strength of the dominant hand was measured, and the skeletal muscle index (SMI) was calculated based on the muscle tissue area at the level of the 12th thoracic vertebrae on chest CT divided by height squared. Sarcopenia was diagnosed when SMI was below 42.6 cm2/m2 for men or 30.6 cm2/m2 for women. Patients were then grouped based on whether they underwent orthopedic robot-assisted surgery, as the robot-assisted (RA) group or the freehand (FH) group. Follow-up evaluations over 24–36 months included various parameters such as operation time, blood loss, X-ray shots, number of needle drilling, cannulated nail parallelism, C-reactive protein (CRP) levels, time to weight-bearing, perioperative infection, VAS (visual analogue scale) scores at 1 and 6 months post-surgery, Harris hip score at 6 months post-surgery, and incidence of nonunions and femoral head necrosis within 24 months post-surgery. Results: A total of 127 participants were enrolled in this study, with 46 individuals in the RG group and 81 in the FG group. Across both groups, factors such as gender, age, SMI, injury sides, Garden classifications, intraoperative blood loss, preoperative CRP, and VAS scores at 6 months post-surgery did not show statistically significant differences (p > 0.05). The RA group exhibited shorter operation time, fewer intraoperative X-ray shots, less needle drilling, and lower postoperative CRP levels compared to the FH group. The VAS score of the RA group was lower one month after surgery, whereas the Harris score was higher six months post-surgery (p 0.05). Furthermore, the rate of femoral head necrosis after fracture within 2 years in the RA group was lower compared to the FH screw placement group, with statistically significant differences (p

Background: The relationship between serum lipids and sarcopenia remains unclear due to conflicting results in previous studies. Objective: To explore the associations and potential causality between serum lipids, including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and total cholesterol (TC), and sarcopenia. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were analysed using multivariable regression and restricted cubic splines (RCSs) to assess the associations between serum lipids and sarcopenia. Bidirectional Mendelian randomization (MR) was employed to investigate the causal relationships with sarcopenia-related traits such as appendicular lean mass (ALM), hand grip strength, and usual walking pace. Results: Serum HDL-C and TG levels were inversely associated with ALMBMI, with each 1-unit increase linked to a 0.13 % and 1.32 % decrease, respectively. Elevated TG, but not HDL-C, LDL-C, or TC levels, was significantly associated with an increased risk of sarcopenia (P for trend = 0.001). RCS analysis revealed a log-shaped dose-response relationship between TG and sarcopenia risk (P overall

Aims: The relationship between sarcopenia and cognitive impairment in older adults remains contentious. This study investigates this association and examines the long-term prognosis for individuals with both conditions. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, this study focuses on the correlation between sarcopenia and cognitive impairment, as well as the extended prognosis for individuals managing these conditions. Results: The study cohort comprised 2890 participants, with 648 (22.4 %) diagnosed with sarcopenia. Multivariable logistic regression analysis identified a significant association between sarcopenia and an increased risk of cognitive impairment (adjusted odds ratio [aOR]: 1.68, 95 % confidence interval [CI]: 1.30–2.17). Over a median follow-up period of 48 months, 200 individuals (6.9 %) succumbed to cardiovascular and cerebrovascular diseases (CCVDs), including hypertension, congestive heart failure, coronary artery disease, and stroke, as well as Alzheimer's disease (AD). Participants had comorbid conditions such as CCVDs and diabetes mellitus. Kaplan–Meier survival analysis and the Cox proportional hazards model indicated that individuals with both sarcopenia and cognitive impairment had the highest mortality risk from CCVDs and AD (adjusted hazard ratio [aHR]: 2.73, 95 % CI: 1.48–5.02). Individuals with sarcopenia and comorbidities exhibited a higher mortality risk from CCVDs or AD compared to those without sarcopenia but with comorbidities (aHR: 2.71, 95 % CI: 1.37–5.37). Conclusion: Sarcopenia is independently associated with cognitive impairment. Older adults with both sarcopenia and cognitive impairment or concurrent comorbidities face increased mortality risks from CCVDs or AD compared to their healthy counterparts. Clinical implication: • Sarcopenia is associated with cognitive impairment. • Cognitive impairment and comorbidities increased the risk of mortality from CCVDs and AD for sarcopenia patients.