Appendicular Skeletal Mass Index Research Articles

Tracking the Plasma C-Terminal Agrin Fragment as a Biomarker of Neuromuscular Decline in 18- to 87-Year-Old Men.

Plasma C-terminal agrin-fragment-22 (CAF22), a breakdown product of neuromuscular junction, is a potential biomarker of muscle loss. However, its levels from adolescence to octogenarians are unknown. We evaluated young (18-34 years, n = 203), middle-aged (35-59 years, n = 163), and old men (60-87 years, n = 143) for CAF22, handgrip strength (HGS), appendicular skeletal-mass index (ASMI), and gait speed. We found an age-associated increase in CAF22 from young (100.9 ± 29 pmol) to middle-aged (128.3 ± 38.7 pmol) and older men (171.5 ± 35.5 pmol) (all p<0.05). This was accompanied by a gradual reduction in HGS (37.7 ± 6.1 kg, 30.2 ± 5.2 kg, and 26.6 ± 4.7 kg, for young, middle-aged, and old men, respectively), ASMI (8.02 ± 1.02 kg/m2, 7.65 ± 0.92 kg/m2, 6.87 ± 0.93 kg/m2, for young, middle-aged, and old men, respectively), and gait speed (1.29 ± 0.24 m/s, 1.05 ± 0.16 m/s, and 0.81 ± 0.13 m/s, for young, middle-aged, and old men, respectively). After adjustment for age, we found negative regressions of CAF22 with HGS (-0.0574, p < 0.001) and gait speed (-0.0162, p < 0.001) in the cumulative cohort. The receiver operating characteristics analysis revealed significant efficacy of plasma CAF22 in diagnosing muscle weakness (HGS < 27 kg) (middle-aged men; AUC = 0.731, 95% CI = 0.629-0.831, p < 0.001, Older men; AUC = 0.816, 95% CI = 0.761-0.833, p < 0.001), and low gait speed (0.8 m/s) (middle-aged men; AUC = 0.737, 95% CI = 0.602-0.871, p < 0.001, older men; AUC = 0.829, 95% CI = 0.772-0.886, p < 0.001), and a modest efficacy in diagnosing sarcopenia (middle-aged men; AUC = 0.701, 95% CI = 0.536-0.865, p = 0.032, older men; AUC = 0.822, 95% CI = 0.759-0.884, p < 0.001) in middle-aged and older men. Altogether, CAF22 increases with advancing age and may be a reliable marker of muscle weakness and low gait speed.

Validity of a video-analysis-based app to detect prefrailty or frailty plus sarcopenia syndromes in community-dwelling older adults: Diagnostic accuracy study.

Sarcopenia and frailty have been associated with an increased risk of suffering health-related adverse events but the combination of both conditions results in worse health-related outcomes than either condition alone. Since both syndromes are reversible states, their early detection is fundamental. This study aims to validate a video analysis-based App to detect the presence of frailty or prefrailty plus sarcopenia syndromes and to analyze its construct validity with health-related risk factors. A total of 686 community-dwelling older adults (median-age: 72, 59% female) were enrolled. Muscle power generated during a sit-to-stand test using the App and calf circumference were considered the index test. The reference standards were the EWGSOP2 criteria (five-chair stand test plus appendicular skeletal mass or skeletal muscle index) and Fried's frailty phenotype. Area under the curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. The prevalence of both syndromes varied from 2.9% to 7.2% depending on the diagnostic criteria used for sarcopenia assessment. Excellent-to-outstanding AUC values were observed (range 0.80-0.92). Sensitivity and specificity ranged from 75% to 100% and 81.7% to 87.2%, respectively. PPV and NPV ranged from 12.1% to 37.5% and 97.9% to 100%, respectively. Individuals diagnosed by the App showed an increased risk of polypharmacy, depression, comorbidities, falls, hospitalization, low socioeconomical and educational levels, and smoking and poor self-perceived health compared to their healthy counterparts. This App seems to be reliable to detect the simultaneous presence of both syndromes in community-dwelling older adults. Individuals diagnosed by the App showed more odds to have health-related risk factors.

Sit-to-Stand Video Analysis-Based App for Diagnosing Sarcopenia and Its Relationship With Health-Related Risk Factors and Frailty in Community-Dwelling Older Adults: Diagnostic Accuracy Study.

Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition. We aimed to create and validate a sit-to-stand video analysis-based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty. A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis-based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test. Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2. The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings. ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351. RR2-10.3390/s22166010.

Association Between Interleukin 6 and C-Reactive Protein Serum Levels and Body Composition Compartments and Components in Breast Cancer Survivors.

Obesity is highly prevalent in breast cancer (BC) survivors. Adipose tissue promotes inflammation, affecting recurrence, morbidity, and quality of life. This study aimed to determine the relationship of body composition parameters with the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) in female BC survivors. Additionally, we evaluated the association of log-transformed serum concentrations of CRP and IL-6 with the appendicular skeletal lean mass index (ASMI). The results showed that CRP was positively associated with body fat percentage (BFP; β adjusted = .08, 95% CI: .02-.14) in all participants, and with fat mass index (FMI; β = .24, 95% CI: .08-.40) only in premenopausal women. IL-6 was positively associated with FMI (β adjusted = .16, 95% CI: .03-.29), while ASMI decreased as CRP levels increased (β adjusted = -.30, 95% CI: -.53 to -.06). Interventions to improve body composition in BC survivors should also consider the role of inflammatory markers in changes in body composition to avoid sarcopenic obesity (SO) and the risk of BC recurrence.

FRI052 Z-score Of The Log-transformed A Body Shape Index As A Screening Tool For Sarcopenia In Population With Central Obesity

Abstract Disclosure: H. Chung: None. Background: Sarcopenic obesity is related with a higher risk of cardiovascular disease, metabolic disease, and mortality than obesity alone. Nevertheless, few studies have investigated body shape indices for the assessment of sarcopenia in obese populations. The purpose of this study was to evaluate the accuracy of the Z-score of the log-transformed A Body Shape Index (LBSIZ) to assess sarcopenia in nationally representative populations with central obesity. Methods: Data from Korea NHANES (KNHANES) and the U.S. National Health and Nutrition Examination Survey (U.S. NHANES) were evaluated. Sarcopenia for the Korean population it was defined when appendicular skeletal mass index (ASMI ) &amp;lt; 7 kg/m2 in men or ASMI &amp;lt; 5.4 kg/m2 in women, according to the Asian Working Group for Sarcopenia and for the American population was defined when ASMI &amp;lt; 7 kg/m2 in men or ASMI &amp;lt; 5.5 kg/m2 in women, according to the revised European consensus on definition and diagnosis for sarcopenia. LBSIZ cut-off value was defined as that with the highest score of the Youden’s index. Changes in odds ratios (OR) for sarcopenia were investigated using restricted cubic spline (RCS) plots. Results: This study was conducted for population with central obesity in 4,855 Koreans and 8,010 Americans. Among these, 330 Koreans and 373 Americans were accompanied with sarcopenia. The cut-off values for the LBSIZ were 1.15 (sensitivity, 78%; specificity, 77%) for Korean men, 0.95 (sensitivity, 74%; specificity, 69%) for Korean women, 1.05 (sensitivity, 88%; specificity, 82%) for American men, and 0.45 (sensitivity, 77%; specificity, 71%) for American women in the development groups. Comparable results were verified in validation groups. The RCS plot indicated that ORs for sarcopenia rapidly increased with an increase in the LBSIZ cut-off value. Conclusion: The LBSIZ index is a powerful and reliable indicator of sarcopenia in adults with central obesity. Presentation: Friday, June 16, 2023

Incident low muscle mass is associated with greater lung disease and lower circulating leptin in a tobacco-exposed longitudinal cohort

BackgroundMuscle loss is prevalent in chronic obstructive pulmonary disease (COPD). Prior studies evaluating musculoskeletal dysfunction in COPD have focused on individuals with baseline low muscle mass. Currently, there is limited data evaluating clinical characteristics and outcomes associated with progression to incident low muscle mass in a tobacco-exposed cohort of individuals with baseline normal muscle mass.MethodsWe evaluated 246 participants from a single-center longitudinal tobacco-exposed cohort with serial spirometry, thoracic imaging, dual energy x-ray absorptiometry (DXA) measurements, walk testing, and plasma adipokine measurements. DXA-derived fat free mass index (FFMI) and appendicular skeletal mass index (ASMI) were used as surrogates for muscle mass. Participants with incident low muscle mass (LM) at follow-up were characterized by FFMI < 18.4 kg/m2 in males and < 15.4 kg/m2 in females and/or ASMI < 7.25 kg/m2 in males and < 5.67 kg/m2 in females.ResultsTwenty-five (10%) participants progressed to incident low muscle mass at follow-up. At baseline, the LM subgroup had greater active smoking prevalence (60% v. 38%, p = 0.04), lower FFMI (17.8 ± 1.7 kg/m2 v. 19.7 ± 2.9 kg/m2, p = 0.002), lower ASMI (7.3 ± 0.9 kg/m2 v. 8.2 ± 1.2 kg/m2, p = 0.0003), and lower plasma leptin (14.9 ± 10.1 ng/mL v. 24.0 ± 20.9 ng/mL, p = 0.04). At follow-up, the LM subgroup had higher COPD prevalence (68% v. 43%, p = 0.02), lower FEV1/FVC (0.63 ± 0.12 v. 0.69 ± 0.12, p = 0.02), lower %DLco (66.5 ± 15.9% v. 73.9 ± 16.8%, p = 0.03), and higher annual rate of FFMI decline (-0.17 kg/m2/year v. -0.04 kg/m2/year, p = 0.006). There were no differences in age, gender distribution, pack years smoking history, or walk distance.ConclusionsWe identified a subgroup of tobacco-exposed individuals with normal baseline muscle mass who progressed to incident DXA-derived low muscle mass. This subgroup demonstrated synchronous lung disease and persistently low circulating leptin levels. Our study suggests the importance of assessing for muscle loss in conjunction with lung function decline when evaluating individuals with tobacco exposure.

Osteosarcopenia later in life: Prevalence and associated risk factors

The identification of risk factors for osteosarcopenia in older adults is important for planning preventative strategies in clinical practice. Therefore, our study aimed to investigate the prevalence and risk factors associated with osteosarcopenia in older adults using different diagnostic criteria. The sample included 171 community-dwelling older adults with a mean age of 79.4±5.9 years and mean body mass index of 25.67±4.70kg/m2. We analyzed sociodemographic, biomarkers, lifestyle, and health condition data from participants of the "Projeto Idosos - Goiânia" cohort study. The outcome osteosarcopenia was defined as the simultaneous occurrence of sarcopenia and osteopenia. Osteopenia was diagnosed by low lumbar spine bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). Sarcopenia was diagnosed using handgrip dynamometry and appendicular skeletal mass index assessed by DEXA following the criteria of the two European consensuses on sarcopenia (2010 and 2018). Two osteosarcopenia outcome variables were evaluated: OsteoSarc1 and OsteoSarc2 using the 2010 and 2018 European sarcopenia consensus criteria, respectively. Multivariate Poisson regression analysis was used to calculate the prevalence ratios (PRs). The prevalence of OsteoSarc1 and OsteoSarc2 were 12.8% and 7.2%, respectively, with no significant gender differences. OsteoSarc1 was associated with low potassium (PR: 3.39, 95% confidence interval [CI]: 1.10-10.43) and malnutrition (PR: 3.84, 95% CI: 1.78-8.30). OsteoSarc2 was associated with being ≥80 years (PR: 7.64, 95% CI: 1.57-37.07), >4 years of education (PR: 3.25, 95% CI: 1.03-10.22), alcohol consumption (PR: 2.41, 95% CI: 1.01-5.77), low potassium (PR: 2.22, 95% CI: 1.45-6.87), low serum vitamin D (PR: 4.47, 95% CI: 1.68-11.88), and malnutrition (PR: 5.00, 95% CI: 1.06-23.51). OsteoSarc1 had a higher prevalence. The risk factors associated with the two outcomes were malnutrition and potassium level, as well as other risk factors, such as alcohol consumption and low vitamin D level. These findings may contribute to the prevention or treatment of this health condition in older adults.

White matter hyperintensities: a possible link between sarcopenia and cognitive impairment in patients with mild to moderate Alzheimer's disease.

Alzheimer's disease (AD) has been reported to be associated with sarcopenia. White matter hyperintensities (WMH) are common in AD patients. However, the effect of WMH on sarcopenia in AD remains unclear. We hence aimed to investigate the possible association between regional WMH volumes and sarcopenic parameters in AD. 57 mild to moderate AD patients and 22 normal controls (NC) were enrolled. Sarcopenic parameters were assessed, including appendicular skeletal mass index (ASMI), grip strength, 5-times sit-to-stand (5-STS) time, and gait speed. The volumes of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) were quantified using 3D-slicer software. AD subjects exhibited a lower ASMI, a slower gait speed, an increased 5-STS time, and larger volumes of PVH and DWMH than those in the NC group. In AD subjects, total WMH and PVH volumes were related to cognitive impairment, particularly executive function decline. Moreover, total WMH volume and PVH volume were negatively correlated with gait speed across various clinical stages of AD. Multiple linear regression analysis showed that PVH volume was independently associated with 5-STS time and gait speed, whereas DWMH volume was only independently associated with gait speed. WMH volume was associated with cognitive decline and various sarcopenic parameters. It thereby suggested that WMH may serve as the connection between sarcopenia and cognitive dysfunction in AD. Further studies are needed to confirm these findings and to determine whether sarcopenia interventions reduce WMH volume and improve cognitive function in AD.

The effect of combining nutrient intake and physical activity levels on central obesity, sarcopenia, and sarcopenic obesity: a population-based cross-sectional study in South Korea

BackgroundThis study was conducted to investigate the effects of combining nutritional and physical activity (PA) factors on four different categories, according to the presence or absence of sarcopenia and central obesity.MethodsFrom the 2008–2011 Korea National Health and Nutrition Examination Survey, 2971 older adults aged ≥ 65 years were included and divided into four groups based on their sarcopenia and central obesity status: healthy control (39.3%), central obesity (28.9%), sarcopenia (27.4%), and sarcopenic obesity (4.4%). Central obesity was defined as a waist circumference of ≥ 90 cm in men and ≥ 85 cm in women. Sarcopenia was defined as an appendicular skeletal mass index of < 7.0 kg/m2 in men and < 5.4 kg/m2 in women, and sarcopenic obesity was defined as the coexistence of sarcopenia and central obesity.ResultsParticipants who consumed more energy and protein than the average requirement had a lower likelihood of having sarcopenia (odds ratio (OR): 0.601, 95% confidence interval (CI): 0.444–0.814) than those who did not consume enough nutrients. The likelihood of central obesity and sarcopenic obesity decreased in groups with recommended PA levels, regardless of whether energy intake met or did not meet the average requirement. Whether PA met or did not meet the recommended level, the likelihood of sarcopenia decreased in groups with energy intake that met the average requirement. However, when PA and energy requirements were met, there was a greater reduction in the likelihood of sarcopenia (OR: 0.436, 95% CI: 0.290–0.655).ConclusionThese findings suggest that adequate energy intake that meets requirements is more likely to be effective as a major prevention and treatment goal for sarcopenia, whereas PA guidelines should be prioritized in the case of sarcopenic obesity.

Consequences of applying the different criteria of the EWGSOP2 guideline for sarcopenia case-finding in Spanish community-dwelling older adults

IntroductionSarcopenia prevalence varies according to differences in diagnostic criteria used. In order to overcome this issue, the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) published a consensus to increase harmonization for sarcopenia diagnosis. This study aimed to determine the prevalence and risk factors across the different sarcopenia diagnosis criteria recommended by EWGSOP2 and to analyze its agreement. MethodsA total of 699 community-dwelling older adults (median-age: 72, 60% female) were recruited in this cross-sectional study. Sarcopenia prevalence was obtained by different combinations of muscle strength (handgrip strength or 5-times sit-to-stand) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the EWGSOP2. Cohen's Kappa coefficient was calculated to analyze agreement among the four sarcopenia diagnostic criteria and logistic regressions were performed to identify risks associated to health-related outcomes for each diagnostic criterion. ResultsSarcopenia prevalence varied from 2.1% to 11.6%, depending on the diagnostic criteria used. Weak-to-moderate agreements (κ-range: 0.13–0.66) were observed among the four sarcopenia diagnosis criteria. There was scarce overlap in sarcopenic people when different diagnostic criteria were used leading to up to 10.4% of underdiagnosis. Sarcopenia defined by 5-times sit-to-stand was more associated with health-related outcomes compared to handgrip strength. ConclusionsSarcopenia prevalence rates vary considerably depending on the diagnostic criteria used. These criteria should not be used in an interchangeable way due to their weak agreement. Sarcopenia diagnosis criteria defined by 5-times sit-to-stand could be more suitable in Spanish community-dwelling older adults due their associations with health-related outcomes.

Calf circumference has a positive correlation with physical performance among community-dwelling middle-aged, older women.

Sarcopenia and frailty are well-known public health problems in middle-aged and older people. Calf circumference (CC) is a representative anthropometric index that may be useful for screening sarcopenia. Physical performance, assessed by hand grip strength and gait speed, measures sarcopenia and frailty. This community-based, cross-sectional study was conducted in Guishan District, Taoyuan City, between April and October 2017 to investigate the relationship between CC and physical performance among community-dwelling middle-aged, older people in Taiwan and to evaluate potential sex differences. CC tends to be an efficient predictor of physical performance in community health screenings and outpatient clinics for community health examinations, where there is limited time for surveys. A total of 1,308 volunteers aged 50-85 were recruited. Volunteers who declined to participate, those with recent cardiovascular disease, and those with an inability to complete an interview, physical performance examinations, and body composition measurements were excluded from the study. A total of 828 participants were enrolled in this study (237 men and 591 women). The statistical methods applied in this study were the Mann-Whitney U-test, independent two-sample t-test, Chi-square test, and multivariate logistic regression models. Significant differences were observed in age, waist circumference, appendicular skeletal mass index, calf circumference, hand grip strength, and income between men and women. No significant differences were observed between the men and women regarding body mass index, gait speed, exercise habits, or underlying disorders of diabetes mellitus, hypertension, or hyperlipidemia. Comparing across three different CC tertiles, we discovered significant differences in age, body mass index, waist circumference, appendicular skeletal muscle index, gait speed, and hand grip strength in both men and women. On multivariate logistic regression, after adjusting for age, appendicular skeletal mass index, body mass index, exercise habits, income levels, and CC were positively correlated with physical performance as measured by both gait speed (β = 0.15, p = 0.01) and hand grip strength (β = 0.25, p < 0.001) in women, compared to only hand grip strength (β = 0.41, p < 0.001) in men. Lower calf circumference is an independent risk factor for poor physical performance, especially among women.

Relation of Plasma High-Density Lipoproteins-Cholesterol with Sarcopenia in Patients with Chronic Obstructive Pulmonary Disease

Background: Plasma high-density lipoproteins-cholesterol (HDL-C) is a marker of metabolic health; however, its association with age-associated muscle loss, termed sarcopenia, is unknown. We evaluated the clinical importance of HDL-C in predicting sarcopenia in patients with chronic obstructive pulmonary disease (COPD). Methods: We investigated male healthy elderly and COPD patients, 54–79 years old (n = 55–59/group) through clinical examination, laboratory investigation, and spirometry. Sarcopenia was evaluated as low handgrip strength (HGS), appendicular skeletal mass index (ASMI), and gait speed. Enzyme-linked immunosorbent assays were used to measure the circulating markers of inflammation (C-reactive protein [CRP]) and oxidative stress (8-isoprostanes). Results: The COPD patients exhibited reduced HGS, ASMI and gait speed, and higher CRP and 8-isoprostanes levels and incidence of sarcopenia than controls (all P < 0.05). Plasma HDL-C levels exhibited significant correlations with CRP, HGS, and 8-isoprostane levels (all P<0.05) but not with ASMI and gait speed in both cohorts. Additionally, plasma HDL-C was an independent predictor of sarcopenia in controls and COPD patients (AUC = 0.631, P<0.05). Conclusion: Altogether, our data show that plasma HDL-C levels are a valuable marker of muscle decline and sarcopenia in healthy elderly and patients with COPD.

PSUN187 Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

Abstract Background Aging and type 2 diabetes (T2DM) are associated with an increased risk of developing sarcopenia which is associated with poor outcomes and may necessitate specific treatment. Diagnosis of sarcopenia often requires the referral of patients to dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). In this study, we examine the accuracy of a DSMF-BIA (InBody 770) for assessing body composition in older adults with T2DM when compared to DXA. Methods 84 older adults (49 women, age 71 ± 5 years. Body mass index 30 ± 5.6 kg /m2) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included in the analysis. The main analysis included Bland-Altman plots and Intra Class Correlation Coefficients (ICC). Sub-analyses were performed according to gender and following 10 weeks of intervention (diet, circuit resistance training, and Empagliflozin). Results The leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg respectively, however, did not differ between devices according to Bland-Altman analyses (p=0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p=0.84; ICC=0.965, p&amp;lt;0.0001; bias of -0.068, p =0.595). The accuracy of DSMF-BIA was limited when estimating fat mass indices reflected by significant biases according to Bland-Altman analyses. Summary In a sample of older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA for the diagnosis of low muscle mass. Better accuracy was observed when comparing parameters of lean mass versus parameters of fat mass. Gender as well as three common treatment modalities for T2DM did not modify the accuracy of the DSMF-BIA when compared to DXA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Circulating miRNA-1-3p as Biomarker of Accelerated Sarcopenia in Patients Diagnosed with Chronic Heart Failure.

While sarcopenia is an important clinical finding in individuals diagnosed with chronic heart failure (CHF), efforts to identify a reliable biomarker capable of predicting the overall muscular and functional decline in CHF patients have been unsuccessful to date. The objectives of this study were to study the diagnostic utility of MicroRNA (miRNA)-1-3p as a predictor of sarcopenia status in individuals diagnosed with CHF. In total, 80 individuals with heart failure exhibiting a left ventricular ejection fraction < 50% were enrolled in this study. All patients were analyzed to assess miR-1-3p expression levels, with body composition being evaluated through dual-energy X-ray absorptiometry and sarcopenia being defined based on the sum of appendicular lean muscle mass (ALM) divided by height in meters squared and handgrip strength (HGS). In addition, the activation of the Akt/mTOR signaling pathway was evaluated in these individuals. In total, 40 of the enrolled patients (50%) exhibited sarcopenia. Sarcopenic patients presented with increased miR-1-3p expression levels as compared to non-sarcopenic individuals (1.69 ± 0.132 vs. 1.22 ± 0.106; p < 0.05). With respect to sarcopenic indices, appendicular skeletal mass index was most strongly correlated with miR-1-3p expression, which was also strongly correlated with HGS. High levels of Akt/mTOR signaling pathway components were expressed in sarcopenic individuals, highlighting a significant relationship between miR-1-3p activity and signaling through this pathway. Moreover, miR-1-3p was identified as a specific marker for sarcopenia in individuals with CHF. These results suggest that circulating miR-1-3p levels are related to Akt/mTOR pathway activation and can offer valuable insight into the overall physical capacity and muscular integrity of CHF patients as a predictor of sarcopenia. (Rev Invest Clin. 2022;74(5):276-83).

Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

BackgroundAging and type 2 diabetes (T2DM) are associated with an increased risk of sarcopenia. Diagnosis of sarcopenia is commonly done using dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). Here, we examine the accuracy of a DSMF-BIA (InBody-770) for assessing body composition in older adults with T2DM when compared to DXA.MethodsEighty-four obese/overweight older adults (49 women, 71 ± 5 years) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included. The analysis included Bland–Altman plots and intra class correlation coefficients. Sub-analyses were performed according to gender and following 10 weeks of interventions (diet, circuit training, and Empagliflozin).ResultsThe leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg, respectively, with no difference between devices according to Bland–Altman analyses (p = 0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p = 0.84; ICC = 0.965, p < 0.0001; mean difference −0.068, p = 0.595). Gender and treatment interventions did not modify the accuracy of the DSMF-BIA when compared to DXA.ConclusionsIn older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA to measure muscle mass.

Association of Sarcopenia and A Body Shape Index With Overall and Cause-Specific Mortality.

AimThis observational study aimed to examine the association between the A Body Shape Index (ABSI) and/or sarcopenia and total, cardiovascular, and cancer mortality.MethodsThe associations of sarcopenia and ABSI with all-cause, cardiovascular, and cancer mortality were assessed in 4,488 participants from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) who were followed up until December 31, 2015. Models were analyzed separately for men and women and adjusted for age, race, and other confounding factors. ABSI was assessed as a continuous measurement by quartile for men and women. Population attributable fractions (PAFs) were calculated to assess mortality caused by sarcopenia and/or ABSI in the study population.ResultsWhen ABSI was assessed as a continuous variable, the ABSI quartile showed a linear trend for total (p = 0.0001), cardiovascular (p = 0.04), and cancer (p = 0.02) mortality in men and for total (p = 0.06) and cardiovascular (p = 0.06) mortality in women. The hazard ratios (HRs) of the fourth ABSI quartile were 1.51 [95% confidence interval (CI): 1.20–1.89] in men and 1.23 (95% CI: 0.93–1.64) in women, compared with those in the first quartile. When ABSI was assessed by quartile, the appendicular skeletal mass index (ASMI) was lower in the groups with high ABSI. When high ABSI was combined with sarcopenia, the HRs of all-cause mortality were 2.05 (95% CI: 1.60–2.62) in men and 1.51 (95% CI: 1.19–1.92) in women. In the subpopulation (sarcopenia group or higher ABSI), the PAFs of mortality due to sarcopenia were 26.16% (95% CI: 12.68–37.56) in men and 21.89% (95% CI: 5.64–35.35) in women, and the PAF of mortality due to higher ABSI was 23.70% (95% CI: 12.11–33.77) in men.ConclusionThe ABSI value was significantly associated with all-cause and cardiovascular mortality, and the co-existence of higher ABSI values and sarcopenia can contribute to a more significant death risk in comparison with high ABSI values or sarcopenia. Moreover, the ABSI values in combination with the ASMI can be used to preliminarily evaluate the content and distribution of fat and muscle and to predict the risk of death in obese and sarcopenic populations.

Association between body shape index and risk of mortality in the United States

The body mass index (BMI) neither differentiates fat from lean mass nor does it consider adipose tissue distribution. In contrast, the recently introduced z-score of the log-transformed A Body Shape Index (LBSIZ) can be applied to measure obesity using waist circumference (WC), height, and weight. We aimed to investigate the association between LBSIZ and mortality. We used data from the National Health and Nutrition Examination Survey 1999–2014 and linked the primary dataset to death certificate data from the National Death Index with mortality follow-up through December 31, 2015. A multiple Cox regression analysis was performed to evaluate the hazard ratio (HR) of all-cause and cardiovascular disease (CVD) mortalities with adjustment for baseline characteristics. LBSIZ, WC, and BMI showed positive association with total fat percentage (P < 0.001); however, only WC and BMI were positively associated with appendicular skeletal mass index (ASMI) (P < 0.001). In the multiple Cox regression analysis, only LBSIZ showed a significant HR for all-cause and CVD mortalities. Under restricted cubic spline regression, mortality risk increased with LBSIZ. However, BMI and WC showed a U-shape association. In conclusion, LBSIZ is strongly associated with all-cause and CVD mortalities. Since LBSIZ is independent of BMI, LBSIZ complements BMI to identify high-risk groups for mortality even in individuals with low or normal BMI.

Significant Loss of Skeletal Muscle Mass Occurs After High-Energy Trauma in Young Adults

ObjectivesSignificant loss of skeletal muscle mass occurs early after high-energy trauma, leading directly to prolonged functional limitations. As we investigate nutrition interventions to reduce loss of muscle mass, we need to quantify changes in muscle mass after these devastating injuries. The aim of this study was to characterize baseline nutrition and changes in muscle mass after high-energy trauma in a young adult population.MethodsWe enrolled patients 18–55 years old indicated for operative fixation of either, an open pelvic or extremity fracture, or ≥2 pelvic and/or extremity fractures due to a high-energy mechanism. Baseline assessment of body composition (Lean Body Mass [LBM], Skeletal Muscle Mass [SMM]), was measured within 72 hours of admission using bioelectrical impedance and repeated 6 weeks after injury. Results are reported as median (IQR). Changes in LBM and SMM were evaluated using Wilcoxon Signed Rank tests. Sarcopenia was defined by gender-specific cutoffs for appendicular skeletal mass index. Dietary intake was evaluated using food frequency questionnaires. Inadequate protein intake was classified using the Estimated Average Requirement cut-point method, while inadequate caloric intake was defined as intake below basal metabolic rate.ResultsSixteen subjects (14 male) age 38.4 ± 9.6 years were enrolled. At baseline, 3 reported inadequate protein intake and 5 reported inadequate caloric intake. Six weeks after injury participants experienced significant losses in LBM (−4.5kg (−8.8 to −1.4), P = 0.019) and SMM (−3.1kg (−5.6 to −0.3), P = 0.043). The injured extremity had significantly greater loss of LBM compared to the uninjured extremity (−4.0 (−17.1–3.5), P = 0.0495). Five were baseline sarcopenic, with one additional participant meeting the criteria by 6 weeks. Baseline protein and calorie deficiency was not significantly associated with muscle loss.ConclusionsThis study documented devastating loss of lean body mass and skeletal muscle mass after high-energy trauma in young adults. These losses are likely a combination of immobilization and catabolic response for wound and fracture healing. Understanding loss of muscle mass after injury is important to design impactful rehabilitative and nutrition interventions in this complicated patient population.Funding SourcesNone.

Sarcopenia in the elderly versus microcirculation, inflammation status, and oxidative stress: A cross-sectional study

Age-related mechanisms of sarcopenia associated with vascular function have been recently suggested. This study compared and tested associations between muscle mass and strength, microcirculation, inflammatory biomarkers, and oxidative stress in older adults classified as sarcopenic and non-sarcopenic. Thirty-three physically inactive individuals (72±7 yrs) were assigned to age-matched sarcopenic (SG) and non-sarcopenic (NSG) groups. Between-group comparisons were performed for appendicular skeletal mass (ASM), handgrip and isokinetic strength, microvascular function and morphology, C-reactive protein, insulin-like growth factor-1, tumor necrosis factor-alpha, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, endothelin-1, and oxidized low-density lipoprotein. ASM and knee isokinetic strength were lower in SG than NSG (P < 0.05). No difference between groups was found for outcomes of microvascular function and morphology, but log-transformed IL-6 concentration was twice greater in SG vs. NSG (P = 0.02). Correlations between ASM index, handgrip and knee isokinetic strength vs. markers of microcirculatory function, capillary diameters, vascular reactivity, and endothelial injury were found only in SG. Decreased ASM index and strength have been associated with microcirculatory profile, indicating that microcirculation impairment may be involved somehow in Sarcopenia development. The inflammation status, particularly elevated IL-6, seems to play an important role in this process.

Should knee extension strength testing be implemented as a screening test for identifying probable and confirmed sarcopenia in older T2DM patients?

BackgroundThe accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Early detection and treatment of probable and confirmed sarcopenia is paramount to delay mobility disability. Using low handgrip strength cut-off points for the initial identification of sarcopenia according to the new European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines may mask the presence of sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results.MethodsA cohort of one hundred T2DM older patients (60% women) (mean age 74.5 years) mostly obese community dwelling older adults were evaluated for body composition by Bioelectrical impedance analysis (BIA), yielding appendicular skeletal mass index (ASMI) results. Patients underwent handgrip strength (HGS) and knee extension strength (KES) tests as well as functional ability tests. Prevalence of probable and confirmed sarcopenia using HGS and KES cut-off points were calculated. Pearson correlations were performed to evaluate the relationship between ASMI and limbs strength. A regression analysis was conducted to examine which variables best predict ASMI values. A multivariate analysis of covariance was performed to assess the effect of independent variables on KES and HGS.ResultsUsing cutoff points for low KES identified 24 patients with probable sarcopenia and two with confirmed sarcopenia. Conversely, using the EWGSOP2 cut off points for low HGS, identified only one patient with probable sarcopenia and none of the patients with confirmed sarcopenia.ConclusionKES cut-off points using a simple hand-held dynamometer can assist in the identification of probable and confirmed sarcopenia using EWGSOP2 cut off points for low muscle mass in a population of older T2DM patients for further analysis and early treatment. This is notably true in patients possessing high body mass index (BMI) alongside normal ASMI and HGS, potentially reducing false positive sarcopenia screening results.Trial registrationClinicalTrials.gov PRS: NCT03560375. Last registration date (last update): 06/06/2018. The trial was a-priori registered before actual recruitment of subjects.