Abstract

Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.

Highlights

  • The term myosteatosis has been used to describe multiple different adipose depots found in skeletal muscle including: (a) intermuscular adipose tissue (IMAT), the extracellular adipose tissue found beneath the fascia and in-between muscle groups; (b) intramuscular adipose tissue, the extracellular adipose tissue found within an individual muscle; and (c) intramyocellular lipids (IMCL)

  • Special attention was given to functional status and standardization of measures of body composition and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis

  • Using 1H magnetic resonance spectroscopy (MRS) to noninvasively assess IMCL content revealed that IMCL was an excellent predictor for muscle insulin resistance in sedentary individuals (Krssak et al, 1999), a finding that has been replicated numerous times (Perseghin et al, 1999; Mayerson et al, 2002; Petersen et al, 2004; Befroy et al, 2007)

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Summary

INTRODUCTION

The term myosteatosis has been used to describe multiple different adipose depots found in skeletal muscle including: (a) intermuscular adipose tissue (IMAT), the extracellular adipose tissue found beneath the fascia and in-between muscle groups; (b) intramuscular adipose tissue, the extracellular adipose tissue found within an individual muscle; and (c) intramyocellular lipids (IMCL). Considering the expanded view of SMFD and its potential multiple components, learning more about the role of myosteatosis in muscle quality and SMFD is critical to allow the development of standardized approaches to its assessment, prevention, and possible treatments. This could, in turn, enhance the quality of life and the potential for healthy and independent living among the fast-growing population of older adults. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration

HISTORIC PERSPECTIVES AND EMERGING PARADIGMS
Relevant Evidence of Increased Myosteatosis With Aging
Myosteatosis in Cancer Survivors and Its Application to Aging
MYOSTEATOSIS POTENTIAL DETERMINANTS AND CLINICAL CONSEQUENCES
STANDARDIZED MEASURES OF BODY COMPOSITION AND IMAGING APPROACHES TO MYOSTEATOSIS
Quantitative Imaging of Myosteatosis and Implications for Physical Performance
INNOVATIVE RELEVANT AREAS OF INVESTIGATION
Muscle Clocks and Homeostasis
Potential Preventative and Therapeutic Approaches
Calorie Restriction
SYMPOSIUM SUMMARY
Findings
Interdisciplinary Workshop Expert Panel Members
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