Association Between the Number of Meals Containing at Least 20 or 30 Grams of Protein and Muscle Mass, Strength, and Functional Capacity in Kidney Transplant Patients.

Introduction: The loss of muscle mass and physical function (strength and functional capacity), known as sarcopenia, is prevalent in adult and older adults kidney transplant patients. This clinical condition is associated with a worse prognosis and greater risk of morbidity and mortality, in addition to making it difficult to carry out activities of daily living. On the other hand, insufficient consumption of energy and nutrients can contribute to the development of sarcopenia. In this sense, it is essential to investigate which nutrients may be associated with protection for this clinical condition in this population. Aim: To evaluate the association between dietary intake and sarcopenia and its components in kidney transplant patients. Material and Methods: A crosssectional study was performed at a clinical hospital of the Federal University of Uberlandia, Minas Gerais, Brazil; evaluating kidney transplant patients (KTPs) at the kidney transplantation ambulatory clinic. Dietary assessment was performed using two 24-hour dietary recalls, using the five steps multiple-pass method. The assessment of body composition was performed using bioimpedance. Appendicular skeletal muscle mass was estimated using the equation by Sergi et al. (2015). The appendicular skeletal muscle mass index was calculated, which consists of the appendicular skeletal muscle mass (kg) divided by the height squared (m²). The handgrip strength test (HGS) and five times sit to stand test (5STS) were performed to assess muscle strength. Functional capacity was assessed using the short physical performance battery (SPPB) and the 4-m walking test. Sarcopenia was diagnosed using the criteria proposed by the Revised European Consensus on Sarcopenia. Several statistical models were performed to verify the association between dietary variables and prevalence of sarcopenia, muscle mass, muscle strength and functional capacity of the participants. Results: In the first article, it was shown that omega-3 fatty acid intake was positively associated with appendicular skeletal muscle mass index and higher intake of polyunsaturated and omega-3 fatty acids was associated with a lower chance of having low muscle mass index skeletal and sarcopenia in total sample. In the second article, it was observed that the number of meals containing at least 30 grams of protein was negatively associated with the time to perform 5STS and positively associated with the SPPB score among KTPs aged 50 years or more, regardless of confounding factors. Conclusions: Intake of omega-3 fatty acids and polyunsaturated fatty acids are protective factors for sarcopenia and low muscle mass, but not for strength and functional capacity, in KTPS. Additionally, the number of meals containing at least 30 grams of protein is associated with better performance on 5STS and SPPB in KTPs aged 50 years and over. Future randomized controlled trials should be performed to assess the effect of these nutrients on sarcopenia and its components in KTPs.

Chronic inflammation has been associated with components of sarcopenia; however, these associations are unknown in kidney transplant patients (KTPs). The aim of this study was to associate neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with strength, muscle mass, and functional capacity in KTPs. A cross-sectional study evaluating 108 KTPs was performed. Strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), and appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. The ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Functional capacity was assessed by the 4-m gait speed test and short physical performance battery (SPPB). The electrochemiluminescence method was used for analyzing CRP levels, and the cytometric method XN-3000 Sysmex was used for obtaining leukogram values to calculate the NLR. Linear regression analysis was used to assess the association between systemic inflammation and sarcopenia components, adjusting for confounders. NLR and CRP levels were not associated with handgrip strength (β = - 0.231, p = 0.389; β = - 0.291, p = 0.577), 5STS (β = - 0.114, p = 0.288; β = - 0.202, p = 0.334), ASM (β = - 0.027, p = 0.813; β = 0.062, p = 0.788), ASMI (β = - 0.036, p = 0.242; β = 0.040, p = 0.505), 4-mgait speed (β = 0.013, p = 0.082; β = 0.004, p = 0.769), and SPPB (β = 0.076, p = 0.170; β = 0.152, p = 0.157), respectively. In conclusion, NLR and CRP levels were not associated with muscle mass, strength, and functional capacity in KTPs.

Patients With Type 2 Diabetes Show a Greater Decline in Muscle Mass, Muscle Strength, and Functional Capacity With Aging

INTRODUCTION: Kidney transplant patients (KTP) have decreased muscle mass, strength and functional capacity. The urea/creatinine ratio (UCR) has been used as a marker of muscle catabolism, but it is still unknown whether this ratio is associated with muscle mass and strength in PTR. OBJECTIVE: To associate UCR with strength, muscle mass and functional capacity in PTR. METHODS: A cross-sectional study was carried out with 125 KTPs. Strength was assessed by handgrip strength and the five times sit-to-stand test (FTSST). Appendicular skeletal muscle mass (ASMM) was estimated by electrical bioimpedance. Functional capacity was assessed by the 4meter gait speed test and short physical performance battery (SPPB). To compare the URC tertiles, one-way analysis of variance (ANOVA) with Tukey's post-hoc test was performed. Nonparametric data were compared using the Kruskal-Wallis test. Data were described as mean and standard deviation or median, interquartile range. Chisquare test (2) was used to compare data in percentages (categorical variables).

Introduction: Little is known about the association of neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with the components of sarcopenia in kidney transplant patients (KTPs). Objective: This study aimed to associate NLR and CRP with strength, muscle mass, and functional capacity in KTPs. Material and methods: A cross-sectional study (n = 108) was performed. Functional capacity was assessed by the 4-meter gait speed test and short physical performance battery (SPPB), strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance, and ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Electrochemiluminescence method was used for analyzing CRP levels and cytometric method XN-3000 Sysmex for obtaining leukogram values to calculate the NLR. Results: No significant associations, both for the NLR and CRP classifications, were noted in the simple and multivariate linear regression for the sarcopenia components. Likewise, in the multivariate linear regression model adjusted for age, sex, waist circumference, total protein intake, glomerular filtration rate, use of calcineurin and mTOR inhibitors, transplant time, and energy intake, NLR and CRP levels were not associated with handgrip strength (β-values = 0.231 and 0.291, p-values = 0.389 and 0.577 for NLR and CRP classifications, respectively), 5STS (β-values = -0.114 and -0.202, p-values = 0.288 and 0.334 for NLR and CRP classifications, respectively), and ASM (β-values = -0.027 and 0.062, p-values = 0.813 and 0.788 for NLR and CRP classifications, respectively). Conclusion: NLR and CRP levels were not associated with the components of sarcopenia in KTPs.

BackgroundSarcopenia, the age-related loss of muscle mass and function, is a major geriatric concern. This study evaluated the impact of Baduanjin, resistance band, and mixed exercise on muscle mass and physical function in elderly sarcopenic patients.Material/MethodsEighty sarcopenic individuals were randomly assigned to Baduanjin, resistance band, mixed exercise, or control groups (n=20 each). Interventions were conducted 3×/week for 30 minutes over 12 weeks. Appendicular skeletal muscle mass (ASM), ASM index (ASMI), handgrip strength (HGS), gait speed (GS), Short Physical Performance Battery (SPPB) scores, and timed up-and-go test (TUGT) were measured before and after the intervention.ResultsBefore the intervention, the groups were comparable. Post-intervention within-group comparisons indicated significant improvements in ASM and ASMI in the resistance band and mixed exercise groups (P<0.05). Between-group comparisons of change scores revealed greater increases in ASM and ASMI in the resistance band group compared to the control group (P<0.05). Furthermore, post-intervention within-group comparisons shows that improvements (P<0.05) were noted in HGS, GS, TUGT, and SPPB across all exercise groups. Between-group comparisons of change scores revealed that the resistance band and mixed exercise groups demonstrated greater enhancements in HGS, GS, and TUGT compared to the control group (p<0.05). Additionally, changed balance scores in SPPB and SPPB were significantly higher in the resistance band group than in the control group (P<0.05).ConclusionsResistance band and mixed exercise improved muscle mass and overall physical function. Baduanjin specifically enhanced balance. These findings support tailored exercise prescriptions for sarcopenia management.The study was registered with the Chinese Clinical Trial Registry under the International Clinical Trial Registration Platform of the World Health Organization, https://www.chictr.org.cn/bin/project/edit?pid=239117.ChiCTR2400089722 (13/09/2024)

Background: Our aim was to associate serum uric acid (UA) with muscle mass, strength and functional capacity in kidney transplant patients (KTPs). Methods: A cross-sectional study was performed on 113 KTPs. The fat-free mass and total and appendicular muscle mass were estimated by performing a bioelectrical impedance analysis. The strength was evaluated using the handgrip strength test (HGS) and the five times sit to stand test (5STS). The functional capacity was evaluated using the 4 m walk test and the short physical performance battery (SPPB). Results: Linear regression showed that the UA levels were positively associated with the muscle mass, fat-free mass, appendicular muscle mass, muscle mass index and appendicular muscle mass index. The 5STS results (seconds) were inversely associated with the UA levels, showing that individuals with higher UA were more likely to have more strength. However, UA was not associated with the HGS, 4 m walk test and SPPB results. Conclusion: UA levels were positively associated with muscle mass and strength, but not with functional capacity, in KTPs.

Association between plasma procollagen type III N-terminal peptide (P3NP) levels and physical performance in elderly men: The Korean Frailty and Aging Cohort Study (KFACS)

Objective To investigate the relationship between calf circumference and skeletal muscle mass, strength and function in the elderly in Shanghai. Methods A total of 401 old people were recruited from physical examination centers in our hospital with the mean age of (71.8±7.4) years, including 202 males and 199 females.Adipose tissue, skeletal muscle mass (SMM) and appendicular skeletal muscle mass (ASM) were measured by bioelectrical impedance analysis. The ASM index (ASM/height2) and SMM index (SMM/height2) were calculated.Muscle function was measured by testing gait speed (m/s). Muscle strength was measured by handgrip strength(HGS) using an electronic hand dynamometer, with the dominant hand gripping for three times and taking the maximum value.Height, weight, right calf circumference and waist circumference were measured. Results Height, weight, ASM, ASM/height2, SMM, SMM/height2 and HGS were significantly higher in men than in women (P<0.01); adipose tissue was significantly higher in women than in men (P<0.05). The age, body mass index, calf circumference, waist circumference and gait speed were not statistically different (P=0.426, P=0.143, P=0.425, P=0.093, P=0.143). There were linear correlations between calf circumference and height, weight, BMI, waist circumference, ASM, ASM/height2, adipose tissue, grip strength, SMM and SMM/height2 (P=0.001, P<0.001, P<0.001, P<0.001, P<0.001, P<0.001, P<0.001, P=0.003, P<0.001, P<0.001). There was no linear correlation between calf circumference and pace and age (P=0.818, P=0.078). Multiple stepwise regression analysis showed that height, BMI, ASM/height2 and SMM were correlated with the calf circumference. Conclusions Skeletal muscle mass and strength are higher in men than in women, while adipose tissue is higher in women than in men. Skeletal musle mass is an important factor affecting the calf circumference. There is a linear correlation between skeletal muscle strength and calf circumference. Key words: Calf circumference; Hand strength; Skeletal muscle mass

Older men with type 2 diabetes mellitus (T2DM) face a heightened risk of sarcopenia. This study aimed to compare the longitudinal effects of semaglutide, a glucagon-like peptide-1 receptor agonist and sitagliptin as the control group on sarcopenia indicators and biomarkers of neuromuscular junction and neuronal health in patients with T2DM over 1 year. A cohort of 141 older men with T2DM (semaglutide, n =68; sitagliptin group, n =73) underwent assessments at baseline, 6months and 1 year. Measured parameters included handgrip strength (HGS), gait speed, appendicular skeletal muscle mass index (ASMI), short physical performance battery (SPPB) and plasma concentrations of C-terminal agrin fragment 22 (CAF22), neurofilament light chain (NfL) and brain-derived neurotrophic factor (BDNF). Over the study period, the semaglutide group exhibited significant reductions in HGS, gait speed, ASMI and SPPB scores (all P < .05). Concurrently, this group exhibited more pronounced elevation of plasma CAF22 and NfL levels compared to the sitagliptin group (all P < .05). Among the patients taking semaglutide, higher CAF22 and NfL levels generally correlated with poorer HGS, ASMI and SPPB scores. In contrast, lower BDNF levels were associated with reduced ASMI and SPPB at specific time points (all P < .05). Multiple regression analysis confirmed significant negative associations between CAF22 and NfL, and a positive association between BDNF and sarcopenia parameters, specifically among patients taking semaglutide. Semaglutide treatment in older men with T2DM may be associated with a decline in muscle strength and physical performance, potentially associated with neuromuscular junction degradation and neuronal damage. These findings underscore the importance of closely monitoring musculoskeletal health in patients receiving semaglutide.

Foods rich in anti-inflammatory components and anti-inflammatory supplements for the prevention and treatment of Sarcopenia in older adults: A systematic review and network meta-analysis.

A Combination of Whey Protein and Vitamin D Reduces Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial.

Skeletal muscles, renowned for their remarkable adaptability, undergo significant mass reduction under catabolic conditions, a phenomenon notably observed during critical illness. Aging, exacerbated by reduced physical activity, accelerates this process, leading to a cascade of health consequences. The term "sarcopenia" has emerged to encapsulate these multifaceted aspects, encompassing diminished muscle strength, mass, and functional capacity. This comprehensive review explores the evolution of the concept of sarcopenia. Irwin Rosenberg's pioneering work 1989 introduced the term, defining it as the age-related loss of muscle mass. Subsequently, Baumgartner in 1998 refined the definition by quantifying sarcopenia as a reduction in appendicular skeletal muscle mass, precisely defined by statistical parameters. The European Working Group on Sarcopenia in the Elderly, in 2018, further advanced our understanding by including muscle strength as a diagnostic criterion. It also underscored the significance of reduced muscle mass in confirming the diagnosis. Severe sarcopenia is marked by the fusion of existing muscle damage and functional impairment, presenting a critical pathological condition. Sarcopenia has garnered official recognition in numerous countries as a distinct muscle disorder, classified under the diagnostic code ICD-10-MC. This review explores the pathophysiological underpinnings of sarcopenia, which can manifest either chronically, often accompanying the aging process, or acutely during hospitalization or prolonged bed rest. A key facet of age-related sarcopenia is the deterioration of type II fast-twitch muscle fibers, crucial for muscle strength and overall performance. Sarcopenia emerges as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is inexorably linked with physical disability, diminished quality of life, and, notably, increased mortality rates. Observational studies have indicated a substantial prevalence of sarcopenia among critically ill patients, affecting up to 60% of individuals admitted to intensive care units, especially those requiring mechanical ventilation. In light of these findings, this review aims to provide insights into the epidemiological, pathophysiological, and clinical facets of sarcopenia. We underscore its particular relevance in the context of critically ill patients in intensive care units, examining the profound impact on mortality. Furthermore, we delve into contemporary diagnostic methods for identification and available treatment modalities, aiming to shed light on the complexities of this pervasive and underrecognized condition.

IntroductionMuscles are crucial for daily activities, and kidney transplant recipients (KTR) often have reduced muscle mass and strength. We aimed to investigate the potential relationship of muscle mass and strength with physical health-related quality of life (HRQoL) in KTR. MethodsData from the TransplantLines Biobank and Cohort Studies were used. Muscle mass was assessed with appendicular skeletal muscle mass index (ASMI) and 24-hour urinary creatinine excretion rate index (CERI). Muscles strength was assessed by handgrip strength index (HGSI). HRQoL was measured using Short Form 36 physical component score (PCS). ResultsWe included 751 KTR (61% male, mean age 56±13y, median 3y post-transplant). Ordinary least squares regression analyses demonstrated that lower ASMI, CERI and HGSI were all non-linearly associated with lower PCS, independent of potential confounders and each other. Below median values, ASMI, CERI and HGSI were each associated with PCS, whereas above median values, associations were less pronounced. Compared to the 50th percentile, a decrease to the 10th percentile was associated with a decrease in PCS of 4.8% for ASMI (P=0.011), of 5.1% for CERI (P=0.008) and 13.2% for HGSI (P<0.001), whereas an increase to the 90th percentile was associated with an increase in PCS of only 0.7% for ASMI (P=0.54), of 3.6% for CERI (P=0.05) and -0.4% for HGSI (P=0.73). ConclusionsLow muscle mass and strength are potentially modifiable risk factors for impaired physical HRQoL in KTR. The non-linear associations suggest that KTR with low muscle mass or strength may particularly benefit from (p)rehabilitation interventions to improve HRQoL.

BackgroundAging is associated with decreases in muscle strength and simultaneous changes in body composition, including decreases in muscle mass, muscle quality and increases in adiposity.MethodsAdults (n = 369; 236 females) aged 65–74 years living independently were recruited from the cross-sectional Researching Eating Activity and Cognitive Health (REACH) study. Body fat percentage and appendicular skeletal muscle mass (ASM) (sum of lean mass in the arms and legs) were assessed using Dual-energy X-ray Absorptiometry (Hologic, QDR Discovery A). The ASM index was calculated by ASM (kilograms) divided by height (meters) squared. Isometric grip strength was measured using a hand grip strength dynamometer (JAMAR HAND).ResultsLinear regression analyses revealed that muscle strength was positively associated with the ASM index (R2 = 0.431, p < 0.001). When exploring associations between muscle strength and muscle mass according to obesity classifications (obesity ≥30% males; ≥40% females), muscle mass was a significant predictor of muscle strength in non-obese participants. However, in participants with obesity, muscle mass was no longer a significant predictor of muscle strength.ConclusionsBody fat percentage should be considered when measuring associations between muscle mass and muscle strength in older adults.