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BACKGROUND: To assess the association between body composition and the risk of adverse outcomes in Fontan patients. METHODS: Participants from the Australian and New Zealand Fontan Registry with dual-energy X-ray absorptiometry scans were included. Appendicular lean mass (ALM), appendicular lean mass index (ALM divided by height squared; ALMI) and total body fat mass percentage (%BF) were calculated. ALMI and %BF z-scores were derived using age- and sex-matched reference ranges. The primary outcome was Fontan failure (death, transplantation, New York Heart Association functional class III/IV, protein-losing enteropathy, and plastic bronchitis) or moderate-or-severe ventricular dysfunction. RESULTS: 144 patients were included. Mean %BF was 29% (SD 10) with 50% having increased adiposity. Mean ALMI z-score was -1.4 (SD 1.1); one third of patients had skeletal muscle deficiency (ALMI z-score

Objectives Sarcopenia Definitions and Outcomes Consortium (SDOC) provides cut-points based on muscle weakness (low grip strength) and slowness (poor gait speed) for low-risk populations; however, it is unknown if these criteria apply to high-risk populations. We examined the association between SDOC criteria and important health status indicators in high-risk older persons. Design Cross-sectional study. Setting and Participants 356 community-dwelling older persons (median age: 79 years, interquartile range: 73, 83; 75.2% women) attending a falls and fractures clinic in Melbourne, Australia. Methods Grip strength (hydraulic dynamometer) and gait speed (over 4 m) were used to define sarcopenia using SDOC cut-points. Health measures included falls (past 1 year) and fractures (past 5 years) by self-report, and malnutrition, depression, balance confidence, fear of falling, static balance (limits of stability), dynamic balance (Four-Square Step Test), and body composition [body mass index and lean mass, fat mass, and bone density (via dual-energy x-ray absorptiometry)] were assessed using validated procedures. Fasting vitamin D and parathyroid hormone concentrations were measured by immunoassays. Participants were categorized as nonsarcopenic or sarcopenic based on the SDOC cut-points, and multivariate models were used to examine the association between sarcopenia and health status indicators while adjusting for confounding factors. Results After adjusting for covariates, sarcopenic older persons (n = 162, 45.5%) were positively associated with malnutrition [odds ratio (OR) 3.21, 95% confidence interval (CI) 1.63, 6.32], depression (OR 4.11, 95% CI 2.31, 7.29), fear of falling (OR 1.08, 95% CI 1.06, 1.10) as well as recurrent (2 or more) falls (OR 1.62, 95% CI 1.01, 2.59) and fractures (OR 2.26, 95% CI 1.17, 4.36), and negatively associated with poor balance confidence (OR 0.96, 95% CI 0.95, 0.97) (P Conclusions and Implications SDOC criteria are strongly associated with important health status indicators in high-risk older persons, which strengthens the clinical utility of the SDOC in these populations.

We sought to examine the associations of osteosarcopenia with physical performance, balance, and falls and fractures in community-dwelling older adults. Additionally, we aimed to determine which clinical outcomes are associated with specific components of osteosarcopenia.Cross-sectional study.253 participants (77% women; aged 77.9 ± 0.42 years) who presented for a falls and fractures risk assessment in Melbourne, Australia.Participants were mobile, community-dwelling older adults (≥65 years) free of cognitive impairment. Body composition (via dual-energy x-ray absorptiometry), physical performance [via Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB)], and balance [via Four-Square Step test (FSS) and posturography] were examined. Falls in the past year and fractures in the past 5 years were self-reported. Osteosarcopenia was defined as (1) low bone mineral density (BMD) [T score-1 standard deviation (SD)] combined with sarcopenia and (2) osteoporosis (BMD T score ≤-2.5 SD) combined with severe sarcopenia. For sarcopenia, we employed the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP1), the revised criteria (EWGSOP2), and that of the Foundation for the National Institutes for Health (FNIH). Kruskal-Wallis and logistic regression tests were used for statistical analysis.Osteosarcopenia was associated with worse SPPB, TUG, FSS, limit of stability, and falls and fractures history. Additionally, osteosarcopenia (using the severe sarcopenia classification) conferred an increased rate of falls [odds ratios (ORs) from 2.83 to 3.63; P .05 for all] and fractures (ORs from 3.86 to 4.38; P .05 for all) when employing the EWGSOP2 and FNIH definitions, respectively.Compared with the nonosteosarcopenic group, those with osteosarcopenia had greater impairment of physical performance and balance. The EWGSOP2 and FNIH criteria resulted in the strongest associations with physical performance and self-reported falls and fractures.

Background Sarcopenia is defined as the age-related loss of muscle mass, strength, and physical performance. The original European Working Group on Sarcopenia in Older Persons (EWGSOP1) definition, and its revision (EWGSOP2), provide new cut-points and alternate measures for sarcopenia diagnosis. However, sarcopenia is rarely diagnosed in clinical settings owing to its labor-intensive diagnostic process. Given the Short Physical Performance Battery (SPPB) is a quick, easily administrable, and objective measure of muscle strength and physical performance, both of which are key components of sarcopenia, this study examined the diagnostic value of the SPPB for this muscle disease. Methods A cross-sectional analysis of 294 community-dwelling older persons (≥65 years) was conducted. Appendicular lean body mass [(ALM) divided by height squared (ALM/h2)], muscle strength (handgrip/sit to stand), and physical performance [gait speed, timed up and go (TUG) and SPPB] were assessed using validated procedures, while participants were diagnosed with sarcopenia following the EWGSOP1 and EWGSOP2 criteria. Diagnostic ability of the SPPB independently and combined with ALM/h2 for sarcopenia was determined using area under the curve (AUC). Potential cut-points were identified, and sensitivity and specificity calculated. Results Prevalence of sarcopenia ranged from 4 to 16% depending on the definition. The SPPB demonstrated moderate (AUC = 0.644–0.770) value in diagnosing sarcopenia, and a cut-point of ≤8points in SPPB performance resulted in high sensitivity (82–100%) but low specificity (36–41%) for diagnosing those with severe sarcopenia. Conclusions The SPPB displayed acceptable value in diagnosing older adults with severe sarcopenia. Moreover, the high sensitivity of the SPPB when using the cut-point of ≤8 suggests it may be a favorable screening tool for sarcopenia in clinical settings where ALM measurements are not available.

To investigate the association between bone mineral density (BMD) and the severity of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition. Osteoporosis was associated with a greater risk of sarcopenia when using the European definition. Health care professionals should screen for sarcopenia in those with osteoporosis. To investigate the association between bone mineral density (BMD) and the severity of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition. BMD [dual energy X-ray absorptiometry (DXA)], appendicular lean mass (DXA), handgrip strength (hydraulic dynamometer) and gait speed (over 4-m) were used to screen for osteoporosis and sarcopenia. Participants were categorized as osteoporotic according to the World Health Organization definition (T score ≤ − 2.5), and classified with probable sarcopenia or confirmed sarcopenia according to the EWGSOP2 criteria. Fasting biochemistry profile, fragility fractures, malnutrition index, geriatric depression scale and fear of falling, were also measured using validated procedures. A total of 484 community-dwelling older adults (69.6% women) with a median age of 76 years [Interquartile range (IQR) 70–81] were included in this study. Osteoporosis prevalence increased from 47.6% in non-sarcopenia to 65.5% in probable sarcopenia and 78.1% in those with confirmed sarcopenia (p

Understanding how changes in nutritional status influence musculoskeletal recovery after falling remains unclear. We explored associations between changes in nutritional status and musculoskeletal health in 106 community-dwelling older adults aged &ge, 65 years, who attended the Falls and Fractures Clinic at Sunshine Hospital in St Albans, Australia after falling. At baseline and after 6 months, individuals were assessed for Mini Nutritional Assessment (MNA&reg, ), grip strength, gait speed, Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and bone turnover marker levels. Associations were examined using multiple linear regression, adjusted for baseline covariates and post-fall care plans. Over 6 months, the prevalence of malnutrition or risk thereof decreased from 29% to 15% using MNA &lt, 24/30. Specifically, 20 individuals (19%) improved, 7 (7%) deteriorated, and 73 (69%) maintained nutritional status, including 65 (61%) who remained well-nourished and 8 (8%) who remained malnourished/at risk. A 1-point increase in MNA score over 6 months was associated with an increase of 0.20 points (95% confidence interval 0.10, 0.31, p &lt, 0.001) in SPPB score. Improvement in nutritional status was associated with improvement in physical performance, providing a basis for interventional studies to ascertain causality and evaluate nutritional models of care for post-fall functional recovery in older adults.