Prevalence of malnutrition, sarcopenia, and sarcopenic obesity in patients with heart failure.

Muscle mass loss occurs early following a stroke, and the rate of decline is more rapid than the normal ageing process. The aim of the present study was to examine the prevalence of and predictive factors for obesity, sarcopenia and sarcopenic obesity (SO) in patients with stroke. Patients with chronic stroke with a duration >6 months were recruited. Their clinical data were recorded, and dual‑energy X‑ray absorptiometry was used to evaluate body composition. Multivariable logistic regression analysis was used to analyse predictive factors for obesity, sarcopenia and SO. A total of 84 participants (58 males and 26 females) with a median age of 58.3 years were enrolled. The median duration following stroke was 2.2 years. The prevalence of obesity, sarcopenia and SO was 26.2, 21.4 and 23.8%, respectively. Age, sex, National Institutes of Health Stroke Scale, Oral Health Assessment Tool, Functional Ambulation Category (FAC), calf circumference, and Mini Nutritional Assessment‑Short Form (MNA‑SF) score were included as independent factors. Multivariable logistic regression analysis revealed that only calf circumference was a predictive factor for obesity [adjusted odds ratio (aOR), 1.38, 95% confidence interval (CI), 1.08‑1.77]. As regards sarcopenia, two factors were found to be significant: The MNA‑SF score (aOR, 0.70; 95% CI, 0.53‑0.94) and calf circumference (aOR, 0.66; 95% CI, 0.49‑0.89). Significant predictive factors for SO were being male (aOR 7.96; 95% CI, 1.05‑60.49) and FAC (aOR, 0.15; 95% CI, 0.04‑0.55). Sarcopenia and SO were observed in almost half of the participants with chronic stroke. On the whole, calf circumference was found to be a predictor for both obesity and sarcopenia. The nutritional status assessed using MNA‑SF was a predictor for sarcopenia. The male sex and FAC were found to be predictive factors for SO.

BackgroundSarcopenia and obesity are two abnormal body composition phenotypes, and sarcopenic obesity (SO) is characterized by both low skeletal muscle mass (sarcopenia) and high adiposity (obesity). SO negatively influences the clinical status of patients with chronic obstructive pulmonary disease (COPD). However, the studies exploring the prevalence and clinical effects of SO in COPD patients are limited. Our study aimed to elucidate the prevalence and impact of SO on COPD patients.MethodsIn this cross-sectional study, the pulmonary function, St. George’s Respiratory Questionnaire, exercise tolerance, body composition, and serum levels of resistin and TNF-α were assessed in 198 COPD patients. The clinical value of serum resistin and TNF-α for predicting SO in patients with COPD was evaluated.ResultsIn the 198 patients with COPD, the prevalence rates of sarcopenia, obesity, and SO in COPD patients were 27.27%, 29.8%, and 9.6%, respectively. Patients with SO experienced more severe symptoms of dyspnea and worse health related quality of life. The expression of resistin increased in patients with SO compared to other patients. The AUC value of serum resistin level for predicting SO was 0.870 (95% CI: 0.799–0.940). BMI (OR: 1.474, 95% CI: 1.124–1.934) and resistin (OR: 1.001, 95% CI: 1.000-1.002) levels were independent risk factors of SO in patients with COPD in Multivariate analysis.ConclusionThe prevalence rates of SO in COPD patients was 9.6%. COPD accompanied by SO is significantly associated with worse pulmonary function and poor physical performance. Serum resistin may be a potential adjunct for predicting SO in COPD patients.

Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke.

Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.

ObjectiveTo explore the association between intracellular water (ICW) and sarcopenic obesity in patients undergoing chronic haemodialysis (HD).MethodsA multicentre, cross-sectional study of 3354 adult chronic HD patients was conducted in 20 haemodialysis centres from June 1, 2021, to August 30, 2021. The diagnosis of sarcopenic obesity was made according to the revised Asian Working Group’s definition of sarcopenia combined with obesity per the body fat percentage definition. Body composition was evaluated by a body composition monitor using bioimpedance spectroscopy. Multiple logistic regression models, stratified analyses, interactive analyses, and receiver-operating characteristic analyses were conducted.ResultsA total of 752 patients were diagnosed with sarcopenic obesity among 3354 participants. The patients were grouped by sex-specific ICW median levels, and the prevalence of sarcopenic obesity was significantly higher in the low ICW group than in the high ICW group (41.3%vs 3.0%). Decreased ICW was significantly associated with sarcopenic obesity. The association remained statistically significant even after adjusting for dialysis vintage, age, body mass index, biochemical indicators, and various medical histories. The odds ratios of the low ICW group were much higher than those of the high ICW group in both males and females (P for trend < 0.001). The association was stable across subgroups, and the interaction analysis showed that age, body mass index and history of diabetes had interactive roles in the association between ICW and sarcopenic obesity (P for interaction < 0.05). Furthermore, the ICW cut-off values for identifying sarcopenic obesity were 19.1 kg and 14.5 kg for males and females, respectively.ConclusionDecreased ICW was an independent risk factor for sarcopenic obesity in chronic HD patients. The measurement of ICW by bioimpedance spectroscopy might be a non-invasive and valid means for identifying the risk of future sarcopenic obesity in HD patients.

Prevalence of sarcopenia and sarcopenic obesity in patients with osteoarthritis: A systematic review and meta-analysis.

BackgroundThe relationship between phase angle (PhA) and sarcopenic obesity (SO) in patients undergoing hemodialysis (HD) has not been well established. Therefore, this study aimed to evaluate the relationship between PhA and SO in patients undergoing HD and to determine the cutoff value of PhA that can predict SO.MethodsWe conducted a cross-sectional study of 436 patients undergoing HD. The PhA was measured by bioelectrical impedance analysis. SO was diagnosed according to the revised definition of the Asian Working Group for Sarcopenia combined with obesity based on body fat percentage. The association between PhA and SO was assessed using multinomial logistic regression. The PhA cutoff values for SO were determined using receiver operating characteristic (ROC) curve analysis.ResultsAmong the participants, 119 (27.3%) had SO. After adjusting for various confounders, PhA was significantly associated with a lower SO risk [odds ratio (OR) = 0.098, 95% confidence interval (CI): 0.048–0.200]. Furthermore, PhA showed a stronger association with SO than with sarcopenia or obesity alone. ROC analysis indicated excellent predictive ability for SO in both sexes (area under the curve (AUC): 0.841 for males, 0.836 for females; cutoff values: 4.49° for males, 4.18° for females).ConclusionPhA exhibited good accuracy in detecting SO in patients undergoing HD, suggesting its utility as a reliable screening tool for the early identification of at-risk individuals.

Objective: Obesity increases the risk of endometrial cancer (EC). In this study, we aimed to investigate the prognostic effect of sarcopenia, sarcopenic obesity and sarcopenic visceral obesity, calculated with the help of cross-sectional imaging methods of muscle and visceral adipose tissue from body composition parameters, in EC. Methods: Patients diagnosed with EC were identified between January 2014 and June 2024. The combination of radiological markers and patient outcomes can predict prognosis. The skeletal muscle index (SMI) and visceral fat index (VFI) were calculated from computed tomography (CT) and/or abdominal magnetic resonance (MR) scans taken at the time of diagnosis at the Lumbal 3 (L3) vertebra level. The findings of these analyses demonstrate the strongest correlation with the ratio of muscle and visceral fat tissue throughout the body. The loss of muscle and fat is an unfavourable indicator in patients with EC. The present study analysed the prognostic values of sarcopenia, sarcopenic obesity, sarcopenic visceral obesity, and the visceral fat index in EC. The total skeletal muscle area was calculated in square centimetres. Body surface area (m2) was calculated using the Mosteller formula: ((height (cm) × weight (kg))/3600)1/2. To normalize body composition components, the skeletal muscle index was calculated as cm2/m2. Results: The study comprised a total of 236 EC patients. The prevalence of sarcopenia, sarcopenic obesity, and sarcopenic visceral obesity were found to be 48.31%, 33.47%, and 22.88%, respectively. The presence of sarcopenia, high VFI levels, sarcopenic obesity, and sarcopenic visceral obesity did not demonstrate statistical significance in the survival analysis. However, stage increase (p = 0.001), primary tumour localization in the lower uterine segment (p = 0.001), serous carcinoma (p = 0.001), increased grade in endometrioid carcinoma (p = 0.023), and lymphovascular invasion (p = 0.001) were significantly associated with increased mortality risk. The presence of sarcopenia was found to be significant in patients with obesity (p = 0.008) and those aged ≥ 65 years (p = 0.001). Conclusions: In EC survival, established prognostic factors such as serous histopathology, LVI positivity, and the extent of surgical staging are prioritised. The presence of these well-established markers means the potential effect of BMI-based observations, such as the ‘obesity paradox’, and even body composition measurements, such as sarcopenic obesity, are now statistically insignificant. Our findings suggest that aggressive tumour biology (serous type, LVI) and surgery, rather than metabolic variables such as sarcopenia, sarcopenic obesity and sarcopenic visceral obesity, are the direct reason for the survival difference. This is due to the tumour’s aggressive nature and clinical characteristics (e.g., age at diagnosis, operability, stage, primary tumour localization in the lower uterine segment, serous carcinoma, grade, and LVI positivity) rather than metabolic variables.

Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

Sarcopenic obesity (SO) in patients with gastrointestinal cancer is associated with a poor prognosis. We aimed to investigate the prognostic impact of SO in patients with gastrointestinal cancer, as well as the diagnostic cut-off value of SO in patients with gastrointestinal cancer among Chinese population. We conducted a consecutive cohort study. Between January 2017 and January 2019, 289 patients diagnosed with gastrointestinal cancer were included in our study. Skeletal muscle area, total fat area, and subcutaneous fat area were measured by CT scan. All patients were followed up for 5 years. Receiver operating characteristic curves (ROC) were adopted to determine the cut-off values of visceral fat obesity for the prediction of sarcopenia. Based on the cut-off values, patients with sarcopenia combined with visceral fat obesity were divided into the SO group, and the others were divided into the non-sarcopenic obesity (NSO) group. Kaplan-Meier curves and univariate and multivariate Cox proportional hazard models were employed to explore the associations of body composition profiles with 5-year overall survival and disease-specific survival. Obtained from Youden's Index for ROC for the prediction of 5-year survival, skeletal muscle mass index (SMI) ≤40.02 cm2/m2 with VFA ≥ 126.30 cm2 in men and SMI ≤32.05 cm2/m2 with VFA ≥72.42 cm2 in women indicate a risk of poor prognosis in patients diagnosed with gastrointestinal cancer. Patients with SO had poorer 5-year overall survival (OS) than patients with NSO (6.74% vs. 82.84%, p < 0.001), and poorer 5-year DFS (6.74% vs. 81.82%, p < 0.001). In multivariate analysis, we found that the long-term mortality risk was approximately 13-fold higher among patients in the SO group compared to those with no conditions. Preoperative assessment of SO is useful not only for monitoring nutritional status but also for predicting 5-year OS in gastrointestinal cancer patients.

Prevalence of sarcopenic obesity in patients with diabetes and adverse outcomes: A systematic review and meta-analysis

This study was developed to determine whether sarcopenic obesity (SO), as identified using screening indices for sarcopenia and obesity, could predict mortality risk among older male individuals. This prospective study enrolled male patients aged ≥ 60 years from 15 nursing homes in Zigong, China. Baseline data were collected from September 2021 to July 2022, with follow-up conducted until April 2024. Three parameters were used to identify SO, namely, handgrip strength (HGS), calf circumference (CC), and several obesity indices (waist-to-hip ratio [WHR], body mass index [BMI], waist circumference [WC], and WC_BMI). The HGS and CC cut-off values were selected based on the Asian Working Group on Sarcopenia (AWGS) 2019 consensus criteria. The WHR, BMI, and WC values were used to stratify patients by obesity status using previously published cut-off values. The cutoff value of WC_BMI was determined according to the third quartile. SO was defined by abnormalities in all three parameters, and the relationship between SO and mortality was examined using Cox proportional hazards models. A total of 491 subjects in nursing homes were enrolled in the study. 72 (14.66%) of the participants died between the baseline and end of follow-up. Of these, deceased males showed significantly lower CC, HGS, WC, and BMI but higher WC_BMI values compared to survivors (all P < 0.05). Mortality was significantly higher in subjects with low CC (18.13% vs. 5.8%, P < 0.001), low HGS (17.93% vs. 5.97%, P < 0.01), and high WC_BMI (25.83% vs. 11.05%, P < 0.001), and lower in those with high WC (17.37% vs. 8.92%, P < 0.05). Using low CC + low HGS+high WC_BMI as criteria for diagnosing SO, Cox regression analysis showed that the risk of death in the SO group was higher than that in the normal group (HR = 3.07, 95% CI: 1.846–5.108). The findings indicate that low CC and HGS, as well as high WC_BMI, were significant independent predictors of mortality in older male nursing home residents. The findings demonstrate the clinical utility of incorporating CC and HGS measurements into routine geriatric assessments in long-term care facilities. Furthermore, the results highlight the need for sex-specific preventive strategies and indicate that WC_BMI may represent a more meaningful anthropometric indicator than traditional BMI for mortality risk stratification in older individuals. These evidence-based insights could significantly improve risk assessment and inform targeted interventions to reduce mortality in this vulnerable demographic.

BackgroundLimited evidence exists regarding the relationship between calf circumference (CC) and global cognition in the Chinese population, with minimal research exploring potential sex disparities. Our goal was to investigate the correlation between CC and global cognition using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), focusing specifically on sex variations.MethodsThe study participants were older adults who participated in the 2018 CLHLS survey. In this cross-sectional study, we employed multiple linear regression to examine the association between CC and global cognition. Smoothed curve fitting was used to explore the non-linear association between CC and global cognition. Furthermore, subgroup analyses were conducted to evaluate the reliability of the correlation between CC and global cognitive performance.ResultsIn total, 12,102 older adults were included in the study. A positive correlation was found between global cognition and CC (β = 0.42, 95% CI = 0.3-0.54, P < 0.001) after controlling for confounding factors. Further analysis revealed a non-linear relationship between CC and global cognitive performance. In the overall population, the inflection point for CC was 31 cm; a positive relationship was observed between CC and global cognition for CC values <31 cm (β = 0.177, 95% CI = 0.128-0.225, P < 0.001); however, this relationship disappeared for CC values ≥ 31 cm (β: −0.009, 95% CI = −0.04 to 0.023, P = 0.591). Furthermore, we identified sex-specific variations in the correlation between global cognitive performance and CC. Notably, among women with CC values <32 cm, a significant positive correlation was observed between CC and overall cognitive function. Conversely, for women with CC ≥ 32 cm, no significant association was found between CC and cognitive performance. Interestingly, no non-linear relationship was detected in males.ConclusionThis study demonstrated a non-linear relationship between CC and global cognition in older Chinese population. Furthermore, sex disparities are observed in the relationship between CC and global cognition, with a non-linear link evident in women but not in men. Older women with lower CC should actively participate in physical activity to maintain an appropriate CC and prevent cognitive decline.

Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review

BackgroundThe purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function.MethodsThe participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study.ResultsASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72).ConclusionThe optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.