Appendicular Lean Mass Index Research Articles

Prevalence of sarcopenic obesity and association with metabolic syndrome in an adult Iranian cohort: The Fasa PERSIAN cohort study.

Sarcopenic obesity (SO) is characterised by a concomitant high fat mass (FM) and low fat free mass (FFM) leading to an increased cardio-metabolic risk. This analysis aims to estimate the SO prevalence in Iranian adults and evaluate the association of SO with metabolic syndrome (MetS) risk. This cross-sectional analysis included 4296 subjects (age 35-70 years, 55.2% females). Body composition parameters, measured by bioelectrical impedance included: FM, FFM, appendicular lean mass (ALM) and skeletal mass index. SO was classified according to five criteria: (1) FM%-SMI; (2) FM%-ALM/% weight (wt%); (3) FM%-ALM/body mass index (BMI); (4) Residuals of ALM and FM and (5) FM/FFM Ratio. Multivariate logistic regression was applied to explore the association between SO models with MetS risk stratified by gender. Receiving operating characteristic (ROC) curves were used to identify the best FM/FFM ratio cut-off value for detecting MetS cases in males and females. The prevalence of SO varied between 4% and 26% depending upon the classification method. The prevalence of MetS was 12.8% and 31.6% in males and females, respectively. SO models based on ALM/wt% and FM/FFM ratio showed the strongest association with MetS risk in males (OR: 11.5, 95%CI: 7.5-17.7, p < 0.001 and OR: 10.1, 95%CI: 6.9-14.7, p < 0.001, respectively) and females (OR: 4.1, 95%CI: 3.0-5.6, p < 0.001 and OR: 4.6, 95%CI: 3.5-5.9, p < 0.001, respectively). SO is a prevalent condition in an adult Iranian population and the ALM/wt% and the FM/FFM ratio models of SO appeared to be associated with higher MetS risk.

P111 Osteoporosis is a significant predictor of frailty in older community dwelling adults: findings from the Hertfordshire Cohort Study

Abstract Background/Aims Frailty is associated with a range of adverse health outcomes, including falls and fractures. Previous work in a Japanese cohort found that the presence of both osteoporosis (OP) and sarcopenia (SP) increased the risk of frailty compared to the presence of OP or SP alone. We examined these relationships in a comparable cohort of community dwelling older people in the UK. Methods Our study comprised of 432 participants (216 men and 216 women) of the UK the Hertfordshire Cohort Study (HCS). Participants were assessed at baseline and followed up 5 years later with questionnaires, clinical examination, measures of physical performance and grip strength. Proximal femur bone mineral density (BMD) values were determined using dual-energy X-ray absorptiometry. OP was defined at BMD T- scores &amp;lt; = -2.5 at the femoral neck or use of anti-osteoporosis medication. Cut-offs for low grip strength; &amp;lt;30kg for men and &amp;lt;20kg for women and ALM index &amp;lt; =7.23kg/m2 for men, &amp;lt; =5.67kg/m2 for women, were used to define SP. Frailty was defined using the Fried definition. Logistic regressions were performed to analyse associations of OP/SP as explanatory variables for frailty. Results The mean (SD) age of participants was 75.7 (2.6) years. At baseline, the prevalence of frailty and pre-frailty was 12.2% (men, 8%, women, 16.3 %), and 57% (men, 55.7%; women, 58.2%) respectively. Individuals living with frailty were older, tended to drink less alcohol, have lower physical activity, lower walking speed and grip strength (P &amp;lt; 0.001). They were more likely to be female compared to non-frail subjects (P = 0.007). Co-existence of SP, OP and frailty was observed in 0.6% of the population; 0.6% had SP and frailty; 1.6% had OP and frailty and 1.6% of the study population had SP and OP. 71.8% did not have SP, OP or frailty at baseline. SP was significantly associated with frailty at baseline (p &amp;lt; 0.001). The cumulative incidence of frailty during the 5-year period was 2.47% /year (2.13%/year in men, 2.89%/year in women) and that of SP was 2.14%/year (2.84% in men, 1.35%/year in women). The presence of OP at baseline was a significant predictive factor for the occurrence of frailty at follow-up (odds ratio [OR], 3.04; 95% confidence interval [95% CI], 1.11,8.38; P = 0.031), while the risk of developing frailty was also increased in those participants who were both osteoporotic and sarcopenic at baseline; though this was not significant (OR; 10.08, 95% CI,0.55,186.08; P = 0.12). Conclusion Our findings demonstrate that the presence of OP is a significant predictive factor for developing frailty and might be used as a trigger for appropriate interventions to reduce or reverse its development in older adults. Our findings are in accordance with the previous reports in Asian populations and warrant further investigation in other national cohorts. Disclosure F. Laskou: None. K. Jameson: None. E. Dennison: None.

Sarcopenic Obesity in Chronic Kidney Disease: Challenges in Diagnosis Using Different Diagnostic Criteria

Objectives: Obesity, muscle impairment (low muscle mass or strength), and sarcopenic obesity are present in chronic kidney disease (CKD) and are associated with worse clinical prognosis. However, the various existing definitions for these conditions make the diagnosis variable. The aim of the present study was to evaluate the agreement between diagnostic criteria for sarcopenic obesity and its components in CKD. Subject and Methods: 267 patients with CKD were included in the study. We assessed body composition by dual-energy X-ray absorptiometry and muscle function by handgrip strength (HGS) and adiposity by body mass index (BMI), waist circumference (WC), fat mass index (FMI), and percentage of FM. Diagnosis of muscle impairment was made by HGS, appendicular lean mass (ALM), and ALM index; obesity by BMI, WC, FMI, and %FM, and sarcopenic obesity was diagnosed by concomitant presence of muscle impairment and obesity. Results: Prevalence of muscle impairment varied from 11 to 50%, higher when low muscle mass criteria were used. Prevalence of obesity varied from 26 to 62%, higher when WC and %FM criteria were used. Prevalence of sarcopenic obesity varied from 2 to 23%. Women were more affected by sarcopenic obesity. Muscle impairment and sarcopenic obesity were more prevalent among patients on hemodialysis and obesity among nondialysis-dependent and kidney transplant patients. The agreement was poor between muscle mass and strength criteria; substantial between FMI, BMI, and %FM and fair between WC and the other measures; for sarcopenic obesity, it varied from poor to almost perfect. Conclusion: Significant differences were found among the various diagnostic criteria that are used in the diagnosis of sarcopenic obesity. Our results highlight the need for standardization in the diagnosis of sarcopenic obesity.

Presarcopenia in Patients with Vitiligo: A Case Control Study.

Background:Sarcopenia is a muscle disease with significant morbidity and mortality. Vitiligo is a common autoimmune inflammatory disease which results from absence, deficiency, or dysfunction of melanocytes. Links between sarcopenia and autoimmune inflammatory processes were reported. However, no previous reports on association between sarcopenia and vitiligo were identified.Objective:To assess presarcopenia in patients with vitiligo and to evaluate the effect of sociodemographic and clinical characteristics of vitiligo patients of sarcopenia if present.Subject and methods:This case control study included 63 patients with Vitiligo and 63 apparently healthy control group matched in age and gender. Sarcopenia was diagnosed by measuring the Appendicular Lean Mass Index. Cut off point required for sarcopenia is <6 for women and <7 for men. Sociodemographic and clinical characteristics were recorded. Sarcopenia was diagnosed according to the 2018 revised European consensus on definition and diagnosis of sarcopenia.Results:Mean age of vitiligo patients was 38.7 ± 14.0 years (range: 20–69 years) and for controls 39.9 ± 11.6 years (range: 20–70 years) (p=0.604). Female were 34 (54.0%) and 29 (46.0%) males, while in the controls 30 (47.6%) were females and 33 (52.4%) males (p=0.604). Presarcopenia was significantly higher in Vitiligo compared to controls. Vitiligo increases the risk of having presarcopenia by about five-fold (OR [95%CI]=4.706[1.26–17.61], p=0.013).Only BMI was significantly negatively correlated with presarcopenia. BMI decreases the risk of having presarcopenia by odds ratio of 0.837 (0.032). other baseline characteristics had no significant impact of presarcopenia in vitiligo (P model<0.01, R2 =0.46 Accuracy= 0.57 AUC=0.92).Conclusions:Vitiligo was significantly positively correlated with presarcopenia and increased the risk of presarcopenia by about five-fold.

Impact of adiposity on clinical outcomes in people living with a Fontan circulation

BackgroundTo assess the association between body composition and the risk of adverse outcomes in Fontan patients. MethodsParticipants from the Australian and New Zealand Fontan Registry with dual-energy X-ray absorptiometry scans were included. Appendicular lean mass (ALM), appendicular lean mass index (ALM divided by height squared; ALMI) and total body fat mass percentage (%BF) were calculated. ALMI and %BF z-scores were derived using age- and sex-matched reference ranges. The primary outcome was Fontan failure (death, transplantation, New York Heart Association functional class III/IV, protein-losing enteropathy, and plastic bronchitis) or moderate-or-severe ventricular dysfunction. Results144 patients were included. Mean %BF was 29% (SD 10) with 50% having increased adiposity. Mean ALMI z-score was −1.4 (SD 1.1); one third of patients had skeletal muscle deficiency (ALMI z-score < −1 and −2) and another third had Fontan-associated myopaenia (ALMI z-score < −2). Age and %BF were associated with the risk of the endpoint in univariable regression (age: HR 1.09 per year, 95% CI 1.02–1.17, p = 0.01; %BF: HR 1.08, 95% CI 1.01–1.17, p = 0.03). On multivariable regression, every 1% increase in %BF was associated with a 10% increased risk of reaching the clinical endpoint (HR 1.10, 95% CI 1.01–1.19; p = 0.03). ALM was not associated with the endpoint (HR 1.02 per kg, 95% CI 0.88–1.20, p = 0.77). ConclusionsIncreased adiposity is associated with higher risk for adverse outcomes. Prospective studies to assess lifestyle interventions to optimise body composition should be prioritised.

Age-related changes in appendicular lean mass in males with Duchenne muscular dystrophy: A retrospective review.

Appendicular lean mass (ALM) trajectory in males with Duchenne muscular dystrophy (DMD) has potential applicability for treatment and research and has not been characterized. This chart review included longitudinal data on 499 males with DMD receiving glucocorticoids and 693 controls, ages 5 to 22.9 y. ALM (kg) was measured by dual energy x-ray absorptiometry (DXA). Appendicular lean mass index (ALMI, kg/m2 ) was calculated for height adjustment. Reference centiles were generated using data from healthy controls, and ALM and ALMI Z-scores were calculated for patients with DMD. Generalized linear models were used to estimate median Z-scores by age and functional mobility status (FMS) score. ALM velocity by age was modeled using superimposition, translation and rotation (SITAR). Compared to controls, males with DMD had lower ALM from an early age. ALMI Z-scores dropped below 0 at age 8 y or FMS of 2, and below -2.0 at age 13 y or FMS of 3 (P < .05). Age at peak ALM velocity was similar in both groups, but the magnitude was higher in controls (3.5 vs. 0.7 kg/y, P < .0001). Patients with DMD had a transient loss of ALM around age 12 y, an increase at age 14 y, then a further decline at age 16 y, remaining low thereafter. Males with DMD have progressive decline in lean mass with age and worsening functional mobility. DXA measurement of ALM may be useful for monitoring lean mass status in patients with DMD, providing valuable information for individual treatment plans and research endeavors.

Prior loss of body mass index, low body mass index, and central obesity independently contribute to higher rates of fractures in elderly women and men.

We aimed to comprehensively evaluate the association of body composition with fracture risk using longitudinal data from a Swedish cohort of 44,366 women and men (mean age of 70 years) and a subcohort of 5022 women. We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18 years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7 years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05-1.19). In the subcohort (median follow-up 10 years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05-1.28) for any fracture and 1.48 (95% CI, 1.16-1.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults.

BackgroundThere is limited evidence on sarcopenia in Asian populations. This study aimed to clarify the prevalence, associated factors, and the magnitude of association with mortality and incident disability for sarcopenia and combinations of its components among Japanese community‐dwelling older adults.MethodsWe conducted a 5.8 year prospective study of 1851 Japanese residents aged 65 years or older (50.5% women; mean age 72.0 ± 5.9) who participated in health check‐ups. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Appendicular lean mass index (ALMI) was measured using direct segmental multi‐frequency bioelectrical impedance analysis. A Cox proportional hazards regression model was used to identify associations of sarcopenia and the combinations of its components with all‐cause mortality and incident disability.ResultsThe prevalence of sarcopenia was 11.5% (105/917) in men and 16.7% (156/934) in women. Significant sarcopenia‐related factors other than ageing were hypoalbuminaemia, cognitive impairment, low activity, and recent hospitalization (all P‐values <0.05) among men and cognitive impairment (P = 0.004) and depressed mood (P < 0.001) among women. Individuals with sarcopenia had higher risks of mortality [hazard ratios (95% confidence interval): 2.0 (1.2–3.5) in men and 2.3 (1.1–4.9) in women] and incident disability [1.6 (1.0–2.7) in men and 1.7 (1.1–2.7) in women]. Compared with the individuals without any sarcopenia components, those having low grip strength and/or slow gait speed without low ALMI tended to have an increased risk of disability [1.4 (1.0–2.0), P = 0.087], but not mortality [1.3 (0.8–2.2)]. We did not find increased risks of these outcomes in participants having low ALMI in the absence of low grip strength and slow gait speed [1.2 (0.8–1.9) for mortality and 0.9 (0.6–1.3) for incident disability].ConclusionsJapanese older men and women meeting Asian criteria of sarcopenia had increased risks of all‐cause mortality and disability. There were no significant increased risks of death or incident disability for both participants with muscle weakness and/or low performance without low muscle mass and those with low muscle mass with neither muscle weakness nor low performance. Further studies are needed to examine the interaction between muscle loss, muscle weakness, and low performance for adverse health‐related outcomes.

Chemotherapy negatively impacts body composition, physical function and metabolic profile in patients with breast cancer

Evidence suggests that chemotherapy (CT) leads to unfavorable outcomes on nutritional and metabolic profile; however, this is poorly understood. To evaluate the impact of CT on body composition, bone mineral density (BMD), insulin resistance, lipid markers related to atherosclerotic cardiovascular diseases in women recently diagnosed with breast cancer according to menopausal status. This is a prospective study that enrolled women newly diagnosed with stage II-III breast cancer (2014-18). Body composition were measured by dual-energy x-ray absorptiometry. Blood samples were collected to assess lipid profile, insulin resistance and sensitivity, visceral adiposity index and lipid accumulation product were calculated. Dietary intake, physical activity and function were also evaluated at the time of breast cancer diagnosis and after CT completion. Ninety-nine women (40.4% in the premenopausal stage) aged 51±1 years took part in this study. CT duration was 197±27 days and main regimen was anthracyclines with taxanes (88.9%). CT was associated with an increase in total and central adiposity, insulin resistance, and all lipid-related markers, and a decrease in appendicular lean mass index, BMD and HDL-c concentration. Premenopausal women experienced greater unfavorable outcomes on adiposity markers and BMD compared to postmenopausal women (p<0.01). No changes were observed in dietary intake and physical activity after CT. Breast cancer CT negatively impacted body composition and metabolic profile. Premenopausal women experienced greater unfavorable impact on adiposity markers and BMD.

Abstract 13382: Increased Adiposity is Associated With Risk of Adverse Clinical Events in Fontan Patients

Introduction: Increased adiposity and reduced lean mass are prevalent in Fontan patients and could be impactful because of the reliance on the peripheral muscle pump and the importance of favourable pulmonary physiology in univentricular physiology. The current study aimed to determine the impact of body fat and lean mass on the risk of adverse outcomes in Fontan patients. Methods: Patients with dual-energy X-ray absorptiometry (DXA) scans from the Australian and New Zealand Fontan Registry were included; they had been consecutively recruited for 2 previous cohort studies. Regression analysis was used to characterize the association between body composition and the composite endpoint of Fontan failure (which included death, transplantation, New York Heart Association (NYHA) functional class III/IV, protein-losing enteropathy, and plastic bronchitis) and development of moderate or worse ventricular dysfunction. Results: 131 DXA scans were analyzed, with mean follow-up of 2.5 (SD 2.2) years after DXA. Mean body fat percentage (%BF) was 29% (SD 10) with 48% having increased adiposity compared with local reference data. Mean appendicular lean mass index (ALMI) z-score was -1.5 (SD 1.1); one third of patients had skeletal muscle deficiency (defined as ALMI z-score between -1 and -2) and another third had Fontan-associated myopenia (defined as ALMI z-score &amp;lt -2). Nine patients reached the composite endpoint during the follow-up period. Age and %BF were predictors of the endpoint in univariable regression (age: HR 1.09 per year, 95% CI 1.02-1.17, p = 0.01; %BF: HR 1.08, 95% CI 1.01-1.17, p = 0.03). On multivariable regression, %BF remained a significant predictor with every 1% increase conferring an 9% increased risk (HR 1.09, 95% CI 1.00-1.19; p = 0.045). ALMI was not a predictor of the endpoint (HR 1.40, 95% CI 0.71-2.76, p = 0.33). However, all patients who experienced a Fontan failure event (n=4) concurrently had increased adiposity and skeletal muscle deficiency. Conclusions: Increased adiposity is associated with increased risk for adverse clinical outcomes. Appropriate lifestyle interventions to optimise body composition should be an important aspect of routine care in this population.

Prevalence of osteosarcopenic obesity in community-dwelling older adults: a cross-sectional retrospective study.

The purposes of the study were (a) to determine the prevalence of osteosarcopenic obesity (OSO) in community-dwelling older adults and (b) to investigate the association between falls and possible factors in individuals with and without OSO. Medical records of patients aged ≥ 65years were retrospectively reviewed. Individuals were diagnosed with OSO based on their T-score assessed by dual x-ray absorptiometry, handgrip strength, appendicular lean mass index (ALMi), gait speed and body fat percentile. Comorbidities, history of falls, depressive state, medications and anthropometric measures were also noted. A sample of 460 individuals were assessed (337 females; 123 males) and 49 patients were diagnosed with OSO. There was no statistically significant difference in falls between the two groups (OR: 0.768, 95% CI: 0.409-1.440, p: 0.41) and the presence of OSO was not significantly associated with increased odds of falling (OR: 1.755, 95% CI: 0.547-5.628, p: 0.344). Handgrip strength (OR: 0.931, 95% CI: 0.893-0.971, p: 0.001), ALMi (OR: 0.799, 95% CI: 0.708-0.901, p < 0.0001) and gait speed (OR: 0.529, 95% CI: 0.283-0.988, p: 0.046) were independently associated with falls in overall group, whereas interaction analysis did not reveal any significant moderator effect of OSO vs. non-OSO in the associations between risk factors and falls. The prevalence of OSO was 10.7%. OSO was not associated with elevated odds of falling, whereas lower handgrip strength, ALMi and gait speed were independent factors associated with falls. Further prospective research is needed to clarify the effect of OSO on odds of falling, in consideration with possible risk factors. NCT04288401 /26.02.2020.

The Relationships between Total Protein Intake, Protein Sources, Physical Activity, and Lean Mass in a Representative Sample of the US Adults.

Background: Although dietary protein and physical activity play essential roles in developing and preserving lean mass, studies exploring these relationships are inconsistent, and large-scale studies on sources of protein and lean mass are lacking. Accordingly, the present study examined the relationship between total protein intake, protein sources, physical activity, and lean mass in a representative sample of US adults. Methods: This cross-sectional study analyzed data from 2011–2016 US National Health and Nutrition Examination Survey and corresponding Food Patterns Equivalents Database (n = 7547). Multiple linear regression models were performed to examine the sex-specific associations between total protein intake, protein sources (Dairy, Total Protein Foods, Seafood, and Plant Proteins), physical activity, and lean mass adjusting for demographics, weight status, and total daily energy intake. Results: Total protein intake was inversely related to lean mass in females only (Lean mass index: β= −0.84, 95%CI: −1.06–−0.62; Appendicular lean mass index: β= −0.35, 95%CI: −0.48–−0.22). However, protein sources and physical activity was positively associated with lean mass in males and/or females (p < 0.05). Conclusion. Study results suggest that consuming more protein daily had a detrimental influence on lean mass in females whereas eating high-quality sources of proteins and being physically active are important for lean mass for men and women. However, the importance of specific protein sources appears to differ by sex and warrants further investigation.

Association between objectively measured physical activity and longitudinal changes in body composition in adolescents: the Tromsø study fit futures cohort

ObjectivesPhysical activity may be important in deterring the obesity epidemic. This study aimed to determine whether objectively measured physical activity in first year of upper secondary high school predicted changes...

Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity

The efficacy and safety of time-restricted eating have not been explored in large randomized clinical trials. To determine the effect of 16:8-hour time-restricted eating on weight loss and metabolic risk markers. Participants were randomized such that the consistent meal timing (CMT) group was instructed to eat 3 structured meals per day, and the time-restricted eating (TRE) group was instructed to eat ad libitum from 12:00 pm until 8:00 pm and completely abstain from caloric intake from 8:00 pm until 12:00 pm the following day. This 12-week randomized clinical trial including men and women aged 18 to 64 years with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 to 43 was conducted on a custom mobile study application. Participants received a Bluetooth scale. Participants lived anywhere in the United States, with a subset of 50 participants living near San Francisco, California, who underwent in-person testing. The primary outcome was weight loss. Secondary outcomes from the in-person cohort included changes in weight, fat mass, lean mass, fasting insulin, fasting glucose, hemoglobin A1c levels, estimated energy intake, total energy expenditure, and resting energy expenditure. Overall, 116 participants (mean [SD] age, 46.5 [10.5] years; 70 [60.3%] men) were included in the study. There was a significant decrease in weight in the TRE (-0.94 kg; 95% CI, -1.68 to -0.20; P = .01), but no significant change in the CMT group (-0.68 kg; 95% CI, -1.41 to 0.05, P = .07) or between groups (-0.26 kg; 95% CI, -1.30 to 0.78; P = .63). In the in-person cohort (n = 25 TRE, n = 25 CMT), there was a significant within-group decrease in weight in the TRE group (-1.70 kg; 95% CI, -2.56 to -0.83; P < .001). There was also a significant difference in appendicular lean mass index between groups (-0.16 kg/m2; 95% CI, -0.27 to -0.05; P = .005). There were no significant changes in any of the other secondary outcomes within or between groups. There were no differences in estimated energy intake between groups. Time-restricted eating, in the absence of other interventions, is not more effective in weight loss than eating throughout the day. ClinicalTrials.gov Identifiers: NCT03393195 and NCT03637855.

Validation of a description of sarcopenic obesity defined as excess adiposity and low lean mass relative to adiposity.

BackgroundThis study aims to assess the construct validity of a body composition‐defined definition of sarcopenic obesity based on low appendicular lean mass relative to fat mass (ALMIFMI) and high fat mass index (FMI) and to compare with an alternative definition using appendicular lean mass index (ALMI) and percent body fat (%BF).MethodsThis is a secondary analysis of two cohort studies: the National Health and Examination Survey (NHANES) and the Health, Aging, and Body Composition study (Health ABC). Sarcopenic obesity was defined as low ALMIFMI combined with high FMI and was compared with a widely used definition based on ALMI and %BF cut‐points. Body composition Z‐scores, self‐reported disability, physical functioning, and incident disability were compared across body composition categories using linear and logistic regression and Cox proportional hazards models.ResultsAmong 14, 850 participants from NHANES, patients with sarcopenic obesity defined by low ALMIFMI and high FMI (ALMIFMI‐FMI) had above‐average FMI Z‐scores [mean (standard deviation): 1.00 (0.72)]. In contrast, those with sarcopenic obesity based on low ALMI and high %BF (ALMI‐%BF) had below‐average FMI Z‐scores. A similar pattern was observed for 2846 participants from Health ABC. Participants with sarcopenic obesity based on ALMIFMI‐FMI had a greater number of disabilities, worse physical function, and a greater risk of incident disability compared with those defined based on ALMI‐%BF.ConclusionsBody composition‐defined measures of sarcopenic obesity defined as excess adiposity and lower‐than‐expected ALMI relative to FMI are associated with functional deficits and incident disability and overcome the limitations of using %BF in estimating obesity in this context.

Sarcopenic Obesity in Facioscapulohumeral Muscular Dystrophy.

BackgroundSarcopenic obesity has been observed in people with neuromuscular impairment, and is linked to adverse health outcomes. It is unclear, however, if sarcopenic obesity develops in adults with facioscapulohumeral muscular dystrophy (FSHD).MethodsThe purpose of this study was to determine if adults with FSHD meet criteria for sarcopenic obesity (appendicular lean mass index (ALMI) scores of < 7.26 or 5.45 kg/m2; % fat mass (FM) ≥ 28 or 40% in men/women). Ten people with FSHD (50 ± 11 years, 2 females) and ten age/sex-matched controls (47 ± 13 years, 2 females) completed one visit, which included a full-body dual-energy x-ray absorptiometry (DXA) scan. Regional and whole body total mass, fat mass (FM), and lean mass (LM) were collected and body mass index (BMI) and sarcopenia measures were computed.ResultsPeople with FSHD and controls had a similar whole body total mass (84.5 ± 12.9 vs. 81.8 ± 13.5 kg, respectively, p = 0.65). Though BMI was 2% lower in the FSHD group (p = 0.77), the % FM was 46% higher in FSHD, compared with controls (p < 0.01). In addition, ALM volume was 23% lower (p = 0.02) and ALMI was 27% lower in FSHD compared with controls (p < 0.01). Whole body LM trended to be lower in FSHD vs. controls (p = 0.05), and arm and leg LM were both lower in FSHD compared with controls (p < 0.05). Furthermore, the % LM was 18% lower in FSHD vs. controls (p < 0.01). FSHD participants exhibited greater total body FM (p < 0.01) and total leg FM (p < 0.01), but were similar in volume of total arm FM compared with controls (p = 0.09).ConclusionFindings from this study suggest that people with FSHD, although similar in BMI and total body mass compared with controls, commonly meet the definition of sarcopenic obesity. Adults with co-existing FSHD and sarcopenic obesity may be at risk for significant impairments in quality of life, and encounter additional challenges in the management of FSHD manifestations.

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults—The Yishun Study

ObjectivesTo describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia. DesignParticipants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition. Setting and ParticipantsIn total, 542 community-dwelling Singaporeans were recruited (21‒90 years old, 57.9% women). MethodsWe assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression. ResultsAccording to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05). Conclusions and ImplicationsThis is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.

Relationships of Bone Mineral Density to Whole Body Mass, Fat Mass and Fat-free Mass in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood.

Body size influences bone mineral density (BMD) in health. Relationships of BMD with body mass index, fat mass (FM), fat-free mass, and appendicular lean mass were explored in acute lymphoblastic leukemia (ALL) survivors (n=75; 41 males; 45 standard risk ALL) >10 years from diagnosis. Dual energy radiograph absorptiometry performed body composition analysis. Relationships were assessed by regression analyses and Pearson correlation coefficients (r). Twenty subjects (26.3%) were osteopenic; lumbar spine (LS) BMD Z score <-1.00. Age at diagnosis, sex, ALL risk-category, type of post-induction steroid or cranial radiation did not correlate with LS or whole body (WB) BMD. Body mass index correlated significantly with LS BMD (r=0.333, P=0.004) and WB BMD (r=0.271, P=0.033). FM index (FM/height²) Z score showed no significant correlation with LS or WB BMD. Fat-free mass index Z score correlated strongly with LS BMD (r=0.386, P=0.013) and WB BMD (r=0.605, P<0.001) in males but not in females. The appendicular lean mass index, a surrogate for skeletal muscle mass, correlated significantly with LS BMD (r=0.367, P=0.018) and WB BMD (r=0.604, P<0.001) in males but not in females. Future studies to evaluate interventions to enhance BMD focused on improving body composition particularly skeletal muscle mass are warranted.

Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy -an observational study.

Objectives In children with cerebral palsy (CP), the most common cause of physical impairment in childhood, less muscle and bone growth has been reported, when compared with typically developing children. The aim of this study was to evaluate the effect of an intensive rehabilitation program including physiotherapy in combination with 6months of home-based, vibration-assisted training on muscle and bone growth in children with CP. Methods We included children with CP, who participated in a rehabilitation program utilizing whole-body vibration (WBV). Muscle mass was quantified by appendicular lean mass index (App-LMI) and bone mass by total-body-less-head bone mineral content (TBLH-BMC) assessed by Dual-energy X-ray absorptiometry (DXA) at the beginning of rehabilitation and one year later. To assess the functional muscle-bone unit, the relation of TBLH-BMC to TBLH lean body mass (TBLH-LBM) was used. Results The study population included 128 children (52 females, mean age 11.9±2.7). App-LMI assessed in kg/m2 increased significantly after rehabilitation. The age-adjusted Z-score for App-LMI showed no significant change. TBLH-BMC assessed in gram increased significantly. The Z-scores for TBLH-BMC decreased lesser than expected by the evaluation of the cross-sectional data at the beginning of rehabilitation. The parameter T B L H - B M C T B L H - L B M $\frac{TBLH-BMC}{TBLH-LBM}$ did not change relevantly after 12months. Conclusions Muscle growth and to a lesser extent bone growth could be increased in children with CP. The intensive rehabilitation program including WBV seemed to have no direct effect on the bone, but the observed anabolic effect on the bone, may only been mediated through the muscle.

Sarcopenic Obesity Among Adults With Facioscapulohumeral Muscular Dystrophy

BACKGROUND: Sarcopenic obesity has been observed in people with neuromuscular impairment and is linked to adverse health outcomes; it is unclear, however, if adults with facioscapulohumeral muscular dystrophy (FSHD) develop this condition. PURPOSE: Determine if adults with FSHD meet criteria for sarcopenic obesity (appendicular lean mass index (ALMI) scores of <7.26 kg/m2 or 5.45 kg/m2; % body fat of ≥27% or 38% in men/women). METHODS: Ten FSHD patients (50±11.4 years, 2 females) and ten age/sex-matched controls (47±13.6 years, 2 females) completed one visit, which included a full-body DXA scan. Regional and whole body total mass (g), fat mass (FM, (g, %)), and lean mass (LM, (g, %)) were collected; body mass index (BMI, kg/m2) and sarcopenia measures (appendicular lean mass (sum of arm/leg lean mass, ALM (kg)) and ALM index (ALMI, kg/m2)) were computed. RESULTS: Whole body total mass was similar between cohorts (FSHD: 84.5±12.9 vs. control: 81.8±13.5 kg; p=0.65). A decrease in ALM volume was found in the FSHD group (FSHD: 20.5±4.4 vs. control: 26.5±5.9 kg; p=0.02); similarly, ALMI scores were different between FSHD and controls (FSHD: 6.3±1.2 vs. control: 8.6±1.4 kg/m2; p=0.001). An increase in the proportion of whole body FM to whole body total mass (% body fat) in the FSHD group was observed (FSHD: 40.8±7.0 vs. control: 27.9±7.5%; p=0.001). While mean alterations in ALMI (6.3 ±1.3 kg/m2) and % body fat (40.0 ± 6.4%) among men with FSHD met diagnostic criteria for sarcopenic obesity, this finding was not mirrored among female FSHD counterparts (ALMI: 6.2 ±1.0 kg/m2, % body fat: 44.1 ±11.4%). Whole body LM was 15% lower in FSHD (p=0.05), furthermore, the FSHD group had a reduced proportion of whole body LM to whole body total mass vs. controls (p=0.001), along with lower total arm (p<0.01) and total leg lean mass (p=0.03). Study participants with FSHD did exhibit an increase in total body FM (p<0.01), along with greater total leg fat mass (p<0.001) but not total arm fat mass (p=0.09). CONCLUSIONS: A loss in ALM and increase in FM may lead to sarcopenic obesity in men with FSHD, resulting in a reduced quality of life and longevity.