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With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.

Sarcopenia in chronic kidney disease （CKD） occurs mainly in patients with end-stage renal disease （ESRD） on hemodialysis. The potential causes are insufficient nutrition intake, protein and energy consumption, inflammatory cytokines, oxidative stress, insulin resistance and uremic toxins. Protein-bound uremic toxin phenol sulfate is an intestinal-derived uremic toxin accumulating in CKD patients. It is difficult to remove through dialysis. It affects the occurrence of sarcopenia through various ways. The review focused upon the mechanisms of sarcopenia caused by indoxyl sulfate.

The aim of this study was to compare the frequency of sarcopenia, functional status, fear-avoidance behaviors, biopsychosocial status and quality of life in RA women with healthy controls.

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.

Inflammation, metabolic acidosis, renin-angiotensin system activation, insulin resistance, and impaired perfusion to skeletal muscles, among others, are possible causes of uremic sarcopenia. These conditions induce the activation of the nuclear factor-kappa B and mitogen-activated protein kinase pathways, adenosine triphosphate ubiquitin-proteasome system, and reactive oxygen species system, resulting in protein catabolism. Strategies for the prevention and treatment of sarcopenia in chronic kidney disease (CKD) are aerobic and resistance exercises along with nutritional interventions. Anabolic hormones have shown beneficial effects. Megestrol acetate increased weight, protein catabolic rate, and albumin concentration, and it increased intracellular water component and muscle mass. Vitamin D supplementation showed improvement in physical function, muscle strength, and muscle mass. Correction of metabolic acidosis showed an increase in protein intake, serum albumin levels, body weight, and mid-arm circumference. The kidney-gut-muscle axis indicates that dysbiosis and changes in gut-derived uremic toxins and short-chain fatty acids affect muscle mass, composition, strength, and functional capacity. Biotic supplements, AST-120 administration, hemodiafiltration, and preservation of residual renal function are alleged to reduce uremic toxins, including indoxyl sulfate (IS) and p-cresyl sulfate (PCS). Synbiotics reversed the microbiota change in CKD patients and decreased uremic toxins. AST-120 administration changed the overall gut microbiota composition in CKD. AST-120 prevented IS and PCS tissue accumulation, ameliorated muscle atrophy, improved exercise capacity and mitochondrial biogenesis, restored epithelial tight junction proteins, and reduced plasma endotoxin levels and markers of oxidative stress and inflammation. In a human study, the addition of AST-120 to standard treatment had modest beneficial effects on gait speed change and quality of life.

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

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: An age-dependent normative values of calf circumference (CC) has been recently proposed as an accessible proxy for muscle mass. However, its usefulness to estimate sarcopenia has not been assessed. The objectives of the present study were to determine if the substitution of the classical way to assess muscle mass by these values have enough diagnostic accuracy and prognostic value among older adults living in the community. Methods: Data from the Toledo Study of Healthy Ageing (TSHA) were used. CC was measured using an anthropometric tape. We used two age-groups CC cut-off points: the TSHA CC median and the one proposed in the Longevity Check-up 7+ (Lookup 7+) project. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and FNIH criteria standardized for our population (sFNIH). Frailty (according to the Frailty Phenotype and the Frailty Trait Scale-5) and disability (Katz index) were assessed at baseline and follow-up. Mortality and first hospitalization were also recorded. Logistic (incident frailty and worsening disability) and Cox (mortality and hospitalization) regressions were performed. Diagnostic accuracy was assessed through Kappa index, AUCs, positive and negative predictive values. Predictive ability was assessed through AUCs and integrated AUCs (IAUCs). Results: 1531 participants (74.8 ± 5.8 years; 45.6% men) were included in the analysis. Prevalence rates of sarcopenia were 22.7% (sFNIH), 15.0% (FNIH), and 13.9% (EWGSOP2). Using TSHA-based cut-points of CC, the prevalence of sarcopenia was 16.8% (sFNIH), 11.0% (FNIH), and 11.5% (EWGSOP2). According to LC7+-based CC cut-off points, sarcopenia prevalence was 17.6% (sFNIH), 11.9% (FNIH), and 12.4% (EWGSOP2). CC cut-off points showed low-to-moderate agreement (Kappa Index values between 0.49 and 0.69) with appendicular lean mass for the evaluation of sarcopenia. Sarcopenia identified by Lookup 7+ and TSHA CC cut-off points was associated with the adverse events examined, with similar AUCs and IAUCs than original sarcopenia definitions, and were lost after adjustment by baseline frailty, except when the original EWGSOP2 definition was used. Conclusions: Using normalized values of CC as a criteria of muscle mass shows moderate agreement with classical criteria for diagnosing sarcopenia and offer similar predictive value in community-dwelling older adults.

Background: There is still no study on the use of the SARC-CalF questionnaire for older critically ill patients. Moreover, there is limited evidence on whether a combination of sarcopenia and frailty can provide incremental improvements in risk stratification for older critically ill patients. Methods: A total of 653 patients older than 60 years were recruited. We used the clinical frailty scale (CFS) and SARC-CalF questionnaire to assess the frailty status and sarcopenia risk, respectively, of older patients shortly after admission to the ICU. The effect of frailty and sarcopenia risk on ICU mortality and 30-day mortality was evaluated. Results: A total of 147 (22.5%) patients died in the ICU, and 187 (28.6%) patients died within 30 days after ICU admission. The CFS score was associated with increased ICU mortality [per 1-score increase: odds ratio (OR) = 1.222, 95% confidential interval (CI): 1.003–1.489] and 30-day mortality (per 1-score increase: OR = 1.307, 95% CI: 1.079–1.583). The SARC-CalF score was also associated with increased ICU mortality (per 1-score increase: OR = 1.204, 95% CI: 1.120–1.294) and 30-day mortality (per 1-score increase: OR = 1.247, 95% CI: 1.163–1.337). The addition of the CFS + SARC-CalF score to Acute Physiology and Chronic Health Evaluation (APACHE) II improved discrimination and reclassified ICU and 30-day mortality risk. Conclusions: Sarcopenia risk assessed by the SARC-CalF questionnaire provided independent prognostic information for older critically ill patients. A combination of sarcopenia and frailty improved the prediction of mortality for older critically ill patients and thus might be useful in the clinical decision-making process.

Objectives: The present retrospective study reviewed the association among sarcopenia, myosteatosis, and overall survival (OS) in patients with postoperative colorectal cancer (CRC) with regard to age. Design: A retrospective study was conducted with a five-year follow-up. Setting: Data from all patients with CRC, who underwent surgery between February 2005 and April 2014, were reviewed. Participants: Data from 1053 patients (622 male [59.1%], 431 female [40.9%]; mean [± SD] age, 62.8 ± 11.8 years) were analyzed. Measurements: Patients were divided into three groups according to age: ≤50, 51–74, and ≥75 years. Data, including perioperative parameters, and the presence of sarcopenia and myosteatosis according to skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), respectively, were collected. Sarcopenia was evaluated using CT by calculating the SMI at the L3 level by dividing the area of the skeletal muscle by height squared (cm2/m2). SMD was also calculated using CT at the L3 level, but by evaluating fat attenuation according to Hounsfield units (HU). Results: Patient allocation according to age group was as follows: ≤50 years, n = 147 (14.0%); 51–74 years, n = 742 (70.5%); and ≥75 years, n = 164 (15.5%). The presence of sarcopenia and myosteatosis were statistically significant with increasing age (P = 0.004 and P

Background: Previous studies had indicated that sarcopenia and depressive symptoms were associated with increased risk of cardiovascular disease (CVD). The aim of present study was to evaluate the combined effect of sarcopenia and depressive symptoms on the CVD risk. Methods: A total of 11,011 participants from the China Health and Retirement Longitudinal Study 2011–2020 were included. Multivariate Cox proportional hazards regression model was used to explore the associations between sarcopenia, depressive symptoms and new-onset CVD, stroke and cardiac events. Results: During the 7-year follow-up, a total of 2,388 respondents experienced CVD (including 812 stroke and 1,831 cardiac events). There is a significant additive and multiplicative interactions of sarcopenia and depressive symptoms on risk of CVD, stroke and cardiac events. Compared with those without sarcopenia and depressive symptoms, individuals with depressive sarcopenia had the highest risk of CVD, stroke and cardiac events, with the corresponding hazard ratios (95% confidence interval) were 1.43 (1.26–1.63), 1.45 (1.15–1.82) and 1.50 (1.29−1.74), respectively. Conclusion: Our study indicated that there was a combined effect of sarcopenia and depressive symptoms on the risk of CVD, stroke and cardiac events. Our findings highlighted the importance of identifying sarcopenia and depressive symptoms, and intervening much earlier both in older and younger population.

Background: Sarcopenia and intrinsic capacity (IC) declines pose significant challenges to healthy aging, particularly in the rapidly growing octogenarian population. This study aimed to elucidate the relationship between sarcopenia and declines in IC across multiple cohorts of community-dwelling older adults. Methods: Data from four Taiwanese cohorts were analyzed. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria (algorithm 1: categorized as either having possible sarcopenia or not (robust); algorithm 2: categorized as robust, possible sarcopenia or sarcopenia). IC was operationalized using the World Health Organization's Integrated Care for Older People (ICOPE) framework (step 1 and step 2), encompassing six domains: locomotion, vitality, vision, hearing, cognition, and psychological well-being. Multivariable logistic regression models were adopted to assess the association between sarcopenia and IC decline. Results: Among 599 octogenarians (median age 82.2 years, 54.8% male), the prevalence of possible sarcopenia (algorithm 1) was 64.6%. When adopting algorithm 2, the prevalence of possible sarcopenia and sarcopenia was 46,2% and 32.1%, respectively. After adjusting for covariates, participants with possible sarcopenia or sarcopenia (algorithm 2) were more likely to exhibit declines in vitality (ICOPE Step 1: possible sarcopenia aOR 3.65, sarcopenia aOR 4.74; ICOPE Step 2: possible sarcopenia aOR 5.11, sarcopenia aOR 14.77) and cognition (ICOPE Step 1: possible sarcopenia aOR 2.40, sarcopenia aOR 2.12; ICOPE Step 2: possible sarcopenia aOR 2.02, sarcopenia aOR 2.51) compared to robust individuals. Conclusions: This study underscores the robust association between sarcopenia and declines in vitality and cognition among octogenarians, highlighting the importance of sarcopenia screening and management in promoting healthy longevity in this vulnerable population.

Background/Aims Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. The diagnosis of sarcopenia is based on documentation of two of the three criteria: low muscle mass, low muscle strength, and low physical performance. Imaging-based assessment of muscle mass is preferred in both clinical and research settings. Anthropometry for the evaluation of muscle mass is prone to errors and is not recommended in the clinical setting.

Masticatory function is associated with a variety of health outcomes. The aim of this systematic review is to clarify the predictive value of masticatory function for adverse health outcomes, such as frailty, sarcopenia and malnutrition, in older adults.An online literature search covered articles published in English or Dutch in three databases (PubMed, Embase and CINAHL, last searched November 4th 2022). Inclusion criteria were: an observational study design, focus on adults aged ≥65 years and evaluation of the association between masticatory function and health outcomes. Reviews and articles published before the year 2000 were excluded. Methodological quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the U.S. National Institutes of Health. Study population demographics, methods for assessing masticatory function, and the association between masticatory function and adverse health outcomes were extracted.From the 34 included studies, 5 studies had a prospective design, 2 had a retrospective design, and the other 27 studies had cross-sectional design. The majority of the studies were conducted in Japan (74%, n = 26). Twenty studies (59%) used one indicator for masticatory function, the other 41% used two (n = 9) or more (n = 5) indicators. Masticatory function was most frequently assessed with the maximum occlusal force (MOF) (79%, n = 27). The identified health outcomes were clustered into 6 categories: physical parameters and sarcopenia, history of falling, nutritional status, frailty, cognitive function and mortality.Despite the complex and multidimensional character of both masticatory function and most identified adverse health outcomes, some significant associations were reported. Prospective studies showed that reduced masticatory function in older adults is associated with incidence of frailty and frailty progression, cognitive decline and all-cause mortality. Regarding the other identified adverse health outcomes, i.e., physical measures and sarcopenia, history of falling and nutritional status, only cross-sectional studies were available and results were less concordant. As all prospective studies showed that reduced masticatory function in older adults is associated with adverse health outcomes, prevention of decline of masticatory function by adequate oral care may contribute to healthy ageing.

Objectives: Inflammation and impaired muscle synthesis are important factors of sarcopenia. Plant protein may reduce inflammation but may not be as efficient as animal protein in providing essential amino acids. We therefore examined the associations between dietary protein intake and changes in muscle mass and physical performance, incident sarcopenia, and the interaction effect of inflammation. Design: Prospective cohort study. Setting: The Mr. OS and Ms. OS (Hong Kong) cohort. Participants: A total of 2,811 sarcopenia-free participants and 569 sarcopenia participants aged ≥65 years were recruited from communities. Measurements: Dietary protein intake was assessed using a validated food frequency questionnaire. Serum high-sensitivity C-reactive protein (hs-CRP) was measured. Linear regression examined the associations between dietary protein intake and 4-year changes in muscle mass and physical performance. Cox regression examined the association between dietary protein intake and incident sarcopenia. Results: Higher plant protein intake, but not total and animal protein, was associated with less decline in muscle mass and gait speed among sarcopenia-free participants. Conversely, higher ratio of animal-to-plant protein was associated with reduced muscle mass loss among participants with sarcopenia. The highest tertile of plant protein intake was associated with lower incident sarcopenia risk (HR: 0.75, 95% CI: 0.57−0.98; P-trend = 0.034) compared to the lowest tertile. Notably, this association was observed among participants with higher serum hs-CRP levels (HR: 0.57, 95% CI: 0.34−0.95), but not in those with lower hs-CRP levels. Conclusion: Dietary animal and plant protein intake have differential associations with muscle mass and physical performance in older adults with and without sarcopenia. The role of plant protein in preventing sarcopenia involves modulation of inflammation.

Objectives: The aim of the study was to comprehensively analyze the effects of whey protein (WP)-enriched supplement intake with or without resistance training (RT) in older patients, either from the community or hospital, who were diagnosed with sarcopenia according to the EWGSOP or AWGS criteria. Methods: This meta-analysis study was registered in PROSPERO (CRD42023407885). We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for RCTs up to June 1, 2023. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used to estimate the pooled results. Results: Ten RCT studies, including 1154 participants, were included and analyzed. The primary outcomes were the changes in muscle mass, strength, and physical performance. In WP group versus (vs.) Isocaloric placebo (PLA)/Routine consultation (RC) group, WP significantly increased the appendicular skeletal muscle mass index (SMD: 0.47, 95%CI: 0.23, 0.71), appendicular skeletal muscle mass (SMD: 0.28, 95%CI: 0.11, 0.45) and gait speed (SMD: 1.13, 95%CI: 0.82, 1.44) in older patients with sarcopenia. In WP with RT group vs. PLA/ RC group, there was significant increase in handgrip strength (SMD: 0.67, 95%CI: 0.29, 1.04). In addition, in the secondary outcomes, WP significantly reduced interleukin-6, significantly increased insulin-like growth factor-1 and albumin, promoted participants' intake of total energy and protein, enhanced activities of daily living scores in patients, and had no significant effect on BMI, weight, or fat mass. Conclusion: This review confirms that WP can improve various aspects of older adult with sarcopenia, thereby enhancing their overall physical condition. More studies should be conducted to validate this result and further explore the effects of WP and RT in patients with sarcopenia.

Aim: Sarcopenia and skeletal muscle density (SMD) have been shown to be both predictive and prognostic marker in oncology. Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). Computed tomography (CT) enables skeletal muscle to be quantified, whereas body mass index (BMI) cannot accurately reflect body composition. The purpose was to evaluate the prognostic value of modified ALI (mALI) using CT-determined third lumbar vertebra (L3) muscle index beyond original ALI and see the interaction between sarcopenia, SMD, neutrophil-lymphocyte ratio (NLR), ALI and mALI at baseline and post 4 cycles of chemotherapy and their effects on OS and progress free survival (PFS) in patients with advanced non-SCLC (NSCLC). Methods: This retrospective study consisted of a total of 285 advanced NSCLC patients. The morphometric parameters such as SMD, skeletal muscle index (SMI) and fat-free mass (FFM) were measured by CT at the L3 vertebra. ALI was defined as BMI × serum albumin/NLR and mALI was defined as SMI × serum albumin/NLR. Results: Sarcopenia was observed in over 70% of patients across all BMI categories. Patients having sarcopenia suffered from a higher incidence of chemotherapeutic drug toxicities but this was not found to be statistically significant. Concordance was seen between ALI and mALI in the pre-treatment setting and this was statistically significant. A significant proportion of patients with poor ALI (90.9%), poor pre-chemotherapy mALI (91.3%) and poor post-chemotherapy mALI (89%) had poor NLR and each of them was statistically significant. Conclusions: In both univariate and multivariate analyses, this study demonstrated the statistical significance of sarcopenia, SMD, and mALI as predictive factors for OS. Additionally, sarcopenia and SMD were also found to be statistically significant factors in predicting PFS. These biomarkers could potentially help triage patients for active nutritional intervention for better outcomes.

Background: Few studies have examined the role of outdoor air pollution exposure in sarcopenia in Asia. We aimed to investigate the association of outdoor air pollutants exposure with sarcopenia among Chinese adults. Methods: This nationally population-representative study used data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 11,700 participants at least 45 years old from 125 Chinese cities were included. Sarcopenia status was identified according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Ambient annual average air pollutants including fine particulate matter (PM2.5), inhalable particles (PM10), coarse particulate matter (PMcoarse), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) were estimated by satellite models and ground-based measurements. Multinomial logistic regression models were performed to examine the associations of air pollutants exposure with different status of sarcopenia (including possible sarcopenia and sarcopenia). Stratified analyses were utilized to assess the effect modifiers. Results: Among the 11,700 participants (52.6% women), the average age was 61.0 years. Each 10 μg/m3 increment of annual PMcoarse was associated with a higher risk of possible sarcopenia (odds ratio (OR) = 1.08, 95% confidence interval (CI) 1.04–1.11). Stratified analyses showed a positive risk of possible sarcopenia in women after exposure to PM10, PMcoarse, and NO2. Ambient NO2 exposure was positively associated with sarcopenia (OR = 1.13, 95% CI 1.04–1.22) in those aged 65 years and older. However, we have not observed differences by sex, age, residence, smoking, and drinking. Robustness results were found for PMcoarse in the sensitivity analyses. Conclusion: This nationwide study suggested that long-term exposure to outdoor air pollution, especially for PMcoarse, was associated with the risk of sarcopenia among Chinese adults. Our findings provide epidemiological implications for protecting healthy ageing by improving air quality.

Objectives: This study aimed to explore the links of handgrip strength and asymmetry with cognitive impairment. Design: This was a seven-year prospective cohort study. Setting and participants: We used data from wave 3 (2015–2017) to wave 5 (2019–2022) from the ongoing Taiwan Initiative of Geriatric Epidemiological Research (TIGER), with wave 3 as the baseline (n = 446). The study included community-dwelling participants aged 65 years or older. Measurements: Handgrip strength was measured, and abnormalities were determined based on handgrip strength weakness and asymmetry. Handgrip strength asymmetry was categorized into three groups at baseline based on the handgrip strength ratio (left handgrip strength/right handgrip strength). Cognitive tests evaluating global and specific cognitive domains were conducted at baseline and two biennial follow-ups. Generalized linear mixed models were utilized to assess the associations of abnormal handgrip strength with global cognition and multiple cognitive domain progression over time. Results: This study included 392 dementia-free participants, with an average age of 75.8 years and 179 (45.7%) males. Mild handgrip strength asymmetry was present in 88 participants (22.4%), while 53 (13.5%) exhibited moderate asymmetry. In men, the coexistence of low handgrip strength and handgrip strength asymmetry was linked to cognitive impairment over time. These associations were observed in global cognition (β^ = −1.76, 95% CI: −2.79 to −0.74), memory (immediate free recall: β^ = −0.67, 95% CI: −1.17 to −0.17), executive function (Trail Making Test-A: β^ = −0.54, 95% CI: −0.94 to −0.13), and attention (Digit span-forward: β^ = −1.00, 95% CI: −1.46 to −0.54). Conclusions: This study found that individuals with reduced handgrip strength and handgrip strength asymmetry had an increased risk of cognitive impairment across various domains. Moreover, this association appears to be more pronounced among men than women. Incorporating these simple assessments into regular clinical practice improves the allocation of limited screening resources and timely clinical interventions in older adults.

Objectives: The main objective was to analyze the evolution of muscle of the Quadriceps Rectus Femoris (QRF) between admission and discharge, in older adults hospitalized with an acute medical disease in Acute Geriatric Units (AGUs). Design: Prospective multicentric observational cohort study. Setting: Seven AGUs from University Hospitals in Spain. Participants: Hospitalized adults ≥ 70 years old, able to ambulate and without severe dementia. Measurements: Ultrasound measurements of QRF were acquired at 2/3 distal between anterior-superior iliac spine and patella in both legs by trained Geriatricians. Ultrasound Chison model ECO2 was used. QRF area, thickness, edema, echogenicity, and fasciculations were measured. Results: From the complete sample (n = 143), in 45 (31.5%) participants, ultrasound images were classified as non-valid by an expert radiologist. Mean age was 87.8 (SD 5.4). Mean hospital stay 7.6 days (SD 4.3). From those with valid images, 36 (49.3%), 2 (2.7%), and 35 (47.9%) presented a decrease, equal values, or an increase in QRF area from baseline to discharge, respectively, and 37 (50.0%), 2 (2.7%), and 35 (47.3%) presented a decrease, equal values, or an increase in QRF thickness, respectively. 26 (35.6%) presented a decrease in more than 0.2 cm2 of QRF area, and 23 (31.1%) a decrease in more than 0.1 cm of QRF thickness. Only 4 (5.4%) patients presented new edema, while 13 (17.6%) worsened echogenicity. Conclusion: One third of older adults develop significant muscle loss during a hospitalization for acute medical diseases. Trial registration number: NCT05113758

Objectives: We aimed to investigate longitudinal associations of overall social support and its sub-domains with risk of sarcopenia and its related traits in community-dwelling Chinese aged ≥ 50 years. We also explored interaction effects of potential factors on such associations. Design: A prospective cohort study. Setting: Community-based setting in western China. Participants: We included participants aged ≥50 years with complete information necessary for analysis from the WCHAT study who did not have sarcopenia at baseline (2018) and had sufficient data for sarcopenia assessment during 2021–2023. Measurements: Exposures included overall social support, subjective support, objective support and support utilization, which were assessed with the Social Support Rating Scale. Outcomes included sarcopenia, low muscle mass (LMM), low muscle strength and low physical performance, which were diagnosed with the 2019 AWGS consensus. Longitudinal associations between the exposures and outcomes were estimated by logistic regression, with generalized estimating equations (GEE) as sensitivity analyses. Subgroup analyses by potential covariates were conducted to detect interaction effects. Results: A total of 1905 participants were finally included in the analytic sample, of whom 326 (17.1%) developed incident sarcopenia during 5-year follow-up. After controlling for confounders, higher degree of overall social support (OR = 0.87, 95%CI 0.76−0.99), subjective support (OR = 0.88, 95%CI 0.77−0.99) and support utilization (OR = 0.87, 95%CI 0.77−0.99) correlated with lower sarcopenia risk, among which higher support utilization degree was indicative of lower risk for LMM (OR = 0.88, 95%CI 0.79−0.98). GEE further revealed that overall support degree was negatively associated with risk for sarcopenia (OR = 0.86, 95%CI 0.76−0.98) and LMM (OR = 0.87, 95%CI 0.77−0.99). Objective support was neither significantly associated with sarcopenia nor its traits. No significant interaction effect was observed between overall support and the concerned confounders on sarcopenia (interaction P-value > 0.05). Conclusion: Overall social support degree was negatively associated with sarcopenia risk, possibly primarily through affecting muscle mass rather than muscle strength or physical performance, and such an association remained robust across subgroups with distinct characteristics. This holds implications for policymakers to conduct population-based risk assessment, and supportive strategies against sarcopenia should focus on enhancing subjective support and support utilization rather than objective support alone.

Objectives: Sarcopenia is associated with functional disability in older adults. However, no consistent conclusions have been reached considering the differences in the measurement and criteria of sarcopenia. We aimed to examine the association between sarcopenia status and functional disability based on China Health and Retirement Longitudinal Study (CHARLS). Design: A nationally representative longitudinal study. Setting and participants: Participants aged at least 60 years old from the CHARLS 2015y were included. Measurements: Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019 algorithm. The outcomes of this study were basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The logistic regression model was conducted to analyze the cross-sectional and longitudinal associations between sarcopenia status and ADLs and IADLs disability. Results: In the cross-sectional study, 37.2% of the 6893 participants were defined as having sarcopenia. Any form of sarcopenia was associated with ADLs and IADLs disability. During three years of follow-up, 786 (16.5%) participants developed new‐onset ADLs disability, and 980 (22.5%) participants developed new‐onset IADLs disability. Compared with the no‐sarcopenia, participants with possible sarcopenia (OR: 1.62, 95%CI: 1.34−1.95), sarcopenia (OR: 1.58, 95%CI: 1.18−2.11), or total sarcopenia (OR: 1.58, 95%CI: 1.34−1.88) had a higher risk of ADLs disability. While, the risk of IADLs disability for participants with possible sarcopenia (OR: 1.68, 95%CI: 1.41−2.00), sarcopenia (OR: 1.87, 95%CI: 1.40−2.51), or total sarcopenia (OR: 1.71, 95%CI: 1.45−2.00) was still significantly increased. With statistical interaction between sarcopenia status and residence or sex in ADLs and IADLs disability, older adults in urban, with ORs ranging from 2.14 to 2.44, were at a higher risk of functional disability than those in rural. Possible sarcopenia was associated with a much higher risk of ADLs disability (OR: 1.68, 95%CI: 1.26–2.25) in males and a higher risk of IADLs disability (OR: 1.98, 95%CI: 1.56–2.52) in females. Conclusions: Sarcopenia was associated with an increased risk of ADLs and IADLs disability among older Chinese adults. Even possible sarcopenia still significantly impacted ADLs and IADLs disability, and this association varied by sex and residence.

Background: Observational studies have shown an association between reduced renal function and the risk of sarcopenia. However, the causal relationship and the underlying biological mechanisms remain uncertain. Using a Mendelian randomization (MR) framework, we investigated the causal role of 27 hypothetical risk mediators, including metabolites, hormones, inflammation, and stress traits, on the risk of sarcopenia. Methods: Instrumental variables (IVs) to proxy renal function were identified by selecting single nucleotide polymorphisms (SNPs) reliably associated with creatinine and cystatin C-based glomerular filtration rate (GFR) in CKDGen summary data. IVs for putative risk traits and sarcopenia traits were constructed from relevant genome-wide association studies (GWAS). MR estimated effects were obtained using an inverse-variance weighted effects model, and various sensitivity analyses were performed. The mediating role of hypothetical risk factors in the relationship between GFR and sarcopenia was assessed through multivariate MR. Results: Genetically predicted reduced GFRcrea was associated with higher odds of appendicular lean mass (ALM) (odds ratio (OR): 0.64, 95% confidence interval (CI) 0.37 to 0.68) and grip strength (OR: 0.67; 95% CI 0.58 to 0.78). Likewise, GFRcys highlighted a causal relationship with ALM (OR: 0.52; 95% CI 0.42 to 0.65) and grip strength (OR: 0.66; 95% CI 0.59 to 0.74). Both estimated GFR (eGFR) were negatively associated with IGF-1, IL-16, 25(OH)D, triglycerides (range of effect size per standard deviation: -0.81 to -0.30), and positively correlated with HDL cholesterol (0.62, 0.31). There was a positive correlation between IGF-1, fasting insulin and ALM as well as grip strength (OR range: 1.04–1.67) and a negative correlation between serum CRP and ALM (OR: 0.95) as well as grip strength (OR: 0.98). Additionally, genetically predicted IL-1β (OR: 0.95) and total cholesterol (OR: 0.96) were negatively associated with ALM. We found evidence that IGF-1 mediates the relationship between eGFR and risk for muscle mass and strength. Conclusions: This MR study provides insight into the potential causal mechanisms between renal function and the risk of sarcopenia and proposes IGF-1 as a potential target for the prevention of renal sarcopenia.

Objectives: The concept of possible sarcopenia (PS) was recently introduced to enable timely intervention in settings without the technologies required to make a full diagnosis of sarcopenia. This study aimed to investigate the association between PS and all-cause mortality in patients with solid cancer. Design: Retrospective observational study. Setting and participants: 13,736 patients with 16 types of solid cancer who were ≥18 years old. Measurements: The presence of both a low calf circumference (men

Abstract Background Patients with pancreatic cancer often lose weight during chemotherapy with associated changes in body composition. The goal of the present analysis was to describe changes in body composition in pancreatic cancer patients on an exercise regimen. The long‐term goal is to determine whether an exercise intervention may attenuate changes in body composition and function. Methods Twenty‐two pancreatic cancer patients of all stages who were to receive chemotherapy were recruited into a pre‐post exercise intervention study. A standard exercise prescription was individualized to include aerobic, resistance, stretch, and balance exercises. Pre‐ and post‐intervention computed tomography‐derived measures of body composition [skeletal muscle index (SMI), skeletal muscle density, visceral fat area, and subcutaneous fat area] and physical function measures (grip strength, timed up and go, 30‐s chair stand, and tandem balance stand) were evaluated using paired t‐tests, χ2 tests, and Pearson correlation coefficients. Results The subjects were, on average, 62 years of age, 55% were female, 95% non‐Hispanic White, and 45% were Stage IV. Body composition changes included a median 4.6% decrease in SMI (P = 0.04), 7.91% increase in skeletal muscle density (P = 0.05), 25.07% decrease in visceral fat area (P = 0.0001), and 22.08% decrease in subcutaneous fat area (P = 0.001). Adherence to aerobic and strength exercise was 65% and 57%, respectively. Some physical function measures improved, though not significantly: chair stands increased from a mean of 11.5 to 13.0 (P = 0.59) and timed up and go improved from a mean of 11.7 to 10.3 (P = 0.26). Change in right hand grip strength was marginally positively associated with changes in SMI (r = 0.53, P = 0.06). Improvements in skeletal muscle density were seen in 63% of patients, including Stage IV patients but did not correlate with change in function. Conclusions Exercise is feasible during neoadjuvant chemotherapy for pancreatic cancer patients of all stages and may assist with maintaining physical function and improving body composition. Further research is needed.

Abstract Background It is unknown to what degree of sarcopenia related to heart failure (HF) is reversible with resolution of the HF syndrome. We evaluated whether (1) weight loss prior to left ventricular assist device (LVAD) is associated with pre‐operative sarcopenia as quantified on pre‐operative chest CTs and (2) determine the relationship between weight recovery (increase) after LVAD implantation and reduction of NT‐proBNP levels. Methods In a large single‐centre cohort (n = 502), CT measures of sarcopenia (pectoralis muscle mass indexed to body surface area and tissue attenuation) were correlated with pre‐LVAD BMI trend (n = 190). BMI and NT‐proBNP trends before and after LVAD implantation were evaluated (n = 403). Linear effects modelling was performed to test the association between NT‐proBNP and BMI trends. Results A downtrending BMI prior to LVAD was associated with pectoralis muscle tissue attenuation (P

Abstract Background Restrictions on outdoor movements due to the coronavirus disease (COVID‐19) pandemic have led to a decreased physical activity; this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community‐dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1‐year follow‐up thereafter. Methods This study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one‐leg stand‐up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods. Results The frequency of going out and the subjective vitality were significantly decreased immediately after the first wave; these recovered at the 1‐year follow‐up (P

Abstract Background The poor survival of pancreatic cancer patients is largely attributable to cachexia, a syndrome of severe weight and muscle loss. To investigate the aetiology of cancer cachexia, preclinical models that closely recapitulate the human disease process are essential. Patient derived tumour organoids are promising novel cancer models, but their ability to induce cachexia in mice has not been investigated. We developed two pancreatic tumour organoid‐based mouse models and demonstrate their potential for cancer cachexia research. Methods Two patients with pancreatic cancer, from whom tumour organoid cultures were previously established, were selected based on their cachexia phenotype. Patient 09 was characterized as cachectic according to the international consensus definition of cancer cachexia, whereas patient 12 was classified as non‐cachectic. Organoid cultures PANCO‐09b and PANCO‐12a in basement membrane extract (BME) were injected subcutaneously into the flanks of 9‐weeks old NMRI‐Foxn1nu mice (n = 8/group). A control group was injected with BME only (n = 4). Body weight was monitored every 2–3 days for 38 days. Hind limb muscle wet and dry weights were measured. Adipocyte size in inguinal white adipose tissue was measured using haematoxylin and eosin‐stained sections. Expression of genes associated with cancer cachexia in muscle and liver tissue was analysed using qPCR. Results Engraftment of tumour organoids was successful in 87.5% of PANCO‐09b implanted mice and in 50% of PANCO‐12a mice, with similar average tumour weights at endpoint (34.4 ± 25.1 mg vs. 32.8 ± 40.2 mg, respectively, P = 0.450). All groups initially gained weight, but PANCO‐12a implanted mice progressively lost an average body weight of 1.7 ± 0.8 g from day 28 onwards. PANCO‐12a‐implanted mice gained significantly less weight from baseline than controls (0.7 ± 0.6 g, P = 0.027). Overall body weight gain of PANCO‐09b mice was also lower but not significantly different from controls (2.0 ± 1.2 g vs. 2.9 ± 1.6 g, P = 0.961). Wet weights of hind leg muscles were negatively correlated with tumour weight but did not differ between groups. Adipocytes of PANCO‐12a implanted mice were smaller compared to SHAM as well as PANCO09b mice (P

Advances in medicine have resulted in increased longevity, which has consequently led to unexpected geriatric syndromes, such as frailty and sarcopenia. Patients with end-stage kidney disease, especially those receiving dialysis treatment, often show characteristic reductions in body protein and energy storage, termed protein energy wasting (PEW). Therefore, maintenance of nutritional condition has a key role in defending against both geriatric syndromes and PEW, which share several components in elderly individuals undergoing hemodialysis. To counteract the development of an undesirable condition, nutritional evaluation is indispensable. In addition to simple measurements of body mass index, and serum albumin and creatinine, a composite nutritional assessment including a malnutrition inflammation score is useful, although subjective elements are included and a well-trained examiner is required. On the other hand, the geriatric nutritional risk index and nutritional risk index for Japanese hemodialysis patients (NRI-JH) are objective tools, and easy to use in clinical settings. Undernutrition is closely related to infectious events and the results of an infection are often serious in elderly patients, even those with survival, with large medical costs incurred. Together with appropriate nutritional evaluation, it is necessary to clarify the underlying relationship of PEW with infection for improvement of prognosis in affected elderly individuals.

An aging population and the prevalence of lifestyle-related ailments have led to a worldwide increase in the rate of chronic kidney disease requiring renal replacement therapy. The mean age of people requiring dialysis has been rising, and Japanese patients are aging more rapidly than those in the United States and Europe. Compared to people with normal kidney function, those undergoing hemodialysis are at increased risk of sarcopenia or frailty and serious health problems that limit access to kidney transplantation and lead to adverse health outcomes such as functional dependence, hospitalization, and death in patients on dialysis treatment. The Japanese Society of Renal Rehabilitation, established in 2011, published a clinical practice guideline for renal rehabilitation in 2019. Although the concept has become widely known among kidney health providers in recent years, efforts have still not focused on routine clinical care for patients with chronic kidney disease. In this review, the theory and clinical application of renal rehabilitation for patients undergoing daily hemodialysis were investigated.

Background Further studies are needed to identify whether muscle mass, muscle strength, or sarcopenia is the best indicator of survival in patients undergoing peritoneal dialysis (PD). We aimed to compare the association of sarcopenia and its components with survival in patients undergoing PD. Methods We identified all patients with PD (n = 199). We routinely recommended handgrip strength (HGS) and lean mass measurements using dual energy X-ray absorptiometry in all patients with PD. Sarcopenia was defined using cutoff values from the Asian Working Group for Sarcopenia. We evaluated the patient and technique survival rates. Results The number of patients with low HGS was 95 (47.7%). The median follow-up interval was 17 months (interquartile range, 13–21 months). Kaplan-Meier curve analysis showed that patients with low HGS or sarcopenia had poorer patient and technique survival compared with patients with normal HGS or without sarcopenia. Cox regression analysis showed that patients with low HGS had greater hazard ratios for patient death and technique failure compared with those with normal HGS. However, patients with low muscle mass were not significantly higher hazard ratios for patient death or technique failure compared with those with normal muscle mass. Patients with sarcopenia had significantly greater hazard ratios for patient death or technique failure than those without sarcopenia only in univariate analysis. Conclusion The present study demonstrated that HGS may be superior to muscle mass or sarcopenia for predicting patient or technique survival in patients undergoing PD.

Background Sarcopenia is a prevalent complication in patients with chronic kidney disease and is associated with poor quality of life, morbidity, and mortality. Several candidate biomarkers have been evaluated for this condition. This study assessed the serum cystatin C to creatinine (serum cystatin C/Cr) ratio as a potential biomarker for sarcopenia in patients with non-dialysis-dependent chronic kidney disease. Methods This study enrolled 517 outpatients. Muscle mass (lean tissue index) was measured using a bioimpedance spectroscopic device, and muscle strength (handgrip strength) was also measured. Sarcopenia was defined as a combination of low muscle strength and low muscle mass. Results Sarcopenia was observed in 25.5% of patients, and the mean serum cystatin C/Cr ratio was significantly higher in patients with sarcopenia than in those without it (1.14 ± 0.26 vs. 1.01 ± 0.27, p < 0.001). The prevalence of sarcopenia and low lean tissue index increased as the cystatin C/Cr ratio increased. The negative predictive value of the cystatin C/Cr ratio for sarcopenia or low lean tissue index was ≥80%. Multivariate analyses revealed that when the serum cystatin C/Cr ratio increased by 1, the risk of sarcopenia, low lean tissue index, and low handgrip strength increased by 4.6-, 7.2-, and 2.6-fold, respectively (p = 0.003, p < 0.001, and p = 0.048). The association was maximized in patients with an estimated glomerular filtration rate of

Background Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension. Methods In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of

Background: Sarcopenia, a reduction in skeletal muscle mass and function, is a condition that contributes to functional decline and disability in older adults. Although research on this geriatric condition has developed rapidly in recent years, little work has been done to document whether practicing physicians are incorporating sarcopenia into their clinical practice. Methods: An online survey of 253 practicing U.S. physicians assessed knowledge of sarcopenia, use of the term in practice, motivation for screening patients, and diagnostic and treatment approaches. They were board certified in four practice areas: internal medicine (n = 69), family medicine (n = 69), geriatrics (n = 40), or physical medicine and rehabilitation (PM&R) (n = 75). Results: Less than 20% of internists and family medicine physicians reported being very familiar with the term sarcopenia, with substantially higher familiarity at this level reported among geriatricians (70%) and among PM&R specialists (41%). Two additional findings pointed to deficiencies in sarcopenia knowledge and practice: participants substantially overestimated the prevalence of sarcopenia in older adults (44% of participants reported an expected prevalence of >25%) compared to findings from published studies (indicating 10% of older adults experience sarcopenia); over 75% reported not typically using specific diagnostic criteria or being unsure if their approach utilized any specific criteria. When asked what terminology they use in a medical chart for a patient presenting with significant loss of muscle mass and strength, only 8% said sarcopenia. Conclusions: Sarcopenia, a condition that can have a major impact on older adults as they age, has not been fully incorporated into the knowledge base and practices of active physicians. The survey data suggest that improving physician familiarity with sarcopenia and having universal agreement on criteria for diagnosis may increase the screening for and treatment of sarcopenia. [ABSTRACT FROM AUTHOR]

Abstract Background Psoas muscle area (PMA) has recently been found to be an appropriate surrogate for whole‐body skeletal muscle mass and a measure of sarcopenia. Sarcopenia, which includes a decreased muscle mass and correlated with physical disability, morbidity, and mortality, is prevalent in and has deleterious consequences for patients with chronic kidney disease (CKD). The current study investigates the association of PMA, as a marker of sarcopenia, with baseline kidney function and CKD progression. Methods A retrospective cohort study was conducted in a community hospital nephrology clinic setting. For this study, sarcopenia was defined as standardized PMA measured at the L3 level either as below 25th percentile or below the median. Progression of CKD was measured by estimated glomerular filtration rate (eGFR) decline rate and change in proteinuria. To assess sarcopenia as a predictor of baseline CKD Grade 4 or 5, a multivariate logistic regression model was applied using standardized PMA 29.9 kg/m2 were categorized by 4.8% (11/229), 24.89% (57/229), 33.19% (76/229), and 37.12% (85/229), respectively. Sarcopenia as a predictor of baseline CKD Grade 4 or 5 had an unadjusted odds ratio of 1.46 (0.87–2.63) and an adjusted odds ratio of 2.45 (1.13–5.31). Sarcopenia as a predictor for eGFR slope had an unadjusted odds ratio of 1.01 (1.00–1.04) and an adjusted odds ratio 1.03 (1.00–1.05). Conclusions Sarcopenia, as measured by PMA, predicts a significant risk of more severe baseline CKD grade and progression. Future studies should examine sex‐specific muscle mass tools as a predictor of renal function to create more targeted interventions.

Introducción: la sarcopenia puede presentarse en las enfermedades de larga evolución como la insuficiencia renal crónica. Su detección permite aplicar medidas terapéuticas específicas para evitar complicaciones. Objetivo: describir la frecuencia de sarcopenia en pacientes adultos con insuficiencia renal crónica del Hospital Nacional y Hospital Militar en 2021. Metodología: se aplicó un diseño estudio observacional, descriptivo, transversal. Se incluyeron a varones y mujeres, mayores de edad, portadores de insuficiencia renal crónica de los hospitales mencionados. La presencia de sarcopenia se evaluó con medidas antropométricas, la fuerza de presión palmar y la funcionalidad determinada con el cuestionario EuroQol-5D. Se midieron también variables demográficas y clínicas. Se reclutó un grupo control de sujetos jóvenes sanos para obtener parámetros antropométricos comparativos. La investigación fue aprobada por el Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: se incluyeron 119 pacientes con insuficiencia renal crónica, siendo 62 varones con edad media 56 ± 15 años y 57 mujeres con edad media 61 ± 16 años. Se reclutaron 150 sujetos sanos, siendo 51 varones con edad media 26 ± 5 años y 99 mujeres con edad media 25 ± 5 años. La etiología predominante de la insuficiencia renal crónica fue la combinación de hipertensión arterial y diabetes mellitus (45,4%). Al medir las medidas antropométricas, la fuerza de presión palmar y la funcionalidad se confirmó sarcopenia en 38,66% de los pacientes. Comparando variables demográficas y clínicas entre los diferentes grados de sarcopenia, sólo la edad resultó mayor en los sujetos con sarcopenia severa. Conclusión: en pacientes con insuficiencia renal crónica la sarcopenia se confirmó en 38,66%.

Sarcopenia is a geriatric syndrome characterized by the widespread and progressive loss of the skeletal muscular mass and decrease of the muscular force and physical performance. In this respect, the non-pharmacological treatment is of great importance due to its action in the skeletal musculature. In this work the fundamental elements to apply this therapy in elderly are specified whose clinical evaluation includes, among others, the valuation of chronic and acute comorbidities and of their physical functionality by means of the Katz index and the Lawton and Brody scale, the volume of planned physical activity and the diagnosis of the sarcopenia phases by the condition of the skeletal muscular mass, according to the European Working Group on Sarcopenia in Older People. Programs of force and resistance exercises corroborated in meta-analysis are also suggested, with an established duration, frequency and intensity, to strengthen the skeletal musculature and its action on the pathophysiological changes, in order to achieve the muscular adaptation and improve the physical functionality; with it, falls and fractures are prevented in the elderly with sarcopenia and improve their life quality.

Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1α, the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.

Abstract Background Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by joint inflammation, abnormal body composition, and an increased risk for sarcopenia. Muscle wasting in turn increases the risk of infection, morbidity, and premature mortality, but little is known of the relation between nutrient intake and sarcopenia in RA. Methods A prospective cohort study with follow‐up for 1 year examined body composition and diet in female outpatients with RA. We performed logistic regression analysis to assess which factors might have contributed to this loss of muscle mass. Multivariate logistic regression analysis with a forward–backward stepwise selection was also analysed. SKG/Jcl mice, which develop RA spontaneously, were fed normal chow or a high‐fat diet (HFD) and evaluated for inflammation and muscle mass. Results A total 53 female patients were included. The median age was 57.0 years, with an interquartile range (IQR) of 49.5 to 62.0 years, and the median disease duration was 4.0 years, with an IQR of 2.0 to 9.0 years. Fourteen patients (26.4%) had skeletal muscle mass index below the cut‐off for sarcopenia (≤5.7 kg/m2) as defined by the Asia Working Group for Sarcopenia. Multiple logistic regression analysis revealed that the intake of saturated fatty acids was associated with a >5% decrease in skeletal muscle index of RA patients over 1 year [odds ratio 95% confidence interval 1.431 (1.082–1.894), P = 0.012]. In 9 weeks old SKG/Jcl mice, HFD feeding precipitated the onset of RA and exacerbated rheumatoid synovitis in association with the induction of T helper 17 cell differentiation. The serum concentrations of inflammatory cytokines including IL‐6 and TNF‐α were significantly higher in HFD‐fed RA mice than in normal chow (NC)‐fed RA mice or in HFD‐fed control mice (IL‐6; 3.8 vs. 32.2 pg/mL, P

Abstract Background Pre‐frailty has been identified as a clinically silent mechanism pre‐disposing people to frailty. The goal of this study is to investigate the impact of low‐dose metformin on pre‐diabetic pre‐frail patients (>50 years) on skeletal muscle mass, speed of gait, handgrip power, and health‐related quality of life (HR‐QoL). Methods We did a retrospective cohort study of subjects aged 50 years and older who were diagnosed with pre‐frailty (one or two criteria present based on Fried Frailty Index) and pre‐diabetes (HbA1c 5.7% to 6.4%) from May 2018 to April 2020. Subjects taking low‐dose metformin were compared with non‐metformin participants through a review of the medical records. The results were analysed at baseline and 6–12 months post‐prescription with or without metformin. All data were accompanied by a 95% confidence interval. Results One hundred and thirteen pre‐diabetic and pre‐frail subjects were recruited to metformin [the mean metformin administration was 750 (140) mg/day] (n = 58) or control group (n = 55). The average age was 66.3 (6.8) years old, with 52.2% of the population being female. The baseline demographic, nutritional, physical, and mental status data did not differ between groups. In comparison with the control group, an 8.9 (1.8) month low‐dose metformin intervention resulted in a higher skeletal muscle mass index of 1.26 (1.66) kg/m2 (P = 0.029), a faster gait speed of 0.15 (0.22) m/s (P = 0.011), and a greater handgrip strength of 2.1 (2.9) kg (P = 0.037). However, there was no difference in myostatin serum levels or HR‐QoL between groups. Conclusions Low‐dose metformin was statistically and clinically meaningful to improve the original skeletal muscle mass index, gait speed, and grip strength as part of the sarcopenia dimension, but the Euro Quality of Life‐5 Dimensions index and myostatin serum levels did not change significantly.

Abstract Background Coronavirus disease 2019 (COVID‐19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. The role of skeletal muscle mass in modulating immune response is well documented. Whilst obesity is well established as a key factor in COVID‐19 and outcome, no study has examined the influence of both sarcopenia (low muscle mass) and obesity, termed ‘sarcopenic obesity’ on the risk of severe COVID‐19. Methods This study uses data from UK Biobank. Probable sarcopenia was defined as low handgrip strength. Sarcopenic obesity was mutually exclusively defined as the presence of obesity and low muscle mass [based on two established criteria: appendicular lean mass (ALM) adjusted for either (i) height or (ii) body mass index]. Severe COVID‐19 was defined by a positive severe acute respiratory syndrome coronavirus 2 test result in a hospital setting and/or death with a primary cause reported as COVID‐19. Fully adjusted logistic regression models were used to analyse the associations between sarcopenic status and severe COVID‐19. This work was conducted under UK Biobank Application Number 52553. Results We analysed data from 490 301 UK Biobank participants (median age 70.0 years, 46% male); 2203 (0.4%) had severe COVID‐19. Individuals with probable sarcopenia were 64% more likely to have had severe COVID‐19 (odds ratio 1.638; P

Abstract Background Low muscle in cancer is associated with an increase in treatment‐related toxicities and is a predictor of cancer‐related and all‐cause mortality. The mechanisms of cancer‐related muscle loss are multifactorial, including anorexia, hypogonadism, anaemia, inflammation, malnutrition, and aberrations in skeletal muscle protein turnover and metabolism. Methods In this narrative review, we summarise relevant literature to (i) review the factors influencing skeletal muscle mass regulation, (ii) provide an overview of how cancer/treatments negatively impact these, (iii) review factors beyond muscle signalling that can impact the ability to participate in and respond to an exercise intervention to counteract muscle loss in cancer, and (iv) provide perspectives on critical areas of future research. Results Despite the well‐known benefits of exercise, there remains a paucity of clinical evidence supporting the impact of exercise in cancer‐related muscle loss. There are numerous challenges to reversing muscle loss with exercise in clinical cancer settings, ranging from the impact of cancer/treatments on the molecular regulation of muscle mass, to clinical challenges in responsiveness to an exercise intervention. For example, tumour‐related/treatment‐related factors (e.g. nausea, pain, anaemia, and neutropenia), presence of comorbidities (e.g. diabetes, arthritis, and chronic obstructive pulmonary disease), injuries, disease progression and bone metastases, concomitant medications (e.g., metformin), can negatively affect an individual's ability to exercise safely and limit subsequent adaptation. Conclusions This review identifies numerous gaps and oppportunities in the area of low muscle and muscle loss in cancer. Collaborative efforts between preclinical and clinical researchers are imperative to both understanding the mechanisms of atrophy, and develop appropriate therapeutic interventions.

Abstract Background The chronic nature of congenital heart diseases (CHDs) leads to the activation of inflammatory and neurohormonal processes in the body, and there is a possibility of the occurrence of other complications such as sarcopenia. The aim of the present study was to evaluate sarcopenia prevalence in adult patients with CHDs. Methods Between April 2017 and December 2019, the current investigation recruited 85 patients from those referring to the Outpatient Adult CHD Clinic. Dual‐energy X‐ray absorptiometry (DXA) was employed to determine body composition and muscle mass. Handgrip strength is usually used to measure muscle strength. The 6‐min walk test (6MWT) and the 4‐m gait speed (4MGS) test were used for the evaluation of muscle performance. The presence of sarcopenia was defined based on the European Working Group on Sarcopenia in Older People. Results The study patients (44.7% male) were aged between 16 and 48 years. More than half of them (48 [56.5%] patients) were classified as severe complex CHDs. Most of the patients (73%) were asymptomatic. The diagnostic criteria of sarcopenia were fulfilled by 24 (28.2%) patients, whereas 15 patients fulfilled two criteria and nine patients met all three criteria for sarcopenia. According to the diagnostic criteria, 32.9% of patients had only a decreased skeletal muscle and considered as pre‐sarcopenia. Sarcopenia was more frequent in female patients (P = 0.02), patients with severe complex CHDs (P = 0.03), those with arterial desaturation (P = 0.001), ones with Eisenmenger syndrome (P = 0.002) and those without a history of corrective interventions (P = 0.03). The 6MWT measure was significantly reduced in the patients with sarcopenia (P

Introducción: Los pacientes con enfermedad renal crónica en hemodiálisis de mantenimiento a menudo lucha contra la desnutrición y sarcopenia. Tanto el uso del test de malnutrición e inflamación (MIS) y el test de fuerza de prensión manual (FPM) se han definido como factores de riesgo independientes en distintos estudios. El objetivo del presente estudio fue realizar los dos test en un grupo de pacientes en programa de hemodiálisis. Métodos: Se trata de un estudio transversal, realizado en el servicio de hemodiálisis de la UMAE 71, Coahuila, México. Las variables fueron: demográficas, clínicas, de laboratorio, el test MIS y FPM, mortalidad. La muestra fue no probabilística. Resultados: Se analizan 101 pacientes, 50.5% hombres. La mortalidad fue de 25.74%, la causa más frecuente de muerte fue el infarto agudo del miocardio 34.61%, seguida por neumonía por SARS CoV2 23.07%. La FPM entre hombres y mujeres, para la mano derecha 17.71 ± 11.94 vs. 11.5 ± 6.99, P=0.0002 y para la mano izquierda 14.63 ± 7.06 vs. 10.31 ± 4.98, P=0.0001. El área bajo la curva ROC para MIS score fue del 0.562 y de 0.567 para la fuerza de agarre manual para hombres y mujeres. La sensibilidad de 96% y una especificidad del 17 % para la FPM, para el MIS se encontro sensibilidad de 92% y especificidad de 20%. Conclusión: el uso de MIS y FPM son un indicadores con baja capacidad discriminativa. El presente estudio encontro una alta sensibilidad y una baja especificidad, para ambas pruebas lo cual no garantiza su aplicación confiable para evaluar el riesgo de mortalidad a corto plazo (< 12 meses ) en pacientes mayores de mayores de 18 años con enfermedad renal crónica en hemodiálisis.

Background: Sarcopenia is associated with worse outcomes in maintenance hemodialysis (MHD) patients. Differences in criteria and methods used to diagnose sarcopenia, results in a wide range of prevalence. Factors associated with sarcopenia in MHD have not been well-studied. This study aimed to investigate the prevalence and factors associated with sarcopenia in the MHD population. Methods: Observational cross-sectional study was done with 96 MHD patients aged ≥18 years old, with dialysis vintage ≥120 days at Cipto Mangunkusumo Hospital March-May 2022. Descriptive, bivariate, and logistic regression analysis were done to find sarcopenia’s prevalence and association with Simplify Creatinine Index (SCI), type 2 diabetes (DM), Interleukin-6 (IL-6), nutritional status, physical activity, and phosphate serum level. Asian Working Group for Sarcopenia (AWGS) 2019 criteria used to diagnose sarcopenia, Hand Grip Strength (HGS) to identify muscle strength, Bioimpedance Spectroscopy (BIS) to calculate muscle mass, and 6-meter walk test to evaluate physical performance. Results: The prevalence of sarcopenia was 54.2%. Factors with a significant association in bivariate analysis were phosphate serum level (p=0.008), SCI (p=0.005) and low physical activity (International Physical Activity Questionnaire) (p-0.006). Logistic regression analysis found higher phosphate serum level and high physical activity protective of sarcopenia (OR 0.677;CI95% 0.493-0.93 and OR 0.313;CI95% 0.130-0.755 respectively). Conclusion: The prevalence of sarcopenia in the MHD population was 54.2%. Phosphate serum level, SCI, and physical activity were significantly correlated with sarcopenia. Both high phosphate level and high physical activity were protective against sarcopenia.